1
|
Winblad S, Eliasdottir O, Nordström S, Lindberg C. Neurocognitive disorder in Myotonic dystrophy type 1. Heliyon 2024; 10:e30875. [PMID: 38778932 PMCID: PMC11109806 DOI: 10.1016/j.heliyon.2024.e30875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 03/08/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
Cognitive deficits and abnormal cognitive aging have been associated with Myotonic dystrophy type 1 (DM1), but the knowledge of the extent and progression of decline is limited. The aim of this study was to examine the prevalence of signs of neurocognitive disorder (mild cognitive impairment and dementia) in adult patients with DM1. A total of 128 patients with childhood, juvenile, adult, and late onset DM1 underwent a screening using the Montreal Cognitive Assessment (MoCA). Demographic and clinical information was collected. The results revealed that signs of neurocognitive disorder were relatively rare among the participants. However, 23.8 % of patients with late onset DM1 (aged over 60 years) scored below MoCA cut-off (=23), and this group also scored significantly worse compared to patients with adult onset. Age at examination were negatively correlated with MoCA scores, although it only explained a small portion of the variation in test results. Other demographic and clinical factors showed no association with MoCA scores. In conclusion, our findings indicate a low prevalence of signs of neurocognitive disorder in adult patients with DM1, suggesting that cognitive deficits rarely progress to severe disorders over time. However, the performance of patients with late onset DM1 suggests that this phenotype warrants further exploration in future studies, including longitudinal and larger sample analyses.
Collapse
Affiliation(s)
- Stefan Winblad
- Icon Lab, Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Olöf Eliasdottir
- Department of Neurology, Neuromuscular Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sara Nordström
- Department of Neurology, Neuromuscular Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christopher Lindberg
- Department of Neurology, Neuromuscular Center, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
2
|
Ramos AA, Machado L. 3-Year test-retest reliability in Parkinson's disease and healthy older adults: The Parkinson's progression markers initiative study. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-13. [PMID: 38241781 DOI: 10.1080/23279095.2024.2303718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Repeated neuropsychological assessments are often conducted in clinical and research settings to track cognitive changes over single or multiple intervals in patients with Parkinson's disease (PD). Yet few studies have documented test-retest reliability in PD. To address this gap, we used data from the Parkinson's Progression Markers Initiative (PPMI) to investigate the reliability of five well-known neuropsychological tests over a 3-year follow-up assessment in early-stage PD with either normal (PD-NC; N = 158) or abnormal (PD-AC; N = 39) cognitive screening, categorized based on recommended cutoffs for the Montreal Cognitive Assessment (MoCA), and healthy older adults (HOA; N = 102). All participants analyzed maintained the same cognitive status category across the assessment points. Intraclass correlation coefficients (ICCs) estimated reliability. The overall ICCs calculated across time points were as follows: Judgment of Line Orientation (PD-NC = .47, PD-AC = .50, HOA = .59); Letter-Number Sequencing (PD-NC = .64, PD-AC = .64, HOA = .65); Semantic Fluency (PD-NC = .69, PD-AC = .89, HOA = .77); Symbol Digit Modalities Test (PD-NC = .67, PD-AC = .83, HOA = .71). For the two primary components of the Hopkins Verbal Learning Test-Revised, we found the following ICCs: immediate recall (PD-NC = .46, PD-AC = .57, HOA = .58); delayed recall (PD-NC = .42, PD-AC = .57, HOA = .54). Findings from this study provide useful information for clinicians and researchers toward selecting suitable neuropsychological tests to monitor cognition at two or more time points among newly diagnosed individuals with PD and HOA.
Collapse
Affiliation(s)
- Ari Alex Ramos
- Sustentabilidade e Responsabilidade Social, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
- Department of Psychiatry, Universidade Federal de São Paulo Medical School, São Paulo, Brazil
| | - Liana Machado
- Department of Psychology and Brain Health Research Centre, University of Otago, Dunedin, New Zealand
- Aotearoa Brain Project, Auckland, New Zealand
| |
Collapse
|
3
|
Lin F, Jia W, Li X, Chen Y, Wan M. Cognitive Profiles Stratified by Education Using Montreal Cognitive Assessment in Parkinson's Disease Patients with Freezing of Gait. Neuropsychiatr Dis Treat 2024; 20:25-34. [PMID: 38223373 PMCID: PMC10785694 DOI: 10.2147/ndt.s439131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose Parkinson's disease (PD) patients with freezing of gait (FOG) may present with complex and heterogeneous cognitive profiles. Owing to limited access to comprehensive neuropsychological battery in ordinary clinical practice, the Montreal Cognitive Assessment (MoCA) is likely to be easily available cognitive data for comparisons among studies. This study aims to explore the cognitive profiles stratified by education using MoCA in PD patients with FOG. Patients and Methods PD patients with FOG (FOG+, n = 52) and without FOG (FOG-, n = 71) were included in our study. MoCA items were categorized into five subsections (attention/working memory, executive function, episodic memory, language, and visuospatial function) referring to previously published criteria. Cognitive assessments were compared based on five subsections between groups stratified by three education levels (0-6 years, 7-12 years, and >12 years). The association of cognitive measurements with FOG were analyzed using binary logistic regression models with adjustment for variables. Results The total scores and subscores of each subsection of MoCA were similar between two groups of each education level. Further detailed analysis showed that a composite measure labeled "Attention/working memory-Composite" (abbreviated to Attention-C), consisting of the scores of four items (target detection task, serial sevens, digit forward and backward, and sentence repetition), were lower significantly in FOG+ group compared with FOG- group in patients with education year ≤6 years. The significant association of Attention-C with FOG held true when controlling for disease duration, but not for H-Y stage, MDS-UPDRS III, HAMA, and HAMD. Conclusion Overall, our findings gave a hint that Attention-C derived from MoCA might be a potential factor associated with FOG in PD patients with lower education level (education year ≤ 6 years), which will need to be validated in future studies.
Collapse
Affiliation(s)
- Fangju Lin
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Weihua Jia
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Xuemei Li
- Department of Neurology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, 261031, People’s Republic of China
| | - Ying Chen
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Min Wan
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, 100043, People’s Republic of China
| |
Collapse
|
4
|
Szymkowicz SM, May PE, Weeks JW, O'Connell D, Nelson Sheese AL. Psychometric properties of the Montreal Cognitive Assessment (MoCA) in inpatient liver transplant candidates. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:19-26. [PMID: 34622723 DOI: 10.1080/23279095.2021.1986510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hepatic encephalopathy (HE) is a consequence of liver disease and often diagnosed via psychometric testing. With inpatients, the Montreal Cognitive Assessment (MoCA) may be used as part of cognitive screening for transplant candidacy. However, the MoCA was developed to detect mild cognitive impairment in aging populations and its psychometric properties in inpatients with liver disease have not been determined. Retrospective chart review identified inpatient liver transplant candidates who were administered a MoCA as part of their neuropsychological screening and had either no cognitive dysfunction or a diagnosis of HE made by a neuropsychologist (n = 57, mean age = 48.8 ± 12.6 years). Psychometric analyses were conducted and regression analysis was performed to determine the predictive value of different variables on total MoCA scores. Internal consistency of MoCA domain scores was good (α = 0.80). Significant inverse relationships were found with Trail Making Test, Parts A and B (r's = -0.43 and -0.71, respectively). A cutoff score of 24 or below had the best sensitivity (0.72) and specificity (0.77) for identifying those with a diagnosis of HE. Increasing age and the presence of altered mental status were the strongest predictors of lower MoCA scores (both p's < 0.05, ηp2 = 0.10-0.14). The MoCA is appropriate to use with inpatient liver transplant candidates, with a cutoff of 24 or below to detect abnormal cognition. In addition to the clinical interview and other neuropsychological tests (including, but not limited to, the Trail Making Test, Parts A and B), low MoCA scores can help determine the presence of HE.
Collapse
Affiliation(s)
- Sarah M Szymkowicz
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pamela E May
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Justin W Weeks
- Department of Psychology, Nebraska Medicine, Omaha, NE, USA
| | - Debra O'Connell
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amelia L Nelson Sheese
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
5
|
Lima Pereira V, Freitas S, Simões MR, Gerardo B. Montreal Cognitive Assessment (MoCA): A validation study among prisoners. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2023; 33:330-341. [PMID: 37552612 DOI: 10.1002/cbm.2306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 07/10/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND There are numerous scales for screening cognitive performance and thus identification of any potential deficits, but in spite of the vulnerability of the prison population to such problems, there has been no adequate validation of screening tools specifically for use with prisoners or others in the criminal justice system. AIM To validate the Montreal Cognitive Assessment (MoCA) for use with prisoners. METHODS 100 adult prisoners in one Portuguese prison were randomly invited by clinicians to take part in this study. A same size sample of community-living adult non-offenders of similar age was selected from the MoCA's normative study database in Portugal. For both groups, the key inclusion criterion was fluency in the Portuguese language. All participants completed the Mini Mental State Examination (MMSE) and the MoCA, both in Portuguese translation. Cronbach's alpha coefficient was calculated as an index of internal consistency and Pearson's r correlations calculated. Group performances were compared using independent samples t-test. Covariance analysis (ANCOVA) was computed with level of education as covariate. To measure the magnitude of the effect,η p 2 ${\eta }_{p}^{2}$ was used. A receiver operating characteristics curve analysis was computed to evaluate the discriminatory accuracy of MoCA and MMSE. RESULTS The MoCA showed a 'reasonable' internal consistency index (α = 0.75) as well as positive and significant correlations with the MMSE. As a cognitive measure, however, the MoCA showed consistently superior psychometric properties and higher discriminatory accuracy (MoCA = 89%) than the MMSE (65%). According to the Youden index, the optimal cut-off point for the MoCA is below 24 points, whereas for the MMSE, it is below 27. CONCLUSIONS The MoCA is a valid cognitive screening tool for use with prisoners. Further validations against detailed cognitive evaluation would be a useful next step.
Collapse
Affiliation(s)
- Vânia Lima Pereira
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Sandra Freitas
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra (FPCEUC), Coimbra, Portugal
- Psychological Assessment and Psychometrics Laboratory (PsyAssessmentLab), Faculty of Psychology and Educational Sciences, University of Coimbra (FPCEUC), Coimbra, Portugal
| | - Mário R Simões
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra (FPCEUC), Coimbra, Portugal
- Psychological Assessment and Psychometrics Laboratory (PsyAssessmentLab), Faculty of Psychology and Educational Sciences, University of Coimbra (FPCEUC), Coimbra, Portugal
| | - Bianca Gerardo
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra (FPCEUC), Coimbra, Portugal
- Psychological Assessment and Psychometrics Laboratory (PsyAssessmentLab), Faculty of Psychology and Educational Sciences, University of Coimbra (FPCEUC), Coimbra, Portugal
| |
Collapse
|
6
|
Carioti D, Stucchi NA, Toneatto C, Masia MF, Del Monte M, Stefanelli S, Travellini S, Marcelli A, Tettamanti M, Vernice M, Guasti MT, Berlingeri M. The ReadFree tool for the identification of poor readers: a validation study based on a machine learning approach in monolingual and minority-language children. ANNALS OF DYSLEXIA 2023; 73:356-392. [PMID: 37548832 PMCID: PMC10522748 DOI: 10.1007/s11881-023-00287-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023]
Abstract
In this study, we validated the "ReadFree tool", a computerised battery of 12 visual and auditory tasks developed to identify poor readers also in minority-language children (MLC). We tested the task-specific discriminant power on 142 Italian-monolingual participants (8-13 years old) divided into monolingual poor readers (N = 37) and good readers (N = 105) according to standardised Italian reading tests. The performances at the discriminant tasks of the "ReadFree tool" were entered into a classification and regression tree (CART) model to identify monolingual poor and good readers. The set of classification rules extracted from the CART model were applied to the MLC's performance and the ensuing classification was compared to the one based on standardised Italian reading tests. According to the CART model, auditory go-no/go (regular), RAN and Entrainment100bpm were the most discriminant tasks. When compared with the clinical classification, the CART model accuracy was 86% for the monolinguals and 76% for the MLC. Executive functions and timing skills turned out to have a relevant role in reading. Results of the CART model on MLC support the idea that ad hoc standardised tasks that go beyond reading are needed.
Collapse
Affiliation(s)
- Desiré Carioti
- DISTUM, Department of Humanities, University of Urbino Carlo Bo, Urbino, Italy
- Psychology Department, University of Milano-Bicocca, Milan, Italy
| | | | - Carlo Toneatto
- Psychology Department, University of Milano-Bicocca, Milan, Italy
| | - Marta Franca Masia
- DISTUM, Department of Humanities, University of Urbino Carlo Bo, Urbino, Italy
| | - Milena Del Monte
- DISTUM, Department of Humanities, University of Urbino Carlo Bo, Urbino, Italy
- Center of Developmental Neuropsychology, AST Pesaro-Urbino, Distretto di Pesaro, Pesaro, Italy
| | - Silvia Stefanelli
- DISTUM, Department of Humanities, University of Urbino Carlo Bo, Urbino, Italy
- Department of Human Sciences, University of the Republic of San Marino, San Marino, Republic of San Marino
| | - Simona Travellini
- DISTUM, Department of Humanities, University of Urbino Carlo Bo, Urbino, Italy
- Center of Developmental Neuropsychology, AST Pesaro-Urbino, Distretto di Pesaro, Pesaro, Italy
| | - Antonella Marcelli
- Center of Developmental Neuropsychology, AST Pesaro-Urbino, Distretto di Pesaro, Pesaro, Italy
| | - Marco Tettamanti
- Psychology Department, University of Milano-Bicocca, Milan, Italy
| | - Mirta Vernice
- DISTUM, Department of Humanities, University of Urbino Carlo Bo, Urbino, Italy
| | | | - Manuela Berlingeri
- DISTUM, Department of Humanities, University of Urbino Carlo Bo, Urbino, Italy
- Center of Developmental Neuropsychology, AST Pesaro-Urbino, Distretto di Pesaro, Pesaro, Italy
- NeuroMi, Milan Center for Neuroscience, Milan, Italy
| |
Collapse
|
7
|
Zhong S, Wroblewski KE, Laumann EO, McClintock MK, Pinto JM. Assessing how Age, Sex, Race, and Education Affect the Relationships Between Cognitive Domains and Odor Identification. Alzheimer Dis Assoc Disord 2023; 37:128-133. [PMID: 36989106 PMCID: PMC10238630 DOI: 10.1097/wad.0000000000000554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 01/30/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The associations between cognitive domains and odor identification are well established, but how sociodemographic variables affect these relationships is less clear. PURPOSE Using the survey-adapted Montreal Cognitive Assessment instrument (MoCA-SA), we assess how age, sex, race, and education shape these relationships. METHODS We first used cluster analysis and multidimensional scaling to empirically derive distinct cognitive domains from the MoCA-SA as it is unclear whether the MoCA-SA can be disaggregated into cognitive domains. We then used ordinal logistic regression to test whether these empirically derived cognitive domains were associated with odor identification and how sociodemographic variables modified these relationships. STUDY POPULATION Nationally representative sample of community-dwelling US older adults. RESULTS We identified 5 out of the 6 theoretical cognitive domains, with the language domain unable to be identified. Odor identification was associated with episodic memory, visuospatial ability, and executive function. Stratified analyses by sociodemographic variables reveal that the associations between some of the cognitive domains and odor identification varied by age, sex, or race, but not by education. CONCLUSIONS These results suggest that (1) the MoCA-SA can be used to identify cognitive domains in survey research and (2) the performance of smell tests as a screener for cognitive decline may potentially be weaker in certain subpopulations.
Collapse
Affiliation(s)
| | | | | | - Martha K. McClintock
- Department of Psychology and Institute for Mind and Biology, University of Chicago
| | - Jayant M. Pinto
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago
| |
Collapse
|
8
|
Torrado JC, Husebo BS, Allore HG, Erdal A, Fæø SE, Reithe H, Førsund E, Tzoulis C, Patrascu M. Digital phenotyping by wearable-driven artificial intelligence in older adults and people with Parkinson's disease: Protocol of the mixed method, cyclic ActiveAgeing study. PLoS One 2022; 17:e0275747. [PMID: 36240173 PMCID: PMC9565381 DOI: 10.1371/journal.pone.0275747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Active ageing is described as the process of optimizing health, empowerment, and security to enhance the quality of life in the rapidly growing population of older adults. Meanwhile, multimorbidity and neurological disorders, such as Parkinson's disease (PD), lead to global public health and resource limitations. We introduce a novel user-centered paradigm of ageing based on wearable-driven artificial intelligence (AI) that may harness the autonomy and independence that accompany functional limitation or disability, and possibly elevate life expectancy in older adults and people with PD. METHODS ActiveAgeing is a 4-year, multicentre, mixed method, cyclic study that combines digital phenotyping via commercial devices (Empatica E4, Fitbit Sense, and Oura Ring) with traditional evaluation (clinical assessment scales, in-depth interviews, and clinical consultations) and includes four types of participants: (1) people with PD and (2) their informal caregiver; (3) healthy older adults from the Helgetun living environment in Norway, and (4) people on the Helgetun waiting list. For the first study, each group will be represented by N = 15 participants to test the data acquisition and to determine the sample size for the second study. To suggest lifestyle changes, modules for human expert-based advice, machine-generated advice, and self-generated advice from accessible data visualization will be designed. Quantitative analysis of physiological data will rely on digital signal processing (DSP) and AI techniques. The clinical assessment scales are the Unified Parkinson's Disease Rating Scale (UPDRS), Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), Apathy Evaluation Scale (AES), and the REM Sleep Behaviour Disorder Screening Questionnaire (RBDSQ). A qualitative inquiry will be carried out with individual and focus group interviews and analysed using a hermeneutic approach including narrative and thematic analysis techniques. DISCUSSION We hypothesise that digital phenotyping is feasible to explore the ageing process from clinical and lifestyle perspectives including older adults and people with PD. Data is used for clinical decision-making by symptom tracking, predicting symptom evolution, and discovering new outcome measures for clinical trials.
Collapse
Affiliation(s)
- Juan C. Torrado
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine (SEFAS), University of Bergen, Bergen, Norway
| | - Bettina S. Husebo
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine (SEFAS), University of Bergen, Bergen, Norway
- Department of Nursing Home Medicine, Municipality of Bergen, Bergen, Norway
| | - Heather G. Allore
- Yale School of Medicine and Yale School of Public Health, New Haven, CT, United States of America
| | - Ane Erdal
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine (SEFAS), University of Bergen, Bergen, Norway
| | - Stein E. Fæø
- Faculty of Health Studies, Department of Nursing, VID Specialized University, Bergen, Norway
| | - Haakon Reithe
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine (SEFAS), University of Bergen, Bergen, Norway
| | - Elise Førsund
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine (SEFAS), University of Bergen, Bergen, Norway
| | - Charalampos Tzoulis
- Department of Neurology, Neuro-SysMed Center, Haukeland University Hospital, Bergen, Norway
- K.G Jebsen Center for Translational Research in Parkinson’s Disease, University of Bergen, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Monica Patrascu
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine (SEFAS), University of Bergen, Bergen, Norway
| |
Collapse
|
9
|
Fisher AP, Gies LM, Chapman L, Aguilar JM, Yeates KO, Taylor HG, Wade SL. The clinical utility of the Children's Communication Checklist-2 in children with early childhood traumatic brain injury. Clin Neuropsychol 2022; 36:1728-1745. [PMID: 33375912 PMCID: PMC9204558 DOI: 10.1080/13854046.2020.1866675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/15/2020] [Indexed: 01/27/2023]
Abstract
ObjectivePediatric traumatic brain injury (TBI) is associated with long-term cognitive and behavioral deficits. Social communication impairments are common and impact functional outcomes, such as social engagement and academic performance. There are many barriers to identifying social communication deficits following TBI, including the absence of a standardized parent-reported communication measure for use in this population. The Children's Communication Checklist-Second Edition (CCC-2) has demonstrated utility in identifying communication deficits in diagnoses other than TBI. This study investigated the clinical utility of the CCC-2's social communication scales in children with TBI. Method: 203 children who sustained TBI or orthopedic injuries between the ages of 36 and 83 months were recruited as part of a larger, longitudinal study. We analyzed social communication subscale scores from the CCC-2 an average of 3.5 years postinjury. We used binary logistic regression analyses to examine the measure's accuracy in classifying children with and without social communication deficits on other measures of pragmatic language and social competence. Correlation analyses and linear mixed models were used to examine the construct validity of the CCC-2. Results: The CCC-2 was able to accurately classify those with and without pragmatic language impairments on the Comprehensive Assessment of Spoken Language 92% of the time (sensitivity = 55%) and 96% of the time on the Home and Community Social Behavior scale (sensitivity = 72%). The CCC-2 demonstrated strong correlations with and predictive validity for measures of social communication and competence. Conclusions: The findings offer support for the clinical utility of the CCC-2 in the pediatric TBI population.
Collapse
Affiliation(s)
- Allison P. Fisher
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, phone: 513-803-7404, fax: 513-636-7360
- University of Cincinnati, Cincinnati, OH
| | - Lisa M. Gies
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, phone: 513-803-7404, fax: 513-636-7360
- University of Cincinnati, Cincinnati, OH
| | - Leah Chapman
- Department of Neurology, Wake Forest Baptist Health, Winston-Salem, NC
| | - Jessica M. Aguilar
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, phone: 513-803-7404, fax: 513-636-7360
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children’s Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary
| | - H. Gerry Taylor
- Professor, Abigail Wexner Research Institute at Nationwide Children’s Hospital, and Department of Pediatrics, The Ohio State University, Nationwide Children’s Hospital
| | - Shari L. Wade
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, phone: 513-803-7404, fax: 513-636-7360
- University of Cincinnati, Cincinnati, OH
| |
Collapse
|
10
|
Pelak VS, Paez YM, Patnaik JL, Holden SK, Subramanian PS, Mathias MT, Mandava N, Lynch AM. An Exploratory Study to Investigate the Utility of Clinical Screening for Neurodegenerative Disease in Age-Related Eye Disease Research. J Neuroophthalmol 2022; 42:346-352. [PMID: 35483065 PMCID: PMC9529756 DOI: 10.1097/wno.0000000000001550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Unrecognized neurodegenerative diseases (NDD) in age-related eye disease research studies have the potential to confound vision-specific quality of life and retinal optical coherence tomography (OCT) outcome measures. The aim of this exploratory study was to investigate relationships between NDD screening tools and visual outcome measures in a small cohort of controls from the Colorado Age-Related Macular Degeneration Registry (CO-AMD), to consider the utility of future studies. METHODS Twenty-nine controls from the CO-AMD were screened using the Montreal Cognitive Assessment (MoCA), a Colorado Parkinsonian Checklist, and the Lewy Body Composite Risk Score. Univariate and multivariable linear regression modeling was used to assess associations between screening tools and the National Eye Institute Visual Function Questionnaire-25 (VFQ-25) and macular OCT outcome measures, and t tests were used to evaluate outcome measure differences between those with normal vs abnormal MoCA scores. RESULTS One patient withdrew. The average age was 72.8 years, and 68% were female patients. Ten participants (36%) had abnormal MoCA scores, and their VFQ-25 scores were only 1 point less and not statistically different than those with normal MoCA scores. Macular OCT volumes and thicknesses for retinal nerve fiber layer (RNFL) and retinal ganglion cell layer were consistently and moderately lower for those with abnormal MoCA scores, and a positive association between MoCA and macular RNFL volume was observed, although differences and regression were not significant. Parkinson screening tests were abnormal for only 4 participants and were not associated with OCT or VFQ-25 measures by regression modeling. CONCLUSIONS Given the degree and direction of observed differences, further investigation is warranted regarding the relationship between cognitive screening tools and macular OCT measures in age-related eye disease research, but future investigations regarding the relationship between NDD screening tools and VFQ-25 seem unwarranted.
Collapse
Affiliation(s)
- Victoria S. Pelak
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Yosbelkys Martin Paez
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer L. Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Prem S. Subramanian
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Surgery, Division of Ophthalmology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Marc T. Mathias
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Naresh Mandava
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anne M. Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
11
|
Pirani A, Nasreddine Z, Neviani F, Fabbo A, Rocchi MB, Bertolotti M, Tulipani C, Galassi M, Belvedere Murri M, Neri M. MoCA 7.1: Multicenter Validation of the First Italian Version of Montreal Cognitive Assessment. J Alzheimers Dis Rep 2022; 6:509-520. [PMID: 36186724 PMCID: PMC9484132 DOI: 10.3233/adr-210053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 07/13/2022] [Indexed: 12/04/2022] Open
Abstract
Background: The early detection of neurocognitive disorders, especially when mild, is a key issue of health care systems including the Italian Dementia National Plan. The Mini-Mental State Examination (MMSE), i.e., the reference screening tool for dementia in Italian Memory Clinics, has low sensitivity in detecting mild cognitive impairment (MCI) or mild dementia. Objective: Availability of a 10-minute screening test sensitive to MCI and mild dementia, such as the Montreal Cognitive Assessment (MoCA), is relevant in the field. This study presents initial validity and reliability data for the Italian version of MoCA 7.1 that is being collected as part of a large ongoing longitudinal study to evaluate the rate of incident MCI and dementia in older adults. Methods: MoCA 7.1 and MMSE were administered to cognitive impaired patients (n = 469; 214 with MCI, 255 with dementia; mean age: 75.5; 52% females,) and healthy older adults (n = 123, mean age: 69.7, 64 % females). Results: Test-retest (0.945, p < 0.001) and inter-rater (0.999, p < 0.001) reliability of MoCA 7.1, assessed on randomly selected participants with normal cognition, MCI, dementia, were significant. MoCA 7.1 showed adequate sensitivity (95.3%) and specificity (84.5%) in detecting MCI compared to MMSE (sensitivity: 53.8%; specificity: 87.5%). The Area Under the Curve of MoCA 7.1 was significantly greater than that of MMSE (0.963 versus 0.742). MoCA 7.1 showed similar results in detecting both MCI and dementia. Conclusion: MoCA 7.1 is a reliable and useful tool that can aid in the diagnosis of MCI and dementia in the Italian population.
Collapse
Affiliation(s)
- Alessandro Pirani
- Center for Cognitive Disorders and Dementia, Health County of Ferrara, Cento, Italy
- Alzheimer’s Association “Francesco Mazzuca”, Cento, (Fe), Italy
| | | | - Francesca Neviani
- Center for Cognitive Disorders and Dementia. Chair of Geriatrics, University of Modenaand Reggio Emilia, Italy
| | - Andrea Fabbo
- Dementia Program, HealthTrust, Health County of Modena, Italy
| | | | - Marco Bertolotti
- Division of Geriatric Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia and University Hospital of Modena, Modena, Italy
- Center for Gerontological Evaluation and Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Tulipani
- Center for Cognitive Disorders and Dementia, Health County of Ferrara, Cento, Italy
- Alzheimer’s Association “Francesco Mazzuca”, Cento, (Fe), Italy
| | - Matteo Galassi
- Center for Cognitive Disorders and Dementia. Chair of Geriatrics, University of Modenaand Reggio Emilia, Italy
| | - Martino Belvedere Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
| | - Mirco Neri
- Center for Cognitive Disorders and Dementia. Chair of Geriatrics, University of Modenaand Reggio Emilia, Italy
| |
Collapse
|
12
|
Copersino ML, Long MP, Bolton P, Ressler KJ, Seiner SJ, Yip AG. First Acute-Course Electroconvulsive Therapy for Moderate-to-Severe Depression Benefits Patients With or Without Accompanying Baseline Cognitive Impairment. J ECT 2022; 38:74-80. [PMID: 34966040 DOI: 10.1097/yct.0000000000000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Researchers are increasingly investigating therapeutic response associated with new patient subgroups as a way to improve electroconvulsive therapy (ECT) treatment outcomes and reduce adverse events. This study is the first to examine baseline cognitive impairment status as a predictor of clinical outcome in first acute-course ECT patients. METHODS Baseline cognitive function at various thresholds and serial depressive symptom severity data from first-time ECT patients were examined using generalized linear mixed-effects models. RESULTS Of 1345 patients who met the inclusion criteria, 617 had available data at their third assessment visit (~15th treatment visit). There was a robust improvement in depression symptoms over time (P < 0.0001), and cognitive function was not associated with baseline levels of depressive symptoms or serially measured change in self-reported symptom severity during acute-phase ECT. CONCLUSIONS These results indicate that an acute course of ECT for the treatment of moderate-to-severe depression benefits patients with or without accompanying baseline cognitive impairment. These findings may be useful in informing shared decision-making discussions about ECT risks and expected benefits.
Collapse
|
13
|
Spencer RJ, Noyes ET, Bair JL, Ransom MT. Systematic Review of the Psychometric Properties of the Saint Louis University Mental Status (SLUMS) Examination. Clin Gerontol 2022; 45:454-466. [PMID: 35107414 DOI: 10.1080/07317115.2022.2032523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This systemic review qualitatively synthesizes existing psychometric support for the Saint Louis University Mental Status (SLUMS) Examination, a cognitive screening measure which presents as a free alternative to other widely used dementia screening measures including the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). METHODS A total of 90 peer-reviewed articles on the SLUMS were identified from PsycINFO and PubMed databases. RESULTS Sixty-eight records were identified and reviewed by the lead author for eligibility. Studies that included at least one psychometric property of the SLUMS (n = 20) were included in this review. CONCLUSIONS Support for the SLUMS remains preliminary; however, it appears to have adequate validity, and adequate sensitivity and specificity in detecting cognitive impairment. Numerous shortcomings were identified, including lack of sufficient normative data, information on test-reliability, explored factor structure, and limited application of criterion measures (e.g., imaging studies, biomarkers). Research is needed to establish diverse normative samples and describe the reliability and validity of the SLUMS to strengthen the empirical support for its use. CLINICAL IMPLICATIONS Until its psychometric properties are better established the SLUMS should be used cautiously when screening for cognitive impairment.
Collapse
Affiliation(s)
- Robert J Spencer
- Mental Health, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Emily T Noyes
- Mental Health, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Jessica L Bair
- Mental Health, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Michael T Ransom
- Mental Health, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| |
Collapse
|
14
|
Ramos AA, Garvey A, Cutfield NJ, Machado L. Forward and backward spatial recall in Parkinson's disease and matched controls: A 1-year follow-up study. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-10. [PMID: 35412882 DOI: 10.1080/23279095.2022.2059372] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Patients with Parkinson's disease (PD) exhibit a domain-general visuospatial dysfunction; however, no previous study has examined changes over time in forward and backward spatial recall in PD against controls. To evaluate changes in short-term (STM) and working memory (WM) dysfunction in PD, the current study assessed performance on a computer-modified version of the Corsi Block-Tapping Test (forward and backward recall) at two-time points 1 year apart, while simultaneously exploring associations with potentially relevant demographic and clinical variables. We enrolled 38 patients with PD and 38 controls matched for age, sex, and Montreal Cognitive Assessment (MoCA) total scores. Linear mixed-effects models analyzed the primary measured variables (forward and backward scores). At baseline, the dysfunction effect sizes were as follows: forward recall (-0.45, 95% CI [-0.90, 0.01]) and backward recall (-0.26, 95% CI [-0.71, 0.19]). At follow-up, patients exhibited substantially greater difficulties in backward recall (-0.65, 95% CI [-1.18, -0.13]) compared to the baseline assessment, whereas the forward dysfunction effect size remained almost the same (-0.43, 95% CI [-0.94, 0.09]). Age (p = .005, f = 0.35) and total scores on MoCA (p = .017, f = 0.18), irrespective of group and recall condition, were significant predictors of spatial block scores. The pattern of dysfunction effect sizes indicates that, in contrast to forward recall, backward recall dysfunction in PD worsened 1-year after the baseline assessment, presumably reflecting the progression of PD-related visuospatial WM dysfunction.
Collapse
Affiliation(s)
- Ari Alex Ramos
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Anthony Garvey
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Liana Machado
- Department of Psychology, University of Otago, Dunedin, New Zealand
| |
Collapse
|
15
|
Ramirez-Garcia G, Galvez V, Diaz R, Campos-Romo A, Fernandez-Ruiz J. Montreal Cognitive Assessment (MoCA) performance in Huntington's disease patients correlates with cortical and caudate atrophy. PeerJ 2022; 10:e12917. [PMID: 35402100 PMCID: PMC8988933 DOI: 10.7717/peerj.12917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/20/2022] [Indexed: 01/11/2023] Open
Abstract
Huntington's Disease (HD) is an autosomal neurodegenerative disease characterized by motor, cognitive, and psychiatric symptoms. Cognitive impairment develops gradually in HD patients, progressing later into a severe cognitive dysfunction. The Montreal Cognitive Assessment (MoCA) is a brief screening test commonly employed to detect mild cognitive impairment, which has also been useful to assess cognitive decline in HD patients. However, the relationship between MoCA performance and brain structural integrity in HD patients remains unclear. Therefore, to explore this relationship we analyzed if cortical thinning and subcortical nuclei volume differences correlated with HD patients' MoCA performance. Twenty-two HD patients and twenty-two healthy subjects participated in this study. T1-weighted images were acquired to analyze cortical thickness and subcortical nuclei volumes. Group comparison analysis showed a significantly lower score in the MoCA global performance of HD patients. Also, the MoCA total score correlated with cortical thinning of fronto-parietal and temporo-occipital cortices, as well as with bilateral caudate volume differences in HD patients. These results provide new insights into the effectiveness of using the MoCA test to detect cognitive impairment and the brain atrophy pattern associated with the cognitive status of prodromal/early HD patients.
Collapse
Affiliation(s)
- Gabriel Ramirez-Garcia
- Departamento de Fisiología, Universidad Nacional Autónoma de Mexico, Ciudad de Mexico, Mexico
| | - Victor Galvez
- Escuela de Psicología, Universidad Panamericana, Ciudad de Mexico, Mexico
| | - Rosalinda Diaz
- Departamento de Fisiología, Universidad Nacional Autónoma de Mexico, Ciudad de Mexico, Mexico
| | - Aurelio Campos-Romo
- Facultad de Medicina, Unidad Periférica de Neurociencias, Universidad Nacional Autónoma de México/Instituto Nacional de Neurologia y Neurocirugia, Ciudad de Mexico, Mexico
| | - Juan Fernandez-Ruiz
- Departamento de Fisiología, Universidad Nacional Autónoma de Mexico, Ciudad de Mexico, Mexico
| |
Collapse
|
16
|
Screening of Cognitive Impairment in Patients with Multiple Sclerosis: A Cross-Sectional Study in Georgia. Neurol Res Int 2021; 2021:5591078. [PMID: 34136283 PMCID: PMC8178012 DOI: 10.1155/2021/5591078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/13/2021] [Indexed: 11/17/2022] Open
Abstract
Cognitive impairment (CI) is a common symptom of multiple sclerosis (MS), with a significant negative impact on the occupational and social functioning of patients. This study aimed to estimate the prevalence and characteristics of CI among MS patients in Georgia. Sixty-eight patients with MS attending a neurology outpatient clinic in Tbilisi, Georgia, were enrolled in the study. Cognitive status was evaluated using two screening tools: the Brief International Cognitive Assessment for MS and the Montreal Cognitive Assessment. The overall prevalence of CI in our MS patients was 47%. We found negative associations between cognitive test results and patients' age, disability status, and depression. Lower education, higher scores on the Expanded Disability Status Scale, and the progressive course of MS were the main predictors of CI in the logistic regression analysis. This is the first study in Georgia to evaluate CI in patients with MS. The prevalence of CI in our study was comparable with those reported in other countries; however, we found greater impairment of the executive system compared to other cognitive domains. In our study, patients who were on continuous DMT showed significantly better performance on the cognitive tests used, indicating possible favorable effect of immunomodulatory drugs on cognition.
Collapse
|
17
|
Correlates of the discrepancy between objective and subjective cognitive functioning in non-demented patients with Parkinson's disease. J Neurol 2021; 268:3444-3455. [PMID: 33723623 PMCID: PMC8357714 DOI: 10.1007/s00415-021-10519-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 11/05/2022]
Abstract
Background Subjective complaints of cognitive deficits are not necessarily consistent with objective evidence of cognitive impairment in Parkinson’s disease (PD). Here we examined the factors associated with the objective-subjective cognitive discrepancy. Methods We consecutively enrolled 90 non-demented patients with PD who completed the Parkinson’s Disease Cognitive Functional Rating Scale (subjective cognitive measure) and the Montreal Cognitive Assessment (MoCA; objective cognitive measure). The patients were classified as “Overestimators”, “Accurate estimators”, and “Underestimators” on the basis of the discrepancy between the objective vs. subjective cognitive measures. To identify the factors distinguishing these groups from each other, we used chi-square tests or one-way analyses of variance, completed by logistic and linear regression analyses. Results Forty-nine patients (54.45%) were classified as “Accurate estimators”, 29 (32.22%) as “Underestimators”, and 12 (13.33%) as “Overestimators”. Relative to the other groups, the “Underestimators” scored higher on the Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), and Parkinson Anxiety Scale (p < 0.01). Logistic regression confirmed that FSS and BDI scores distinguished the “Underestimators” group from the others (p < 0.05). Linear regression analyses also indicated that FSS and BDI scores positively related to objective-subjective cognitive discrepancy (p < 0.01). “Overestimators” scored lower than other groups on the MoCA’s total score and attention and working memory subscores (p < 0.01). Conclusion In more than 45% of consecutive non-demented patients with PD, we found a ‘mismatch’ between objective and subjective measures of cognitive functioning. Such discrepancy, which was related to the presence of fatigue and depressive symptoms and frontal executive impairments, should be carefully evaluated in clinical setting. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10519-4.
Collapse
|
18
|
Ko D, Bratzke LC. Cognitive Function in Liver Transplant Recipients Who Survived More Than 6 Months. Prog Transplant 2020; 30:335-341. [DOI: 10.1177/1526924820958144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Introduction: Current research in the areas of liver transplant and cognitive function has primarily examined cognitive changes from pre- to 1-year posttransplant, resulting in an insufficient understanding of cognitive trajectory beyond early periods of transplant and its impact on self-management. This study aimed (1) to describe global and domain-specific cognitive function in liver transplant recipients who survived more than 6 months after transplant and (2) to describe patient and clinical characteristics of recipients with impaired global and/or domain-specific cognitive function. Further, this study explored the potential relationships between cognitive function and self-management by examining differences in cognitive function by levels of self-management. Design: This secondary data analysis included 107 adult liver transplant recipients, who had a functioning transplant for at least 6 months. Data of cognitive function, demographic and clinical characteristics, and self-management were extracted for this study. T tests, Mann-Whitney tests, and Kruskal-Wallis tests were used to examine differences in cognitive function by variables. Results: More than half of the recipients had global cognitive impairment. Significant differences were found in global and domain-specific cognitive function. Older, male, married, or deceased donor recipients had lower cognitive test scores than younger, female, single, or living donor recipients. There were no significant differences in global and domain-specific cognitive function by time since transplant and levels of self-management. Discussion: Future longitudinal studies should examine the long-term trajectory of cognitive function posttransplant. Other factors such as caregivers’ participation in self-management should be accounted for in future studies when examining the relationship between cognitive function and self-management.
Collapse
Affiliation(s)
- Dami Ko
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Lisa C. Bratzke
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
19
|
Cognitive impairment in Parkinson's disease: Associations between subjective and objective cognitive decline in a large longitudinal study. Parkinsonism Relat Disord 2020; 80:127-132. [PMID: 32987359 DOI: 10.1016/j.parkreldis.2020.09.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 09/14/2020] [Accepted: 09/18/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cognitive decline creates substantial morbidity and cost in Parkinson's disease (PD) and clinicians have limited tools for counseling patients on prognosis. We aimed to use data from a randomized, controlled trial of isradipine in Parkinson's disease (STEADY-PD III) to determine which objective cognitive domain deficits drive patient complaints of cognitive symptoms. METHODS Neuro-Quality of Life (Neuro-QoL) Cognition: General Concerns (GC), and Cognition: Executive Function (EF) (subjective measures), were administered at baseline, 1, 2, and 3 years in 324 people with PD. Baseline Montreal Cognitive Assessment (MoCA) was divided into 4 domains: visuospatial/executive, memory, attention, and language (objective measures). Spearman rank correlations and multiple regression models adjusted for other clinical variables evaluated associations between baseline Neuro-QoL domains and individual MoCA domains. Multiple regression models evaluated the association between baseline MoCA domain performance and Neuro-QoL change over three years. Cox proportional hazards predicted development of PD-MCI based on baseline and time-varying Neuro-QoL reporting. RESULTS Higher MoCA memory performance was associated with better Neuro-QoL-GC (β = 0.75, SE = 0.391, p = 0.05) and Neuro-QoL-EF (β = 0.81, SE = 0.36, p = 0.02) at baseline. There was a trend for baseline MoCA memory to predict the degree of subjective cognitive decline on the Neuro-QoL-EF (β = 0.70, SE = 0.42, p = 0.09). Baseline depression and anticholinergic use were associated with worsened Neuro-QoL-EF and Neuro-QoL-GC. Increasing subjective cognitive complaints in Neuro-QoL-EF were associated with development of PD-MCI over 3 years of follow-up (HR = 0.95, CI = 0.90-1.0, p = 0.039). CONCLUSIONS Objective memory impairment may be a stronger predictor than executive or visuospatial dysfunction for the presence of subjective cognitive complaints in early PD.
Collapse
|
20
|
Exploring the relationship between visuospatial function and age-related deficits in motor skill transfer. Aging Clin Exp Res 2020; 32:1451-1458. [PMID: 31520336 DOI: 10.1007/s40520-019-01345-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/31/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Generalizing learned information from one motor task to another is critical for effective motor rehabilitation. A recent study demonstrated age-related declines in motor skill transfer, yet findings from other motor learning studies suggest that visuospatial impairments may explain such aging effects. AIMS The purpose of this secondary analysis was to test whether age-related deficits in motor skill transfer were related to low visuospatial ability. METHODS Forty-two participants (mean ± SD age: 72.1 ± 9.9 years) were tested on an upper extremity dexterity task before and after 3 days of training on an upper extremity reaching task. Training and control data have been published previously. Prior to training, global cognitive status and specific cognitive domains (visuospatial/executive, attention, and delayed memory) were evaluated using the Montreal Cognitive Assessment. RESULTS Backward-stepwise linear regression indicated that the Visuospatial/Executive subtest was related to motor skill transfer (i.e., the amount of change in performance on the untrained motor task), such that participants with higher visuospatial scores improved more on the untrained dexterity task than those with lower scores. Global cognitive status was unrelated to motor skill transfer. DISCUSSION Consistent with previous studies showing a positive relationship between visuospatial function and other aspects of motor learning, this secondary analysis indicates that less motor skill transfer among older adults may indeed be due to declines in visuospatial function. CONCLUSIONS The present study highlights the potential utility of assessing older patients' visuospatial ability within motor rehabilitation to provide valuable insight into the extent to which they may learn and generalize motor skills through training.
Collapse
|
21
|
Zhang X, Yang L, Hou L, Liu J, Zhu H, Zhang J. Effect of a psychological nursing intervention on quality of life and cognitive function in patients with gastric carcinoma: A randomised controlled trial. Eur J Cancer Care (Engl) 2020; 29:e13292. [PMID: 32666638 DOI: 10.1111/ecc.13292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/18/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022]
Abstract
AIM We aimed to evaluate the effect of a psychological nursing intervention on quality of life (QoL) and cognitive function in patients with gastric carcinoma (GC) and proposed that the intervention might improve the QoL and cognitive function of GC patients. METHODS Gastric carcinoma patients were randomly assigned into two groups: (a) intervention group: receiving proper psychological nursing intervention; (b) control group: receiving conventional care. RESULTS The QoL and Montreal Cognitive Assessment (MoCA) scores at each dimensionality between the intervention group and the control group at baseline showed no significant differences (p > .05). However, after the 6-month psychological nursing intervention, 5 of 10 dimensionalities in QoL and 5 of 6 dimensionalities in MoCA showed statistically differences between the intervention group and the control group (p < .05). In comparison with the scores at baseline, the QoL scores measured after the 6-month psychological nursing intervention showed remarkable improvement in multiple dimensionalities in the intervention group, but only appetite loss improved in the control group. MoCA scores in multiple dimensionalities in the intervention group also exhibited obvious improvement compared with those in control group. CONCLUSION A psychological nursing intervention benefits the QoL and cognitive function in GC patients, indicating the importance of a psychological nursing intervention.
Collapse
Affiliation(s)
- Xia Zhang
- Department of General Surgery, The Forth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lingshu Yang
- Department of General Surgery, The Forth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li Hou
- Department of General Surgery, The Forth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianing Liu
- Department of General Surgery, The Forth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huijuan Zhu
- Department of General Surgery, The Forth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jing Zhang
- Department of General Surgery, The Forth Affiliated Hospital of Harbin Medical University, Harbin, China
| |
Collapse
|
22
|
Stern RB, d'Alencar MS, Uscapi YL, Gubitoso MD, Roque AC, Helene AF, Piemonte MEP. Goalkeeper Game: A New Assessment Tool for Prediction of Gait Performance Under Complex Condition in People With Parkinson's Disease. Front Aging Neurosci 2020; 12:50. [PMID: 32194393 PMCID: PMC7064547 DOI: 10.3389/fnagi.2020.00050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 02/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background: People with Parkinson's disease (PD) display poorer gait performance when walking under complex conditions than under simple conditions. Screening tests that evaluate gait performance changes under complex walking conditions may be valuable tools for early intervention, especially if allowing for massive data collection. Objectives: To investigate the use of the Goalkeeper Game (GG) to predict impairment in gait performance under complex conditions in people with Parkinson's disease (PPD) and compare its predictive power with the one of the Montreal Cognitive Assessment (MoCA) test. Methods: 74 PPD (HY stages: 23 in stage 1; 31 in stage 2; 20 in stage 3), without dementia (MoCA cut-off 21), tested in ON period with dopaminergic medication were submitted to single individual cognitive/motor evaluation sessions. MoCA and GG were used to assess cognition, and the dynamic gait index (DGI) test was used to assess gait performance under complex condition. GG test resulted in 9 measures extracted via a statistical model. The predictive power of the GG measures and the MoCA score with respect to gait performance, as assessed by DGI, were compared. Results: The predictive models based on GG obtained a better score of prediction (65%) then MoCA (56%) for DGI scores (at a 50% specificity). Conclusion: GG is a novel tool for noninvasive screening that showed a superior predictive power in assessing gait performance under complex condition in people with PD than the well-established MoCa test.
Collapse
Affiliation(s)
- Rafael B. Stern
- Department of Statistics, Federal University of São Carlos, São Carlos, Brazil
| | - Matheus Silva d'Alencar
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
| | - Yanina L. Uscapi
- Department of Physiology, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - Marco D. Gubitoso
- Department of Computer Science, Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Antonio C. Roque
- Department of Physics, School of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - André F. Helene
- Department of Physiology, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - Maria Elisa Pimentel Piemonte
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
23
|
Hshieh TT, Jung WF, Grande LJ, Chen J, Stone RM, Soiffer RJ, Driver JA, Abel GA. Prevalence of Cognitive Impairment and Association With Survival Among Older Patients With Hematologic Cancers. JAMA Oncol 2019; 4:686-693. [PMID: 29494732 DOI: 10.1001/jamaoncol.2017.5674] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance As the population ages, cognitive impairment has promised to become increasingly common among patients with cancer. Little is known about how specific domains of cognitive impairment may be associated with survival among older patients with hematologic cancers. Objective To determine the prevalence of domain-specific cognitive impairment and its association with overall survival among older patients with blood cancer. Design, Setting, and Participants This prospective observational cohort study included all patients 75 years and older who presented for initial consultation in the leukemia, myeloma, or lymphoma clinics of a large tertiary hospital in Boston, Massachusetts, from February 1, 2015, to March 31, 2017. Patients underwent screening for frailty and cognitive dysfunction and were followed up for survival. Exposures The Clock-in-the-Box (CIB) test was used to screen for executive dysfunction. A 5-word delayed recall test was used to screen for impairment in working memory. The Fried frailty phenotype and Rockwood cumulative deficit model of frailty were also assessed to characterize participants as robust, prefrail, or frail. Results Among 420 consecutive patients approached, 360 (85.7%) agreed to undergo frailty assessment (232 men [64.4%] and 128 women [35.6%]; mean [SD] age, 79.8 [3.9] years), and 341 of those (94.7%) completed both cognitive screening tests. One hundred twenty-seven patients (35.3%) had probable executive dysfunction on the CIB, and 62 (17.2%) had probable impairment in working memory on the 5-word delayed recall. Impairment in either domain was modestly correlated with the Fried frailty phenotype (CIB, ρ = 0.177; delayed recall, ρ = 0.170; P = .01 for both), and many phenotypically robust patients also had probable cognitive impairment (24 of 104 [23.1%] on CIB and 9 of 104 [8.7%] on delayed recall). Patients with impaired working memory had worse median survival (10.9 [SD, 12.9] vs 12.2 [SD, 14.7] months; log-rank P < .001), including when stratified by indolent cancer (log-rank P = .01) and aggressive cancer (P < .001) and in multivariate analysis when adjusting for age, comorbidities, and disease aggressiveness (odds ratio, 0.26; 95% CI, 0.13-0.50). Impaired working memory was also associated with worse survival for those undergoing intensive treatment (log-rank P < .001). Executive dysfunction was associated with worse survival only among patients who underwent intensive treatment (log-rank P = .03). Conclusions and Relevance These data suggest that domains of cognitive dysfunction may be prevalent in older patients with blood cancer and may have differential predictive value for survival. Targeted interventions are needed for this vulnerable patient population.
Collapse
Affiliation(s)
- Tammy T Hshieh
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Wooram F Jung
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Laura J Grande
- Psychology Service, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Jiaying Chen
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Robert J Soiffer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jane A Driver
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Geriatric Research, Education, and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Gregory A Abel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| |
Collapse
|
24
|
Hamzah N, Mohamad NA, Thiruselvam I, Hariri F, Veeramuthu V, Mazlan M, Narayanan V, Ramli N. Validity and reliability of the Neuropsychological Assessment Battery - Screening Module (S-NAB) in a subset of Malaysian population with mild traumatic brain injury (mTBI). APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:416-426. [PMID: 31431094 DOI: 10.1080/23279095.2019.1648264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study assessed the validity (construct validity) and reliability (internal consistency) of the Neuropsychological Assessment Battery Screening Module (S-NAB) in detecting mild cognitive deficit/alteration in multicultural, multilingual, and multiethnic mild traumatic brain injury (mTBI) population of Malaysia. S-NAB and Montreal Cognitive Assessment (MoCA) data from 114 patients with mTBI (93 males; 21 females) aged 18 to 60 years old were obtained at University Malaya Medical Center, Malaysia. The mean age was 28.17 ± 8.57 years and mean education years was 12.40 ± 2.01. Convergent validity was assessed between S-NAB domain scores and MoCA total scores by using Pearson's correlation and internal consistency was assessed using Cronbach's alpha. Acceptable internal consistency (α ≥ .70) was found for Attention, Language, and Memory domains but weak internal consistencies (α < .50) were found for Spatial and Executive Function domains. There were positive but weak correlations between S-NAB and MoCA. These findings provide some support for the application of S-NAB in assessing mild cognitive deficits of mTBI population in a Malaysian setting.
Collapse
Affiliation(s)
- Norhamizan Hamzah
- Rehabilitation Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Indrani Thiruselvam
- School of Liberal Arts and Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Firdaus Hariri
- Faculty of Dentistry, Oral & Maxillofacial Clinical Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Mazlina Mazlan
- Rehabilitation Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Norlisah Ramli
- Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW Whereas it was previously thought that there was a single overarching frontal lobe syndrome, it is now clear that several distinct cognitive and behavioral processes are mediated by the frontal lobes. This article reviews these processes and the underlying neuroanatomy and provides an approach to the assessment of prefrontal lobe functions at the bedside. RECENT FINDINGS Cognitive and behavioral frontal lobe functions are mediated by the prefrontal regions rather than the frontal lobes as a whole. At least five separate prefrontal functions have been defined: energization, task setting, monitoring, behavioral/emotional regulation, and metacognition. Energization is mediated by the superior medial prefrontal cortices bilaterally, task setting by the left lateral frontal cortex, monitoring by the right lateral prefrontal cortex, behavioral/emotional regulation by the orbitofrontal cortex, and metacognition by the frontal poles. Only task setting and monitoring are considered executive functions. SUMMARY Distinct cognitive and behavioral processes are mediated by different parts of the frontal lobe. Lesions in these areas result in characteristic clinical deficits that are discussed in this article. Key messages are that prefrontal regions mediate the higher cortical functions (as opposed to the frontal lobes in general) and that prefrontal functions are not equivalent to executive functions.
Collapse
|
26
|
Ng YH, Al Mawed S, Pankratz VS, Argyropoulos C, Singh P, Shaffi SK, Myaskovsky L, Unruh M, Harford A. Cognitive assessment in a predominantly Hispanic and Native American population in New Mexico and its association with kidney transplant wait-listing. Clin Transplant 2019; 33:e13674. [PMID: 31332845 DOI: 10.1111/ctr.13674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 06/30/2019] [Accepted: 07/15/2019] [Indexed: 02/04/2023]
Abstract
The association between cognitive function and the likelihood of kidney transplant (KT) wait-listing, especially in minority populations, has not been clearly delineated. We performed a retrospective review of our pre-KT patients, who consist mainly of Hispanics and Native Americans, over a 16-month period. We collected data on baseline demographics and the Montreal Cognitive Assessment (MoCA) score, at the initial KT evaluation. We defined cognitive impairment as MoCA scores of <24. We constructed linear regression models to identify associations between baseline characteristics with MoCA scores and used Cox proportional hazards models to assess associations between MoCA score and KT wait-listing. During the study period, 154 patients completed the MoCA during their initial evaluation. Mean (standard deviation) MoCA scores were 23.9 (4.6), with 58 (38%) participants scoring <24. Advanced age, lower education and being on dialysis were associated with lower MoCA scores. For every one-point increase in MoCA, the likelihood of being wait-listed increased 1.10-fold (95% CI 1.01-1.19, P = .022). Being Native American and having kidney disease due to diabetes or hypertension were associated with longer time to wait-listing. Cognitive impairment was common in our pre-KT patients and was associated with a lower likelihood of KT wait-listing.
Collapse
Affiliation(s)
- Yue-Harn Ng
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Saleem Al Mawed
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Vernon Shane Pankratz
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Christos Argyropoulos
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Pooja Singh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Saeed Kamran Shaffi
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Larissa Myaskovsky
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Mark Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Antonia Harford
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| |
Collapse
|
27
|
Liu MA, DuMontier C, Murillo A, Hshieh TT, Bean JF, Soiffer RJ, Stone RM, Abel GA, Driver JA. Gait speed, grip strength, and clinical outcomes in older patients with hematologic malignancies. Blood 2019; 134:374-382. [PMID: 31167800 PMCID: PMC6659254 DOI: 10.1182/blood.2019000758] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/18/2019] [Indexed: 12/27/2022] Open
Abstract
This study aimed to evaluate whether gait speed and grip strength predicted clinical outcomes among older adults with blood cancers. We prospectively recruited 448 patients aged 75 years and older presenting for initial consultation at the myelodysplastic syndrome/leukemia, myeloma, or lymphoma clinic of a large tertiary hospital, who agreed to assessment of gait and grip. A subset of 314 patients followed for ≥6 months at local institutions was evaluated for unplanned hospital or emergency department (ED) use. We used Cox proportional hazard models calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for survival, and logistic regression to calculate odds ratios (ORs) for hospital or ED use. Mean age was 79.7 (± 4.0 standard deviation) years. After adjustment for age, sex, Charlson comorbidity index, cognition, treatment intensity, and cancer aggressiveness/type, every 0.1-m/s decrease in gait speed was associated with higher mortality (HR, 1.20; 95% CI, 1.12-1.29), odds of unplanned hospitalizations (OR, 1.33; 95% CI, 1.16-1.51), and ED visits (OR, 1.34; 95% CI, 1.17-1.53). Associations held among patients with good Eastern Cooperative Oncology Group performance status (0 or 1). Every 5-kg decrease in grip strength was associated with worse survival (adjusted HR, 1.24; 95% CI, 1.07-1.43) but not hospital or ED use. A model with gait speed and all covariates had comparable predictive power to comprehensive validated frailty indexes (phenotype and cumulative deficit) and all covariates. In summary, gait speed is an easily obtained "vital sign" that accurately identifies frailty and predicts outcomes independent of performance status among older patients with blood cancers.
Collapse
Affiliation(s)
- Michael A Liu
- Harvard T.H. Chan School of Public Health, Boston, MA
- Division of Aging, Brigham and Women's Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | - Clark DuMontier
- Dana-Farber Cancer Institute, Boston, MA
- Division of Gerontology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | - Tammy T Hshieh
- Division of Aging, Brigham and Women's Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | - Jonathan F Bean
- Spaulding Rehabilitation Hospital, Boston, MA; and
- Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
| | | | | | | | - Jane A Driver
- Division of Aging, Brigham and Women's Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
- Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
| |
Collapse
|
28
|
Edge D, Ewing L. The predictive validity of the MoCA‐LD for assessing mental capacity in adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:1280-1287. [DOI: 10.1111/jar.12621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/07/2019] [Accepted: 05/02/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel Edge
- Jeesal Akman Care Corporation Ltd Dereham UK
- School of Psychology University of East Anglia Norwich UK
| | - Louise Ewing
- School of Psychology University of East Anglia Norwich UK
| |
Collapse
|
29
|
Berg JL, Durant J, Léger GC, Cummings JL, Nasreddine Z, Miller JB. Comparing the Electronic and Standard Versions of the Montreal Cognitive Assessment in an Outpatient Memory Disorders Clinic: A Validation Study. J Alzheimers Dis 2019; 62:93-97. [PMID: 29439349 PMCID: PMC5817908 DOI: 10.3233/jad-170896] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Montreal Cognitive Assessment (MoCA) has become widely used as a brief test of cognitive function in patients with neurological disease. More convenient application of the MoCA might increase its use and enhance its utility. An electronic version of the MoCA has recently been developed. To establish validity of the electronic version (eMoCA), discrepancy scores, concordance correlation coefficients (CCC), and root mean squared differences (RMSD) were calculated between each administration method in a sample of 43 new adult patients presenting with primary memory complaints. The CCC was 0.84 and the RMSD was 2.27, with 76% of the sample having a difference score within 2 points. Overall, this study establishes adequate convergent validity between the MoCA and eMoCA among an adult population presenting with memory concerns.
Collapse
Affiliation(s)
- Jody-Lynn Berg
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - January Durant
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Gabriel C Léger
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | | | | | - Justin B Miller
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| |
Collapse
|
30
|
The Montreal Cognitive Assessment as a predictor of dropout from residential substance use disorder treatment. Heliyon 2019; 5:e01282. [PMID: 31025003 PMCID: PMC6476942 DOI: 10.1016/j.heliyon.2019.e01282] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/18/2019] [Accepted: 02/25/2019] [Indexed: 11/24/2022] Open
Abstract
Background Cognitive function is a challenge for many SUD patients, and residential SUD treatment is cognitively demanding. Treatment retention is a predictor for success in SUD treatment, and the literature links low cognitive function to increased dropout rates. In our study we investigate cognitive function and dropout in a residential SUD treatment setting, also accounting for psychological distress. Methods We screened a cohort (N = 142) of inpatients for cognitive function (MoCA®) and psychological distress (SCL-10) and calculated the relative risk for dropping out if over versus under the respective cut-off values (<26 and >1.85), and sex, and age-group (<23 years). We also employed a logistic regression with dropout as outcome and MoCA- and SCL-10 scores, and age and days before testing as input. Results Dropout risk was higher (RR = 1.70) if scoring below MoCA cut-off, and for those younger than 23 years (RR = 2.36). The other variables did not influence dropout risk. MoCA raw scores, age, and SCL-10 were associated with dropout (p < .05); with lower symptoms of psychological distress predicting increased dropout. The interaction between MoCA and SCL-10 scores was not significant (p = .26). Conclusions SUD patients should routinely be screened for cognitive impairment, as it predicts dropout. Screenings should be ensued by appropriate adaptations to treatment and further assessment. The MoCA is a useful screening tool for this, independent of psychological distress. Future studies should replicate our findings, investigate specific interventions, and establish SUD population norms for the MoCA.
Collapse
|
31
|
Williams AM, Lindholm J, Cook D, Siddiqui F, Ghanem TA, Chang SS. Association Between Cognitive Function and Quality of Life in Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2019; 143:1228-1235. [PMID: 29121151 DOI: 10.1001/jamaoto.2017.2014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amy M Williams
- Department of Otolaryngology, Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
| | | | - Diana Cook
- Division of Speech-Language Sciences and Disorders, Department of Neurology, Henry Ford Health System, Detroit, Michigan
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Tamer A Ghanem
- Department of Otolaryngology, Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
| | - Steven S Chang
- Department of Otolaryngology, Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
| |
Collapse
|
32
|
Helene Bergly T, Julius Sømhovd M. The Relation Between ADHD Medication and Mild Cognitive Impairment, as Assessed by the Montreal Cognitive Assessment (MoCA), in Patients Entering Substance Use Disorder Inpatient Treatment. J Dual Diagn 2018; 14:228-236. [PMID: 30183548 DOI: 10.1080/15504263.2018.1496305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) frequently co-occurs with substance use disorders and has some overlapping symptoms with mild cognitive impairment, including executive functions. We wanted to investigate whether patients with ADHD have an excess risk of mild cognitive impairment-like symptoms, as defined by the Montreal Cognitive Assessment (MoCA). Second, we assessed the impact of ADHD medication on the dichotomized MoCA for patients with ADHD. METHODS The participants in this study were 129 inpatients at seven treatment clinics in Norway. All were screened with the MoCA. We calculated relative risk estimates (RR) for scoring in the mild cognitive impairment range (< 26) for those having ADHD. Finally, we calculated the RR for the patients within the ADHD group who were taking medication. RESULTS Of the 129 participants included in the analyses, 38 (29.5%) scored below the MoCA threshold (< 26), and 24 (18.6%) had ADHD that was diagnosed before or during the inpatient treatment. Of the 105 participants without ADHD, 31 (29.5%) scored below the threshold. Seven (29.2%) of those with ADHD scored below the threshold. The risk of scoring in the mild cognitive impairment range for those with and without ADHD was equal (RR = 0.98). Of the 24 patients with ADHD, 9 (37.5%) were taking medication at the time of testing. One of the patients taking medication scored below the threshold compared to six of those not taking medication. This suggests a 72% lower risk of mild cognitive impairment-like symptoms when taking medication (RR = 0.28); however, the effect was not significant. CONCLUSIONS We revealed no excess risk of mild cognitive impairment-like symptoms for the ADHD group. However, within the ADHD group, there was a possible lower risk of mild cognitive impairment-like symptoms for patients taking medication. These results suggest that there may be a confounding overlap of symptoms between ADHD and cognitive function screens that necessitates adequate assessment and treatment of ADHD before screening or measuring cognitive function.
Collapse
Affiliation(s)
| | - Mikael Julius Sømhovd
- a Research and Development , The Tyrili Foundation , Oslo , Norway.,b Department of Psychology , Technical University of Denmark, University of Copenhagen , Copenhagen , Denmark
| |
Collapse
|
33
|
Ram D, George M, Gowdappa B. Correlation of cognitive functions with emotional dysregulation in alcohol dependence: A preliminary study. Indian J Psychiatry 2018; 60:307-311. [PMID: 30405256 PMCID: PMC6201679 DOI: 10.4103/psychiatry.indianjpsychiatry_183_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
CONTEXT AND AIMS Dysfunction of cognition and emotion is known in alcohol dependence; however, their relationship in alcohol dependence is unknown. Thus, this study aimed to know the level of emotional dysregulation and cognitive functions and their correlation in patients with alcohol dependence. MATERIALS AND METHODS In this hospital-based cross-sectional study, 120 patients with alcohol dependence were consecutively recruited and assessed with sociodemographic and clinical pro forma, Montreal Cognitive Assessment (MoCA), and Difficulty in Emotional Regulation Scale-Short Form (DERS-SF). STATISTICAL ANALYSIS Descriptive statistical, Kruskal-Wallis H, and regression analysis. RESULTS Results revealed a mild level of cognitive impairment (mean MoCA score = 0 23.76) and high levels of emotional dysregulation (mean DERS-SF score = 0 26.90). On linear regression analysis (R 2 = 0.266, df = 0 1, F = 0 42.782, P =0.000), the score on MoCA had statistically significant negative association with score on DERS-SF (P = 0.001). CONCLUSIONS Cognitive impairment and emotional dysregulation are inversely related in patients with alcohol dependence. Improving the dysfunction may improve the outcome of alcohol dependence.
Collapse
Affiliation(s)
- Dushad Ram
- Department of Psychiatry, JSS Medical College and Hospital, Mysore, Karnataka, India
| | - Manju George
- Department of Psychiatry, JSS Medical College and Hospital, Mysore, Karnataka, India
| | - Basawanna Gowdappa
- Department of Medicine, JSS Medical College and Hospital, Mysore, Karnataka, India
| |
Collapse
|
34
|
Coleman KKL, Coleman BL, MacKinley JD, Pasternak SH, Finger EC. Association between Montreal Cognitive Assessment Sub-Item Scores and Corresponding Cognitive Test Performance in Patients with Frontotemporal Dementia and Related Disorders. Dement Geriatr Cogn Disord 2018; 43:170-179. [PMID: 28199994 DOI: 10.1159/000457119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2017] [Indexed: 11/19/2022] Open
Abstract
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 (p = 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.
Collapse
|
35
|
Performance of the French version of the 4AT for screening the elderly for delirium in the emergency department. CAN J EMERG MED 2018; 20:903-910. [PMID: 29769154 DOI: 10.1017/cem.2018.367] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Delirium is very frequent in older patients presenting to the emergency department (ED), but is often undetected. The purpose of this study was to evaluate the performance of the French version of the 4 A’s Test (4AT-F) for the detection of delirium and cognitive impairment in older patients. METHODS The study was conducted in four Canadian ED. Participants (n= 320) were independent or semi-independent patients (able to perform ≥5 activities of daily living) aged 65 and older and had an 8-hour exposure to the ED environment. The Telephone Interview for Cognitive Status (TICS-m), the Confusion Assessment Method (CAM) as well as the 4AT-F were administered to patients at the initial interview. The CAM and 4AT-F were then administered twice a day during the patients’ ED or hospital stay. The 4AT-F’s sensitivity and specificity were compared to those of the CAM (for delirium), and to that of the TICS (for cognitive impairment). RESULTS Our results suggest that the 4AT-F has a sensitivity of 84% (95% CI: [76, 93]) and a specificity of 74% (95% CI: [70, 78]) for delirium, as well as a sensitivity of 49% (95% CI: [34, 64]) and a specificity of 87% (95% CI: [82, 92]) for cognitive impairment. CONCLUSION The 4AT-F is a fast and reliable screening tool for delirium and cognitive impairment in ED. Due to its quick administration time, it allows a systematic screening of patients at risk of delirium, without significantly increasing the workload of the ED staff.
Collapse
|
36
|
Postoperative cognitive dysfunction after cochlear implantation. Eur Arch Otorhinolaryngol 2018; 275:1419-1427. [DOI: 10.1007/s00405-018-4976-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/13/2018] [Indexed: 12/27/2022]
|
37
|
Ritter A, Hawley N, Banks SJ, Miller JB. The Association between Montreal Cognitive Assessment Memory Scores and Hippocampal Volume in a Neurodegenerative Disease Sample. J Alzheimers Dis 2018; 58:695-699. [PMID: 28453481 PMCID: PMC5467712 DOI: 10.3233/jad-161241] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Despite widespread use, there have been few investigations into the neuroanatomical correlates of the Montreal Cognitive Assessment (MoCA). In a sample of 138 consecutive patients presenting with cognitive complaints, we report significant correlations between lower MoCA memory scores and smaller hippocampal volumes (r = 0.36–0.41, p < 0.001). We also report that the newly devised memory index score, designed to better capture encoding deficits than the standard delayed recall score, was not significantly better for predicting hippocampal volume. These initial results suggest that poor performance on the MoCA’s memory section should prompt further evaluation for hippocampal atrophy.
Collapse
Affiliation(s)
- Aaron Ritter
- Correspondence to: Aaron Ritter, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Avenue, Las Vegas, NV 89106, USA. Tel.: +1 702 484 6000; Fax: +1 702 483 6039; E-mail:
| | | | | | | |
Collapse
|
38
|
Trudel X, Gilbert-Ouimet M, Milot A, Duchaine CS, Vézina M, Laurin D, Sultan-Taïeb H, Brisson C. Cohort Profile: The PROspective Québec (PROQ) Study on Work and Health. Int J Epidemiol 2018. [PMID: 29534180 DOI: 10.1093/ije/dyy026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Xavier Trudel
- Department of Social and Preventive Medicine, Laval University, Québec, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center, Québec, Canada
| | - Mahée Gilbert-Ouimet
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center, Québec, Canada
| | - Alain Milot
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center, Québec, Canada.,Department of Medicine, Laval University, Québec, Canada
| | - Caroline S Duchaine
- Department of Social and Preventive Medicine, Laval University, Québec, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center, Québec, Canada
| | - Michel Vézina
- National Institute of Public Health of Québec (INSPQ), Québec, Canada
| | - Danielle Laurin
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center, Québec, Canada.,Faculty of Pharmacy, Laval University, Québec, Canada
| | - Hélène Sultan-Taïeb
- Université du Québec à Montréal (UQÀM), School of Management, Montréal, ON, Canada
| | - Chantal Brisson
- Department of Social and Preventive Medicine, Laval University, Québec, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center, Québec, Canada
| | | | | | | |
Collapse
|
39
|
Phua AKS, Hiu SKW, Goh WK, Ikram MK, Venketasubramanian N, Tan BY, Chen CLH, Xu X. Low Accuracy of Brief Cognitive Tests in Tracking Longitudinal Cognitive Decline in an Asian Elderly Cohort. J Alzheimers Dis 2018; 62:409-416. [DOI: 10.3233/jad-170831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- April Ka Sin Phua
- Department of Pharmacology, National University of Singapore, Singapore
- Memory Aging and Cognition Centre, National University Health System, Singapore
| | - Shaun Kuan Wei Hiu
- Department of Pharmacology, National University of Singapore, Singapore
- Memory Aging and Cognition Centre, National University Health System, Singapore
| | - Win King Goh
- Department of Pharmacology, National University of Singapore, Singapore
- Memory Aging and Cognition Centre, National University Health System, Singapore
| | - Mohammad Kamran Ikram
- Departments of Epidemiology and Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Narayanaswamy Venketasubramanian
- Memory Aging and Cognition Centre, National University Health System, Singapore
- Raffles Neuroscience Centre, Raffles Hospital, Singapore
| | | | - Christopher Li-Hsian Chen
- Department of Pharmacology, National University of Singapore, Singapore
- Memory Aging and Cognition Centre, National University Health System, Singapore
| | - Xin Xu
- Department of Pharmacology, National University of Singapore, Singapore
- Memory Aging and Cognition Centre, National University Health System, Singapore
- Centre for Population Health Sciences, Nanyang Technological University, Singapore
| |
Collapse
|
40
|
A pilot study evaluating the association between physical activity and cognition among individuals with Parkinson's disease. Disabil Health J 2018; 11:165-168. [DOI: 10.1016/j.dhjo.2017.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/23/2017] [Accepted: 05/29/2017] [Indexed: 11/19/2022]
|
41
|
Koga S, Parks A, Kasanuki K, Sanchez-Contreras M, Baker MC, Josephs KA, Ahlskog JE, Uitti RJ, Graff-Radford N, van Gerpen JA, Wszolek ZK, Rademakers R, Dickson DW. Cognitive impairment in progressive supranuclear palsy is associated with tau burden. Mov Disord 2017; 32:1772-1779. [PMID: 29082658 DOI: 10.1002/mds.27198] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/14/2017] [Accepted: 09/13/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cognitive impairment is one of the core features of progressive supranuclear palsy. This study aimed to clarify the profile of cognitive impairment and its underlying pathology in progressive supranuclear palsy. METHODS We retrospectively reviewed medical records to evaluate the pattern and severity of cognitive impairment in 121 autopsy-confirmed progressive supranuclear palsy patients. A subset of 37 patients underwent neuropsychological evaluation as part of their clinical workup. The burden of progressive supranuclear palsy-related tau pathology (neurofibrillary tangles/pretangles, coiled bodies, tufted astrocytes, and threads) was semiquantitatively scored in 20 vulnerable brain regions. Concurrent pathologies potentially associated with cognitive impairment, such as Alzheimer's-type pathology, were also assessed. To evaluate possible genetic risk factors for cognitive impairment, genetic analysis for APOE and MAPT was performed. RESULTS Ninety patients (74%) had documented cognitive impairment based on neurologic evaluation. In a subgroup with neuropsychological testing (n = 37), executive functioning was the most severely impaired cognitive domain. A global cognitive impairment index (Spearman's rho, -0.49; P = 0.005) and executive functioning were negatively correlated with total tau burden (Spearman's rho, -0.51; P = 0.003), but not correlated with the Alzheimer's-type pathology. APOE ɛ4 carriers had more severe amyloid pathology, but total tau burden and a global cognitive impairment index did not differ from APOE ɛ4 noncarriers. CONCLUSION Cognitive impairment in progressive supranuclear palsy, most notably executive dysfunction, is associated with severity of progressive supranuclear palsy-related tau pathology. © 2017 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Adam Parks
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
| | - Koji Kasanuki
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Matthew C Baker
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Keith A Josephs
- Department of Neurology (Behavioural Neurology & Movement Disorders), Mayo Clinic, Rochester, Minnesota, USA
| | - J Eric Ahlskog
- Department of Neurology (Behavioural Neurology & Movement Disorders), Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Jay A van Gerpen
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
42
|
Magnetic resonance imaging and clinical outcome in patients with symptomatic carotid artery stenosis after carotid artery revascularization. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:225-232. [PMID: 29056995 PMCID: PMC5644041 DOI: 10.5114/aic.2017.70190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/12/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction About 30% of patients with carotid artery stenosis (CAS) develop dementia after a cerebral ischemic event (CIE), and 20–50% suffer from CIE recurrence during 6 months. Carotid artery revascularization (CAR) may prevent CIE recurrence, at the cost of new microembolic lesions (MES). The impact of CAR on cognitive function is debatable. Aim To assess functional and cognitive outcome, cerebral flow on transcranial Doppler (TCD) and brain magnetic resonance imaging (MRI) in patients with symptomatic CAS referred for CAR. Material and methods Twenty-two patients (aged 69.0 ±7.2 y.o., 15 male) with recent CIE (21.9 ±20.9 days to CAR) related to CAS of mean 89.8 ±3.9% lumen reduction were prospectively evaluated with TCD, diffusion and perfusion MRI, Montreal Cognitive Assessment (MoCA), Mini Mental State Examination (MMSE), modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS) 24 h before, at 24–48 h and 1 month following CAR. Results New MES were found in 11 (50%) subjects following CAR. CAR resulted in a significant increase of cerebral flow velocity in the middle and anterior cerebral arteries (p < 0.002 and p = 0.003; respectively) and cerebral perfusion measured by time to peak (TTP) and mean transit time (MTT) (p = 0.0009 and p = 0.0002; respectively). Neurologic tests showed improvement in NIHSS (2.4 ±1.6 to 1.5 ±1.2, p = 0.003), mRS (from 1.3 ±0.9 to 0.7 ±0.9, p = 0.005), and MMSE (26.7 ±2.2 to 27.6 ±2.3, p = 0.019) at 1 month, while similar MoCA scores were observed before and 1 month after CAR (23.4 ±3.3 vs. 24.1 ±3.7, p = 0.136). Conclusions Improvement of cerebral flow and perfusion and functional outcome, as well as at least no cognitive decline, is observed after CAR for symptomatic CAS.
Collapse
|
43
|
Benge JF, Balsis S, Madeka T, Uhlman C, Lantrip C, Soileau MJ. Factor structure of the Montreal Cognitive Assessment items in a sample with early Parkinson's disease. Parkinsonism Relat Disord 2017; 41:104-108. [DOI: 10.1016/j.parkreldis.2017.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/16/2017] [Accepted: 05/24/2017] [Indexed: 01/10/2023]
|
44
|
Durant J, Berg JL, Banks SJ, Miller JB. Comparing the test of practical judgment with the neuropsychological assessment battery judgment subtest in a neurodegenerative disease clinic population. APPLIED NEUROPSYCHOLOGY-ADULT 2017; 25:489-496. [PMID: 28605212 DOI: 10.1080/23279095.2017.1329147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Test of Practical Judgment (TOP-J) and the Judgment subtest from the Neuropsychological Assessment Battery (NAB-JDG) are both brief interview-based measures that assess judgment. This study compared estimates of judgment obtained from these measures in a neurodegenerative disease population. Records from 61 referrals seen for neuropsychological evaluation in a neurodegenerative disorders clinic were reviewed. Measures of interest included the TOP-J and NAB-JDG. Concordance correlation coefficients (CCC) and root mean square differences (RMSD) were calculated between judgment T-scores. Discrepancy scores were calculated by subtracting NAB-JDG scores from TOP-J scores. CCC showed poor agreement between the judgment measures, with evidence of fixed bias, such that the NAB-JDG systematically generates higher scores than the TOP-J. This fixed bias was present whether NAB-JDG scores are demographically adjusted or unadjusted. There was no evidence of proportional bias. In a neurodegenerative disease clinic population, the TOP-J and NAB-JDG provide estimates of judgment ability that are systematically different. These two measures may be assessing different aspects within the larger construct of judgment and the inconsistency between measures would contraindicate using them interchangeably. Clinicians will need to carefully consider patient characteristics, clinical needs, and review specific item content when selecting between these measures.
Collapse
Affiliation(s)
- January Durant
- a Cleveland Clinic Lou Ruvo Center for Brain Health , Las Vegas , Nevada , USA
| | - Jody-Lynn Berg
- a Cleveland Clinic Lou Ruvo Center for Brain Health , Las Vegas , Nevada , USA
| | - Sarah Jane Banks
- a Cleveland Clinic Lou Ruvo Center for Brain Health , Las Vegas , Nevada , USA
| | | |
Collapse
|
45
|
Mills KA, Mari Z, Pontone GM, Pantelyat A, Zhang A, Yoritomo N, Powers E, Brandt J, Dawson TM, Rosenthal LS. Cognitive impairment in Parkinson's disease: Association between patient-reported and clinically measured outcomes. Parkinsonism Relat Disord 2016; 33:107-114. [PMID: 27733275 PMCID: PMC5154808 DOI: 10.1016/j.parkreldis.2016.09.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/16/2016] [Accepted: 09/24/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND In Parkinson's disease, the association between objective and patient-reported measures of cognitive dysfunction is unknown and highly relevant to research and clinical care. OBJECTIVE To determine which cognitive domain-specific Montreal Cognitive Assessment (MoCA) subscores are most strongly associated with patient-reported cognitive impairment on question 1 (Q1) of the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). METHODS We analyzed data from 759 PD participants and 481 persons without PD with in a retrospective, cross sectional analysis using data from the NINDS Parkinson's Disease Biomarkers Program (PDBP), a longitudinal, multicenter biomarker study. The relationship between a patient-reported cognitive rating (MDS-UPDRS q1.1) and objective cognitive assessments (MoCA) was assessed using multinomial logistic regression modeling and the outcomes reported as conditional odds ratios (cOR's) representing the relative odds of a participant reporting cognitive impairment that is "slight" versus "normal" on MDS-UPDRSq1.1 for a one unit increase in a MoCA sub-score, adjusted for age and education. RESULTS In PD participants, changes in visuospatial-executive performance and memory had the most significant impact on subjective cognitive impairment. A 1-point increase in visuospatial-executive function decreased the chance of reporting a MDS-UPDRS Q1 score of "slight" versus "normal" by a factor of 0.686 (p < 0.001) and each 1 point improvement in delayed recall decreased the odds of reporting "slight" cognitive impairment by a factor of 0.836 (p < 0.001). CONCLUSIONS Conversion from a PD patient's report of "normal" to "slight" cognitive impairment may be associated with changes in visuospatial-executive dysfunction and memory more than other cognitive domains.
Collapse
Affiliation(s)
- Kelly A Mills
- Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Corresponding author. Johns Hopkins Dept. of Neurology, 600 N. Wolfe Street, Meyer 6-181D, Baltimore, MD, 21287, United States.
| | - Zoltan Mari
- Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States
| | - Gregory M Pontone
- Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States
| | - Alexander Pantelyat
- Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States
| | - Angela Zhang
- Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States
| | - Nadine Yoritomo
- Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States
| | - Emma Powers
- Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States
| | - Jason Brandt
- Division of Medical Psychology, Dept. of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 218, Baltimore, MD, 21287, United States
| | - Ted M Dawson
- Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States; Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, United States; Solomon H. Snyder Department of Neuroscience, United States; Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, 21205, United States
| | - Liana S Rosenthal
- Movement Disorders Division, Dept. of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 6-181, Baltimore, MD, 21287, United States; Morris K. Udall Parkinson's Disease Research Center, Johns Hopkins University School of Medicine, 10751 Fall Road, Suite 250, Lutherville, MD 21093, Baltimore, MD, United States
| |
Collapse
|
46
|
Zenisek R, Millis SR, Banks SJ, Miller JB. Prevalence of below-criterion Reliable Digit Span scores in a clinical sample of older adults. Arch Clin Neuropsychol 2016; 31:426-33. [PMID: 27193362 DOI: 10.1093/arclin/acw025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The Reliable Digit Span (RDS) is a well-validated embedded indicator of performance validity. An RDS score of ≤7 is commonly referenced as indicative of invalid performance; however, few studies have examined the classification accuracy of the RDS among individuals suspected for dementia. The current study evaluated performance of the RDS in a clinical sample of 934 non-litigating individuals presenting to an outpatient memory disorders clinic for assessment of dementia. METHOD The RDS was calculated for each participant in the context of a comprehensive neuropsychological assessment completed as part of routine clinical care. Score distributions were examined to establish the base rate of below criterion performance for RDS cutoffs of ≤7, ≤6, and ≤5. One-way ANOVA was used to compare performance on a cognitive screening measure and informant reports of functional independence of those falling below and above cutoffs. RESULTS A cutoff score of ≤7 resulted in a high prevalence of below-criterion performance (29.7%), though an RDS of ≤6 was associated with fewer below-criterion scores (12.8%) and prevalence of an RDS of ≤5 was infrequent (4.3%). Those scoring below cutoffs performed worse on cognitive measures compared with those falling above cutoffs. CONCLUSIONS Using the RDS as a measure of performance validity among individuals presenting with a possibility of dementia increases the risk of misinterpreting genuine cognitive impairment as invalid performance when higher cutoffs are used; lower cutoffs may be useful when interpreted in conjunction with other measures of performance validity.
Collapse
Affiliation(s)
- RyAnna Zenisek
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Scott R Millis
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - Sarah J Banks
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Justin B Miller
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| |
Collapse
|
47
|
Gagnon MM, Laforce R. Computerized vs. Paper-Pencil Assessment of Cognitive Change following Acute Ischemic Stroke. ACTA ACUST UNITED AC 2016. [PMID: 28649579 PMCID: PMC5482710 DOI: 10.4172/2329-6895.1000317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Cognitive impairment is common among patients with stroke and early recognition can optimize patient care. Objective To determine the validity of computerized cognitive testing in an adult population with acute ischemic stroke. Design Validation study comparing computerized vs paper-pencil assessments at two time points three months apart in a stroke unit. Main outcome Correlation analyses between computerized (using CogState Brief Battery) and paper-pencil testing (using the Montreal Cognitive Assessment) both at study entry and follow-up visits. Results We found moderate to strong significant correlations between the two instruments at study entry and follow-up sessions. Executive dysfunctions were the main cognitive changes. Test-retest correlations were strong. Conclusion and Relevance The CogState Brief Battery is a valid alternative for clinicians who wish to measure cognitive skills following acute ischemic stroke. Limitations of computerized testing are discussed.
Collapse
Affiliation(s)
- Maude-Marie Gagnon
- Département des Sciences Neurologiques, CHU de Québec-Université Laval, Québec, Canada.,Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, CHU de Québec-Université Laval, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - Robert Laforce
- Département des Sciences Neurologiques, CHU de Québec-Université Laval, Québec, Canada.,Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, CHU de Québec-Université Laval, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| |
Collapse
|