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Article ; Online: The Role of Neuropsychology in the Assessment of the Cognitively Impaired Elderly.

Lu, Po H / Lee, Grace J

2017 Volume 35, Issue 2, Page(s) 191–206

Abstract: Cognitive abilities decline with age and older adults, as a group, are at increased risk for developing age-related cognitive disorders. Neuropsychological evaluation provides objective quantification of the type and severity of cognitive deficits that ... ...

Abstract	Cognitive abilities decline with age and older adults, as a group, are at increased risk for developing age-related cognitive disorders. Neuropsychological evaluation provides objective quantification of the type and severity of cognitive deficits that can affect the elderly population and elucidates a pattern of scores that provides diagnostic clues regarding etiology. It can also detect mild cognitive impairment that may not be evident on bedside assessment or mental status examination and provides critical information regarding the progression of cognitive changes through serial evaluations. Such information assists in counseling patients and family members and can guide therapeutic decisions.
MeSH term(s)	Aged ; Aged, 80 and over ; Aging ; Cognition Disorders/diagnosis ; Cognitive Aging/physiology ; Humans ; Mental Status Schedule ; Neuropsychological Tests
Language	English
Publishing date	2017-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1013148-6
ISSN	1557-9875 ; 0733-8619
ISSN (online)	1557-9875
ISSN	0733-8619
DOI	10.1016/j.ncl.2017.01.002
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Article ; Online: Reduced quality-of-life ratings in mild cognitive impairment: analyses of subject and informant responses.

Teng, Edmond / Tassniyom, Kanida / Lu, Po H

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry

2012 Volume 20, Issue 12, Page(s) 1016–1025

Abstract: Objectives: To determine whether quality-of-life (QOL) ratings are reduced in mild cognitive impairment (MCI) and analyze correlations between QOL ratings and cognitive, neuropsychiatric, and functional indices in MCI.: Design: Cross-sectional.: ... ...

Abstract	Objectives: To determine whether quality-of-life (QOL) ratings are reduced in mild cognitive impairment (MCI) and analyze correlations between QOL ratings and cognitive, neuropsychiatric, and functional indices in MCI. Design: Cross-sectional. Setting: The Easton Center for Alzheimer's Disease Research at the University of California, Los Angeles. Participants: A total of 205 individuals who met criteria for normal cognition (n = 97) or MCI (n = 108). The MCI group included amnestic (n = 72) and nonamnestic (n = 36) MCI. Measurements: QOL was assessed using subject and informant ratings on the Quality of Life-Alzheimer's Disease (QOL-AD) scale. Cognitive performance was assessed with the National Alzheimer's Disease Coordinating Center Uniform Data Set neuropsychological battery. Neuropsychiatric symptoms were assessed with the Geriatric Depression Scale (GDS) and the Neuropsychiatric Inventory. Functional abilities were assessed with the Functional Activities Questionnaire (FAQ). Results: The normal cognition group had significantly higher QOL-AD scores than the MCI group on both subject and informant assessments. Individual item analyses indicated that the largest group differences were seen on the mood and memory items. Similar QOL-AD scores were seen in the amnestic and nonamnestic MCI subgroups. Multiple regression analyses within the MCI group indicated that QOL-AD ratings were not correlated with neuropsychological performance. Subject QOL-AD ratings were inversely correlated with GDS scores and informant QOL-AD ratings were inversely correlated with GDS, Neuropsychiatric Inventory, and FAQ scores. Conclusions: Significant declines in QOL are seen in MCI and are associated with neuropsychiatric symptoms and functional decline. Interventions targeting mood symptoms and/or instrumental activities of daily living may improve QOL in MCI.
MeSH term(s)	Affect ; Aged ; Aged, 80 and over ; Cognitive Dysfunction/psychology ; Cross-Sectional Studies ; Dementia/psychology ; Female ; Geriatric Assessment ; Humans ; Los Angeles ; Male ; Memory Disorders/psychology ; Middle Aged ; Neuropsychological Tests ; Quality of Life/psychology ; Regression Analysis ; Surveys and Questionnaires
Language	English
Publishing date	2012-09-26
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1278145-9
ISSN	1545-7214 ; 1064-7481
ISSN (online)	1545-7214
ISSN	1064-7481
DOI	10.1097/JGP.0b013e31826ce640
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Article ; Online: Longitudinal declines in instrumental activities of daily living in stable and progressive mild cognitive impairment.

Hsiao, Julia J / Lu, Po H / Grill, Joshua D / Teng, Edmond

Dementia and geriatric cognitive disorders

2014 Volume 39, Issue 1-2, Page(s) 12–24

Abstract: Background: Previous cross-sectional studies suggest that assessments of instrumental activities of daily living (IADLs) may be useful for operationalizing the differences in functional deficits seen in mild cognitive impairment (MCI) and dementia. ... ...

Abstract	Background: Previous cross-sectional studies suggest that assessments of instrumental activities of daily living (IADLs) may be useful for operationalizing the differences in functional deficits seen in mild cognitive impairment (MCI) and dementia. However, their utility for longitudinal changes in IADLs in the transition between MCI and dementia remains unclear. Methods: We analyzed longitudinal IADL data with the Functional Activities Questionnaire (FAQ) in stable (MCI-S; n = 1,318) or progressive (MCI-P; n = 1,108) MCI patients. Results: Larger increases in FAQ scores were seen in the MCI-P group across a 14.5-month interval, but overlapping distributions in the two groups yielded poorer discriminatory power than prior cross-sectional reports. Conclusion: Our findings emphasize the difficulties in operationalizing the criterion of 'essentially intact' IADLs in MCI, which may complicate the interpretation of disease progression in MCI treatment trials.
MeSH term(s)	Activities of Daily Living ; Aged ; Alzheimer Disease/physiopathology ; Amnesia/physiopathology ; Case-Control Studies ; Cognitive Dysfunction/physiopathology ; Cross-Sectional Studies ; Disability Evaluation ; Disease Progression ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Surveys and Questionnaires
Language	English
Publishing date	2014-10-03
Publishing country	Switzerland
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1026007-9
ISSN	1421-9824 ; 1013-7424
ISSN (online)	1421-9824
ISSN	1013-7424
DOI	10.1159/000365587
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Article ; Online: Longitudinal Declines in Instrumental Activities of Daily Living in Stable and Progressive Mild Cognitive Impairment

Hsiao, Julia J. / Lu, Po H. / Grill, Joshua D. / Teng, Edmond

Dementia and Geriatric Cognitive Disorders

2015 Volume 39, Issue 1-2, Page(s) 12–24

Abstract	Background: Previous cross-sectional studies suggest that assessments of instrumental activities of daily living (IADLs) may be useful for operationalizing the differences in functional deficits seen in mild cognitive impairment (MCI) and dementia. However, their utility for longitudinal changes in IADLs in the transition between MCI and dementia remains unclear. Methods: We analyzed longitudinal IADL data with the Functional Activities Questionnaire (FAQ) in stable (MCI-S; n = 1,318) or progressive (MCI-P; n = 1,108) MCI patients. Results: Larger increases in FAQ scores were seen in the MCI-P group across a 14.5-month interval, but overlapping distributions in the two groups yielded poorer discriminatory power than prior cross-sectional reports. Conclusion: Our findings emphasize the difficulties in operationalizing the criterion of ‘essentially intact' IADLs in MCI, which may complicate the interpretation of disease progression in MCI treatment trials.© 2014 S. Karger AG, Basel
Keywords	Mild cognitive impairment ; Dementia ; Diagnosis ; Activities of daily living ; Functional abilities ; Assessment measures
Language	English
Publisher	S. Karger AG
Publishing place	Basel
Publishing country	Switzerland
Document type	Article ; Online
ZDB-ID	1026007-9
ISSN	1421-9824 ; 1420-8008 ; 1013-7424 ; 1420-8008 ; 1013-7424
ISSN (online)	1421-9824
ISSN	1420-8008 ; 1013-7424
DOI	10.1159/000365587
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Article: Longitudinal Declines in Instrumental Activities of Daily Living in Stable and Progressive Mild Cognitive Impairment

Hsiao, Julia J. / Lu, Po H. / Grill, Joshua D. / Teng, Edmond

Dementia and Geriatric Cognitive Disorders

2014 Volume 39, Issue 1-2, Page(s) 12–24

Institution	Department of Neurology, David Geffen School of Medicine, University of California, and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, Calif., USA
Abstract	Background: Previous cross-sectional studies suggest that assessments of instrumental activities of daily living (IADLs) may be useful for operationalizing the differences in functional deficits seen in mild cognitive impairment (MCI) and dementia. However, their utility for longitudinal changes in IADLs in the transition between MCI and dementia remains unclear. Methods: We analyzed longitudinal IADL data with the Functional Activities Questionnaire (FAQ) in stable (MCI-S; n = 1,318) or progressive (MCI-P; n = 1,108) MCI patients. Results: Larger increases in FAQ scores were seen in the MCI-P group across a 14.5-month interval, but overlapping distributions in the two groups yielded poorer discriminatory power than prior cross-sectional reports. Conclusion: Our findings emphasize the difficulties in operationalizing the criterion of ‘essentially intact' IADLs in MCI, which may complicate the interpretation of disease progression in MCI treatment trials. © 2014 S. Karger AG, Basel
Keywords	Mild cognitive impairment ; Dementia ; Diagnosis ; Activities of daily living ; Functional abilities ; Assessment measures
Language	English
Publishing date	2014-10-03
Publisher	S. Karger AG
Publishing place	Basel, Switzerland
Document type	Article
Note	Original Research Article
ZDB-ID	1026007-9
ISSN	1421-9824 ; 1420-8008 ; 1013-7424
ISSN (online)	1421-9824
ISSN	1420-8008 ; 1013-7424
DOI	10.1159/000365587
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Article ; Online: Human brain myelination and amyloid beta deposition in Alzheimer's disease.

Bartzokis, George / Lu, Po H / Mintz, Jim

Alzheimer's & dementia : the journal of the Alzheimer's Association

2008 Volume 3, Issue 2, Page(s) 122–125

Abstract: We hypothesized that myelin breakdown in vulnerable late-myelinating regions releases oligodendrocyte- and myelin-associated iron that promotes amyloid beta (A beta) oligomerization, its associated toxicity, and the deposition of oligomerized A beta and ... ...

Abstract	We hypothesized that myelin breakdown in vulnerable late-myelinating regions releases oligodendrocyte- and myelin-associated iron that promotes amyloid beta (A beta) oligomerization, its associated toxicity, and the deposition of oligomerized A beta and iron in neuritic plaques observed in Alzheimer's disease (AD). The model was tested by using published maps of cortical myelination from 1901 and recent in vivo imaging maps of A beta deposits in humans. The data show that in AD, radiolabeled ligands detect A beta deposition in a distribution that matches the map of late-myelinating regions. Furthermore, the strikingly lower ability of this imaging ligand to bind A beta in animal models is consistent with the much lower levels of myelin and associated iron levels in rodents when compared with humans. The hypotheses derived from the "myelin model" are testable with current imaging methods and have important implications for therapeutic interventions that should be expanded to include novel targets such as oligodendrocytes, myelin, and brain iron.
Language	English
Publishing date	2008-06-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2211627-8
ISSN	1552-5279 ; 1552-5260
ISSN (online)	1552-5279
ISSN	1552-5260
DOI	10.1016/j.jalz.2007.01.019
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Article ; Online: Increased iron levels and decreased tissue integrity in hippocampus of Alzheimer's disease detected in vivo with magnetic resonance imaging.

Raven, Erika P / Lu, Po H / Tishler, Todd A / Heydari, Panthea / Bartzokis, George

Journal of Alzheimer's disease : JAD

2013 Volume 37, Issue 1, Page(s) 127–136

Abstract: Background: Iron can catalyze damaging free radical reactions. With age, iron accumulates in brain gray matter regions and may contribute to the risk of developing age-related diseases such as Alzheimer's disease (AD). Prior MRI studies demonstrated ... ...

Abstract	Background: Iron can catalyze damaging free radical reactions. With age, iron accumulates in brain gray matter regions and may contribute to the risk of developing age-related diseases such as Alzheimer's disease (AD). Prior MRI studies demonstrated increased iron deposits in basal ganglia regions; however, the hippocampus (Hipp), which is heavily damaged in AD, and comparator regions that are resistant to AD damage, such as thalamus (Th), have rarely been examined. Objective: To assess iron levels and evidence of tissue damage in Hipp and Th of AD subjects and healthy controls. Methods: Thirty-one AD and sixty-eight healthy control subjects participated in this study. High- and low-field strength MRI instruments were used in combination to quantify iron content of ferritin molecules (ferritin iron) using the field dependent relaxation rate increase (FDRI) method. Decreased transverse relaxation rate (R2) was used as an index of tissue damage. Results: Compared with healthy controls, AD subjects had increased ferritin iron in Hipp (p = 0.019) but not Th (p = 0.637), and significantly decreased R2 in Hipp (p < 0.001) but not Th (p = 0.37). In the entire sample, FDRI and R2 were negatively correlated. Conclusion: The data shows that in AD, Hipp damage occurs in conjunction with ferritin iron accumulation. Prospective studies are needed to evaluate how increasing iron levels may influence the trajectory of tissue damage and cognitive and pathologic manifestations of AD.
MeSH term(s)	Aged ; Aged, 80 and over ; Alzheimer Disease/diagnosis ; Alzheimer Disease/metabolism ; Female ; Ferritins/analysis ; Ferritins/metabolism ; Hippocampus/chemistry ; Hippocampus/metabolism ; Hippocampus/pathology ; Humans ; Iron/analysis ; Iron/metabolism ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged
Chemical Substances	Ferritins (9007-73-2) ; Iron (E1UOL152H7)
Language	English
Publishing date	2013
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1440127-7
ISSN	1875-8908 ; 1387-2877
ISSN (online)	1875-8908
ISSN	1387-2877
DOI	10.3233/JAD-130209
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Article ; Online: Methodological improvements in voxel-based analysis of diffusion tensor images: applications to study the impact of apolipoprotein E on white matter integrity.

Newlander, Shawn M / Chu, Alan / Sinha, Usha S / Lu, Po H / Bartzokis, George

Journal of magnetic resonance imaging : JMRI

2013 Volume 39, Issue 2, Page(s) 387–397

Abstract: Purpose: To identify regional differences in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) using customized preprocessing before voxel-based analysis (VBA) in 14 normal subjects with the specific genes that decrease (apolipoprotein ...

Abstract	Purpose: To identify regional differences in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) using customized preprocessing before voxel-based analysis (VBA) in 14 normal subjects with the specific genes that decrease (apolipoprotein [APO] E ε2) and that increase (APOE ε4) the risk of Alzheimer's disease. Materials and methods: Diffusion tensor images (DTI) acquired at 1.5 Tesla were denoised with a total variation tensor regularization algorithm before affine and nonlinear registration to generate a common reference frame for the image volumes of all subjects. Anisotropic and isotropic smoothing with varying kernel sizes was applied to the aligned data before VBA to determine regional differences between cohorts segregated by allele status. Results: VBA on the denoised tensor data identified regions of reduced FA in APOE ε4 compared with the APOE ε2 healthy older carriers. The most consistent results were obtained using the denoised tensor and anisotropic smoothing before statistical testing. In contrast, isotropic smoothing identified regional differences for small filter sizes alone, emphasizing that this method introduces bias in FA values for higher kernel sizes. Conclusion: Voxel-based DTI analysis can be performed on low signal to noise ratio images to detect subtle regional differences in cohorts using the proposed preprocessing techniques.
MeSH term(s)	Aged ; Algorithms ; Anisotropy ; Apolipoproteins E/metabolism ; Brain/metabolism ; Brain/ultrastructure ; Diffusion Tensor Imaging/methods ; Female ; Humans ; Image Enhancement/methods ; Image Interpretation, Computer-Assisted/methods ; Imaging, Three-Dimensional/methods ; Male ; Nerve Fibers, Myelinated/metabolism ; Nerve Fibers, Myelinated/ultrastructure ; Reproducibility of Results ; Sensitivity and Specificity
Chemical Substances	Apolipoproteins E
Language	English
Publishing date	2013-04-15
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1146614-5
ISSN	1522-2586 ; 1053-1807
ISSN (online)	1522-2586
ISSN	1053-1807
DOI	10.1002/jmri.24157
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Article ; Online: Myelin breakdown mediates age-related slowing in cognitive processing speed in healthy elderly men.

Lu, Po H / Lee, Grace J / Tishler, Todd A / Meghpara, Michael / Thompson, Paul M / Bartzokis, George

Brain and cognition

2013 Volume 81, Issue 1, Page(s) 131–138

Abstract: Background: To assess the hypothesis that in a sample of very healthy elderly men selected to minimize risk for Alzheimer's disease (AD) and cerebrovascular disease, myelin breakdown in late-myelinating regions mediates age-related slowing in cognitive ... ...

Abstract	Background: To assess the hypothesis that in a sample of very healthy elderly men selected to minimize risk for Alzheimer's disease (AD) and cerebrovascular disease, myelin breakdown in late-myelinating regions mediates age-related slowing in cognitive processing speed (CPS). Materials and methods: The prefrontal lobe white matter and the genu of the corpus callosum myelinate later in brain development (late-myelinating white matter; LMWM) and are more vulnerable to breakdown due to the effects of normal aging. An in vivo MRI biomarker of myelin integrity (transverse relaxation rates; R(2)) of LMWM was obtained for 38 very healthy elderly adult men (mean age=66.3 years; SD=6.0; range=55-76). To evaluate regional specificity, we also assessed a contrasting early-myelinating region (splenium of the corpus callosum; SWM), which primarily contains axons involved in visual processing. CPS was assessed using the Trail Making Test. Results: LMWM R(2) and CPS measures were significantly correlated (r=.515, p=.0009), but no significant association between R(2) and CPS was detected in the splenium (p=.409). LMWM R(2), but not SWM R(2), was a significant mediator of the relationship between age and CPS (p=.037). Conclusions: In this very healthy elderly sample, age-related slowing in CPS is mediated by myelin breakdown in highly vulnerable late-myelinating regions but not in the splenium.
MeSH term(s)	Age Factors ; Aged ; Cognition ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Mental Processes/physiology ; Middle Aged ; Myelin Sheath/metabolism ; Myelin Sheath/pathology ; Nerve Fibers, Myelinated/physiology ; Neuropsychological Tests ; Time Factors
Language	English
Publishing date	2013-02
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	603163-8
ISSN	1090-2147 ; 0278-2626
ISSN (online)	1090-2147
ISSN	0278-2626
DOI	10.1016/j.bandc.2012.09.006
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Article: Suspect cognitive symptoms in a 9-year-old child: malingering by proxy?

Lu, Po H / Boone, Kyle Brauer

The Clinical neuropsychologist

2002 Volume 16, Issue 1, Page(s) 90–96

Abstract: Even though the veracity of children's claim of psychiatric symptoms has received increased attention in recent years, identification of noncredible neuropsychological symptoms in children has been virtually overlooked in clinical practice and research. ... ...

Abstract	Even though the veracity of children's claim of psychiatric symptoms has received increased attention in recent years, identification of noncredible neuropsychological symptoms in children has been virtually overlooked in clinical practice and research. A case is presented of a 9-year-old child involved in litigation regarding a head injury sustained when he was struck by a car. Neuropsychological evaluation revealed evidence of feigned cognitive symptoms; the child displayed noncredible performance on several specialized tests designed to discreetly assess effort and an atypical pattern of responses on standard cognitive measures, as well as discrepancies between neuropsychological scores and tests administered in school and the rehab setting. Results demonstrate that children as young as 9 years of age are capable of feigning cognitive impairment, which highlights the need for routine evaluation of effort, irrespective of the age of the patient.
MeSH term(s)	Child ; Cognition Disorders/diagnosis ; Humans ; Male ; Malingering/diagnosis ; Munchausen Syndrome by Proxy/diagnosis ; Neuropsychological Tests ; Severity of Illness Index
Language	English
Publishing date	2002-02
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	639080-8
ISSN	1744-4144 ; 1385-4046 ; 0920-1637
ISSN (online)	1744-4144
ISSN	1385-4046 ; 0920-1637
DOI	10.1076/clin.16.1.90.8328
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