Publications by authors named "Mary H Kosmidis"

87 Publications

Late life psychotic features in prodromal Parkinson's disease.

Parkinsonism Relat Disord 2021 Apr 7;86:67-73. Epub 2021 Apr 7.

1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece; Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece. Electronic address:

Introduction: Some case series have suggested that psychotic features could occur even before the onset of motor symptoms of Parkinson's Disease (PD). Our aim was to investigate a possible association between psychotic symptoms and prodromal Parkinson's disease in a population-based cohort, the Hellenic Longitudinal Investigation of Aging and Diet study.

Methods: This cross-sectional study included participants aged ≥65 years without dementia or PD. We defined psychotic symptoms as the presence of at least one new hallucinatory or delusional feature, assessed with the Neuropsychiatric Inventory scale and the Columbia University Scale for Psychopathology in Alzheimer's Disease, exhibited only at follow-up and not present at baseline visit. We calculated the probability of prodromal PD (pPD) for every participant, according to the 2019 International Parkinson and Movement Disorders Society research criteria for prodromal PD.

Results: Participants who developed psychotic manifestations over a three-year follow up (20 of 914) had 1.3 times higher probability of pPD score (β [95%CI]: 1.3 [0.9-1.5], p=0.006) compared to non-psychotic subjects. This association was driven mostly by depressive symptoms, constipation and subthreshold parkinsonism (p<0.05).

Conclusion: Our data indicate that emerging psychotic features evolve in parallel with the probability of pPD. This is the first study that provides evidence for the presence of psychotic experiences in pPD. The association detected needs to be confirmed in longitudinal studies.
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http://dx.doi.org/10.1016/j.parkreldis.2021.04.001DOI Listing
April 2021

Mediterranean diet and risk for dementia and cognitive decline in a Mediterranean population.

J Am Geriatr Soc 2021 Mar 16. Epub 2021 Mar 16.

1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.

Background: Current evidence suggests that nutrition in general and specific dietary patterns in particular, such as the Mediterranean type diet (MeDi), can be employed as potential preventive strategies against the development of dementia and cognitive decline. However, longitudinal data exploring the applicability of these findings in populations of Mediterranean origin are limited. The aim of the present study was to explore the potential relationships of MeDi adherence with dementia incidence rates and cognitive change over time in a traditional Mediterranean population, characterized by a lifelong exposure to Mediterranean eating habits and lifestyle.

Methods: The sample consisted of 1046 non-demented individuals over the age of 64 (mean age = 73.1; SD = 5.0), with available baseline dietary information and longitudinal follow-up. Diagnosis of dementia was made by a full clinical and neuropsychological evaluation, while cognitive performance was assessed according to five cognitive domains (memory, language, attention-speed, executive functioning, visuospatial perception) and a global cognitive score. Adherence to MeDi was evaluated by an a priori score (range 0-55), derived from a detailed food frequency questionnaire.

Results: A total of 62 incident dementia cases occurred during a mean (SD) of 3.1 (0.9) years of follow-up. Individuals in the highest MeDi quartile (highest adherence to MeDi) had a 72% lower risk for development of dementia, compared to those in the lowest one (p = 0.013). In addition, analysis of cognitive performance as a function of MeDi score revealed that the biennial cognitive benefit of a 10-unit increase in MeDi score offsets the cognitive decline associated with 1 year of cognitive aging.

Conclusion: In the present study, higher adherence to MeDi was associated with a reduced risk for dementia and cognitive decline in a traditional Mediterranean population.
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http://dx.doi.org/10.1111/jgs.17072DOI Listing
March 2021

Incidence of mild cognitive impairment in the elderly population in Greece: results from the HELIAD study.

Aging Clin Exp Res 2021 Mar 8. Epub 2021 Mar 8.

1st Department of Neurology, Aeginition University Hospital, National and Kapodistrian University of Athens Medical School, 72 Vassilissis Sophias Avenue, 11528, Athens, Greece.

Background: There are no published data on Mild Cognitive Impairment (MCI) incidence in people over 65 years of age in Greece, relevant literature is scarce for Southern Europe, and reported rates worldwide show great variability.

Aims: To investigate the incidence and risk factors of MCI and its subtypes in the elderly population in Greece.

Methods: The incidence cohort of the HELIAD study (Hellenic Epidemiological Longitudinal Investigation of Aging and Diet) comprised 955 individuals who received full neurological and neuropsychological evaluation on two separate occasions about three years apart.

Results: The MCI incidence rate in our cohort is 54.07 new cases per 1000 person-years, standardized by age and sex to 59.99. Each additional year of age over 65 raises the probability of novel MCI by 6.2%, while lower educational attainment more than doubles the risk for incident MCI. Apolipoprotein E-ε4 (APOE-ε4) carriage results in increased risk for MCI by more than 1.7 times. Incidence rates for amnestic MCI are slightly higher than for the non-amnestic subtype, and AD is the most common potential underlying etiology.

Discussion: The MCI incidence rate in the Greek population over 65 years of age is 54/1000 person-years. Advanced age and APOE-ε4 carriage are predisposing factors, while higher educational attainment was found to exert a protective effect.

Conclusions: MCI incidence in people over 65 years-old in Greece is consistent with reported rates around the world. Larger studies encompassing neuroimaging and cerebrospinal fluid biomarkers will hopefully shed more light on MCI epidemiology in Greece in the future.
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http://dx.doi.org/10.1007/s40520-021-01819-wDOI Listing
March 2021

Neuropsychological functioning in patients with interstitial lung disease.

Appl Neuropsychol Adult 2021 Jan 28:1-6. Epub 2021 Jan 28.

Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Objective: We undertook the present study to investigate the cognitive status of patients with interstitial lung disease (ILD) and its relationship to pulmonary function and cardiovascular efficiency.

Method: Fifty-one patients with a diagnosis of ILD [mean duration = 3.13 years ( = 3.01)] received a respiratory examination, including spirometry and the six-minute walk test, and completed a neuropsychological assessment including several cognitive domains. Eighty-eight healthy individuals matched on age, education, and gender, completed the neuropsychological test battery.

Results: Patients performed more poorly than their healthy peers on cognitive tasks related to verbal and visual memory, visual perception, and working memory, but not attention, processing speed and executive functioning. Stepwise linear regression analyses showed that exercise-related measures (heart rate, oxygen saturation and distance walked) predicted performance on neuropsychological tests of psychomotor speed, verbal memory and word production. Additionally, an index of pulmonary function, specifically, lung diffusion capacity, predicted performance on selective and sustained attention and word generation.

Conclusion: The present preliminary findings may have implications for the quality of life and treatment compliance of patients with ILD and warrant further study with a larger sample of patients.
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http://dx.doi.org/10.1080/23279095.2020.1870465DOI Listing
January 2021

The factors associated with the presence of psychotic symptoms in the HELIAD Greek community study of older adults.

Aging Ment Health 2021 Jan 20:1-10. Epub 2021 Jan 20.

Department of Social Medicine, Psychiatry and Neurology, National and Kapodistrian University of Athens, Athens, Greece.

Background: The prevalence and associated factors related to psychotic symptoms in older adults are understudied. The objectives were to assess the prevalence, incidence and factors associated with psychotic symptoms in a representative Greek sample of community living older adults.

Methods: The sample includes  = 1,904 residents of the cities of Larissa and Maroussi in Greece participating in the Hellenic Longitudinal Investigation of Aging and Diet study with available data at baseline and  = 947 individuals at the 3-year follow-up. Past-month presence of delusions and hallucinations was assessed on the grounds of the 17 symptoms of the Columbia University Scale for Psychopathology in Alzheimer's Disease and 14 symptoms of the Neuropsychiatric Inventory Questionnaire. A comprehensive neuropsychological assessment for probable diagnosis of dementia and physical comorbidity was carried out by neurologists. Penalized logistic regression analyses were used to assess the socio-economic and clinical factors associated with psychotic symptoms.

Results: Past-month prevalence of psychotic symptoms was 1.9% and 1.0% when excluding cases of dementia. The prevalence of any delusion and hallucination was 0.8% and 0.3% when excluding dementia. The incidence of psychotic symptoms without dementia was 1.3%. Recent widows and farmers/breeders/craftsmen, versus public servants/teachers/executives, had both six times the odds of experiencing psychotic symptoms without dementia. Hearing impairment and the number of health conditions also increased the odds while increased age was protective.

Conclusion: Psychotic symptoms unrelated to dementia constitute a considerable mental health problem in old age. Paranoid delusions were the most prevalent. Socio-economic and health status factors are significant predictors of psychotic symptoms.
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http://dx.doi.org/10.1080/13607863.2021.1871882DOI Listing
January 2021

Selective impairment of auditory attention processing in idiopathic generalized epilepsies: Implications for their cognitive pathophysiology.

Appl Neuropsychol Adult 2020 Dec 7:1-10. Epub 2020 Dec 7.

Department of Neurosurgery, Epilepsy Surgery Unit, School of Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece.

The neuropsychological characteristics of Idiopathic Generalized Epilepsies (IGEs) as a wide syndrome encompassing different clinical entities have been as yet not well understood. We have studied neuropsychological performance in patients suffering Juvenile Myoclonic Epilepsy (JME) and Generalized Tonic Clonic Seizures (IGE-GTCS-only) to provide indirect-cognitive evidence on the pathophysiology of IGE-related neuropsychological dysfunction. Greater arousal-related impairments were expected for the auditory modality, by drawing on previous anatomo-clinical and neuro-evolutionary accounts. We have studied neurocognitive functioning in 26 IGE patients, suffering either JME ( = 16) or IGE-GTCS-only ( = 10), and their healthy counterparts consisted of 26 (18 females) demographically matched participants. IGE patients (JME and IGE-GTCS-only) did worse with respect to HC (healthy controls) in visual- and auditory- speed of information processing (reaction time), auditory-vigilance and -response inhibition, visuo-motor coordination, visual working memory and motor speed, delayed visual recall, immediate- and delayed verbal episodic recall, lexical access and retrieval, semantic associative processing, auditory-verbal memory span and verbal learning. Although both IGE-GTCS-only and JME patients delayed episodic recall was defective, the former did significantly worse. We believe that IGE patients' neuropsychological derailments represent indirect-secondary manifestations of a primary cortical tone deregulation inherent to IGEs' pathophysiology. In particular, IGE patients' worse-dissociated performance in auditory TOVA-also seen previously in TBI and schizophrenia-may implicate a grater vulnerability of the auditory information processing system, as well as a possibly shared cognitive pathophysiological component between IGE and the above nosologies.
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http://dx.doi.org/10.1080/23279095.2020.1852566DOI Listing
December 2020

Clinical Neuropsychology as a Specialist Profession in European Health Care: Developing a Benchmark for Training Standards and Competencies Using the Europsy Model?

Front Psychol 2020 6;11:559134. Epub 2020 Oct 6.

Department of Psychology, University of Oslo, Oslo, Norway.

The prevalence and negative impact of brain disorders are increasing. Clinical Neuropsychology is a specialty dedicated to understanding brain-behavior relationships, applying such knowledge to the assessment of cognitive, affective, and behavioral functioning associated with brain disorders, and designing and implementing effective treatments. The need for services goes beyond neurological diseases and has increased in areas of neurodevelopmental and psychiatric conditions, among others. In Europe, a great deal of variability exists in the education and training of Clinical Neuropsychologists. Training models include master's programs, continuing education courses, doctoral programs, and/or post-doctoral specialization depending on the country, with no common framework of requirements, although patients' needs demand equal competencies across Europe. In the past 5 years, the Standing Committee on Clinical Neuropsychology of the European Federation of Psychologists' Association has conducted a series of surveys and interviews with experts in the field representing 30 European countries. The information, along with information from the existing literature, is used in presenting an overview of current and relevant topics related to policy and guidelines in the training and competencies in Clinical Neuropsychology. An option for the way forward is the EuroPsy Specialist Certificate, which is currently offered in Work and Organizational Psychology, and in psychotherapy. It builds upon the basic certificate and complements national standards without overriding them. General principles can be found that can set the basis for a common, solid, and comprehensive specialty education/training, sharpening the Neuropsychologists' competencies across Europe. The requirements in Clinical Neuropsychology should be comparable to those for the existing specialty areas in the EuroPsy model. Despite the perceived challenges, developing a specialist certificate appears a step forward for the development of Clinical Neuropsychology. Recommendations are proposed toward a shared framework of competencies by the means of a common level of education/training for the professionals in Europe. Benchmarking training standards and competencies across Europe has the potential of providing protection against unqualified and ethically questionable practice, creating transparency, raising the general European standard, and promoting mobility of both Clinical Neuropsychologists and patients in Europe, for the benefit of the professional field and the population.
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http://dx.doi.org/10.3389/fpsyg.2020.559134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573555PMC
October 2020

Dementia Incidence in the Elderly Population of Greece: Results From the HELIAD Study.

Alzheimer Dis Assoc Disord 2021 Jan-Mar 01;35(1):48-54

1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School.

Objectives: Recently a declining trend in dementia incidence rates has been reported in high-income countries. We investigated dementia incidence in a representative sample of the Greek population in the age group of 65 years and above.

Methods: This research is part of the Hellenic Epidemiological Longitudinal Investigation of Aging and Diet (HELIAD). The incidence cohort consisted of 1072 participants who were reevaluated after a mean period of 3.09 years.

Results: The incidence rate of dementia was 19.0 cases per 1000 person-years (age-standardized and sex-standardized incidence: 25.4/1000 person-years), of which 16.3 per 1000 person-years were attributable to Alzheimer disease. Each additional year of age increased dementia risk by 19.3% and each additional year of education decreased dementia risk by 12.1%. Apolipoprotein E (APOE)-ε4 homozygous participants were 18 times more likely to be diagnosed with dementia. A baseline diagnosis of mild cognitive decline (MCI) resulted in a risk for dementia increased by 3.7 times compared with the cognitively normal; in participants with MCI at baseline, APOE-ε4 carriage increased dementia risk by 4.5 times.

Conclusions: The incidence rate of dementia in people 65 years and above in Greece is generally consistent with recently published rates in Europe and North America. Advancing age, baseline MCI, and APOE-ε4 homozygosity are risk factors, while higher educational attainment seems protective.
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http://dx.doi.org/10.1097/WAD.0000000000000407DOI Listing
April 2020

Association Between Sleep Disturbances and Frailty: Evidence From a Population-Based Study.

J Am Med Dir Assoc 2021 Mar 25;22(3):551-558.e1. Epub 2020 Sep 25.

1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School, Greece; Taub Institute for Research in Alzheimer's Disease and the Aging Brain, the Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.

Objective: To explore the association between both self-reported quality and quantity sleep characteristics and frailty status in a large non-sex-specific population of older individuals in Greece.

Design: Cross-sectional study.

Setting And Participants: In total, 1984 older individuals (≥65 years old) were drawn from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD).

Measures: Frailty was assessed using 3 different definitions, the Frailty Index (FI), the Tilburg Frailty Indicator (TFI), and the Groningen Frailty Indicator (GFI). Sleep quality was evaluated through the Sleep Index II, which includes 9 of the 12 self-reported items of the Medical Outcomes Study-Sleep Scale. To examine sleep duration, participants were asked to report on how many hours they slept each night during the past 4 weeks. Logistic regression models adjusted for multiple covariates were explored. Additional analyses, stratified by gender, adjusting for sleep-related medications and excluding participants diagnosed with dementia, were also performed.

Results: In total, 389 (20%), 619 (31.9%), and 608 (31.3%) participants were categorized as frail according to the FI, the TFI, and the GFI respectively. Sleep quality was significantly associated with frailty in all models. Even after adjusting for subjective sleep duration, compared with participants who subjectively reported high sleep quality, those with low sleep quality had 3.7, 2.6, and 2.5 more times to be frail as measured with FI, TFI, and GFI respectively. Regarding the associations between frailty and self-reported sleep duration, sex-specific associations were observed: prolonged sleep duration was associated with frailty in the subsample of male participants.

Conclusions And Implications: The present study shows a strong correlation between subjective sleep quality and frailty status, contributing substantial information to the growing literature demonstrating that sleep is associated with older people's overall health. Sleep complaints should not be underestimated, and older individuals who self-report sleep disorders should be further assessed for frailty.
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http://dx.doi.org/10.1016/j.jamda.2020.08.012DOI Listing
March 2021

Off-road assessment of cognitive fitness to drive.

Appl Neuropsychol Adult 2020 Sep 9:1-11. Epub 2020 Sep 9.

Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Road safety is a major issue in every society. The assessment of driving ability with a real vehicle is a lengthy and costly process; therefore, there is a growing need for the development of a neuropsychological battery that can provide a fast and reliable evaluation of a person's cognitive fitness to drive. In the present study, we examined the relationship of an off-road lab-type test, namely, the Driving Scenes test, with performance on a driving simulator, as well as the influence of cognitive factors on driving ability as evaluated by Driving Scenes. Our results demonstrated a relationship between Driving Scenes and driving simulator performance. They also showed that some cognitive factors (namely, selective attention and verbal memory), were predictive of driving ability (as determined by the Driving Scenes test), but not others (namely visuospatial perception/memory, working memory, and visuospatial recognition). In addition, age strongly predicted performance on this test (younger age was associated with better performance). The conclusions derived from the present study highlight the need to identify off-road tools with high predictive value in assessing driving ability.
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http://dx.doi.org/10.1080/23279095.2020.1810041DOI Listing
September 2020

Frailty and Prodromal Parkinson's Disease: Results From the HELIAD Study.

J Gerontol A Biol Sci Med Sci 2021 Mar;76(4):622-629

1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece.

Background: To investigate the association between frailty, Parkinson's disease (PD), and the probability of prodromal Parkinson's disease (prodromal PD) in Greek community-dwelling older individuals.

Methods: Parkinson's disease diagnosis was reached through standard clinical research procedures. Probability of prodromal PD was calculated according to the International Parkinson and Movement Disorder Society's research criteria for PD-free participants. Frailty was evaluated according to definitions of the phenotypic and multidomain approach. Logistic and linear regression models were performed to investigate associations between frailty (predictor) and the probability of prodromal PD, either continuous or dichotomous (≥30% probability score), or PD (outcome).

Results: Data from 1765 participants aged 65 and older were included in the present analysis. Parkinson's disease and prodromal PD prevalence were 1.9% and 3.0%, respectively. Compared to nonfrail participants, those who were frail, as identified with either the Fried frailty phenotype or Frailty Index had approximately 4 (odds ratio [OR] 4.09, 95% confidence interval [CI] 1.54-10.89) and 12 times (OR 12.16, 95% CI 5.46-27.09) higher odds of having a PD diagnosis, respectively. Moreover, compared to the nonfrail, frail participants as identified with either the Fried frailty phenotype or Frailty Index had 2.8 (OR 2.83, 95% CI 1.09-7.37) and 8.3 times (OR 8.39, 95% CI 4.56-15.42) higher odds of having possible/probable prodromal PD, respectively.

Conclusions: Frailty status was associated with prodromal PD and PD, suggesting common characteristics or underlying mechanisms of these conditions. Although prospective studies are warranted, acknowledging the possible association of frailty, PD, and prodromal PD may improve their clinical management.
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http://dx.doi.org/10.1093/gerona/glaa191DOI Listing
March 2021

A Prospective Validation of the Updated Movement Disorders Society Research Criteria for Prodromal Parkinson's Disease.

Mov Disord 2020 10 22;35(10):1802-1809. Epub 2020 Jun 22.

Parkinson's Disease and Movement Disorders Department, Hygeia Hospital, Athens, Greece.

Objective: The objective of this study was to validate the recently updated research criteria for prodromal Parkinson's disease (pPD) proposed by the International Parkinson's Disease and Movement Disorders Society.

Methods: A total of 16 of 21 markers of pPD were ascertained in the Hellenic Longitudinal Investigation of Aging and Diet cohort composed of community-dwelling individuals aged ≥65 years. The probability of pPD was calculated for 961 individuals without Parkinson's disease (PD) or dementia with Lewy bodies at baseline who were followed-up for a median of 3 years. The ability of the criteria to predict conversion to PD/dementia with Lewy bodies was assessed by estimating their sensitivity and specificity, plotting receiver operating characteristics curves, and using logistic regression. These analyses were repeated using the original criteria.

Results: No incident PD/dementia with Lewy bodies case had probable pPD at baseline (ie, ≥80% pPD probability). At cut-offs of 10%, 30%, and 50% probability of pPD, the sensitivity and specificity of the criteria ranged from 4.5% to 27.3%, and 85.7% to 98.3% respectively. The area under the receiver operating characteristics curve was 0.691 (95% confidence intervals, 0.605-0.777). In logistic regression models, the criteria-derived posttest odds of pPD were a significant predictor of conversion at follow-up. The updated criteria performed similarly to the original but showed a slight increase in sensitivity.

Conclusions: The new criteria demonstrated suboptimal sensitivity in our random sample of community-dwelling individuals. The absence of specialized assessments with high likelihood ratios in our cohort could be hindering the demonstration of higher sensitivities. Such assessments should be a part of future validation attempts. © 2020 International Parkinson and Movement Disorder Society.
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http://dx.doi.org/10.1002/mds.28145DOI Listing
October 2020

Clinically reliable cognitive decline in relapsing remitting multiple sclerosis: Is it the tip of the iceberg?

Neurol Res 2020 Jul 19;42(7):575-586. Epub 2020 May 19.

Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, University of Thessaly, University Hospital of Larissa , Larissa, Greece.

Objectives: Cognitive impairment is common in multiple sclerosis, but the brain MRI correlates in relapsing remitting multiple sclerosis remain controversial. The current study aimed to investigate whether cognitive decline can be predicted by global and/or regional brain atrophy.

Methods: Sixty-three patients with relapsing remitting multiple sclerosis (36 men, mean age 39.9 ± 9.4 years old, mean EDSS 1.4 ± 1.2, mean disease duration 4.9 ± 4.3 years) and 46 healthy controls (21 men, mean age 37.5 ± 10.8 years old) were included. Demographic data were obtained, and a longitudinal neuropsychological and global and regional MRI brain volume assessment was performed.

Results: The patients performed worse than controls in most neuropsychological tests at baseline. The percentage of patients with clinically meaningful cognitive decline ranged from only 0% to 7.9%. Statistically significant volume reduction was found for all MRI measures except for the left accumbens nucleus. Whole or regional brain atrophy ranged from -0.02% to -0.25%, with subcortical structures showing the largest atrophy rates. A total of 22.2% to 93.7% patients showed atrophy across the brain structures assessed volumetrically.

Discussion: It was regional rather than whole-brain changes that significantly predicted cognitive decline for the patients in the tasks that tested processing speed, visuo-spatial and inhibition skills. The overall data suggest that the progression of cognitive impairment in relapsing remitting multiple sclerosis as captured by conventional neuropsychological testing is the tip of the iceberg of neurodegenerative sequelae in the disease. Also, regional volumetric changes are better than whole-brain atrophy at predicting cognitive dysfunction.
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http://dx.doi.org/10.1080/01616412.2020.1761175DOI Listing
July 2020

Do Secondary Progressive Multiple Sclerosis patients benefit from Computer- based cognitive neurorehabilitation? A randomized sham controlled trial.

Mult Scler Relat Disord 2020 Jan 7;39:101932. Epub 2020 Jan 7.

University of Patras Medical School, Patras 26504, Greece.

Background: Cognitive impairment is common in multiple sclerosis (MS), but deficits tend to be more pronounced in progressive MS, negatively impacting daily functional capacity. Despite this, most cognitive rehabilitation (CR) interventions to date have focused on relapsing-remitting MS (RRMS). Moreover, information on the efficacy of CR in progressive MS is limited and controversial. The present study investigated the efficacy of a home based, computer assisted cognitive rehabilitation (HBCACR) intervention (RehaCom software) exclusively in a Secondary Progressive Multiple Sclerosis (SPMS) sample.

Methods: This was a randomized, multi site, sham controlled trial. Thirty six (36) individuals with SPMS, naïve to the RehaCom software, with cognitive deficits were randomized to the treatment (IG; n= 19) or control group condition (CG; n=17). Treatment with the RehaCom modules consisted of 24 domain and task specific, 45 minute session's over an 8-week period, three sessions per week, applied by each patient at home. The CG completed non specific computer based activities at home with the same frequency and duration. Primary cognitive outcome measures included the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery, and secondary outcome measures for depression (BDI-FS), fatigue (MFIS), and quality of life (EuroQol EQ-5D) visual analogue scale (VAS).

Results: The two groups were well matched on demographic and clinical characteristics, cognitive reserve and severity of cognitive deficits at baseline assessment. At post treatment assessment the IG group showed significant improvements with large effect sizes; in verbal learning [z = -4.759, p <.0005, g = 2.898], visuospatial memory [z = -3.940, p <.0005, g = 1.699] and information processing speed [z= -4.792, p <.0005, g = 2.980], compared with the sham control group. We also found significant between group differences on physical [z=-3.308, p = .001, g= -.604], cognitive [z = -4.011, p <.0005, g = -1.654], psychosocial [z= 3.308, p = .010, g = -.940], and general fatigue impact [z= -2.623, p = .008, g = -.519], depression severity [z = -2.730, p = .006, g = -.519], and quality of life [z= -4.239, p <.0005, g = -1.885] in favor of the treated group.

Conclusion: These data provide the first evidence supporting the efficacy of computer based restorative cognitive rehabilitation applied at home exclusively in SPMS patients, suggesting that adaptive neuroplasticity may occur after functional cognitive training in progressive MS. Improved cognitive functioning in combination with mood augmentation appear to have ameliorated fatigue, which impacted daily functioning activity and culminated in improved health related quality of life.
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http://dx.doi.org/10.1016/j.msard.2020.101932DOI Listing
January 2020

Prevalence of Mild Cognitive Impairment in the Elderly Population in Greece: Results From the HELIAD Study.

Alzheimer Dis Assoc Disord 2020 Apr-Jun;34(2):156-162

1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School.

Introduction: Timely recognition of mild cognitive impairment (MCI) is essential in optimizing prevention and treatment for Alzheimer disease. Because of the paucity of data on MCI epidemiology in Greece and the variability of worldwide published results, we investigated the prevalence and determinants of MCI in the elderly population in Greece.

Methods: As part of the Hellenic Epidemiological Longitudinal Investigation of Aging and Diet (HELIAD), we randomly selected 1960 individuals 65 years and older to undergo full neurological and neuropsychological assessment by a multidisciplinary team. MCI was diagnosed according to the Petersen criteria.

Results: The age-standardized and gender-standardized prevalence of MCI in people aged 65 years and older in Greece is 13.11%. The amnestic and multidomain MCI subtypes are more common than their nonamnestic and single-domain counterparts, respectively. Almost two thirds of cases are because of suspected Alzheimer disease. Every additional year of age increases the odds of prevalent MCI by 7.4%, every additional year of education decreases the odds of MCI by 6.3%, and apolipoprotein E (APOE-ε4) carriage increases the odds of MCI by 57.9%.

Conclusions: MCI prevalence in the elderly population in Greece is on par with previously reported rates. Prospective studies with robust methodology will enhance our understanding of the dementia continuum.
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http://dx.doi.org/10.1097/WAD.0000000000000361DOI Listing
January 2020

Malnutrition in older adults: Correlations with social, diet-related, and neuropsychological factors.

Nutrition 2020 03 9;71:110640. Epub 2019 Nov 9.

Department of Nutrition and Dietetics, Harokopio University, Athens, Greece. Electronic address:

Background: The number of older adults is increasing rapidly. Malnutrition is a major problem in this age group, which may adversely affect health and quality of life. Several physiological, socioeconomic, and neuropsychological factors can lead to malnutrition.

Objectives: The aim of this study was to evaluate the nutritional status of community-dwelling older adults, and explore the associations of malnutrition risk with physiological, socioeconomic, and neuropsychological characteristics.

Methods: This study is part of the Hellenic Longitudinal Investigation of Aging and Diet study, a cross-sectional observational study in Greece, and study participants were 1831 urban-dwelling elderly individuals (mean age: 73.1 ± 5.9 y; 40.8% men). Risk for malnutrition was assessed with the Determine Your Nutritional Health checklist. Data on age, sex, level of education, marital status, depression, cognitive performance, body mass index, total energy intake, and adherence to the Mediterranean diet were recorded. Correlations and multivariate analyses were performed between these variables and risk for malnutrition.

Results: The estimated prevalence of moderate and high nutritional risks was 34.8% and 29.4%, respectively. Risk for malnutrition was associated with marital status (unmarried), increased body mass index, male sex, lower level of education, lower cognitive performance, and lower adherence to the Mediterranean diet (P < 0.05).

Conclusions: Nutritional screening should be performed frequently in all community-dwelling older adults. Health experts should perform nutritional screening in all community-dwelling older adults as part of secondary prevention, and nutrition counselling and support should be offered in those at risk for malnutrition.
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http://dx.doi.org/10.1016/j.nut.2019.110640DOI Listing
March 2020

Social life characteristics in relation to adherence to the Mediterranean diet in older adults: findings from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) study.

Public Health Nutr 2020 02 23;23(3):439-445. Epub 2019 Aug 23.

Department of Nutrition and Dietetics, Harokopio University, Eleftheriou Venizelou 70, 17676 Athens, Greece.

Objective: The present study aimed to explore the associations between social life and adherence to a healthy dietary pattern, the Mediterranean diet (MD), in a population-representative cohort of older people.

Design: Cross-sectional study. Adherence to the MD was evaluated by an a priori score; tertiles of the score, indicating low, medium and high adherence, were used in the analyses. Social life was assessed by a questionnaire evaluating participation in leisure-time activities and the number of social contacts; primary occupation was also recorded and job characteristics were further explored.

Setting: Community-dwelling older adults.

Participants: Adults from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) study (n 1933; age range 65-99 years).

Results: Each unit increase in the number of social contacts/month and in the frequency score of intellectual, social and physical activities was associated with a 1·6, 6·8, 4·8 and 13·7 % increase in the likelihood of a participant being in the high MD adherence group, respectively. The analysis by age group revealed that younger elderly participants had a 1·4, 8·4 and 11·3 % higher likelihood to be in the high adherence group for each unit increase in the number of social contacts/month and in the frequency score of engagement in intellectual and physical activities, respectively. Similar associations were found for older elderly participants with high compared with low MD adherence, except for the intellectual activities.

Conclusions: The present results suggest that high MD adherence is associated with good social life, suggesting a clustering of health-promoting lifestyle factors in older adults.
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http://dx.doi.org/10.1017/S1368980019002350DOI Listing
February 2020

Pesticide exposure and cognitive function: Results from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD).

Environ Res 2019 Oct 13;177:108632. Epub 2019 Aug 13.

Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus. Electronic address:

Background: Results from studies to date, regarding the role of chronic pesticide exposure on cognitive function remain contradictory.

Objective: To investigate the relationship between self-reported pesticide exposure and cognitive function.

Methods: Data from a population-based cohort study of older adults (HEllenic Longitudinal Investigation of Aging and Diet) in Greece was used. Pesticide exposure classification was based on 1) living in areas that were being sprayed; 2) application of spray insecticides/pesticides in their gardens; and 3) occupational application of sprays. Associations between z-scores of cognitive performance and self-reported pesticide exposure were examined with linear regression analyses. Adjusted models were applied, for all analyses.

Results: Non-demented individuals who reported that they had been living in areas near sprayed fields, had poorer neuropsychological performance, compared to those who had never lived in such areas. Sub-analyses revealed poorer performance in language, executive and visual-spatial functioning, and attention. These associations remained after a sensitivity analysis excluding subjects with mild cognitive impairment.

Conclusion: Self-reported exposure to pesticides was negatively associated with cognitive performance.
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http://dx.doi.org/10.1016/j.envres.2019.108632DOI Listing
October 2019

Motor function and the probability of prodromal Parkinson's disease in older adults.

Mov Disord 2019 09 17;34(9):1345-1353. Epub 2019 Jul 17.

1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.

Background: Identification and characterization of Parkinson's disease (PD) in its prodromal stage is crucial.

Objective: The objective of this study was to investigate the association between motor function and the probability of prodromal PD in a community-dwelling older population.

Methods: We used data from a population-based cohort of older adults (HELIAD study). Subjective motor function was evaluated with a 12-item motor symptoms questionnaire and objective motor function indirectly with a physical activity questionnaire and two gait speed tests. The probability of prodromal PD was calculated according to the Movement Disorder Society research criteria for n = 1731 without PD. Regression multiadjusted models were used to investigate the associations between each motor measure and prodromal PD probability.

Results: For each unit increase in motor symptoms score and for each kcal/kg/day lower energy expenditure (corresponding to 20 minutes of light walking/day for a 75-kg man) there was a 27% and 3% higher probability for prodromal PD, respectively (P < 0.001). Having at least one subjective motor symptom increased the odds of having possible/probable prodromal PD (n = 49; P < 0.05). Including subjective and indirect motor variables in the same model showed that both (symptoms and physical activity) contributed significantly to the model (P < 0.01). Excluding subthreshold parkinsonism from the calculation showed that gait speed less than 0.8 m/s was also associated with a higher prodromal PD probability score (P < 0.001).

Conclusions: Subjective motor symptoms as well as simple objective motor measures of physical activity or gait speed are associated with a higher probability of prodromal PD in older adults. These data may serve to enable the early identification of prodromal PD cohorts, particularly if they are confirmed in longitudinal studies. © 2019 International Parkinson and Movement Disorder Society.
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http://dx.doi.org/10.1002/mds.27792DOI Listing
September 2019

Higher probability of prodromal Parkinson disease is related to lower cognitive performance.

Neurology 2019 05 3;92(19):e2261-e2272. Epub 2019 Apr 3.

From the 1st Department of Neurology (A.B., E.N., C.A.A., L.S., N.S.), Aiginition Hospital, National and Kapodistrian, University of Athens Medical School; Department of Nutrition and Dietetics (M.I.M., M.Y., E.N., C.A.A.), Harokopio University; Parkinson's Disease and Movement Disorders Department (M.S.), Hygeia Hospital, Athens, Greece; Department of Neurology (M.S.), Philipps University, Marburg, Germany; School of Medicine (G.X., E.D., G.M.H.), University of Thessaly, Larissa; Laboratory of Cognitive Neuroscience, School of Psychology (M.H.K.), Aristotle University of Thessaloniki, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (E.N., P.S.), Maroussi; Center of Clinical, Experimental Surgery and Translational Research (L.S.), Biomedical Research Foundation of the Academy of Athens, Greece; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.

Objective: Given the limited information on cognitive function before Parkinson disease (PD) clinical onset in the general population, we sought to assess prodromal PD (pPD) probability and relate it to detailed cognitive performance in a community cohort.

Methods: In a population-based cohort of 1,629 dementia-free and PD-free participants ≥65 years of age in Greece, we assessed probability of pPD according to the International Parkinson and Movement Disorder Society's criteria. Clinical cognitive diagnoses (cognitively unimpaired, mild cognitive impairment [MCI], dementia) considering neuropsychological testing and functional status were assigned in consensus conferences. Cognitive performance in 5 cognitive domains was assessed by a detailed neuropsychological battery and summarized in the form of z scores. We investigated associations between pPD probability (and its individual constituents) and cognitive outcomes.

Results: The median probability of pPD was 1.81% (0.2%-96.7%). Participants with MCI had higher probability of pPD compared to those with normal cognition ( < 0.001). Higher probability of pPD was related to lower performance in all cognitive domains (memory, language, executive, attention, and visuospatial function) ( < 0.001). Lower cognitive performance was further associated with certain nonmotor markers of pPD, such as daytime somnolence, depression, urinary dysfunction, constipation, and subthreshold parkinsonism ( < 0.001).

Conclusions: Higher probability of pPD was associated with lower cognitive performance in all domains and higher probability of MCI. This may reflect a widespread pathologic process although future studies are warranted to infer causality. These results suggest to clinicians that they should assess cognition early, and to researchers that they should further look into the possible mechanisms that may underlie this observation.
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http://dx.doi.org/10.1212/WNL.0000000000007453DOI Listing
May 2019

The neuropsychological profile of parietal and occipital lobe epilepsy.

Epilepsy Behav 2019 05 22;94:137-143. Epub 2019 Mar 22.

Epilepsy Surgery Unit, Department of Neurosurgery, School of Medicine, Evangelismos Hospital, University of Athens, Greece.

Despite the extensive body of research in clinical neurology on the functional organization of posterior cortices, parietal and occipital lobe epilepsy (PLE and OLE) have not as yet received the attention afforded frontal and temporal lobe epilepsy (FLE and TLE), perhaps due to their low prevalence. Posterior epilepsies however, represent a challenge for epileptology in general and neuropsychological differential diagnosis in particular. Our main purpose was to examine the likely existence of a pattern of cognitive dysfunction characterizing patients suffering from seizures with a parietal and/or occipital ictal onset. We hypothesized that such patients would present difficulties in the visuospatial and visuoconstructive domains, since spatial analysis and synthesis is an inherent feature of posterior cortical systems. Participants were 14 patients with epilepsy and 14 healthy controls matched for demographic characteristics (gender, age, and education level). We used an extensive battery of neuropsychological tests to assess auditory-verbal memory and learning, episodic memory, attention and working memory, verbal abilities, haptic perception, arithmetic abilities, and executive functions. Special attention was given to visuospatial abilities. Depression and anxiety symptoms were assessed through a self-administered questionnaire. Nonparametric (Mann-Whitney U test) statistical tests were conducted. We found that patients with epilepsy performed significantly worse in visuoconstruction, verbal, and executive functions compared to their healthy matches. Finally, we interpret our findings from the perspective of Luria of mental functions organized into functional systems and the current trends in epileptology to view epilepsy as a system (network) problem.
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http://dx.doi.org/10.1016/j.yebeh.2019.02.021DOI Listing
May 2019

Test of Everyday Attention for Children (TEA-Ch): Greek Normative Data and Discriminative Validity for Children with Combined Type of Attention Deficit-Hyperactivity Disorder.

Dev Neuropsychol 2019 Mar-Apr;44(2):189-202. Epub 2019 Feb 20.

a School of Psychology , Aristotle University of Thessaloniki , Thessaloniki , Greece.

We examined the utility of the Test of Everyday Attention for Children (TEA-Ch) for Greek children. Discrete and regression-based norms, controlling for demographic characteristics and intelligence, were derived from the performance of 172 children. We also assessed the ability of the TEA-Ch to differentiate children with ADHD-Combined Type (ADHD-C) from healthy matched peers. Children with ADHD-C displayed dysfunction in multiple attentional domains. Discriminant function analysis indicated that two subtests (Sky Search and Walk, Don't Walk) correctly classified 84.2% of children with ADHD-C.
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http://dx.doi.org/10.1080/87565641.2019.1578781DOI Listing
June 2019

Prevalence and determinants of subjective cognitive decline in a representative Greek elderly population.

Int J Geriatr Psychiatry 2019 06 22;34(6):846-854. Epub 2019 Mar 22.

Department of Social Medicine, Psychiatry and Neurology, National and Kapodistrian University of Athens, First Department of Neurology, Aeginition University Hospital, Athens, Greece.

Objectives: We studied the prevalence of subjective cognitive decline (SCD) and its determinants in a sample of 1456 cognitively normal Greek adults ≥65 years old.

Methods/design: Subjects were evaluated by a multidisciplinary team on their neurological, medical, neuropsychological, and lifestyle profile to reach consensus diagnoses. We investigated various types of SCD, including single-question, general memory decline, specific subjective memory decline based on a list of questions and three types of subjective naming, orientation, and calculation decline.

Results: In a single general question about memory decline, 28.0% responded positively. The percentage of our sample that reported at least one complaint related to subjective memory decline was 76.6%. Naming difficulties were also fairly common (26.0%), while specific deficits in orientation (5.4%) and calculations/currency handling (2.6%) were rare. The majority (84.2%) of the population reported subjective deficits in at least one cognitive domain. Genetic predisposition to dementia increased the odds for general memory decline by more than 1.7 times. For each one-unit reduction in the neuropsychological composite score (a mean of memory, executive, language, visuospatial, and attention-speed composite scores), the odds for decline in orientation increased by 40.3%. Depression/anxiety and increased cerebrovascular risk were risk factors for almost all SCD types.

Conclusions: SCD regarding memory is more frequent than non-memory decline in the cognitively normal Greek elderly population. Genetic predisposition to dementia, lower cognitive performance, affective symptoms, and increased cerebrovascular risk are associated with prevalent SCD. Further prospective research is needed to improve understanding of the evolution of SCD over time.
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http://dx.doi.org/10.1002/gps.5073DOI Listing
June 2019

Associations between sleep and obesity indices in older adults: results from the HELIAD study.

Aging Clin Exp Res 2019 Nov 9;31(11):1645-1650. Epub 2019 Jan 9.

Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.

Background: Short sleep duration and low sleep quality are negatively associated with obesity in young adults, but in older people the results are inconsistent.

Aims: The aim of the present study was to examine the associations between sleep duration and quality with both body mass index (BMI) and waist circumference (WC) and to investigate sex- and age-specific associations in a population-representative cohort of older adults.

Methods: 1781 participants ≥ 65 years old from the HELIAD study were included. Sleep duration and quality were based on self-report, whereas BMΙ and WC were evaluated clinically.

Results: Sleep duration was inversely related to WC, only in women, even after adjustment for age, sex, years of education, total energy intake and level of physical activity. Furthermore, sleep quality was negatively related to both BMI and WC in women. In men, however, no significant relationships were observed between these variables. Associations between sleep and weight did not differ between those aged < 73 and ≥ 73 years old.

Discussion: To the best of our knowledge, this is the first study examining both sleep duration and quality with BMI and WC in older adults, performing by-sex analysis. Although additional studies are needed, improvements in sleep habits should be considered in weight management of older individuals.

Conclusions: Our results suggest that poor sleep is associated to adverse weight effects in older women, but not men.
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http://dx.doi.org/10.1007/s40520-018-01113-2DOI Listing
November 2019

Visual memory tests enhance the identification of amnestic MCI cases at greater risk of Alzheimer's disease.

Int Psychogeriatr 2018 Oct 25:1-10. Epub 2018 Oct 25.

Department of Health Psychology,University of Alicante,Alicante,Spain.

ABSTRACTObjectives:To investigate whether amnestic mild cognitive impairment (aMCI) identified with visual memory tests conveys an increased risk of Alzheimer's disease (risk-AD) and if the risk-AD differs from that associated with aMCI based on verbal memory tests.

Participants: 4,771 participants aged 70.76 (SD = 6.74, 45.4% females) from five community-based studies, each a member of the international COSMIC consortium and from a different country, were classified as having normal cognition (NC) or one of visual, verbal, or combined (visual and verbal) aMCI using international criteria and followed for an average of 2.48 years. Hazard ratios (HR) and individual patient data (IPD) meta-analysis analyzed the risk-AD with age, sex, education, single/multiple domain aMCI, and Mini-Mental State Examination (MMSE) scores as covariates.

Results: All aMCI groups (n = 760) had a greater risk-AD than NC (n = 4,011; HR range = 3.66 - 9.25). The risk-AD was not different between visual (n = 208, 17 converters) and verbal aMCI (n = 449, 29 converters, HR = 1.70, 95%CI: 0.88, 3.27, p = 0.111). Combined aMCI (n = 103, 12 converters, HR = 2.34, 95%CI: 1.13, 4.84, p = 0.023) had a higher risk-AD than verbal aMCI. Age and MMSE scores were related to the risk-AD. The IPD meta-analyses replicated these results, though with slightly lower HR estimates (HR range = 3.68, 7.43) for aMCI vs. NC.

Conclusions: Although verbal aMCI was most common, a significant proportion of participants had visual-only or combined visual and verbal aMCI. Compared with verbal aMCI, the risk-AD was the same for visual aMCI and higher for combined aMCI. Our results highlight the importance of including both verbal and visual memory tests in neuropsychological assessments to more reliably identify aMCI.
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http://dx.doi.org/10.1017/S104161021800145XDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483891PMC
October 2018

Mediterranean Lifestyle in Relation to Cognitive Health: Results from the HELIAD Study.

Nutrients 2018 Oct 20;10(10). Epub 2018 Oct 20.

Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, 11528 Athens, Greece.

Many lifestyle factors have been linked to cognitive function but little is known about their combined effect. An overall lifestyle pattern for people living in the Mediterranean basin has been proposed, including diet, but also physical activity, sleep and daily living activities with social/intellectual aspects. We aimed to examine the associations between a combination of these lifestyle factors and detailed cognitive performance. A total of 1716 participants from the Hellenic Longitudinal Investigation of Ageing and Diet (HELIAD), a population-based study of participants ≥65 years, were included in this analysis. Lifestyle factors were evaluated using standard, validated questionnaires and a Total Lifestyle Index (TLI) was constructed. Cognitive outcomes included mild cognitive impairment (MCI) diagnosis, a composite z-score (either continuous or with a threshold at the 25th percentile) and z-scores for five cognitive domains. A higher TLI was associated with 65% reduced odds for MCI in the non-demented individuals and 43% reduced odds for low global cognition when MCI participants were excluded, a risk reduction equivalent to 9 and 2.7 fewer years of ageing, respectively. Each lifestyle factor was differentially associated with domain-specific cognitive performance. Our results suggest that a TLI, more so than single lifestyle parameters, may be related to cognitive performance.
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http://dx.doi.org/10.3390/nu10101557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213445PMC
October 2018

Theory of Mind impairment in focal versus generalized epilepsy.

Epilepsy Behav 2018 11 11;88:244-250. Epub 2018 Oct 11.

Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece. Electronic address:

Theory of Mind (ToM) is a critical component of social cognition, and thus, its impairment may adversely affect social functioning and quality of life. Recent evidence has suggested that it is impaired in epilepsy. What is not clear, however, is whether it is related to particular types of epilepsy or other factors. We undertook the present study to explore ToM in patients with focal versus those with generalized epilepsy, the particular pattern of ToM deficits, and the potential influence of antiepileptic medication load. Our sample included 149 adults: 79 patients with epilepsy (34 with generalized epilepsy and 45 with focal epilepsy) and 70 healthy controls. Theory of Mind tasks included a) comprehension of hinting, b) comprehension of sarcasm and metaphor, c) comprehension of false beliefs and deception, d) recognition of faux pas, and e) a visual ToM task in cartoon form. We found significant ToM impairment in the group with focal epilepsy relative to the performance of both the healthy group and the group with generalized epilepsy on all tasks, with the exception of faux pas, on which the group with generalized epilepsy also performed more poorly than the healthy group. Additionally, early age at seizure onset, but not antiepileptic drug (AED) load, was associated with ToM performance. Our findings suggest that focal temporal and frontal lobe, but not generalized, epilepsies were associated with impaired ToM. This may reflect the neuroanatomical abnormalities in the relevant neuronal networks and may have implications for differential cognitive-behavioral interventions based on epilepsy type.
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http://dx.doi.org/10.1016/j.yebeh.2018.09.026DOI Listing
November 2018

Mediterranean diet adherence is related to reduced probability of prodromal Parkinson's disease.

Mov Disord 2019 01 10;34(1):48-57. Epub 2018 Oct 10.

1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece.

Background: The International Parkinson and Movement Disorder Society recently introduced a methodology for probability score calculation for prodromal PD.

Objectives: To assess the probability of prodromal PD in an older population and investigate its possible association with Mediterranean diet adherence.

Methods: Data from a population-based cohort study of older adults (HEllenic Longitudinal Investigation of Aging and Diet) in Greece were used. Probability of prodromal PD was calculated according to International Parkinson and Movement Disorder Society research criteria. A detailed food frequency questionnaire was used to evaluate dietary intake and calculate Mediterranean diet adherence score, ranging from 0 to 55, with higher scores indicating higher adherence.

Results: Median probability of prodromal PD was 1.9%, ranging from 0.2 to 96.7% in 1,731 PD-free individuals aged ≥ 65 (41% male). Lower probability for prodromal PD (P < 0.001) in the higher Mediterranean diet adherence groups was noted, driven mostly by nonmotor markers of prodromal PD, depression, constipation, urinary dysfunction, and daytime somnolence. Each unit increase in Mediterranean diet score was associated with a 2% decreased probability for prodromal PD (P < 0.001). Compared to participants in the lowest quartile of Mediterranean diet adherence, those in the highest quartile were associated with a ∼21% lower probability for prodromal PD.

Conclusions: Adherence to the Mediterranean diet is associated with lower probability of prodromal PD in older people. Further studies are needed to elucidate the potential causality of this association, potential relation of the Mediterranean diet to delayed onset or lower incidence of PD, as well as the underlying neurobiological mechanisms. © 2018 International Parkinson and Movement Disorder Society.
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http://dx.doi.org/10.1002/mds.27489DOI Listing
January 2019

Sleep and subjective cognitive decline in cognitively healthy elderly: Results from two cohorts.

J Sleep Res 2019 10 25;28(5):e12759. Epub 2018 Sep 25.

Cognitive Neuroscience Division and the Taub Institute, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Center, New York, NY.

Subjective cognitive decline may reflect a dementia prodrome or modifiable risk factor such as sleep disturbance. What is the association between sleep and subjective cognitive decline? Cross-sectional design, from two studies of older adults: the WHICAP in the USA and the HELIAD in Greece. A total of 1,576 WHICAP and 1,456 HELIAD participants, without mild cognitive impairment, dementia or severe depression/anxiety, were included. Participants were mostly women, with 12 (WHICAP) and 8 (HELIAD) mean years of education. Sleep problems were estimated using the Sleep Scale from the Medical Outcomes Study. Subjective cognitive decline was assessed using a structured complaint questionnaire that queries for subjective memory and other cognitive symptoms. Multinomial or logistic regression models were used to examine whether sleep problems were associated with complaints about general cognition, memory, naming, orientation and calculations. Age, sex, education, sleep medication, use of medications affecting cognition, co-morbidities, depression and anxiety were used as co-variates. Objective cognition was also estimated by summarizing neuropsychological performance into composite z-scores. Sleep problems were associated with two or more complaints: WHICAP: β = 1.93 (95% confidence interval: 1.59-2.34), p ≤ .0001; HELIAD: β = 1.48 (95% confidence interval: 1.20-1.83), p ≤ .0001. Sleep problems were associated with complaints in all the cognitive subcategories, except orientation for the WHICAP. The associations were noted regardless of objective cognition. At any given level of objective cognition, sleep disturbance is accompanied by subjective cognitive impairment. The replicability in two ethnically, genetically and culturally different cohorts adds validity to our results. The results have implications for the correlates, and potential aetiology of subjective cognitive decline, which should be considered in the assessment and treatment of older adults with cognitive complaints.
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http://dx.doi.org/10.1111/jsr.12759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688963PMC
October 2019