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Mild cognitive impairment with Lewy bodies (MCI-LB) may be identified prospectively based on the presence of cognitive impairment and several core clinical features (visual hallucinations, cognitive fluctuations, parkinsonism, and REM sleep behavior disorder). MCI-LB may vary in its presenting features, which may reflect differences in underlying pathological pattern, severity, or comorbidity.
We aimed to assess how clinical features of MCI-LB accumulate over time, and whether this is associated with the rate of cognitive decline.
Methods
In this cohort study, 74 individuals seen with MCI-LB prospectively underwent repeated annual cognitive and clinical assessment up to nine years. Relationships between clinical features (number of core features present and specific features present) and cognitive change on the Addenbrooke’s Cognitive Examination–Revised (ACE-R) were examined with time-varying mixed models. The accumulation of core clinical features over time was examined with a multi-state Markov model.
Results
When an individual with MCI-LB endorsed more clinical features, they typically experienced a faster cognitive decline (ACE-R Score Difference β = −1.1 [−1.7 to −0.5]), specifically when experiencing visual hallucinations (β = −2.1 [−3.5 to −0.8]) or cognitive fluctuations (β = −3.4 [−4.8 to −2.1]).
Individuals with MCI-LB typically acquired more clinical features with the passage of time (25.5% [20.0–32.0%] one-year probability), limiting the prognostic utility of baseline-only features.
Conclusions
The clinical presentation of MCI-LB may evolve over time. The accumulation of more clinical features of Lewy body disease, in particular visual hallucinations and cognitive fluctuations, may be associated with a worse prognosis in clinical settings.
The aim of this study was to determine whether there was a significant change in cardiac [123I]-metaiodobenzylguanidine uptake between baseline and follow-up in individuals with mild cognitive impairment with Lewy bodies (MCI-LB) who had normal baseline scans. Eight participants with a diagnosis of probable MCI-LB and a normal baseline scan consented to a follow-up scan between 2 and 4 years after baseline. All eight repeat scans remained normal; however, in three cases uptake decreased by more than 10%. The mean change in uptake between baseline and repeat was −5.2% (range: −23.8% to +7.0%). The interpolated mean annual change in uptake was −1.6%.
Impaired olfaction may be a biomarker for early Lewy body disease, but its value in mild cognitive impairment with Lewy bodies (MCI-LB) is unknown. We compared olfaction in MCI-LB with MCI due to Alzheimer’s disease (MCI-AD) and healthy older adults. We hypothesized that olfactory function would be worse in probable MCI-LB than in both MCI-AD and healthy comparison subjects (HC).
Design:
Cross-sectional study assessing olfaction using Sniffin’ Sticks 16 (SS-16) in MCI-LB, MCI-AD, and HC with longitudinal follow-up. Differences were adjusted for age, and receiver operating characteristic (ROC) curves were used for discriminating MCI-LB from MCI-AD and HC.
Setting:
Participants were recruited from Memory Services in the North East of England.
Participants:
Thirty-eight probable MCI-LB, 33 MCI-AD, 19 possible MCI-LB, and 32HC.
Measurements:
Olfaction was assessed using SS-16 and a questionnaire.
Results:
Participants with probable MCI-LB had worse olfaction than both MCI-AD (age-adjusted mean difference (B) = 2.05, 95% CI: 0.62–3.49, p = 0.005) and HC (B = 3.96, 95% CI: 2.51–5.40, p < 0.001). The previously identified cutoff score for the SS-16 of ≤ 10 had 84% sensitivity for probable MCI-LB (95% CI: 69–94%), but 30% specificity versus MCI-AD. ROC analysis found a lower cutoff of ≤ 7 was better (63% sensitivity for MCI-LB, with 73% specificity vs MCI-AD and 97% vs HC). Asking about olfactory impairments was not useful in identifying them.
Conclusions:
MCI-LB had worse olfaction than MCI-AD and normal aging. A lower cutoff score of ≤ 7 is required when using SS-16 in such patients. Olfactory testing may have value in identifying early LB disease in memory services.
The present study aimed to clarify the neuropsychological profile of the emergent diagnostic category of Mild Cognitive Impairment with Lewy bodies (MCI-LB) and determine whether domain-specific impairments such as in memory were related to deficits in domain-general cognitive processes (executive function or processing speed).
Method:
Patients (n = 83) and healthy age- and sex-matched controls (n = 34) underwent clinical and imaging assessments. Probable MCI-LB (n = 44) and MCI-Alzheimer’s disease (AD) (n = 39) were diagnosed following National Institute on Aging-Alzheimer’s Association (NIA-AA) and dementia with Lewy bodies (DLB) consortium criteria. Neuropsychological measures included cognitive and psychomotor speed, executive function, working memory, and verbal and visuospatial recall.
Results:
MCI-LB scored significantly lower than MCI-AD on processing speed [Trail Making Test B: p = .03, g = .45; Digit Symbol Substitution Test (DSST): p = .04, g = .47; DSST Error Check: p < .001, g = .68] and executive function [Trail Making Test Ratio (A/B): p = .04, g = .52] tasks. MCI-AD performed worse than MCI-LB on memory tasks, specifically visuospatial (Modified Taylor Complex Figure: p = .01, g = .46) and verbal (Rey Auditory Verbal Learning Test: p = .04, g = .42) delayed recall measures. Stepwise discriminant analysis correctly classified the subtype in 65.1% of MCI patients (72.7% specificity, 56.4% sensitivity). Processing speed accounted for more group-associated variance in visuospatial and verbal memory in both MCI subtypes than executive function, while no significant relationships between measures were observed in controls (all ps > .05)
Conclusions:
MCI-LB was characterized by executive dysfunction and slowed processing speed but did not show the visuospatial dysfunction expected, while MCI-AD displayed an amnestic profile. However, there was considerable neuropsychological profile overlap and processing speed mediated performance in both MCI subtypes.
Electroencephalographic (EEG) abnormalities are greater in mild cognitive impairment (MCI) with Lewy bodies (MCI-LB) than in MCI due to Alzheimer’s disease (MCI-AD) and may anticipate the onset of dementia. We aimed to assess whether quantitative EEG (qEEG) slowing would predict a higher annual hazard of dementia in MCI across these etiologies. MCI patients (n = 92) and healthy comparators (n = 31) provided qEEG recording and underwent longitudinal clinical and cognitive follow-up. Associations between qEEG slowing, measured by increased theta/alpha ratio, and clinical progression from MCI to dementia were estimated with a multistate transition model to account for death as a competing risk, while controlling for age, cognitive function, and etiology classified by an expert consensus panel.
Over a mean follow-up of 1.5 years (SD = 0.5), 14 cases of incident dementia and 5 deaths were observed. Increased theta/alpha ratio on qEEG was associated with increased annual hazard of dementia (hazard ratio = 1.84, 95% CI: 1.01–3.35). This extends previous findings that MCI-LB features early functional changes, showing that qEEG slowing may anticipate the onset of dementia in prospectively identified MCI.
Dopaminergic imaging is an established biomarker for dementia with Lewy bodies, but its diagnostic accuracy at the mild cognitive impairment (MCI) stage remains uncertain.
Aims
To provide robust prospective evidence of the diagnostic accuracy of dopaminergic imaging at the MCI stage to either support or refute its inclusion as a biomarker for the diagnosis of MCI with Lewy bodies.
Method
We conducted a prospective diagnostic accuracy study of baseline dopaminergic imaging with [123I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane single-photon emission computerised tomography (123I-FP-CIT SPECT) in 144 patients with MCI. Images were rated as normal or abnormal by a panel of experts with access to striatal binding ratio results. Follow-up consensus diagnosis based on the presence of core features of Lewy body disease was used as the reference standard.
Results
At latest assessment (mean 2 years) 61 patients had probable MCI with Lewy bodies, 26 possible MCI with Lewy bodies and 57 MCI due to Alzheimer's disease. The sensitivity of baseline FP-CIT visual rating for probable MCI with Lewy bodies was 66% (95% CI 52–77%), specificity 88% (76–95%) and accuracy 76% (68–84%), with positive likelihood ratio 5.3.
Conclusions
It is over five times as likely for an abnormal scan to be found in probable MCI with Lewy bodies than MCI due to Alzheimer's disease. Dopaminergic imaging appears to be useful at the MCI stage in cases where Lewy body disease is suspected clinically.
Recently published diagnostic criteria for mild cognitive impairment with Lewy bodies (MCI-LB) include five neuropsychiatric supportive features (non-visual hallucinations, systematised delusions, apathy, anxiety and depression). We have previously demonstrated that the presence of two or more of these symptoms differentiates MCI-LB from MCI due to Alzheimer's disease (MCI-AD) with a likelihood ratio >4. The aim of this study was to replicate the findings in an independent cohort.
Methods
Participants ⩾60 years old with MCI were recruited. Each participant had a detailed clinical, cognitive and imaging assessment including FP-CIT SPECT and cardiac MIBG. The presence of neuropsychiatric supportive symptoms was determined using the Neuropsychiatric Inventory (NPI). Participants were classified as MCI-AD, possible MCI-LB and probable MCI-LB based on current diagnostic criteria. Participants with possible MCI-LB were excluded from further analysis.
Results
Probable MCI-LB (n = 28) had higher NPI total and distress scores than MCI-AD (n = 30). In total, 59% of MCI-LB had two or more neuropsychiatric supportive symptoms compared with 9% of MCI-AD (likelihood ratio 6.5, p < 0.001). MCI-LB participants also had a significantly greater delayed recall and a lower Trails A:Trails B ratio than MCI-AD.
Conclusions
MCI-LB is associated with significantly greater neuropsychiatric symptoms than MCI-AD. The presence of two or more neuropsychiatric supportive symptoms as defined by MCI-LB diagnostic criteria is highly specific and moderately sensitive for a diagnosis of MCI-LB. The cognitive profile of MCI-LB differs from MCI-AD, with greater executive and lesser memory impairment, but these differences are not sufficient to differentiate MCI-LB from MCI-AD.
To utilise a community-based participatory approach in the design and implementation of an intervention targeting diet-related health problems on Navajo Nation.
Design:
A dual strategy approach of community needs/assets assessment and engagement of cross-sectorial partners in programme design with systematic cyclical feedback for programme modifications.
Setting:
Navajo Nation, USA.
Participants:
Navajo families with individuals meeting criteria for programme enrolment. Participant enrolment increased with iterative cycles.
Results:
The Navajo Fruit and Vegetable Prescription (FVRx) Programme.
Conclusions:
A broad, community-driven and culturally relevant programme design has resulted in a programme able to maintain core programmatic principles, while also allowing for flexible adaptation to changing needs.
Background: Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord impairment. In a public healthcare system, wait times to see spine specialists and eventually access surgical treatment for CSM can be substantial. The goals of this study were to determine consultation wait times (CWT) and surgical wait times (SWT), and identify predictors of wait time length. Methods: Consecutive patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) prospective and observational CSM study from March 2015 to July 2017 were included. A data-splitting technique was used to develop and internally validate multivariable models of potential predictors. Results: A CSORN query returned 264 CSM patients for CWT. The median was 46 days. There were 31% mild, 35% moderate, and 33% severe CSM. There was a statistically significant difference in median CWT between moderate and severe groups; 207 patients underwent surgical treatment. Median SWT was 42 days. There was a statistically significant difference in SWT between mild/moderate and severe groups. Short symptom duration, less pain, lower BMI, and lower physical component score of SF-12 were predictive of shorter CWT. Only baseline pain and medication duration were predictive of SWT. Both CWT and SWT were shorter compared to a concurrent cohort of lumbar stenosis patients (p <0.001). Conclusions: Patients with shorter duration (either symptoms or medication) and less neck pain waited less to see a spine specialist in Canada and to undergo surgical treatment. This study highlights some of the obstacles to overcome in expedited care for this patient population.
Dense, controlled-impedance, superconducting cables with small cross-sections are desirable, especially for quantum computing applications. In this study, superconductivity properties, rf microwave response and mechanical reliability performance of embedded Nb dc cables and Nb microstrip transmission line resonators with different thicknesses of polyimide PI-2611 encapsulation layers (0, 4 and 8 μm) have been investigated. Critical temperature (Tc) and critical current (Ic) of embedded Nb dc cables are ∼ 8.2 K and ∼ 0.2 A, respectively. Embedded Nb resonators yield high loaded quality factor (QL), with values as high as 14481 at ∼ 1.2 K and at a fundamental resonance of ∼ 2 GHz. From mechanical fatigue testing, we have observed that a polyimide encapsulation layer can effectively enhance the mechanical reliability of superconducting Nb flexible cables.
Recently, flexible electronics is attracting growing attention due to its various properties such as lightness and flexibility, which cannot be replaced by rigid electronics. In this study, we investigate flexible ink-jet printed Cu/CuxO/Ag capacitor-like structure that exhibits bipolar resistive switching behavior under direct current voltage sweeps. A vaccum-free and low temperature process is used to fabricate this ReRAM memory device, which allows straightforward fabrication and a structure for characterization of the possible use of CuxO as an insulating layer in these devices. Our device displays a resistive switching ratio greater than 30 between the high resistance and low resistance state at room temperature. The devices exhibit metallic behavior in the low resistance state and a semiconductor behavior is found in the initial and high resistance states as observed in temperature dependent resistance measurements. The resistive switching mechanism of the fabricated structures is explained by the formation and rupture of conductive filament paths.
Carbon nanotubes patterns of micron-level resolution have been achieved using inkjet printing of DNA and SDS assisted CNT dispersions. DNA/CNT film has a significantly higher resistance compared to SDS/CNT film. Taking advantage of the porous nature of printed SDS/CNT film after SDS removal, indium can be electroplated to fill the CNT network and form a CNT/In composite. The CNT/In composite was used as interconnect material. Reworkability and RF performance of In-plated CNT bump structures are studied and the results are presented.
We present two distinct methods to nanostructure the surface of amorphous silicon to produce unique, nanoscale surface features. One method is a dry etch process that employs a modified Bosch1 process on an advanced silicon etcher to produce needle-like features of amorphous silicon. Likewise, we also investigated metal-assisted wet chemical etching2 as an alternative method to nanostructure the amorphous silicon to produce porous-like features. The resulting surface topography leads to an optically black appearance over patterned or large areas. This is a result of the interspacing between each needle and pore that leads to a high optical absorption. Thus, we designate it as black amorphous silicon (b-a-Si). We have deposited and formed regions of b-a-Si on variety of insulating films and metal electrodes, including chrome and titanium. In this study, we characterize the electrical and optical properties of as-deposited amorphous silicon and nanostructured amorphous silicon.
Organic polymer based thin-film transistors (OP-TFTs) look very promising for flexible organic electronics. In this paper, we describe devices based on a gate-planarized structure and using spin-coated organic polymer. We have analyzed the role of the device source and drain contacts and we present data indicating Schottky behavior of the contacts in OP-TFTs. In addition, we describe a quantitative evaluation of the source drain series resistances and extract the OP-TFT intrinsic electrical parameters.
We have investigated the effects of white-light illumination on the electrical performance of organic polymer thin-film transistors (OP-TFTs). The OFF-state drain current is significantly increased, while the drain current in the strong accumulation regime is relatively unaffected. At the same time, the threshold voltage is decreased and the subthreshold slope is increased, while the field-effect mobility of the charge carriers is not affected. The observed effects are explained in terms of the photogeneration of free charge carriers in the channel region due to the absorbed photons.
The surface composition of Mars has been investigated using the Thermal Emission Spectrometer (TES) instrument during the mapping phase of the Mars Global Surveyor mission. The TES has mapped ~85% of the Martian surface at a resolution of 3-9 km. Separation of the atmospheric dust, water-ice cloud, CO2, water vapor, and surface components has been accomplished using radiative transfer and deconvolution. Two distinct surface compositional units have been mapped; (1) a basalt with plagioclase feldspar, Ca-rich pyroxene, minor sheet silicates; and (2) a basaltic andesite with silica glass, plagioclase, and minor pyroxene. Three large-scale (100’s km) accumulations of hematite have been found in Sinus Meridiani, Aram Chaos and Ophir/Candor Chasms. These regions are interpreted to be formed by aqueous precipitation under either ambient or hydrothermal conditions. No surfaces with detectable abundances of carbonate have been found. The albedo of the surface has been mapped with an absolute accuracy of ~1-2% and significant changes in surface albedo have occurred from the orbital measurements obtained by the Viking IRTM instrument.
In this paper we first give a brief overview of the MOCVD of high temperature superconductors and consider the general requirements of a precursor. We then present results for deposition from Y containing precursors and compare apparent enthalpies of sublimation and deposition activation energies with values in the literature. The problem of Ba containing precursors are briefly reviewed and results given for the sublimation of and deposition from a new stable and volatile precursor. Finally, some comments are made about possible deposition mechanisms.
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