Papers by Julia MacKinley
The Montreal Cognitive Assessment (MoCA), a brief screening test developed to detect patients wit... more The Montreal Cognitive Assessment (MoCA), a brief screening test developed to detect patients with mild cognitive impairment, is used in clinical settings across North America [Nasreddine et al.: J Am Geriatr Soc 2005;53:695-699]. The MoCA has been demonstrated to be sensitive to cognitive deficits in frontotemporal dementias (FTD) and related disorders [Coleman et al.: Alzheimer Dis Assoc Disord 2016;30:258-263]. Given attentional impairments in patients with FTD, whether and to what extent the abbreviated items on the MoCA may predict performance on corresponding assessments is not known. Testing and demographic data were extracted from a clinical database using a sample of 91 patients with FTD and related disorders. The relationship between MoCA items and corresponding neuropsychological tasks was assessed through McNemar tests and Spearman correlations. While some MoCA items such as letter fluency, orientation, and clock drawing were strongly correlated with the corresponding standard cognitive test, the MoCA trails were insensitive to impairment compared to the full Trail Making B Test (<i>p</i> = 0.01). In contrast, MoCA naming and delayed recall sub-items detected cognitive impairment more frequently than available comparison tests. The MoCA is a sensitive screening measure to detect impairment in patients with FTD and related disorders, but cognitive deficits specific to FTD result in differential performance on MoCA items compared to longer standard cognitive tests.
Journal of Neurology, 2019
Background Changes in financial judgement and skills can herald a neurodegenerative dementia and ... more Background Changes in financial judgement and skills can herald a neurodegenerative dementia and are a common reason for referral for cognitive neurologic assessment. However, patients with neurodegenerative diseases affecting the frontal or temporal lobes may perform well on standard cognitive tests, complicating clinical determinations about their diagnosis and financial capacity. Methods Forty-five patients with possible or probable FTD or Alzheimer's disease and 22 healthy controls completed two financial assessment batteries, the FACT and the FCAI. Patients' performance was compared to study partner estimates of patients' financial abilities. Results All three patient groups performed worse than controls on both the FACT and the FCAI. Study partners overestimated the performance of patients with Alzheimer's disease. Conclusions These initial findings suggest that accurate clinical assessment of financial skills and judgement in patients with possible neurodegenerative dementias requires performance-based assessment.
Archives of physical medicine and rehabilitation, Jan 12, 2016
To determine if scores on a cognitive measure are associated with walking endurance and functiona... more To determine if scores on a cognitive measure are associated with walking endurance and functional mobility of individuals with transfemoral or transtibial amputations at discharge from inpatient prosthetic rehabilitation. Retrospective cohort study. Rehabilitation hospital. Consecutive admissions (n=176, age 64.27 ± 13.23 years) with transfemoral or transtibial amputation that had data at admission and discharge from inpatient prosthetic rehabilitation program. Not applicable. Cognitive status was assessed using the Montreal Cognitive Assessment (MoCA). The L Test and the 2 Minute Walk Test (2MWT) were used to estimate functional mobility and walking endurance. Mean MoCA score was 24.05 (±4.09), range 6 to 30 and 56.3% of patients had scores < 26. MoCA scores had a small positive correlation with the 2MWT, r=0.29, p<0.01, and a small negative correlation to the L test, r=-0.24, p<0.01. In multivariable linear regression, compared to people with the highest MoCA score quart...
Alzheimer Disease & Associated Disorders, 2016
The Montreal Cognitive Assessment (MoCA) is a cognitive screening tool used by practitioners worl... more The Montreal Cognitive Assessment (MoCA) is a cognitive screening tool used by practitioners worldwide. The efficacy of the MoCA for screening frontotemporal dementia (FTD) and related disorders is unknown. The objectives were: (1) to determine whether the MoCA detects cognitive impairment (CI) in FTD subjects; (2) to determine whether Alzheimer disease (AD) and FTD subtypes and related disorders can be parsed using the MoCA; and (3) describe longitudinal MoCA performance by subtype. We extracted demographic and testing data from a database of patients referred to a cognitive neurology clinic who met criteria for probable AD or FTD (N = 192). Logistic regression was used to determine whether dementia subtypes were associated with overall scores, subscores, or combinations of subscores on the MoCA. Initial MoCA results demonstrated CI in the majority of FTD subjects (87%). FTD subjects (N = 94) performed better than AD subjects (N = 98) on the MoCA (mean scores: 18.1 vs. 16.3; P = 0.02). Subscores parsed many, but not all subtypes. FTD subjects had a larger decline on the MoCA within 13 to 36 months than AD subjects (P = 0.02). The results indicate that the MoCA is a useful tool to identify and track progression of CI in FTD. Further, the data informs future research on scoring models for the MoCA to enhance cognitive screening and detection of FTD patients.
Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2015
To assess the validity of the Edinburgh Cognitive and Behaviour ALS Screen (ECAS), a multi-domain... more To assess the validity of the Edinburgh Cognitive and Behaviour ALS Screen (ECAS), a multi-domain screen designed to detect cognitive deficits in patients with motor disorders. METHODS 40 ALS patients (without pre-diagnosed dementia) and 40, age, gender and education matched healthy controls were recruited. All participants underwent extensive neuropsychological assessment and the ECAS. Performance at neuropsychological assessment across five domains (fluency, executive function, language, memory and visuospatial function) was compared to the ECAS ALS-Specific (fluency; executive functions and social cognition; language), ALS Non-specific (memory; visuospatial functions), and total scores. RESULTS Data from the healthy controls produced population-based abnormality cutoffs: composite score performance < 2 SD in any domain classified impairment at neuropsychological assessment. 33% of patients were impaired, most commonly in a single domain (executive or language dysfunction). Receiver Operator Curve (ROC) analyses using ECAS total scores and ALS-Specific scores revealed 85% sensitivity and 85% specificity in the detection of cognitive impairment characteristic of ALS (fluency, executive function, language). A five point borderline range produced optimal values (ALS-Specific Score 77-82 and ECAS-Total Score 105-110) CONCLUSIONS Validation against gold standard extensive neuropsychology demonstrated that the ECAS is a screening tool with high sensitivity and specificity to impairment characteristic of ALS.
Neurology, 2014
Objective: To determine the safety and tolerability of 3 doses of intranasal oxytocin (Syntocinon... more Objective: To determine the safety and tolerability of 3 doses of intranasal oxytocin (Syntocinon; Novartis, Bern, Switzerland) administered to patients with frontotemporal dementia (FTD). Methods: We conducted a randomized, parallel-group, double-blind, placebo-controlled study using a dose-escalation design to test 3 clinically feasible doses of intranasal oxytocin (24, 48, or 72 IU) administered twice daily for 1 week to 23 patients with behavioral variant FTD or semantic dementia (clinicaltrials.gov registration number NCT01386333). Primary outcome measures were safety and tolerability at each dose. Secondary measures explored efficacy across the combined oxytocin vs placebo groups and examined potential dose-related effects. Results: All 3 doses of intranasal oxytocin were safe and well tolerated. Conclusions: A multicenter trial is warranted to determine the therapeutic efficacy of long-term intranasal oxytocin for behavioral symptoms in FTD. Classification of evidence: This study provides Class I evidence that for patients with FTD, intranasal oxytocin is not significantly associated with adverse events or significant changes in the overall neuropsychiatric inventory. Neurology ® 2015;84:174-181 GLOSSARY bvFTD 5 behavioral variant frontotemporal dementia; FBI 5 Frontal Behavioral Inventory; FTD 5 frontotemporal dementia; IRI 5 Interpersonal Reactivity Index; NPI 5 Neuropsychiatric Inventory. Loss of empathy is a hallmark symptom of the most common subtype of frontotemporal dementia (FTD), behavioral variant FTD (bvFTD). 1,2 Presently, there are no treatments for the emotional blunting, lack of empathy, and social behavioral decline in FTD. Without treatments targeting these difficulties, physicians are unable to manage the symptoms most destructive and emotionally challenging to caregivers. 3,4 Research suggests that the neuropeptide oxytocin is an important mediator of social behavior, potentially enhancing empathy and prosocial behaviors. 5 Oxytocin administration to healthy adults or patients with autism improves emotional expression processing, 6,7 empathy, 8 and cooperative behavior. 9 A single dose of intranasal oxytocin vs placebo was associated with a transient improvement in social and neuropsychiatric behaviors in patients with FTD. 10 Thus, upregulation of oxytocin-mediated mechanisms of empathy and prosocial behavior may be a potential treatment approach in FTD. The optimal dosage and outcome measures for a clinical trial of oxytocin in FTD are unknown. Animal studies report increases in some forms of aggression after oxytocin administration, leading to concerns regarding potential adverse effects of extended dosing in humans. 11 Other potential dose-limiting toxicities include uterine contractions and hyponatremia. The objectives of this study were (1) to determine the optimum dosage of intranasal oxytocin based on safety, feasibility, and tolerability in patients with FTD; (2) to preliminarily evaluate the
Mindfulness, 2011
How best to operationalize the mindfulness construct requires further research. In two related st... more How best to operationalize the mindfulness construct requires further research. In two related studies, we examined undergraduates' self-reported ability to maintain their attention toward the process of their breathing during 10-and 15-min practices of mindful breath meditation, referred to as "Meditation Breath Attention Scores" (MBAS). MBAS were positively correlated with self-reported interest in and awareness of the breath during both 10-and 15-min meditations and negatively correlated with self-reported difficulties maintaining attention toward breathing (i.e., mind wandering) during the 15-min meditation. MBAS were not positively correlated with the Toronto Mindfulness Scale (TMS) measures of mindful "decentering" and "curiosity." In study 2 but not study 1, MBAS were positively correlated with the five-factor mindfulness trait "Acting with Awareness." Secondary analyses replicated an association between measures of trait mindfulness and trait difficulty letting go of depressive thoughts, although MBAS and the TMS measures were unrelated with trait difficulty letting go of depressive thoughts. Future research directions are discussed.
Neuropsychologia, 2015
Behavioural variant frontotemporal dementia (bvFTD) is a debilitating neurodegenerative disorder ... more Behavioural variant frontotemporal dementia (bvFTD) is a debilitating neurodegenerative disorder characterized by frontal and temporal lobe atrophy primarily affecting social cognition and emotion, including loss of empathy. Many consider empathy to be a multidimensional construct, including cognitive empathy (the ability to adopt and understand another&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s perspective) and emotional empathy (the capacity to share another&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s emotional experience). Cognitive and emotional empathy deficits have been associated with bvFTD; however, little is known regarding the performance of patients with bvFTD on behavioural measures of emotional empathy, and whether empathic responses differ for negative versus positive stimuli. 24 patients with bvFTD and 24 healthy controls completed the Multifaceted Empathy Test (MET; Dziobek et al., 2008), a performance-based task that taps both cognitive and emotional facets of empathy, and allows for the discrimination of responses to negative versus positive realistic images. MET scores were also compared with caregiver ratings of patient behaviour on the Interpersonal Reactivity Index, which assesses patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; everyday demonstrations of perspective taking and empathic concern. Patients with bvFTD were less accurate than controls at inferring mental states for negative and positive stimuli. They also demonstrated lower levels of shared emotional experience, more positive emotional reactions, and diminished arousal to negative social stimuli relative to controls. Patients showed reduced emotional reactions to negative non-social stimuli as well. Lastly, the MET and IRI measures of emotional empathy were found to be significantly correlated within the bvFTD group. The results suggest that patients with bvFTD show a global deficit in cognitive empathy, and deficient emotional empathy for negative, but not positive, experiences. Further, a generalized emotional processing impairment for negative stimuli was observed, which could contribute to the emotional empathy deficit. This work highlights potential treatment targets and a means to assess the impact of novel therapies on socioemotional impairment in bvFTD.
Mindfulness, 2012
ABSTRACT The sensitivity of an experience-sampling measure of meditators’ ability to maintain att... more ABSTRACT The sensitivity of an experience-sampling measure of meditators’ ability to maintain attention to their breathing during 15-min practices of mindful breath awareness meditation, referred to as “Meditation Breath Attention Scores” (MBAS), was previously shown to vary with other meditative experiences and mindfulness-related traits. The objectives of the present study were to assess: (1) the test–retest reliability of MBAS and (2) the sensitivity to practice-related effects of MBAS. Participants completed as many as four meditation sessions held on average 8–10 days apart. Ninety-five participants took part in session 1, with 77 (81 %) completing all four sessions. Test–retest reliability of MBAS was established (mean r between sessions = 0.50) and MBAS were sensitive to practice effects (η 2 = 0.20) consistent with their interpretation as a performance measure. Individual differences in MBAS thus appear to be reliable over time but improve with the repeated practice of meditation. Future research directions are discussed.
Cognitive and Behavioral Neurology, 2013
OBJECTIVE-To describe in detail the presenting symptoms and clinical course of a cohort of patien... more OBJECTIVE-To describe in detail the presenting symptoms and clinical course of a cohort of patients with Frontotemporal dementia and the recently described C9ORF72 repeat expansion. BACKGROUND-Recent discovery of the C9ORF72 repeat expansion linked to familial frontotemporal dementia and ALS has permitted retrospective evaluation of potential defining clinical characteristics that may distinguish C9ORF72 mutation carriers from other patients with FTD. Prior reports have identified a subset of patients with an increased incidence of psychosis, specifically delusions, though the detailed nature of these symptoms is not yet well described. METHODS-We conducted a retrospective chart review of to report the detailed case histories of 7 patients with C9ORF72 mutations from a cohort of 61 patients with FTD. Results-Detailed histories available from these patients reveal an increased incidence of psychosis, including visual and auditory hallucinations and delusions compared to sporadic FTD patients in our cohort. CONCLUSIONS-This cohort confirms and adds symptom-related details to prior reports of increased incidence of psychotic phenomenon in FTD and ALS patients with C9ORF72 mutations, to enhance future clinical identification and diagnosis of patients presenting with these symptoms.
Uploads
Papers by Julia MacKinley