Examining the Validity and Utility of Montreal Cognitive Assessment Domain Scores for Early Neurocognitive Disorders

PENSIEVE-AI a brief cognitive test to detect cognitive impairment across diverse literacy

Undiagnosed cognitive impairment is a pervasive global issue, often due to subtle nature of early symptoms, necessitating the use of brief cognitive tests for early detection. However, most brief tests are not scalable (requiring trained professionals), and are not designed for lower literacy groups (e.g. in underserved communities). Here, we developed PENSIEVE-AITM, a drawing-based digital test that is less dependent on literacy, and can be self-administered in <5 min. In a prospective study involving 1758 community-dwelling individuals aged 65 and older from Singapore (education range = 0-23 years), our deep-learning model showed excellent performance in detecting clinically-adjudicated mild cognitive impairment and dementia (AUC = 93%), comparable to traditional neuropsychological assessments (AUC = 94%, Pcomparison = 1.000). Results were consistent even across education subgroups. Being less dependent on literacy, PENSIEVE-AI holds promise for broader deployment in literacy-diverse populations similar to Singapore (e.g. some Asian and lower- and middle-income countries), potentially improving early detection and intervention of cognitive impairment.

Cerebrospinal Fluid Biomarkers and Cognition in Alzheimer Disease and Frontotemporal Dementia in a Memory Clinic Setting

OBJECTIVE

Currently available literature on the relationships between cerebrospinal fluid (CSF) biomarkers and cognitive performance in frontotemporal dementia (FTD) is very limited and inconclusive. In this study, we investigated the association of cognitive symptoms, as measured with Montreal Cognitive Assessment (MoCA), with CSF levels of total tau (t-tau), phosphorylated tau at threonine 181 (p-tau181), and amyloid β 1-42 (Aβ1-42) in a group of patients with probable FTD and Alzheimer disease (AD).

METHODS

We conducted a retrospective cohort study with participants selected from the electronic records of patients seen at Yale New Haven Hospital's Memory Clinic, CT. A total of 61 patients, 28 with FTD (mean age=64.1) and 33 with AD (mean age=66.8), with available CSF results and cognitive test scores in their chart were included in analyses.

RESULTS

T-tau levels negatively and significantly correlated with total MoCA scores as well as the different MoCA index scores in patients with FTD (r=-0.47, P=0.04). There were no significant associations between MoCA scores and p-tau181 levels in patients with FTD (r=-0.22, P=0.25). Patients with AD exhibited significant correlations between MoCA scores and both t-tau (r=-0.54, P<0.01) and p-tau (r=-0.55, P<0.01) levels. Also, Aβ1-42 levels were not significantly correlated with MoCA scores in either of the FTD and AD groups.

CONCLUSION

CSF concentrations of t-tau are inversely correlated to cognitive performance in patients with FTD and both t-tau and p-tau181 in AD. This study provides valuable insights into the relationship between clinical cognitive performance and tau-related pathology in FTD in comparison with AD.

The association between insomnia and cognitive decline: A scoping review

OBJECTIVE

This study aimed to investigate the association between insomnia and cognitive decline to provide insights for clinical interventions and future research.

METHODS

The PubMed, Embase, Web of Science, Scopus, Cochrane Library, and ProQuest databases were systematically searched to identify studies on the association between insomnia and cognitive decline published within the last decade. The quality of the included studies was evaluated, followed by data extraction and summary analysis.

RESULTS

A total of 36 studies were included in the review. Both subjective and objective measures were utilized across 12 indices to assess sleep status, while cognitive function was evaluated using 5 scales and 34 tests. The results revealed a significantly increased risk of cognitive decline or Alzheimer's disease among patients with insomnia, alongside notable impairments in attention, memory, visuospatial abilities, executive function, and verbal memory. Comprehensive assessments of cognitive domains were more sensitive in detecting group differences compared to assessments of specific cognitive sub-functions. Furthermore, MRI analyses showed reduced gray matter volumes in regions such as the prefrontal cortex, cingulate gyrus, temporal lobe, and hippocampus, together with reduced integrity of the white matter in patients with insomnia.

CONCLUSIONS

The findings indicate a potentially bidirectional relationship between insomnia and cognitive decline, suggesting that each may influence and exacerbate the other. Insomnia may increase the risk of cognitive decline and appears to be associated with reduced gray matter volume and compromised white matter integrity in the brain, which could potentially lead to declines in attention, memory, visuospatial abilities, executive function, and verbal memory. Conversely, cognitive decline may contribute to the onset of insomnia, further deteriorating sleep quality. However, further research is necessary to fully comprehend this intricate relationship.

The Impact of Lexical-semantic Impairment on Spoken Verb Production in Individuals With Mild Cognitive Impairment

BACKGROUND

Although episodic memory is the primary concern in individuals with mild cognitive impairment (MCI), other cognitive functions may also be affected, including language. Language impairment in individuals with MCI has been attributed primarily to the breakdown of semantic representations, difficulties in accessing semantic information, and the weakening of executive functions. However, in most prior studies of word processing in individuals with MCI, researchers have used measures focused on noun production.

OBJECTIVE

To investigate how verb production tasks might aid in detecting cognitive impairment in individuals with MCI.

METHODS

We compared the performance of 45 individuals with MCI and 45 healthy controls on action naming and action fluency tasks.

RESULTS

In the action naming task, the performance of participants with MCI was significantly impaired compared to healthy controls in terms of total score, the number of semantic errors produced, and the use of generic terms. In the action fluency task, participants with MCI produced significantly fewer verbs, fewer clusters, and fewer switches than healthy controls.

CONCLUSION

The results of our study emphasize the utility of verb production tasks in the identification of cognitive impairment in individuals with MCI and provide evidence of the importance of including action naming and action fluency tasks in the assessment of individuals with MCI.

Relationship between neuroimaging and cognition in frontotemporal dementia: An FDG-PET and structural MRI study

BACKGROUND AND PURPOSE

Frontotemporal dementia (FTD) is a clinically and pathologically heterogeneous neurodegenerative condition with a prevalence comparable to Alzheimer's disease for patients under 65 years of age. Limited studies have examined the association between cognition and neuroimaging in FTD using different imaging modalities.

METHODS

We examined the association of cognition using Montreal Cognitive Assessment (MoCA) with both gray matter (GM) volume and glucose metabolism using magnetic resonance imaging and fluorodeoxyglucose (FDG)-PET in 21 patients diagnosed with FTD. Standardized uptake value ratio (SUVR) using the brainstem as a reference region was the primary outcome measure for FDG-PET. Partial volume correction was applied to PET data to account for disease-related atrophy.

RESULTS

Significant positive associations were found between whole-cortex GM volume and MoCA scores (r = 0.46, p = .04). The association between whole-cortex FDG SUVR and MoCA scores was not significant (r = 0.37, p = .09). GM volumes of the frontal cortex (r = 0.54, p = .01), caudate (r = 0.62, p<.01), and insula (r = 0.57, p<.01) were also significantly correlated with MoCA, as were SUVR values of the insula (r = 0.51, p = .02), thalamus (r = 0.48, p = .03), and posterior cingulate cortex (PCC) (r = 0.47, p = .03).

CONCLUSIONS

Whole-cortex atrophy is associated with cognitive dysfunction, and this association is larger than for whole-cortex hypometabolism as measured with FDG-PET. At the regional level, focal atrophy and/or hypometabolism in the frontal cortex, insula, PCC, thalamus, and caudate seem to be important for the decline of cognitive function in FTD. Furthermore, these results highlight how functional and structural changes may not overlap and might contribute to cognitive dysfunction in FTD in different ways.

The Relationship of Cerebrospinal Fluid Biomarkers and Cognitive Performance in Frontotemporal Dementia

Objective

Currently available literature on the relationships between cerebrospinal fluid (CSF) biomarkers and cognitive performance in frontotemporal dementia (FTD) is very limited and inconclusive. In this study, we investigated the association of cognition, as measured with Montreal Cognitive Assessment (MoCA), with CSF levels of total tau (t-tau), phosphorylated tau at threonine 181 (p-tau181), and amyloid β 1-42 (Aβ1-42) in a group of patients with FTD and Alzheimer's disease (AD).

Methods

We conducted a retrospective cohort study with participants selected from the electronic records of patients seen at Yale New Haven Hospital's Memory Clinic, CT, USA. We included 61 patients, 28 with FTD (mean age=64.1) and 33 with AD (mean age=66.8).

Results

T-tau levels negatively and significantly correlated with total MoCA scores as well as the different MoCA index scores in both the FTD (r=-0.469, p<0.05) and AD (r=-0.545, p<0.01) groups. There were no significant associations with MoCA scores and p-tau181 levels in patients with FTD (r=-0.224, p>0.05), unlike patients with AD, who exhibited significant correlations (r=-0.549, p<0.01). Also, Aβ1-42 levels were not significantly correlated with MoCA scores in either of the FTD and AD groups.

Conclusion

CSF concentrations of t-tau are inversely correlated to cognitive performance in patients with FTD and both t-tau and p-tau181 in AD. These findings provide valuable insights into the relationship between clinical cognitive performance and tau-related pathology in FTD.

Relationship between Neuroimaging and Cognition in Frontotemporal Dementia: A [18 F]FDG PET and Structural MRI Study

Background

Frontotemporal dementia (FTD) is a clinically and pathologically heterogeneous condition with a prevalence comparable to Alzheimer's Disease for patients under sixty-five years of age. Gray matter (GM) atrophy and glucose hypometabolism are important biomarkers for the diagnosis and evaluation of disease progression in FTD. However, limited studies have systematically examined the association between cognition and neuroimaging in FTD using different imaging modalities in the same patient group.

Methods

We examined the association of cognition using Montreal Cognitive Assessment (MoCA) with both GM volume and glucose metabolism using structural magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography scanning ([18F]FDG PET) in 21 patients diagnosed with FTD. Standardized uptake value ratio (SUVR) using the brainstem as a reference region was the primary outcome measure for [18F]FDG PET. Partial volume correction was applied to PET data to account for disease-related atrophy.

Results

Significant positive associations were found between whole-cortex GM volume and MoCA scores (r = 0.461, p = 0.035). The association between whole-cortex [18F]FDG SUVR and MoCA scores was not Significant (r = 0.374, p = 0.094). GM volumes of the frontal cortex (r = 0.540, p = 0.011), caudate (r = 0.616, p = 0.002), and insula (r = 0.568, p = 0.007) were also Significantly correlated with MoCA, as were SUVR values of the insula (r = 0.508, p = 0.018), thalamus (r = 0.478, p = 0.028), and posterior cingulate cortex (PCC) (r = 0.472, p = 0.030).

Discussion

Whole-cortex atrophy is associated with cognitive dysfunction, and this effect is larger than for cortical hypometabolism as measured with [18F]FDG PET. At the regional level, focal atrophy and/or hypometabolism in the frontal lobe, insula, PCC, thalamus, and caudate seem to imply the importance of these regions for the decline of cognitive function in FTD. Furthermore, these results highlight how functional and structural changes may not overlap and might contribute to cognitive dysfunction in FTD in different ways. Our findings provide insight into the relationships between structural, metabolic, and cognitive changes due to FTD.