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Vlahovic L, McDonald J, Hinman J, Tomczak A, Lock C, Palmer CA, Cook LJ, Yeaman MR, Burnett MK, Deutsch GK, Nelson LM, Han MH. Prevalence, Demographic, and Clinical Factors Associated With Cognitive Dysfunction in Patients With Neuromyelitis Optica Spectrum Disorder. Neurology 2024; 102:e207965. [PMID: 38165361 PMCID: PMC10834131 DOI: 10.1212/wnl.0000000000207965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Neuromyelitis optica spectrum disorder (NMOSD) is a chronic CNS demyelinating autoimmune disorder targeting the astrocyte antigen aquaporin-4 (AQP4), typically presenting with optic neuritis, transverse myelitis, and brain syndromes. Cognitive dysfunction (CD) in NMOSD is under-recognized and poorly understood. The purpose of this study was to evaluate the prevalence and clinical variables associated with CD in NMOSD. METHODS This observational retrospective study with longitudinal follow-up describes a clinical cohort seen in the Collaborative International Research in Clinical and Longitudinal Experience Study in NMOSD. Serial Montreal Cognitive Assessments (MoCAs) were performed upon enrollment and at 6-month intervals to evaluate longitudinal cognitive function relative to demographic and disease-related factors. We used 2-tailed t test, analysis of variance, the χ2 test, linear regression for univariable and adjusted analyses and simultaneous linear regression and mixed-effects model for multivariable analyses. RESULTS Thirty-four percent (75/219) of patients met criteria for CD (MoCA <26); 29% (64/219) showed mild dysfunction (MoCA 20-26/30), and 5% (11/219) showed moderate (MoCA <20/30) dysfunction. Patients with less neurologic disability and lower pain scores had higher MoCA scores (95% CI 0.24-0.65 and 95% CI 0.09-0.42, respectively). Patients with at least high school education scored higher on the MoCA (95% CI 2.2-5). When comparing patients dichotomized for CD, patients never on rituximab scored higher than patients only treated with rituximab (p < 0.029). There was no significant association between annualized relapse rate, age, sex, disease duration, AQP4 serostatus or brain lesions, and CD. CD was more pronounced among Black than White patients (95% CI -2.7 to -0.7). Multivariable analysis of serial MoCA did not indicate change (p = 0.715). Descriptive analysis of serial MoCA showed 30% (45/150) of patients with worsening MoCA performance had impaired language and verbal recall. DISCUSSION To our knowledge, this is the largest study of diverse cohort to investigate CD in patients with NMOSD. Our findings demonstrate 34% of patients with NMOSD experience mild-to-moderate CD, while 30% of patients demonstrated decline on serial testing. The substantial prevalence of CD in this pilot report highlights the need for improved and validated screening tools and comprehensive measures to investigate CD in NMOSD.
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Affiliation(s)
- Luka Vlahovic
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Jamie McDonald
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Jessica Hinman
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Anna Tomczak
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Christopher Lock
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Chella A Palmer
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Lawrence J Cook
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Michael R Yeaman
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Melinda K Burnett
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Gayle K Deutsch
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Lorene M Nelson
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - May H Han
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
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Oz M, Ozel Asliyuce Y, Demirel A, Cetin H, Ulger O. Determination of cognitive status and influencing variables in patients with chronic neck pain: A cross-sectional study. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:764-771. [PMID: 34597197 DOI: 10.1080/23279095.2021.1980795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aimed to evaluate cognitive function in individuals with chronic neck pain (CNP) and investigate the effects of different variables on cognition. METHODS The sociodemographic characteristics of the individuals who participated in this study were recorded. Pain intensity of the individuals was evaluated using the Visual Analog Scale, pain-related disability was evaluated with the Neck Disability Index and cognitive function was evaluated using Montreal Cognitive Assessment (MoCA). RESULTS For this study, 95 patients with CNP were recruited. The mean age was 45.61 ± 11.14, and the median MoCA score was 24 (20-26), and 64.2% of the patients scored below the original cutoff (<26/30 points). The regression analysis showed that higher age and lower education levels were associated with lower MoCA scores. Education appeared to be the most influential variable. Younger participants (18-45) performed systematically better on naming, attention and language domains than their older counterparts (over 45). CONCLUSIONS The findings suggest that age and education play an important role in MoCA total and domain scores in these patients. While treating these patients, assessment of cognitive function can be useful for effective pain management.
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Affiliation(s)
- Muzeyyen Oz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Yasemin Ozel Asliyuce
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Aynur Demirel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Hatice Cetin
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ozlem Ulger
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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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.
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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
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Silva AR, Santos I, Fernandes C, Silva C, Pereira D, Galego O, Queiroz H, Almeida MDR, Baldeiras I, Santo G. The relevance of the socio-emotional deficits in cerebral small vessels disease (CSVD): An exploratory study with sporadic CSVD and CADASIL patients. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 5:100186. [PMID: 38162294 PMCID: PMC10757198 DOI: 10.1016/j.cccb.2023.100186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/03/2023] [Accepted: 09/25/2023] [Indexed: 01/03/2024]
Abstract
Background Cerebral Small Vessels Disease (CSVD) is categorized in different forms, the most common being the sporadic form and a genetic variant - Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL). Amongst the most frequent clinical manifestations are the neuropsychological changes of cognitive, behavioral, and emotional nature, whose features are still under debate. Objective This exploratory study aimed to compare the neuropsychological profile of a sporadic CSVD sample and a CADASIL sample with an age, education, and gender matched control group, between the ages of 30-65 YO (total sample mean age=51.16; SD=4.31). Methods 20 patients with sporadic CSVD, 20 patients with CADASIL and 20 matched controls completed a neuropsychological assessment battery. Global cognitive state, processing speed, working memory, attention, executive dysfunction, episodic memory, social cognition, impulsivity, apathy, alexithymia, depression, and anxiety were measured. White matter hyperintensities (WMH) volume were quantified and measured as lesion burden. Results The cognitive differences found between the clinical groups combined (after confirming no differences between the two clinical groups) and matched controls were restricted to speed processing scores (d = 0.32 95 % CI [.12-.47]). The socio-emotional and behavioral profile revealed significantly higher levels of depression (d = 0.21, 95 % CI [.16-.33]). and anxiety (d = 0.25 95 % CI [.19-.32]) in CADASIL and sporadic CSVD groups, and the same for the alexithymia score (d = 0.533 95 % CI [.32-.65]) were the clinical groups revealed impoverished emotional processing compared to controls. WMH only significantly correlated with the cognitive changes and age. Conclusions In our study, CADASIL and sporadic cSVD patients combined, present multiple emotional-behavioral symptoms - alexithymia, anxiety, depression, and in a lower extent apathy and impulsivity - suggesting for the presence of emotion dysregulation behaviors, present independently of age and of the presence of cognitive deficits. Despite of the small sample size that could underpower some findings, this exploratory research supported that these symptoms may have a significant impact in disease monitoring, progression, and prognosis, requiring further investigation regarding their neurophysiological substrates.
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Affiliation(s)
- Ana Rita Silva
- CINEICC – Center for Research in Neuropsychology and Cognitive Behavioral Interventions of the University of Coimbra, Colegio Novo Street, N/A, Coimbra 3000-115, Portugal
| | - Irina Santos
- Neurology Department, Academic and Clinical Centre – Coimbra University Hospitals, Coimbra, Portugal
| | - Carolina Fernandes
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, CNC-CIBB, Coimbra, Portugal
| | - Cristiana Silva
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, CNC-CIBB, Coimbra, Portugal
| | - Daniela Pereira
- Neurorradiology Functional Unit, Coimbra University Hospitals, Coimbra, Portugal
| | - Orlando Galego
- Neurorradiology Functional Unit, Coimbra University Hospitals, Coimbra, Portugal
| | - Henrique Queiroz
- Neurorradiology Functional Unit, Coimbra University Hospitals, Coimbra, Portugal
| | | | - Inês Baldeiras
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - Gustavo Santo
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, CNC-CIBB, Coimbra, Portugal
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Neelamegam M, Ahmad A, Meng Li C, Pui Li W, Zulhaimi NS, Cysique L, Earnshaw V, Omar SFS, Kamarulzaman A, Kamaruzzaman SB, Rajasuriar R. Psychosocial risk factors and cognitive decline in people living with HIV: results from the Malaysian HIV and aging (MHIVA) study. AIDS Care 2023:1-9. [PMID: 37666210 PMCID: PMC10909927 DOI: 10.1080/09540121.2023.2254543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Abstract
HIV-associated mortality has improved with the advent of antiretroviral therapy, yet neurocognitive decline persists. We assessed the association between psychosocial risk factors and cognitive function among Malaysian PLWH. Data of virally suppressed PLWH (n = 331) on stable ART, from the Malaysian HIV and Aging study was assessed. Psychosocial factors were assessed using the Lubben Social Network Scale-6 (social isolation) and Depression Anxiety Stress Scale-21 (DASS-21). The Montreal Cognitive Assessment (MoCA) with normative standards for the Malaysian population was used to determine cognitive function. Linear and logistic regression were used to assess the associations between cognition, and psychosocial risk factors. Median age of participants was 43.8 years (IQR 37.7-51.0). Participants were predominantly male (82.8%), with secondary education or higher (85.2%). Participants were on ART for 5.7 years (IQR 3.0-9.7), with a mean MoCA score of 24.6 (±3.7). Social isolation was found in 34.6% of participants, and severe depression, severe stress, and severe anxiety in 10.6%, 15.4%, and 6.0% respectively. After adjusting for demographic, clinical, and HIV parameters, MoCA scores were significantly associated with severe stress (β = -0.11, p = 0.02) and having marginal friendship ties (β = -0.13, p = 0.03). Social isolation and severe stress are associated with neurocognitive impairment in PLWH.
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Affiliation(s)
- Malinee Neelamegam
- Department of Biostatistics and Epidemiology, School of Public Health, The University of North Texas Health Science Center, TX, USA
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Ahsan Ahmad
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- School of Medicine, Yale University, New Haven, CT, USA
| | - Chong Meng Li
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wong Pui Li
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nurul Syuhada Zulhaimi
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lucette Cysique
- School of Psychology, Faculty of Science, The University of New South Wales, Sydney, Australia
| | - Valerie Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, DE, United States
| | - Sharifah Faridah Syed Omar
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Reena Rajasuriar
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Turner JR, Hill NL, Brautigam L, Bhargava S, Mogle J. How Does Exposure to Dementia Relate to Subjective Cognition? A Systematic Review. Innov Aging 2023; 7:igad056. [PMID: 37497342 PMCID: PMC10368315 DOI: 10.1093/geroni/igad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Indexed: 07/28/2023] Open
Abstract
Background and Objectives Subjective cognitive decline (SCD) may be indicative of future objective cognitive decline. However, factors other than objective cognitive performance may influence SCD. This review addresses whether family history or close, nonfamilial exposure to dementia is associated with self-reported SCD. Research Design and Methods Searches were conducted in PubMed, PsycINFO, Web of Science, and the Dissertations and Theses database. Eligible articles included measures of self-reported cognition for community-dwelling middle-aged or older adults (40+ years) not diagnosed with dementia, and who had either a family history of dementia, a family member, spouse, or close friend with dementia. The quality of evidence was evaluated using the LEGEND Appraisal Tool. Evidence was synthesized narratively. Results A total of 32 articles were included, with 28 rated as good quality. Across studies, the relationship between dementia exposure and SCD was inconsistent. A significant association between exposure and SCD was found in 6 studies; however, 17 reviewed studies found no evidence of a relationship. The remaining 9 studies found mixed associations. Modifying factors that could potentially influence these associations were exploratorily identified among studies to provide context to our results. These factors included dementia worry, emotional closeness, and measurement sensitivity. Discussion and Implications Findings of this review suggest that both first-degree relatives and spouses of persons with dementia may have an increased likelihood of reporting SCD, although the current heterogeneity in definitions of exposure to dementia and SCD may influence these findings. In addition to the relationship between dementia exposure and SCD, future research should examine potential modifiers, including meaning attributed to exposure, as identifying how these perceptions affect cognition may promote early intervention.
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Affiliation(s)
- Jennifer R Turner
- Edna Bennett Pierce Prevention Research Center, College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Psychology, College of Arts and Sciences, University of Hawaiʻi at Hilo, Hilo, Hawaii, USA
| | - Nikki L Hill
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Leslie Brautigam
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Sakshi Bhargava
- Department of Patient-Centered Outcomes Assessment, RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Jacqueline Mogle
- Edna Bennett Pierce Prevention Research Center, College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Psychology, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, South Carolina, USA
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Wang C, Nester CO, Chang K, Rabin LA, Ezzati A, Lipton RB, Katz MJ. Tracking cognition with the T-MoCA in a racially/ethnically diverse older adult cohort. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12410. [PMID: 36950700 PMCID: PMC10026378 DOI: 10.1002/dad2.12410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/03/2023] [Accepted: 01/25/2023] [Indexed: 03/10/2023]
Abstract
Introduction We investigated the utility of the Telephone-Montreal Cognitive Assessment (T-MoCA) to track cognition in a diverse sample from the Einstein Aging Study. Methods Telephone and in-person MoCA data, collected annually, were used to evaluate longitudinal cognitive performance. Joint models of T-MoCA and in-person MoCA compared changes, variance, and test-retest reliability measured by intraclass correlation coefficient by racial/ethnic group. Results There were no significant differences in baseline performance or longitudinal changes across three study waves for both MoCA formats. T-MoCA performance improved over waves 1-3 but declined afterward. Test-retest reliability was lower for the T-MoCA than for the in-person MoCA. In comparison with non-Hispanic Whites, non-Hispanic Blacks and Hispanics performed worse at baseline on both MoCA formats and showed lower correlations between T-MoCA and in-person versions. Conclusions The T-MoCA provides valuable information on cognitive change, despite racial/ethnic disparities and practice effects. We discuss implications for health disparity populations. Highlights We assessed the comparability of Telephone-Montreal Cognitive Assessment (T-MoCA) and in-person MoCA for tracking cognition.Changes within 3 years in T-MoCA were similar to that for the in-person MoCA.T-MoCA is subject to practice effects and shows difference in performance by race/ethnicity.Test-retest reliability of T-MoCA is lower than that for in-person MoCA.
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Affiliation(s)
- Cuiling Wang
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Caroline O. Nester
- Department of PsychologyBrooklyn CollegeCity University of New York (CUNY)BrooklynNew YorkUSA
- Department of PsychologyThe Graduate CenterCity University of New York (CUNY)New YorkNew YorkUSA
| | - Katherine Chang
- Department of PsychologyBrooklyn CollegeCity University of New York (CUNY)BrooklynNew YorkUSA
- Department of PsychologyThe Graduate CenterCity University of New York (CUNY)New YorkNew YorkUSA
| | - Laura A. Rabin
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of PsychologyBrooklyn CollegeCity University of New York (CUNY)BrooklynNew YorkUSA
- Department of PsychologyThe Graduate CenterCity University of New York (CUNY)New YorkNew YorkUSA
| | - Ali Ezzati
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Richard B. Lipton
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Psychiatry and Behavioral SciencesAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Mindy J. Katz
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
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López-Martos D, Brugulat-Serrat A, Cañas-Martínez A, Canals-Gispert L, Marne P, Gramunt N, Suárez-Calvet M, Milà-Alomà M, Minguillon C, Fauria K, Zetterberg H, Blennow K, Gispert JD, Molinuevo JL, Grau-Rivera O, Sánchez-Benavides G. Reference Data for Attentional, Executive, Linguistic, and Visual Processing Tests Obtained from Cognitively Healthy Individuals with Normal Alzheimer's Disease Cerebrospinal Fluid Biomarker Levels. J Alzheimers Dis 2023; 95:237-249. [PMID: 37483000 PMCID: PMC10578268 DOI: 10.3233/jad-230290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Conventional neuropsychological norms likely include cognitively unimpaired (CU) individuals with preclinical Alzheimer's disease (AD) pathology (amyloid-β, tau, and neurodegeneration) since they are based on cohorts without AD biomarkers data. Due to this limitation, population-based norms would lack sensitivity for detecting subtle cognitive decline due to AD, the transitional stage between healthy cognition and mild cognitive impairment. We have recently published norms for memory tests in individuals with normal cerebrospinal fluid (CSF) AD biomarker levels. OBJECTIVE The aim of the present study was to provide further AD biomarker-based cognitive references covering attentional, executive function, linguistic, and visual processing tests. METHODS We analyzed 248 CU individuals aged between 50-70 years old with normal CSF Aβ, p-tau, and neurodegeneration (t-tau) biomarker levels. The tests included were the Trail Making Test (TMT), Semantic Fluency Test, Digit and Symbol Span, Coding, Matrix Reasoning, Judgement of Line Orientation and Visual Puzzles. Normative data were developed based on regression models adjusted for age, education, and sex when needed. We present equations to calculate z-scores, the corresponding normative percentile tables, and online calculators. RESULTS Age, education, and sex were associated with performance in all tests, except education for the TMT-A, and sex for the TMT-B, Coding, and Semantic Fluency. Cut-offs derived from the current biomarker-based reference data were higher and more sensitive than standard norms. CONCLUSION We developed reference data obtained from individuals with evidence of non-pathologic AD biomarker levels that may improve the objective characterization of subtle cognitive decline in preclinical AD.
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Affiliation(s)
- David López-Martos
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Anna Brugulat-Serrat
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Global Brain Health Institute, San Francisco, CA, USA
| | - Alba Cañas-Martínez
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Lidia Canals-Gispert
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Paula Marne
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | | | - Marc Suárez-Calvet
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Servei de Neurologia, Hospital del Mar, Barcelona, Spain
| | - Marta Milà-Alomà
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Department of Veterans Affairs Medical Center, Northern California Institute for Research and Education (NCIRE), San Francisco, CA, USA
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Carolina Minguillon
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Karine Fauria
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBERBBN), Instituto de Salud Carlos III, Madrid, Spain
| | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Oriol Grau-Rivera
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Servei de Neurologia, Hospital del Mar, Barcelona, Spain
| | - Gonzalo Sánchez-Benavides
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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Zhang J, Basnet D, Du X, Yang J, Liu J, Wu F, Zhang X, Liu J. Does cognitive frailty predict delayed neurocognitive recovery after noncardiac surgery in frail elderly individuals? Probably not. Front Aging Neurosci 2022; 14:995781. [DOI: 10.3389/fnagi.2022.995781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
IntroductionDelayed neurocognitive recovery (DNR) is a common post-surgical complication among the elderly. Cognitive frailty (CF) is also an age-related medical syndrome. However, little is known about the association between CF and DNR. Therefore, this study aimed to study whether CF is associated with DNR in elderly patients undergoing elective noncardiac surgery, as well as to explore the potential risk factors for DNR in frail elderly individuals and construct a prediction model.MethodsThis prospective cohort study administered a battery of cognitive and frailty screening instruments for 146 individuals (≥65 years old) scheduled for elective noncardiac surgery. Screening for CF was performed at least one day before surgery, and tests for the presence of DNR were performed seven days after surgery. The association between CF and DNR was investigated. Moreover, the study subjects were randomly divided into a modeling group (70%) and a validation group (30%). Univariate and multivariate logistic regression was performed to analyze the modeling group data and identify the independent risk factors for DNR. The R software was used to construct DNR's nomogram model, verifying the model.ResultsIn total, 138 individuals were eligible. Thirty-three cases were diagnosed with DNR (23.9%). No significant difference in the number of patients with CF was observed between the DNR and non-DNR groups (P > 0.05). Multivariate analysis after adjusting relevant risk factors showed that only the judgment of line orientation (JLOT) test score significantly affected the incidence of DNR. After internal validation of the constructed DNR prediction model, the area under the curve (AUC) of the forecast probability for the modeling population (n = 97) for DNR was 0.801, and the AUC for the validation set (n = 41) was 0.797. The calibration curves of both the modeling and validation groups indicate that the prediction model has good stability.ConclusionCognitive frailty is not an independent risk factor in predicting DNR after noncardiac surgery in frail elderly individuals. The preoperative JLOT score is an independent risk factor for DNR in frail elderly individuals. The prediction model has a good degree of discrimination and calibration, which means that it can individually predict the risk probability of DNR in frail elderly individuals.
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Lim XR, Chew POK, Lim GH, Low YL, Lim JWP, Ong HN, Law WG, Tan JWL, Thong BY, Chia FLA, Lian TY, Chan GYL, Chan MTL, Koh ET, Kong KO, Howe HS. Montreal cognitive assessment as a screening instrument for cognitive impairment in systemic lupus erythematosus patients without overt neuropsychiatric manifestations. Lupus 2022; 31:1759-1769. [PMID: 36218127 DOI: 10.1177/09612033221132237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The Montreal Cognitive Assessment (MoCA) is an increasingly used screening tool for cognitive impairment. The aim of this study was to examine how MoCA performed in identifying cognitive impairment (CI) domains in SLE patients compared with formal standardized neuropsychological testing (NPT). Factors related to SLE disease, immunologic and psychological state associated with CI were also explored. METHODS This cross-sectional study recruited 50 SLE patients without overt neuropsychiatric manifestations from April 2017 to May 2018. The patients were evaluated with MoCA, formal NPT and the Depression, Anxiety, and Stress Scales (DASS) 42-item self-report questionnaire. Values of sensitivity and specificity were computed for different cut-offs of MoCA within each cognitive domain of NPT and descriptive analysis was used to identify the factors affecting cognitive function. RESULTS The median score for MoCA was 27.5 (range 22-30). Using a MoCA cutoff of <26, 18 (36%) were identified to have CI using NPT compared to 8 (16%) using MoCA. The most frequently affected cognitive domain was executive functioning with 15 affected patients. Sensitivities and specificities of the MoCA range from 50% to 100% and 5.7% to 16.7%, respectively, across cognitive domains. A lower MoCA cutoff of <25 improve sensitivity of identifying impairment in executive functioning from 60% to 80%. In univariate analysis, DASS scores, disease activity, presence of antiphospholipid antibodies, presence of concurrent autoimmune disease, current, and cumulative corticosteroid therapy did not predict cognitive performance. CONCLUSION MoCA may be a useful screening tool to identify the most frequently affected cognitive domain which is executive functioning using a lower cutoff of <25 in SLE patients without overt neuropsychiatric manifestations.
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Affiliation(s)
- Xin Rong Lim
- Department of Rheumatology, Allergy and Immunology, 63703Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Gek Hsiang Lim
- Clinical Research and Innovation Office, 63703Tan Tock Seng Hospital, Singapore, Singapore
| | - Yung Ling Low
- Department of Psychology, 63703Tan Tock Seng Hospital, Singapore, Singapore
| | - June Wei Ping Lim
- Department of Psychology, 63703Tan Tock Seng Hospital, Singapore, Singapore
| | - Huey Ni Ong
- Department of Rheumatology, Allergy and Immunology, 63703Tan Tock Seng Hospital, Singapore, Singapore
| | - Weng Giap Law
- Department of Rheumatology, Allergy and Immunology, 63703Tan Tock Seng Hospital, Singapore, Singapore
| | - Justina Wei Lynn Tan
- Department of Rheumatology, Allergy and Immunology, 63703Tan Tock Seng Hospital, Singapore, Singapore
| | - Bernard Yh Thong
- Department of Rheumatology, Allergy and Immunology, 63703Tan Tock Seng Hospital, Singapore, Singapore
| | - Faith Li-Ann Chia
- Department of Rheumatology, Allergy and Immunology, 63703Tan Tock Seng Hospital, Singapore, Singapore
| | - Tsui Yee Lian
- Department of Rheumatology, Allergy and Immunology, 63703Tan Tock Seng Hospital, Singapore, Singapore
| | - Grace Yin Lai Chan
- Department of Rheumatology, Allergy and Immunology, 63703Tan Tock Seng Hospital, Singapore, Singapore
| | - Madelynn Tsu-Li Chan
- Department of Rheumatology, Allergy and Immunology, 63703Tan Tock Seng Hospital, Singapore, Singapore
| | - Ee Tzun Koh
- Department of Rheumatology, Allergy and Immunology, 63703Tan Tock Seng Hospital, Singapore, Singapore
| | - Kok Ooi Kong
- Department of Rheumatology, Allergy and Immunology, 63703Tan Tock Seng Hospital, Singapore, Singapore
| | - Hwee Siew Howe
- Department of Rheumatology, Allergy and Immunology, 63703Tan Tock Seng Hospital, Singapore, Singapore
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Gül Ö, Gündüz A, Sevgi DY, Demirbaş ND, Uzun N, Dökmetaş İ. Cognitive Assessment of Young Adults Before and After Initiation of Combination Antiretroviral Therapy. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2022; 4:163-171. [PMID: 38633390 PMCID: PMC10986713 DOI: 10.36519/idcm.2022.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/16/2022] [Indexed: 04/19/2024]
Abstract
Objective In the determination and monitoring of neurocognitive disorders in human immunodeficiency virus (HIV)-positive individuals, there is a need for significantly more practical methods which provide results in a shorter time than the tests that require challenging and specialized expertise. This study aimed to evaluate cognitive functions and the factors affecting them in naïve HIV-positive patients using by Montreal Cognitive Assessment (MoCA) test before and after the initiation of combination antiretroviral therapy. Materials and Methods HIV-positive, treatment-naïve patients monitored between January-June 2017 were included in the study. The MoCA test was performed at the beginning and the sixth month of the treatment. Results Forty male patients were included in the study. The mean age was calculated as 29.1±4.0. When the factors affecting the MoCA score were examined, there was a significant relationship between the education level and the MoCA score. Smoking, using alcohol, and substance did not have a significant impact on baseline MoCA values. A significant correlation was found between cluster differentiation 4 (CD4) count and HIV RNA level and attention function. There was a significant increase in the total MoCA score and the MoCA subgroup scores at the end of the sixth month of the treatment. Conclusion MoCA test is one of the most practical tests that can be applied in a short time period, and it was found useful in evaluating the changes in the cognitive functions of HIV-positive patients during antiretroviral treatment.
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Affiliation(s)
- Özlem Gül
- Infectious Disease and Clinical Microbiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
| | - Alper Gündüz
- Infectious Disease and Clinical Microbiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
| | - Dilek Yıldız Sevgi
- Infectious Disease and Clinical Microbiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
| | - Nazife Duygu Demirbaş
- Infectious Disease and Clinical Microbiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
| | - Nuray Uzun
- Infectious Disease and Clinical Microbiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
| | - İlyas Dökmetaş
- Infectious Disease and Clinical Microbiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
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Ma J, Yang X, Xu F, Li H. Application of Diffusion Tensor Imaging (DTI) in the Diagnosis of HIV-Associated Neurocognitive Disorder (HAND): A Meta-Analysis and a System Review. Front Neurol 2022; 13:898191. [PMID: 35873786 PMCID: PMC9302369 DOI: 10.3389/fneur.2022.898191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/20/2022] [Indexed: 12/20/2022] Open
Abstract
Background The patients with HIV-associated neurocognitive disorder (HAND) are often accompanied by white matter structure damage. Diffusion tensor imaging (DTI) is an important tool to detect white matter structural damage. However, the changes in DTI values reported in many studies are diverse in different white matter fiber tracts and brain regions. Purpose Our research is dedicated to evaluating the consistency and difference of the correlation between HAND and DTI measures in different studies. Additionally, the value of DTI in HAND evaluation is used to obtain consensus and independent conclusions between studies. Methods We searched PubMed and Web of Science to collect relevant studies using DTI for the diagnosis of HAND. After screening and evaluating the search results, meta-analysis is used for quantitative research on data. Articles that cannot collect data but meet the research relevance will be subjected to a system review. Results The meta-analysis shows that the HAND group has lower fractional anisotropy (standardized mean difference = −0.57 p < 0.0001) and higher mean diffusivity (standardized mean difference = 0.04 p < 0.0001) than the healthy control group in corpus callosum. In other white matter fibers, we found similar changes in fractional anisotropy (standardized mean difference = −1.18 p < 0.0001) and mean diffusivity (standardized mean difference = 0.69 p < 0.0001). However, the heterogeneity (represented by I2) between the studies is high (in corpus callosum 94, 88%, in other matter fibers 95, 81%). After subgroup analysis, the heterogeneity is obtained as 19.5, 40.7% (FA, MD in corpus callosum) and 0, 0% (FA, MD among other white matter fibers). Conclusion The changes in white matter fibers in patients with HAND are statistically significant at the observation level of DTI compared with healthy people. The differences between the studies are mainly derived from demographics, start and maintenance time of antiretroviral therapy, differences in nadir CD4+T cells, and the use of different neurocognitive function scales. As an effective method to detect the changes in white matter fibers, DTI is of great significance for the diagnosis of HAND, but there are still some shortcomings. In the absence of neurocognitive function scales, independent diagnosis remains difficult. Systematic Review Registration:https://inplasy.com/inplasy-2021-10-0079/.
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Affiliation(s)
- Juming Ma
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Xue Yang
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Fan Xu
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Hongjun Li
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
- *Correspondence: Hongjun Li
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Garg P, Maass F, Sundaram SM, Mollenhauer B, Mahajani S, van Riesen C, Kügler S, Bähr M. The relevance of synuclein autoantibodies as a biomarker for Parkinson's disease. Mol Cell Neurosci 2022; 121:103746. [PMID: 35660088 DOI: 10.1016/j.mcn.2022.103746] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 11/27/2022] Open
Abstract
Several studies have investigated if the levels of α-synuclein autoantibodies (α-syn AAb) differ in serum of Parkinson's disease (PD) patients and healthy subjects. Reproducible differences in their levels could serve as a biomarker for PD. The results of previous studies however remain inconclusive. With the largest sample size examined so far, we aimed to validate serum α-syn AAb levels as a biomarker for PD and investigated the presence of AAbs against other synucleins. We performed ELISA and immunoblots to determine synuclein AAb levels in the serum of 295 subjects comprising 157 PD patients from two independent cohorts, 46 healthy subjects, and 92 patients with other neurodegenerative disorders. Although serum α- and β-syn AAb levels were significantly reduced in patients with PD and other neurodegenerative disorders as compared to controls, the AAb levels displayed high inter-and intra-cohort variability. Furthermore, α-syn AAb levels showed no correlation to clinical parameters like age, disease duration, disease severity, and gender, that might also be directed against beta- and gamma-syn. In conclusion, serum synuclein AAb levels do allow the separation of PD from healthy subjects but not from other neurodegenerative disorders. Thus, synuclein AAbs cannot be regarded as a reliable biomarker for PD.
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Affiliation(s)
- Pretty Garg
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany; Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, 37073 Göttingen, Germany.
| | - Fabian Maass
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Sivaraj M Sundaram
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany; Department of Neurogenetics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Brit Mollenhauer
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany; Paracelsus-Elena-Klinik Kassel, Kassel, Germany
| | - Sameehan Mahajani
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany; Department of Neuropathology, Stanford University, California, USA
| | - Christoph van Riesen
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Sebastian Kügler
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Mathias Bähr
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
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14
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Dominguez JC, de Guzman MFP, Joson MLC, Fowler K, Natividad BP, Cruz PS, Jiloca JL, Mactal PB, Dominguez JD, Domingo J, Dominguez-Awao JK, Reandelar M, Javier JR, Phung T, Morris JC, Galvin JE. Validation of AD8-Philippines (AD8-P): A Brief Informant-Based Questionnaire for Dementia Screening in the Philippines. Int J Alzheimers Dis 2021; 2021:7750235. [PMID: 34754516 PMCID: PMC8572610 DOI: 10.1155/2021/7750235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022] Open
Abstract
AIM This study was aimed at validating the Filipino version of AD8 (AD8-P). METHODS Community-dwelling Filipino older persons aged ≥60 years, together with their informants, participated in this study. Psychologists independently interviewed the informants with AD8-P and administered the Filipino-validated Mini-Mental State Examination (MMSE-P) and Montreal Cognitive Assessment (MoCA-P) to the older persons. Neurologists and geriatrician conducted physical and neurological examination and Clinical Dementia Rating™ (CDR™) to determine cognitive diagnosis and were blinded with the results of AD8-P. Dementia was diagnosed based on DSM-IV-TR criteria. AD8-P discriminatory ability to screen for dementia was evaluated according to DSM-IV-TR diagnostic criteria for dementia. RESULTS A total of 366 community-dwelling Filipino older persons aged ≥60 years, 213 with normal cognition and 153 with dementia, and their informants were included in this study. Majority (90%) were at the mildest stage of dementia. Area under the receiver-operating-characteristic curve (AUROC) for AD8-P was 0.94 (95% CI 0.92 to 0.96), demonstrating excellent overall predictive power to screen for dementia. The optimal AD8-P cut-off score with best balance sensitivity (91.5%) and specificity (77.9%) was ≥3. CONCLUSION AD8-P demonstrated good psychometric properties to screen for dementia, even at the earliest stage of cognitive decline.
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Affiliation(s)
- Jacqueline C. Dominguez
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City 1102, Philippines
- Institute for Dementia Care Asia, Quezon City 1102, Philippines
- Dementia Society of the Philippines, Manila City 1008, Philippines
| | - Ma. Fe P. de Guzman
- Institute for Dementia Care Asia, Quezon City 1102, Philippines
- Dementia Society of the Philippines, Manila City 1008, Philippines
- Research and Biotechnology Division, St. Luke's Medical Center, Quezon City 1102, Philippines
| | - Ma. Lourdes C. Joson
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City 1102, Philippines
- Dementia Society of the Philippines, Manila City 1008, Philippines
- Department of Neuroscience and Behavioral Medicine, Faculty of Medicine and Surgery, University of Santo Tomas, Manila 1008, Philippines
| | - Krizelle Fowler
- Institute for Dementia Care Asia, Quezon City 1102, Philippines
- Dementia Society of the Philippines, Manila City 1008, Philippines
- Research and Biotechnology Division, St. Luke's Medical Center, Quezon City 1102, Philippines
| | - Boots P. Natividad
- Institute for Dementia Care Asia, Quezon City 1102, Philippines
- Research and Biotechnology Division, St. Luke's Medical Center, Quezon City 1102, Philippines
| | - Precy S. Cruz
- Institute for Dementia Care Asia, Quezon City 1102, Philippines
- Dementia Society of the Philippines, Manila City 1008, Philippines
| | - Jose Leo Jiloca
- Institute for Dementia Care Asia, Quezon City 1102, Philippines
- Dementia Society of the Philippines, Manila City 1008, Philippines
- Geriatric Center, St. Luke's Medical Center, Quezon City 1102, Philippines
| | - Primitivo B. Mactal
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City 1102, Philippines
- Dementia Society of the Philippines, Manila City 1008, Philippines
| | - Jayvee Dyne Dominguez
- Institute for Dementia Care Asia, Quezon City 1102, Philippines
- St. Luke's College of Medicine William H. Quasha Memorial, Quezon City 1102, Philippines
| | - Jeffrey Domingo
- Institute for Dementia Care Asia, Quezon City 1102, Philippines
- St. Luke's College of Medicine William H. Quasha Memorial, Quezon City 1102, Philippines
| | - Jhozel Kim Dominguez-Awao
- Institute for Dementia Care Asia, Quezon City 1102, Philippines
- St. Louis University College of Medicine, Baguio City 2600, Philippines
| | - Macario Reandelar
- Research and Biotechnology Division, St. Luke's Medical Center, Quezon City 1102, Philippines
| | - Jem R. Javier
- Department of Linguistics, College of Social Sciences and Philosophy, University of the Philippines, Quezon City 1100, Philippines
| | - ThienKieuThi Phung
- Department of Neurology, Danish Dementia Research Center, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - John C. Morris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, USA
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Yu NC, Zhu D, Watts KL, Abraham N, Choice C. Implementation of the telephone montreal cognitive assessment in a telemedicine based pre-admission testing clinic during COVID-19. PERIOPERATIVE CARE AND OPERATING ROOM MANAGEMENT 2021; 24:100191. [PMID: 36568726 PMCID: PMC9764502 DOI: 10.1016/j.pcorm.2021.100191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 12/27/2022]
Abstract
Introduction Postoperative delirium (POD) affects 10-70% of patients 60 years or older and has been linked to increasing length of hospitalization, mortality, and morbidity. Pre-existing cognitive impairment is a predictor of POD. COVID-19 restricted use of in-person cognitive screens. The Telephone Montreal Cognitive Assessment (T-MoCA) can screen for cognitive dysfunction remotely. We evaluated the feasibility of administering T-MoCA in a multiethnic population during pre-operative testing televisits. Methods Patients scheduled for surgery between July 2020 and August 2020 were asked to participate in the T-MoCA at the end of their preadmission testing (PAT) televisit. A retrospective chart review was conducted to collect patient comorbidities and demographics. Patients were stratified by negative (T-MoCA≥19) or positive (T-MoCA<19) for mild cognitive impairment (MCI) and compared using 2-tailed χ2-tests. Univariate logistic regression was used to identify associations between patient characteristics and positive T-MoCA result. Results Fifty out of 65 (77%) patients who consented to the T-MoCA completed the test. The average time to complete the assessment was 10.5 mins. Twenty two (44%) had a negative score and 28 (56%) had a positive score. Patients who had a positive T-MoCA were older (70.04±7.61 yrs) compared to those with a negative T-MoCA (67.68±4.69 yrs, p=0.007), although the distribution of patients above and below age 65 was not different (p=0.243). The two groups did not vary by gender, race/ethnicity, obesity, surgery type, or medical co-morbidities. When we examined our population for predictors of a positive T-MoCA, we found a trend toward men being less likely to score positive on T-MoCA (OR=0.33, 95% CI: 0.10-1.10, p=0.07) compared to women; and that patients with Hispanic race/ethnicity were more likely to test positive on the T-MoCA (OR=4.13, 95% CI: 0.84-20.28, p=0.08) compared to Non-Hispanic Whites. Conclusions Implementation of the T-MoCA in a telemedicine-based PAT setting is feasible. In our cohort, most people who consented to the assessment completed it, and more than half scored positively, which may have important implications on the surgical plan and post-operative recovery. There may be limitations in using T-MoCA in certain populations, such as non-English preferred language, hearing difficulties, lack of focus, and use of external aids, which would need to be explored in a larger sample size.
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Affiliation(s)
- Nick C Yu
- Albert Einstein College of Medicine, Bronx, NY, United States
| | - Denzel Zhu
- Albert Einstein College of Medicine, Bronx, NY, United States
| | - Kara L Watts
- Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Urology, Montefiore Medical Center, Bronx, NY, United States
| | - Nitya Abraham
- Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Urology, Montefiore Medical Center, Bronx, NY, United States
| | - Curtis Choice
- Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Anesthesiology, Montefiore Medical Center, Bronx, NY, United States
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16
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Khaw J, Subramaniam P, Abd Aziz NA, Ali Raymond A, Wan Zaidi WA, Ghazali SE. Current Update on the Clinical Utility of MMSE and MoCA for Stroke Patients in Asia: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178962. [PMID: 34501552 PMCID: PMC8431226 DOI: 10.3390/ijerph18178962] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022]
Abstract
Objective: Primary care clinicians in Asia employed the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) to aid dementia diagnosis post-stroke. Recent studies questioned their clinical utility in stroke settings for relying on verbal abilities and education level, as well as lack of consideration for aphasia and neglect. We aimed to review the clinical utility of the MMSE and MoCA for stroke patients in Asia and provide recommendations for clinical practice. Methods: PubMed, Scopus, Web of Science, and Science Direct were searched for relevant articles. Included studies were assessed for risk of bias. RevMan 5.4 was used for data synthesis (sensitivity and specificity) and covariates were identified. Results: Among the 48 full-text articles reviewed, 11 studies were included with 3735 total subjects; of these studies, 7 (77%) were conducted in China, 3 (27%) in Singapore, and 1 (9%) in South Korea. Both the MMSE and MoCA generally showed adequate sensitivity and specificity. Education was identified as a covariate that significantly affected detection accuracy. Due to heterogeneity in cutoff scores, methodologies, and languages, it was not feasible to suggest a single cutoff score. One additional point is recommended for MoCA for patients with <6 years of education. Conclusion: Clinicians in Asia are strongly recommended to consider the education level of stroke patients when interpreting the results of the MMSE and MoCA. Further studies in other Asian countries are needed to understand their clinical value in stroke settings.
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Affiliation(s)
- Julia Khaw
- Clinical Psychology and Behavioral Health Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (J.K.); (S.E.G.)
| | - Ponnusamy Subramaniam
- Clinical Psychology and Behavioral Health Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (J.K.); (S.E.G.)
- Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
- Correspondence:
| | - Noor Azah Abd Aziz
- Department of Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
| | - Azman Ali Raymond
- Neurology Unit, Department of Internal Medicine, Universiti Teknologi MARA, Shah Alam, Selangor 40450, Malaysia;
| | - Wan Asyraf Wan Zaidi
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
| | - Shazli Ezzat Ghazali
- Clinical Psychology and Behavioral Health Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (J.K.); (S.E.G.)
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17
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Mishra RK, Park C, Zhou H, Najafi B, Thrasher TA. Evaluation of Motor and Cognitive Performance in People with Parkinson's Disease Using Instrumented Trail-Making Test. Gerontology 2021; 68:234-240. [PMID: 33940574 DOI: 10.1159/000515940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/16/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Parkinson's disease (PD) progressively impairs motor and cognitive performance. The current tools to detect decline in motor and cognitive functioning are often impractical for busy clinics and home settings. To address the gap, we designed an instrumented trail-making task (iTMT) based on a wearable sensor (worn on the shin) with interactive game-based software installed on a tablet. The iTMT test includes reaching to 5 indexed circles, a combination of numbers (1-3) and letters (A&B) randomly positioned inside target circles, in a sequential order, which virtually appears on a screen kept in front of the participants, by rotating one's ankle joint while standing and holding a chair for safety. By measuring time to complete iTMT task (iTMT time), iTMT enables quantifying cognitive-motor performance. PURPOSE This study's objective is to examine the feasibility of iTMT to detect early cognitive-motor decline in PDs. METHOD Three groups of volunteers, including 14 cognitively normal (CN) older adults, 14 PDs, and 11 mild cognitive impaireds (MCI), were recruited. Participants completed MoCA, 20 m walking test, and 3 trials of iTMT. RESULTS All participants enabled to complete iTMT with <3 min, indicating high feasibility. The average iTMT time for CN-Older, PD, and MCI participants were 20.9 ± 0.9 s, 32.3 ± 2.4 s, and 40.9 ± 4.5 s, respectively. After adjusting for age and education level, pairwise comparison suggested large effect sizes for iTMT between CN-older versus PD (Cohen's d = 1.7, p = 0.024) and CN-older versus MCI (d = 1.57, p < 0.01). Significant correlations were observed when comparing iTMT time with the gait speed (r = -0.4, p = 0.011) and MoCA score (r = -0.56, p < 0.01). CONCLUSION This study demonstrated the feasibility and early results supporting the potential application of iTMT to determine cognitive-motor and distinguishing individuals with MCI and PD from CN-older adults. Future studies are warranted to test the ability of iTMT to track its subtle changes over time.
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Affiliation(s)
- Ram Kinker Mishra
- Michael E. DeBakey Department of Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Baylor College of Medicine, Houston, Texas, USA, .,Department of Health and Human Performance, Center for Neuromotor and Biomechanics Research, University of Houston, Houston, Texas, USA,
| | - Catherine Park
- Michael E. DeBakey Department of Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Baylor College of Medicine, Houston, Texas, USA
| | - He Zhou
- Michael E. DeBakey Department of Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Baylor College of Medicine, Houston, Texas, USA
| | - Bijan Najafi
- Michael E. DeBakey Department of Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Baylor College of Medicine, Houston, Texas, USA
| | - T Adam Thrasher
- Department of Health and Human Performance, Center for Neuromotor and Biomechanics Research, University of Houston, Houston, Texas, USA
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18
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Goyal M, Ganesh A, Tymianski M, Hill MD, Ospel JM. Iatrogenic Diffusion-Weighted Imaging Lesions: What Is Their Impact and How Can It Be Measured? Stroke 2021; 52:1929-1936. [PMID: 33827240 DOI: 10.1161/strokeaha.120.033984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infarct volume in acute ischemic stroke is closely linked with clinical outcome, with larger infarct volumes being associated with a worse prognosis. Small iatrogenic infarcts, which can occur as a result of surgical or endovascular procedures, are often only seen on diffusion-weighted MR imaging. They often do not lead to any overtly appreciable clinical deficits, hence the term covert or silent infarcts. There is relative paucity of data on the clinical impact of periprocedural hyperintense diffusion-weighted MR imaging lesions, partly because they commonly remain undiagnosed. Clearly, a better understanding of iatrogenic periprocedural diffusion-weighted MR imaging lesions and their clinical significance is needed. In this article, we describe the current limitations of our understanding of the significance of iatrogenic diffusion-weighted MR imaging lesions using exemplary data from the ENACT trial (Safety and Efficacy of NA-1 in Patients With Iatrogenic Stroke After Endovascular Aneurysm Repair) and outline a framework for how to investigate their clinical impact.
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Affiliation(s)
- Mayank Goyal
- Department of Clinical Neurosciences (M.G., A.G., M.D.H., J.M.O.), University of Calgary, Canada.,Department of Radiology (M.G., M.D.H.), University of Calgary, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences (M.G., A.G., M.D.H., J.M.O.), University of Calgary, Canada
| | | | - Michael D Hill
- Department of Clinical Neurosciences (M.G., A.G., M.D.H., J.M.O.), University of Calgary, Canada.,Department of Radiology (M.G., M.D.H.), University of Calgary, Canada
| | - Johanna Maria Ospel
- Department of Clinical Neurosciences (M.G., A.G., M.D.H., J.M.O.), University of Calgary, Canada.,Department of Neuroradiology, University Hospital Basel, Switzerland (J.M.O.)
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19
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Katz MJ, Wang C, Nester CO, Derby CA, Zimmerman ME, Lipton RB, Sliwinski MJ, Rabin LA. T-MoCA: A valid phone screen for cognitive impairment in diverse community samples. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12144. [PMID: 33598528 PMCID: PMC7864219 DOI: 10.1002/dad2.12144] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/23/2020] [Accepted: 12/02/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION There is an urgent need to validate telephone versions of widely used general cognitive measures, such as the Montreal Cognitive Assessment (T-MoCA), for remote assessments. METHODS In the Einstein Aging Study, a diverse community cohort (n = 428; mean age = 78.1; 66% female; 54% non-White), equivalence testing was used to examine concordance between the T-MoCA and the corresponding in-person MoCA assessment. Receiver operating characteristic analyses examined the diagnostic ability to discriminate between mild cognitive impairment and normal cognition. Conversion methods from T-MoCA to the MoCA are presented. RESULTS Education, race/ethnicity, gender, age, self-reported cognitive concerns, and telephone administration difficulties were associated with both modes of administration; however, when examining the difference between modalities, these factors were not significant. Sensitivity and specificity for the T-MoCA (using Youden's index optimal cut) were 72% and 59%, respectively. DISCUSSION The T-MoCA demonstrated sufficient psychometric properties to be useful for screening of MCI, especially when clinic visits are not feasible.
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Affiliation(s)
- Mindy J. Katz
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Cuiling Wang
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Caroline O. Nester
- Department of PsychologyBrooklyn CollegeCity University of New York (CUNY)BrooklynNew YorkUSA
| | - Carol A. Derby
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | | | - Richard B. Lipton
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Psychiatry and Behavioral MedicineAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Martin J. Sliwinski
- Department of Human Development & Family StudiesCenter for Healthy AgingThe Pennsylvania State UniversityUniversity ParkPennsylvaniaUSA
| | - Laura A. Rabin
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of PsychologyBrooklyn CollegeCity University of New York (CUNY)BrooklynNew YorkUSA
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20
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Dujardin K, Duhem S, Guerouaou N, Djelad S, Drumez E, Duhamel A, Bombois S, Nasreddine Z, Bordet R, Deplanque D. Validation in French of the Montreal Cognitive Assessment 5-Minute, a brief cognitive screening test for phone administration. Rev Neurol (Paris) 2021; 177:972-979. [PMID: 33478740 DOI: 10.1016/j.neurol.2020.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/24/2020] [Accepted: 09/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The prevalence of cognitive impairment and dementia is high and steadily increasing. Early detection of cognitive decline is crucial since some interventions can reduce the risk of progression to dementia. However, there is a lack of manageable scales for assessing cognitive functions outside specialized consultations. Recently, the MoCA-5min, a short version of the Montreal Cognitive assessment (MoCA), phone-administered, was validated for screening for vascular cognitive impairment. The aim of the present study was to validate the MoCA-5min in French in diverse clinical populations. METHODS The Cantonese version of the MoCA-5min was adapted for French language. Healthy volunteers and patients with possible or established cognitive impairment (Alzheimer's disease or related disorders, Parkinson's disease, Huntington's disease, type-2 diabetes) participated in the study. The original MoCA and the MoCA-5min were administered, by phone, with a 30-day interval. Alternate forms were used to reduce learning effects. RESULTS The scores of the original MoCA and MoCA-5min correlated significantly (Spearman rho=0.751, P<0.0001, 95% confidence interval 0.657 to 0.819). Internal consistency was good (Cronbach alpha=0.795). The area under the ROC curve was 0.870 and the optimal cut-off value for separating patients with and without cognitive impairment with the MoCA-5min was≤27 with 87.32% sensitivity and 76.09% specificity. Interrater and test-retest reliability were adequate. CONCLUSION This study demonstrates that the French version of the MoCA-5min is a valid and reliable scale for detecting cognitive impairment in different clinical populations. It is administrable by phone and thus suitable for remote assessment as well as for large-scale screening and epidemiological studies.
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Affiliation(s)
- K Dujardin
- Inserm, Lille Neurosciences and Cognition, CHU de Lille, University Lille, 59000 Lille, France; Neurology and Movement Disorders, Lille University Medical Center, Lille, France.
| | - S Duhem
- Clinical Investigation Center, Lille University Medical Center, Lille, France
| | - N Guerouaou
- Clinical Investigation Center, Lille University Medical Center, Lille, France
| | - S Djelad
- Neurology and Movement Disorders, Lille University Medical Center, Lille, France
| | - E Drumez
- EA 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, CHU de Lille, University Lille, Lille, France
| | - A Duhamel
- EA 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, CHU de Lille, University Lille, Lille, France
| | - S Bombois
- Inserm, Lille Neurosciences and Cognition, CHU de Lille, University Lille, 59000 Lille, France
| | | | - R Bordet
- Inserm, Lille Neurosciences and Cognition, CHU de Lille, University Lille, 59000 Lille, France
| | - D Deplanque
- Inserm, Lille Neurosciences and Cognition, CHU de Lille, University Lille, 59000 Lille, France
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21
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Sirivarasai J, Chaisungnern K, Panpunuan P, Chanprasertyothin S, Chansirikanjana S, Sritara P. Role of MT1A Polymorphism and Environmental Mercury Exposure on the Montreal Cognitive Assessment (MoCA). Neuropsychiatr Dis Treat 2021; 17:2429-2439. [PMID: 34326641 PMCID: PMC8314684 DOI: 10.2147/ndt.s320374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/24/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Many age-related structural and functional changes in the brain have important consequences. Long-term exposure to mercury and the impact of functional polymorphisms of metal-regulating proteins such as metallothioneins (MTs) can result in neurological-neurobehavioral effects in elderly individuals. Therefore, the aims of this study are to examine the associations between biomarkers of mercury exposure and cognitive impairment and to investigate the effect of the rs8052394 single nucleotide polymorphism (SNP) of the potential modifier gene MT1A on different domains of the Montreal Cognitive Assessment (MoCA). MATERIALS AND METHODS We studied 436 participants aged ≥55 years from the Electricity Generating Authority of Thailand study. They underwent a physical examination, an extensive cognitive assessment with the MoCA (cutoff <26 points), and a biochemical analysis related to diabetes and dyslipidemia. The blood mercury level was determined by inductively coupled plasma mass spectrometry. Genotyping of the MT1A rs8052394 SNP was performed by the restriction fragmentation length polymorphism method. RESULTS The mean age of the study population was 58.8±3.01 years, and most had ≥12 years of education (75.7%). The primary study finding was that the prevalence of mild cognitive impairment (MCI) in older Thai adults was 39.7%. The frequency distributions of the G allele of the rs8052394 SNP of the MT1A gene were significantly associated with the total and sub-domain MoCA scores. The prevalence of MCI was significantly associated with increased age, hypertriglyceridemia, hyperhomocysteinemia, the third tertile of blood mercury concentration, and the rs8052394 variant genotype of MT1A (P values for all odds ratios <0.05). CONCLUSION These findings suggested that neurocognitive effects associate with mercury exposure and genetic susceptibility in toxicokinetics. Public health strategies can be used to implement as a comprehensive action plan to educate vulnerable populations on how to reduce mercury exposure. Concurrently, impact of such genetic predisposition requires replication for identifying and protecting susceptible individuals from mercury toxicity.
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Affiliation(s)
- Jintana Sirivarasai
- Graduate Program in Nutrition, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kanchaporn Chaisungnern
- Master of Science Program in Food and Nutritional Toxicology, Institute of Nutrition, Mahidol University, Bangkok, Thailand
| | - Pachara Panpunuan
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suwannee Chanprasertyothin
- Research and Innovation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirintorn Chansirikanjana
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Piyamitr Sritara
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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22
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Hebbrecht K, Giltay EJ, Birkenhäger TK, Sabbe B, Verwijk E, Obbels J, Roelant E, Schrijvers D, Van Diermen L. Cognitive change after electroconvulsive therapy in mood disorders measured with the Montreal Cognitive Assessment. Acta Psychiatr Scand 2020; 142:413-422. [PMID: 32895922 DOI: 10.1111/acps.13231] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The Montreal Cognitive Assessment (MoCA) is a sensitive and clinically practical test but its usefulness in measuring long-term cognitive effects of ECT is unclear. Using the MoCA, we investigated short- and long-term global cognitive change in ECT-treated patients with a Major Depressive Episode (MDE). METHOD We included 65 consecutive ECT-treated patients with MDE, in whom global cognitive functioning was assessed at baseline (T0); during ECT (before the third session; T1); and 1 week (T2), 3 months (T3), and 6 months (T4) after completion of the index course. Changes in MoCA (sub)scores were analyzed using linear mixed models and reliable change indices were computed to investigate individual changes in MoCA total scores. RESULTS There was a significant effect of time on MoCA scores (F(4, 230.5) = 4.14, P = 0.003), with an improvement in global cognitive functioning from T3 compared to T1 and T2. At the individual level, 26% (n = 17) of patients showed a significantly worse cognitive functioning at T2 and 12% (n = 8) an improved cognitive functioning compared to T0. For T4, these percentages ameliorated to 8% and 18% respectively. CONCLUSION No persistent global cognitive impairment induced by ECT was found at the group level using the MoCA. At the individual level, however, there was clear heterogeneity in the effects of ECT on cognitive functioning. The MoCA is a suitable tool to monitor short- and long-term global cognitive functioning in ECT-treated patients with MDE but in younger patients, potential ceiling effects must be taken into account.
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Affiliation(s)
- K Hebbrecht
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerpen, Belgium.,VZW Emmaüs, University Psychiatric Hospital Duffel, Duffel, Belgium
| | - E J Giltay
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerpen, Belgium.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - T K Birkenhäger
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerpen, Belgium.,Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - B Sabbe
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerpen, Belgium
| | - E Verwijk
- Department of Medical Psychology (EV), Neuropsychology Department, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Psychology (EV), Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands.,ECT Department Haaglanden (EV), Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - J Obbels
- Academic Center for ECT and Neuromodulation (AcCENT) University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium
| | - E Roelant
- StatUa, Center for Statistics, University of Antwerp, Antwerp, Belgium
| | - D Schrijvers
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerpen, Belgium.,VZW Emmaüs, University Psychiatric Hospital Duffel, Duffel, Belgium
| | - L Van Diermen
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerpen, Belgium.,VZW Emmaüs, University Psychiatric Hospital Duffel, Duffel, Belgium.,Psychiatric Hospital Bethanië, Zoersel, Belgium
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23
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Galinha IC, Farinha M, Lima ML, Palmeira AL. Sing4Health: protocol of a randomized controlled trial of the effects of a singing group intervention on the well-being, cognitive function and health of older adults. BMC Geriatr 2020; 20:354. [PMID: 32948120 PMCID: PMC7501704 DOI: 10.1186/s12877-020-01686-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 08/03/2020] [Indexed: 01/07/2023] Open
Abstract
Background Singing is a multimodal activity that requires physical, cognitive and psychosocial performance, with benefits to various domains of well-being and health in older adults. In recent years, research has increasingly studied group singing as an important cost-effective intervention to promote active and healthy aging. However, the specific factors responsible for these benefits need further experimental support, as most studies do not allow for causal inferences. This study responds to the need for further randomized controlled trials (RCT), with follow-up measurement, on the benefits of group singing in older adults from a low socioeconomic background. Also, while most studies often focus on specific outcome measure dimensions, in this study, the conjoint effect of several physical, psychosocial, psychoemotional and cognitive dimensions are analyzed, testing mediation effects of psychosocial and psychoemotional variables on the well-being and health of the participants. Methods We implement and measure the effects of a singing group program for older adults, with an RCT crossover design study, in a natural context, before and after the intervention and in a follow-up, 6 months after the intervention. Participants 140 retired older adults (> 60 years) users of a social support institution, will be invited to participate in a singing group program and randomly allocated to an experimental (n = 70) and a control (n = 70) group, which will enroll in the regular activities proposed by the institution. The intervention consists of 34 bi-weekly group singing sessions, of 2 h each, for 4 months. Measures on social and emotional well-being, cognitive function, and health indicators (e.g., blood pressure, glycemia, cholesterol, c-reactive protein, sedimentation rate, respiratory function, body balance, sleep quality, medication intake, and health services attendance) will be collected. Interviews will be conducted on the motivation and perceived benefits of participation. Discussion Significant improvements are expected in the outcome measures in the experimental group after the intervention, validating singing groups as a cost-effective intervention for healthy aging. Psychosocial and psychoemotional variables are expected to be mediators of the effects of the program in the cognitive function, well-being and health of the participants. Trial registration NCT03985917. Registered 14th June 2019 (retrospectively registered).
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Affiliation(s)
- Iolanda Costa Galinha
- Centro de Investigação em Psicologia (CIP), da Universidade Autónoma de Lisboa / Universidade do Algarve, CIS-ISTE-IUL; APPSYCI, Rua de Santa Marta, 47, 3° (Room, 304), 1169-023, Lisbon, Portugal.
| | - Manuel Farinha
- Centro de Investigação em Psicologia (CIP), da Universidade Autónoma de Lisboa / Universidade do Algarve from Rua de Santa Marta, 47, 3° (Room, 304), 1169-023, Lisbon, Portugal
| | - Maria Luísa Lima
- ISCTE CIS IUL, Av. das Forças Armadas, ISCTE-IUL building, 2w17 Room, 1649-026, Lisbon, Portugal
| | - António Labisa Palmeira
- Universidade de Lisboa & Universidade Lusófona de Humanidades e Tecnologias, Campo Grande, 376, 1749-024, Lisbon, Portugal
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The MoCA as a cognitive screening tool for Mild Cognitive Impairment (MCI) in elderly adults in China. Psychiatry Res 2020; 291:113210. [PMID: 32540686 DOI: 10.1016/j.psychres.2020.113210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/06/2020] [Accepted: 06/06/2020] [Indexed: 11/22/2022]
Abstract
The objective of this paper is to explore the mild cognitive impairment (MCI) status of elderly individuals in community settings in China and to analyze the associated factors. A quantitative method was used, and a closed-ended survey of 50 elderly individuals was conducted in China. The MoCA scores of elderly adults in the community differed significantly by age, education, and gender. The MoCA scores of elderly individuals with education levels below elementary school were significantly different from those of individuals higher levels of education. By adopting a quantitative method, the author revealed that the incidence rate of MCI in elderly individuals in the community setting is significantly related to gender, age, and education. Future studies should focus on the prevention of dementia, especially in elderly people diagnosed with MCI.
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Gerardo B, Cabral Pinto M, Nogueira J, Pinto P, Almeida A, Pinto E, Marinho-Reis P, Diniz L, Moreira PI, Simões MR, Freitas S. Associations between Trace Elements and Cognitive Decline: An Exploratory 5-Year Follow-Up Study of an Elderly Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6051. [PMID: 32825289 PMCID: PMC7503463 DOI: 10.3390/ijerph17176051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/12/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022]
Abstract
Trace elements (TE) homeostasis is crucial in normal brain functioning. Although imbalances have the potential to exacerbate events leading neurodegenerative diseases, few studies have directly addressed the eventual relationships between TE levels in the human body and future cognitive status. The present study aimed to assess how different TE body-levels relate to cognitive decline. This exploratory research included a study-group (RES) of 20 elderly individuals living in two Portuguese geographical areas of interest (Estarreja; Mértola), as well as a 20 subjects neuropsychological control-group (CTR). Participants were neuropsychologically assessed through the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) and the RES group was biomonitored for TE through fingernail analysis. After 5 years, the cognitive assessments were repeated. Analyses of the RES neuropsychological data showed an average decrease of 6.5 and 5.27 points in MMSE and MoCA, respectively, but TE contents in fingernails were generally within the referenced values for non-exposed individuals. Higher levels of Nickel and Selenium significantly predicted lesser cognitive decline within 5 years. Such preliminary results evidence an association between higher contents of these TE and higher cognitive scores at follow-up, suggesting their contribution to the maintenance of cognitive abilities. Future expansion of the present study is needed in order to comprehensively assess the potential benefits of these TE.
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Affiliation(s)
- Bianca Gerardo
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences (FPCEUC), Univ Coimbra, 3000-115 Coimbra, Portugal; (J.N.); (M.R.S.); (S.F.)
- Psychological Assessment and Psychometrics Laboratory (PsyAssessmentLab), Faculty of Psychology and Educational Sciences (FPCEUC), Univ Coimbra, 3000-115 Coimbra, Portugal;
| | - Marina Cabral Pinto
- Geobiotec Research Centre, Department of Geosciences, University of Aveiro, 3810-193 Aveiro, Portugal; (M.C.P.); (P.M.-R.)
| | - Joana Nogueira
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences (FPCEUC), Univ Coimbra, 3000-115 Coimbra, Portugal; (J.N.); (M.R.S.); (S.F.)
- Psychological Assessment and Psychometrics Laboratory (PsyAssessmentLab), Faculty of Psychology and Educational Sciences (FPCEUC), Univ Coimbra, 3000-115 Coimbra, Portugal;
| | - Paula Pinto
- Psychological Assessment and Psychometrics Laboratory (PsyAssessmentLab), Faculty of Psychology and Educational Sciences (FPCEUC), Univ Coimbra, 3000-115 Coimbra, Portugal;
| | - Agostinho Almeida
- LAQV/REQUIMTE, Laboratory of Applied Chemistry, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (A.A.); (E.P.); (L.D.)
| | - Edgar Pinto
- LAQV/REQUIMTE, Laboratory of Applied Chemistry, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (A.A.); (E.P.); (L.D.)
- Department of Environmental Health, School of Health, P.Porto, CISA/Research Center in Environment and Health, 4200-072 Porto, Portugal
| | - Paula Marinho-Reis
- Geobiotec Research Centre, Department of Geosciences, University of Aveiro, 3810-193 Aveiro, Portugal; (M.C.P.); (P.M.-R.)
- Departamento de Ciências da Terra, Instituto de Ciências da Terra, Polo da Universidade do Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Luísa Diniz
- LAQV/REQUIMTE, Laboratory of Applied Chemistry, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (A.A.); (E.P.); (L.D.)
| | - Paula I. Moreira
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, 3004-504 Coimbra, Portugal;
- Institute of Physiology, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Mário R. Simões
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences (FPCEUC), Univ Coimbra, 3000-115 Coimbra, Portugal; (J.N.); (M.R.S.); (S.F.)
- Psychological Assessment and Psychometrics Laboratory (PsyAssessmentLab), Faculty of Psychology and Educational Sciences (FPCEUC), Univ Coimbra, 3000-115 Coimbra, Portugal;
| | - Sandra Freitas
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences (FPCEUC), Univ Coimbra, 3000-115 Coimbra, Portugal; (J.N.); (M.R.S.); (S.F.)
- Psychological Assessment and Psychometrics Laboratory (PsyAssessmentLab), Faculty of Psychology and Educational Sciences (FPCEUC), Univ Coimbra, 3000-115 Coimbra, Portugal;
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Sex-moderated association between body composition and cognition in older adults. Exp Gerontol 2020; 138:111002. [PMID: 32561399 DOI: 10.1016/j.exger.2020.111002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Some studies have reported an association between body composition and cognition in older adults, but underlying mechanisms and physiological factors remain poorly understood. Moreover, sex-related differences in metabolic health and age-related cognitive decline have gained major interest lately. The present study investigated the potential moderating effect of sex on the relationship between body composition and cognition in older adults. METHODS Global cognition, assessed by the Montreal Cognitive Assessment (MoCA), and body composition, measured using dual-energy x-ray absorptiometry (DXA), were analyzed in 155 women and 65 men aged 60 years old or more. Moderation analyses were computed to determine if sex moderates the effect of the different body composition parameters on the MoCA while controlling for the body mass index and the level of education of the participants. RESULTS Sex moderated the association between total lean mass, trunk lean mass, arms lean mass, and the MoCA score. These body composition parameters were positively associated with cognition only in men. Fat mass was not associated with cognition in any sex. CONCLUSION Overall, higher lean mass and in particular trunk and arms lean mass was associated with higher cognitive abilities in older men. Longitudinal studies or intervention studies are needed to further identify physiological mechanisms that sustain the relationship between lean mass and cognition.
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Emerson A, Muruganantham P, Park MY, Pillay D, Vasan N, Park SJ, Van KL, Pampapathi P, Seow CS, Yau SM. Comparing the Montreal Cognitive Assessment and Rowland Universal Dementia Assessment Scale in a multicultural rehabilitation setting. Intern Med J 2020; 49:1035-1040. [PMID: 31387144 DOI: 10.1111/imj.14392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/11/2019] [Accepted: 05/30/2019] [Indexed: 11/30/2022]
Abstract
In Australia it is recommended that all older people undergoing rehabilitation have a cognitive screen. We performed a longitudinal study comparing the correlation of two cognitive screening tools - the Rowland Universal Dementia Assessment Scale (RUDAS) and Montreal Cognitive Assessment (MoCA) with discharge outcomes in a geriatric inpatient setting. The RUDAS cut-off (<23/30) was associated with discharge to a nursing home (sensitivity 52%, specificity 70%). This was also noted with a MoCA cut-off <18/30 (sensitivity 57%, specificity 69%). Furthermore the association between the RUDAS and discharge destination was independent of its association with the Functional Independence Measure (r = 0.116; P = 0.275) and had a shorter administration time. Both RUDAS and MoCA scores could be used as predictors of discharge destination in a multicultural population.
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Affiliation(s)
- Andrew Emerson
- Department of Geriatric Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Poorani Muruganantham
- Department of Geriatric Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Min Y Park
- Western Clinical School, Westmead Hospital, Sydney, New South Wales, Australia
| | - Deren Pillay
- Western Clinical School, Westmead Hospital, Sydney, New South Wales, Australia
| | - Nikhil Vasan
- Western Clinical School, Westmead Hospital, Sydney, New South Wales, Australia
| | - Seong J Park
- Western Clinical School, Westmead Hospital, Sydney, New South Wales, Australia
| | - Kim L Van
- Western Clinical School, Westmead Hospital, Sydney, New South Wales, Australia
| | - Preethi Pampapathi
- Western Clinical School, Westmead Hospital, Sydney, New South Wales, Australia
| | - Cui S Seow
- Western Clinical School, Westmead Hospital, Sydney, New South Wales, Australia
| | - Siu-Ming Yau
- Department of Geriatric Medicine, Westmead Hospital, Sydney, New South Wales, Australia
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Dautzenberg G, Lijmer J, Beekman A. Diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) for cognitive screening in old age psychiatry: Determining cutoff scores in clinical practice. Avoiding spectrum bias caused by healthy controls. Int J Geriatr Psychiatry 2020; 35:261-269. [PMID: 31650623 PMCID: PMC7028034 DOI: 10.1002/gps.5227] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 09/24/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE/METHODS The Montreal Cognitive Assessment (MoCA) is an increasingly used screening tool for cognitive impairment. While it has been validated in multiple settings and languages, most studies have used a biased case-control design including healthy controls as comparisons not representing a clinical setting. The purpose of the present cross-sectional study is to test the criterion validity of the MoCA for mild cognitive impairment (MCI) and mild dementia (MD) in an old age psychiatry cohort (n = 710). The reference standard consists of a multidisciplinary, consensus-based diagnosis in accordance with international criteria. As a secondary outcome, the use of healthy community older adults as additional comparisons allowed us to underscore the effects of case-control spectrum-bias. RESULTS The criterion validity of the MoCA for cognitive impairment (MCI + MD) in a case-control design, using healthy controls, was satisfactory (area under the curve [AUC] 0.93; specificity of 73% less than 26), but declined in the cross-sectional design using referred but not cognitive impaired as comparisons (AUC 0.77; specificity of 37% less than 26). In an old age psychiatry setting, the MoCA is valuable for confirming normal cognition (greater than or equal to 26, 95% sensitivity), excluding MD (greater than or equal to 21; negative predictive value [NPV] 98%) and excluding MCI (greater than or equal to 26;NPV 94%); but not for diagnosing MD (less than 21; positive predictive value [PPV] 31%) or MCI (less than 26; PPV 33%). CONCLUSIONS This study shows that validating the MoCA using healthy controls overestimates specificity. Taking clinical and demographic characteristics into account, the MoCA is a suitable screening tool-in an old age psychiatry setting-for distinguishing between those in need of further diagnostic investigations and those who are not but not for diagnosing cognitive impairment.
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Affiliation(s)
- Géraud Dautzenberg
- Department of Old Age PsychiatryAltrecht Institute for Mental Health CareUtrechtThe Netherlands
| | - Jeroen Lijmer
- Department of Psychiatry OLVG HospitalAmsterdamThe Netherlands
| | - Aartjan Beekman
- Department of PsychiatryGGZ inGeest/VU University Medical CenterAmsterdamThe Netherlands
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Pinto TCC, Machado L, Costa MLG, Santos MSP, Bulgacov TM, Rolim APP, Silva GA, Rodrigues-Júnior AL, Sougey EB, Ximenes RCC. Accuracy and Psychometric Properties of the Brazilian Version of the Montreal Cognitive Assessment as a Brief Screening Tool for Mild Cognitive Impairment and Alzheimer's Disease in the Initial Stages in the Elderly. Dement Geriatr Cogn Disord 2020; 47:366-374. [PMID: 31466064 DOI: 10.1159/000501308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the applicability and the psychometric properties of Montreal Cognitive Assessment Brazilian Version (MoCA-BR) in the elderly, as well as comparing its accuracy as a tracking test for mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) with the accuracy of Mini-Mental State Examination (MMSE). METHOD A transversal study was performed in 4 reference medical centers that care for the elderly. In all, 229 elderly participated in the study. To select the sample, the clinical history of the elderly, Pfeffer Functional Activities Questionnaire, and neuropsychological battery, apart from MMSE and MoCA-BR cognitive tests, were selected. The elderly were classified into control, MCI, and mild AD groups. RESULTS There was a significant statistical difference between the MoCA-BR scores of the elderly and the control group, MCI, and mild AD (p < 0.001). The Cronbach alpha for MoCA-BR was 0.77, indicating a good internal consistency. The test-retest reliability was elevated, with intraclass correlation coefficient (ICC) 0.91. The inter-examiner reliability was excellent (ICC 0.96). The area under curve of the receiver operating characteristics curve was 0.95, when evaluating the ability of MoCA-BR to discriminate between the elderly with cognitive impairment and cognitively healthy elderly. CONCLUSIONS The results of the study show that the Brazilian version of MoCA is a reliable cognitive tracking tool and is accurate for the detection of MCI and early stage AD, with good applicability on the elderly with education equal to or more than 4 years and adequate to discriminate between cognitively healthy elderly, and those with MCI and mild, proving to be superior to MMSE in tracking MCI and similar to this test when tracking mild AD.
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Affiliation(s)
- Tiago Coimbra Costa Pinto
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil, .,University Hospital Doctor Washington Antônio de Barros of Universidade Federal do Vale do São Francisco, Petrolina, Brazil, .,Faculdade de Medicina da Estácio de Juazeiro, Juazeiro, Brazil,
| | - Leonardo Machado
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Maria Lúcia G Costa
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil.,Post-Graduate Program in Gerontology at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Marilia S P Santos
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Tatiana M Bulgacov
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Ana Paula P Rolim
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Gabriela A Silva
- Post-Graduate Program in Nutrition Clinical at the Universidade de Pernambuco, Recife, Brazil
| | - Antônio L Rodrigues-Júnior
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil.,Busca Vida Clinical Gerontology, Recife, Brazil
| | - Everton B Sougey
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Rosana C C Ximenes
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
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Zhang YR, Ding YL, Chen KL, Liu Y, Wei C, Zhai TT, Wang WJ, Dong WL. The items in the Chinese version of the Montreal cognitive assessment basic discriminate among different severities of Alzheimer's disease. BMC Neurol 2019; 19:269. [PMID: 31684893 PMCID: PMC6829928 DOI: 10.1186/s12883-019-1513-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/24/2019] [Indexed: 11/15/2022] Open
Abstract
Background To determine whether items of the Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC) could discriminate among cognitively normal controls (NC), and those with mild cognitive impairment (MCI), mild Alzheimer’s disease (AD), and moderate-severe (AD), as well as their sensitivity and specificity. Methods MCI (n = 456), mild AD (n = 502) and moderate-severe AD (n = 102) patients were recruited from the memory clinic, Huashan Hospital, Shanghai, China. NC (n = 329) were recruited from health checkup outpatients. Five MoCA-BC item scores were collected in interviews. Results The MoCA-BC orientation test had high sensitivity and specificity for discrimination among MCI, mild AD and moderate-severe AD. The delayed recall memory test had high sensitivity and specificity for MCI screening. The verbal fluency test was efficient for detecting MCI and differentiating AD severity. Conclusions Various items of the MoCA-BC can identify MCI patients early and identify the severity of dementia.
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Affiliation(s)
- Yan-Rong Zhang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu, China.,Department of Neurology, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jingjiang, 214500, Jiangsu, China
| | - Yun-Long Ding
- Department of Neurology, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jingjiang, 214500, Jiangsu, China
| | - Ke-Liang Chen
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
| | - Yan Liu
- Department of Neurology, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jingjiang, 214500, Jiangsu, China
| | - Can Wei
- Department of Neurology, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jingjiang, 214500, Jiangsu, China
| | - Ting-Ting Zhai
- Department of Neurology, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jingjiang, 214500, Jiangsu, China
| | - Wen-Juan Wang
- Department of Neurology, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jingjiang, 214500, Jiangsu, China
| | - Wan-Li Dong
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu, China. .,Department of Neurology, the First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China.
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Bruijnen CJWH, Dijkstra BAG, Walvoort SJW, Markus W, VanDerNagel JEL, Kessels RPC, DE Jong CAJ. Prevalence of cognitive impairment in patients with substance use disorder. Drug Alcohol Rev 2019; 38:435-442. [PMID: 30916448 PMCID: PMC6593747 DOI: 10.1111/dar.12922] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION AND AIMS Cognitive impairments in substance use disorder predict treatment outcome and are assumed to differ between substances. They often go undetected, thus the current study focuses on the prevalence of and differences in cognitive functioning across substances by means of a cognitive screen at the early stage of addiction treatment. DESIGN AND METHODS The Montreal Cognitive Assessment was administered to outpatients seeking treatment for substance use disorder. Patient characteristics (age, years of regular use, polysubstance use, severity of dependence/abuse, depression, anxiety and stress) were also taken into account. RESULTS A total of 656 patients were included (n = 391 used alcohol, n = 123 used cannabis, n = 100 used stimulants and n = 26 used opioids). The prevalence of cognitive impairments was 31%. Patients using alcohol had a lower total- and memory domain score than those using cannabis. Patients using opioids scored lower on visuospatial abilities than those using cannabis or stimulants. Younger patients scored higher than older patients. No effect was found for the other investigated characteristics. DISCUSSION AND CONCLUSIONS Given the high prevalence of cognitive impairments, standard screening at an early stage of treatment is important to determine the course of treatment and maximise treatment outcome. Caution is needed in interpreting results about opioids due to an underrepresentation of this patient group, and more research is needed on the effect of age on Montreal Cognitive Assessment performance.
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Affiliation(s)
- Carolien J W H Bruijnen
- Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Boukje A G Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.,Novadic-Kentron, Addiction Care Centre, Vught, The Netherlands
| | - Serge J W Walvoort
- Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands
| | - Wiebren Markus
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.,IrisZorg, Centre for Addiction Treatment, Arnhem, The Netherlands
| | - Joanne E L VanDerNagel
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.,Tactus, Centre for Addiction and Intellectual Disability, Deventer, The Netherlands.,Aveleijn, Borne, The Netherlands
| | - Roy P C Kessels
- Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.,Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Cornelis A J DE Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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Evaluation of extent and pattern of neurocognitive functions in mild and moderate traumatic brain injury patients by using Montreal Cognitive Assessment (MoCA) score as a screening tool: An observational study from India. Asian J Psychiatr 2019; 41:60-65. [PMID: 30396805 DOI: 10.1016/j.ajp.2018.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/25/2018] [Accepted: 08/06/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Cognitive impairment is one of the most important culprit influencing the long-term neurological outcome commonlyobserved in TBI survivors. AIMS To examine the performance of patients with Mild and Moderate traumatic brain injury (TBI) on the Montreal Cognitive Assessment (MoCA) using as a screening tool. RESULTS Total 228 (127 Mild TBI & 101 Moderate TBI) patients were recruited in this study. Results showed that patients with moderate TBI had lower score on the MoCA as compared to patients with mild TBI (p Value = 0.031). This difference was observed statistically significant among mild and moderate TBI for the cube copy (p = 0.039) and clock (p = 0.017) i.e. visuospatial/executive function, Digit span test (p value = 0.040) i.e. concentration and recall memory (p = 0.04). MoCA Score were higher for patients with higher GCS score at admission. Education status was also correlated with MoCA scores; those patients with higher level of education had significant association with higher MoCA scores (p value = 0.012). This study showed that age and gender were insignificant variables to determine cognitive function. CONCLUSION Assessment of cognitive impairment should be considered as a mandatory protocol while evaluating post TBI patients, even in cases of mild TBI. Visuospatial/Executive function, memory and attention are the most commonly impaired cognitive functions in patients of TBI, and these are the main domain of cognition which differentiates mild impairment from moderate impairment. This information enables us and provides insight to our experience to predict the burdens of problem and plan to develop post TBI dedicated rehabilitating programme.
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Pinto TCC, Santos MSP, Machado L, Bulgacov TM, Rodrigues-Junior AL, Silva GA, Costa MLG, Ximenes RCC, Sougey EB. Optimal Cutoff Scores for Dementia and Mild Cognitive Impairment in the Brazilian Version of the Montreal Cognitive Assessment among the Elderly. Dement Geriatr Cogn Dis Extra 2019; 9:44-52. [PMID: 31043963 PMCID: PMC6477465 DOI: 10.1159/000495562] [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: 09/13/2018] [Accepted: 11/16/2018] [Indexed: 11/19/2022] Open
Abstract
Objective To propose cutoff scores for the Brazilian version of the Montreal Cognitive Assessment (MoCA-BR) stratified by education in order to detect mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) in the elderly. Method A transversal study in health centers was performed on 159 elderly people with 4–12 years of education and 70 of their peers with over 12 years of schooling. The MoCA-BR cutoff scores for screening cognitive impairment were determined based on an ROC curve analysis. Results The ROC curve analysis indicated that cutoff scores under 20 were good for screening elderly people with cognitive impairment with more than 12 years of education, and scores under 21 were good for screening those with 4–12 years of education. Conclusions MoCA-BR scores under 21 points (after adding 1 point to the elderly with ≤12 years of education) indicate a need to continue the diagnostic investigation with regular follow-ups.
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Affiliation(s)
- Tiago C C Pinto
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil.,University Hospital Doctor Washington Antônio de Barros of Universidade Federal do Vale do São Francisco (UNIVASF), Petrolina, Brazil
| | - Marília S P Santos
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Leonardo Machado
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Tatiana M Bulgacov
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Antônio L Rodrigues-Junior
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil.,Busca Vida Clinical Gerontology, Recife, Brazil
| | - Gabriela A Silva
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Maria Lúcia G Costa
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil.,Post-graduate program in Gerontology at the Federal University of Pernambuco, Recife, Brazil
| | - Rosana C C Ximenes
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Everton B Sougey
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil
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Mukherjee T, Sakthivel R, Fong HY, McStea M, Chong ML, Omar SF, Chin AV, Kamaruzzaman S, Kamarulzaman A, Rajasuriar R, Cysique LA. Utility of Using the Montreal Cognitive Assessment (MoCA) as a Screening Tool for HIV-Associated Neurocognitive Disorders (HAND) In Multi-Ethnic Malaysia. AIDS Behav 2018; 22:3226-3233. [PMID: 29508103 PMCID: PMC6123290 DOI: 10.1007/s10461-018-2073-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study determines the optimal cut-off scores for the Montreal Cognitive Assessment (MoCA) to detect HIV-associated neurocognitive disorders (HAND) in a multi-ethnic Malaysian HIV-positive cohort by developing demographically corrected normative standards among 283 HIV-negative community-based controls with overlapping demographic characteristics. The norms (corrected for age, sex, education, ethnicity) were applied to 342 HIV-positive virally suppressed individuals on cART. Impairment rates were classified using the Global Deficit Score (GDS ≥ .5) method. The MoCA was also scored according to the recommended cut-off of ≤ 26, and functional decline was applied to both impairment definitions to classify HAND per the Frascati criteria. The ≤ 26 cut-off considerably overestimated cognitive impairment in both samples (59.4% HIV-negative; 69.3% HIV-positive). In contrast, corrected scores yielded impairment rates consistent with what has been reported internationally in virally suppressed cohorts (23.4% with 83.3% mild impairment, 16.7% moderate impairment). A supplemental file allowing the computation of corrected MoCA scores and impairment status is included.
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Affiliation(s)
- Trena Mukherjee
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rishanantini Sakthivel
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Ho Yen Fong
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Megan McStea
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Meng Li Chong
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Sharifah Faridah Omar
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai Vyrn Chin
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia.
- Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia.
| | - Lucette A Cysique
- Neuroscience Research Australia, School of Medical Sciences, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
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Book S, Luttenberger K, Stemmler M, Meyer S, Graessel E. The Erlangen test of activities of daily living in persons with mild dementia or mild cognitive impairment (ETAM) - an extended validation. BMC Psychiatry 2018; 18:308. [PMID: 30249231 PMCID: PMC6154426 DOI: 10.1186/s12888-018-1886-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ability to perform activities of daily living (ADLs) is a central marker in the diagnosis and progression of the dementia syndrome. ADLs can be identified as basic ADLs (BADLs), which are fairly easy to perform, or instrumental ADLs (IADLs), which involve more complex activities. Presently, the only performance-based assessment of IADL capabilities in persons with cognitive impairment is the Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM). The aim of the present study was to revalidate the ETAM in persons with mild cognitive impairment (MCI) or mild dementia and to analyze its application to persons with moderate dementia. METHODS We used baseline data from a cluster randomized controlled trial involving a sample of 443 users of 34 day-care centers in Germany. We analyzed groups of persons with MCI, mild dementia, and moderate dementia, categorized on the basis of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). An item analysis was performed, and new discriminant validities were calculated. We computed a confirmatory factor analysis (CFA) to examine the postulated theoretical model of the ETAM with all six items loading on a single IADL factor. This was the first time that the ETAM's sensitivity to change was analyzed after a time period of 6 months. RESULTS The overall sample scored on average 17.3 points (SD = 7.2) on the ETAM (range: 0-30 points). Persons with MCI scored on average 23.2 points, persons with mild dementia scored 18.4 points, and persons with moderate dementia scored 12.9 points, p < .001 (ANOVA). The item analysis yielded good difficulty indices and discrimination powers. The CFA indicated a good fit between the model and the observed data. After 6 months, both the ETAM score at baseline and the change in MMSE score (t0-t1) were significant predictors of the ETAM score at t1. CONCLUSIONS The ETAM is a valid and reliable instrument for assessing IADL capabilities in persons with MCI or mild dementia. It is sensitive to changes in cognitive abilities. The test parameters confirm its application to persons with moderate dementia. TRIAL REGISTRATION Identifier: ISRCTN16412551 (Registration date: 30 July 2014, registered retrospectively).
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Affiliation(s)
- Stephanie Book
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Katharina Luttenberger
- 0000 0001 2107 3311grid.5330.5Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Mark Stemmler
- 0000 0001 2107 3311grid.5330.5Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nägelsbachstr. 49c, 91052 Erlangen, Germany
| | - Sebastian Meyer
- 0000 0001 2107 3311grid.5330.5Institute of Medical Informatics, Biometry, and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstraße 6, 91054 Erlangen, Germany
| | - Elmar Graessel
- 0000 0001 2107 3311grid.5330.5Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
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Ahalt C, Stijacic-Cenzer I, Miller BL, Rosen HJ, Barnes DE, Williams BA. Cognition and Incarceration: Cognitive Impairment and Its Associated Outcomes in Older Adults in Jail. J Am Geriatr Soc 2018; 66:2065-2071. [PMID: 30232805 DOI: 10.1111/jgs.15521] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To determine prevalence of, and outcomes associated with, a positive screen for cognitive impairment in older adults in jail. DESIGN Combined data from cross-sectional (n=185 participants) and longitudinal (n=125 participants) studies. SETTING Urban county jail. PARTICIPANTS Individuals in jail aged 55 and older (N = 310; mean age 59, range 55-80). Inclusion of individuals aged 55 and older is justified because the criminal justice system defines "geriatric prisoners" as those aged 55 and older. MEASUREMENTS Baseline and follow-up assessments of health, psychosocial factors, and cognitive status (using the Montreal Cognitive Assessment (MoCA)); 6-month acute care use and repeat arrest assessed in those followed longitudinally. RESULTS Participants were of low socioeconomic status (85% annual income < $15,000) and predominantly nonwhite (75%). Many (70%) scored less than 25 on the MoCA; those with a low MoCA score were more likely to be nonwhite (81% vs 62%, p<.001) and report fair or poor health (54% vs 41%, p=.04). Over 6 months, a MoCA score of less than 25 was associated with multiple emergency department visits (32% vs 13%, p=.02), hospitalization (35% vs 16%, p=.03), and repeat arrests (45% vs 21%, p=.01). CONCLUSIONS Cognitive impairment is prevalent in older adults in jail and is associated with adverse health and criminal justice outcomes. A geriatric approach to jail-based and transitional health care should be developed to assess and address cognitive impairment. Additional research is needed to better assess cognitive impairment and its consequences in this population. J Am Geriatr Soc 66:2065-2071, 2018.
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Affiliation(s)
- Cyrus Ahalt
- Division of Geriatrics Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Irena Stijacic-Cenzer
- Division of Geriatrics Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Bruce L Miller
- Department of Neurology, University of California, San Francisco, San Francisco, California.,Memory and Aging Center, University of California, San Francisco, San Francisco, California.,Global Brain Health Institute, University of California, San Francisco, San Francisco, California
| | - Howard J Rosen
- Department of Neurology, University of California, San Francisco, San Francisco, California.,Memory and Aging Center, University of California, San Francisco, San Francisco, California.,Global Brain Health Institute, University of California, San Francisco, San Francisco, California
| | - Deborah E Barnes
- Department of Psychiatry, University of California, San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.,Research Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Brie A Williams
- Division of Geriatrics Department of Medicine, University of California, San Francisco, San Francisco, California.,Global Brain Health Institute, University of California, San Francisco, San Francisco, California.,Tideswell, University of California, San Francisco, San Francisco, California
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Factors associated with cognitive impairment in elderly versus nonelderly patients with metabolic syndrome: the different roles of FGF21. Sci Rep 2018; 8:5174. [PMID: 29581470 PMCID: PMC5980096 DOI: 10.1038/s41598-018-23550-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 03/13/2018] [Indexed: 12/30/2022] Open
Abstract
Increased fibroblast growth factor 21 (FGF21) levels have been found in patients with metabolic syndrome (MetS). MetS is also associated with cognitive decline. However, the correlation between FGF21 and cognitive decline in elderly and nonelderly MetS patients has not been investigated. 116 non-elderly patients (age <65 years old) and 96 elderly patients (≥65 years old) with MetS were enrolled. Blood samples for FGF21 were collected from all participants after 12-hour fasting. Cognitive function was assessed using the Montreal cognitive assessment (MoCA) test. The MoCA score was negatively associated with age and was different among different levels of education in these MetS patients. In the non-elderly group, body mass index (BMI) showed positively correlated with MoCA score while, FGF21 level and HbA1C were negatively associated with the MoCA score in non-elderly MetS patients. BMI was the only factor which showed a negative correlation with the MoCA score in elderly MetS patients. This study demonstrated that FGF21 level was independently associated with cognitive impairment in non-elderly patients but not in elderly patients. The possible role of FGF21 level in cognitive impairment in non-elderly should be confirmed in a prospective study.
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Nogueira J, Freitas S, Duro D, Almeida J, Santana I. Validation study of the Alzheimer's disease assessment scale-cognitive subscale (ADAS-Cog) for the Portuguese patients with mild cognitive impairment and Alzheimer's disease. Clin Neuropsychol 2018; 32:46-59. [PMID: 29566598 DOI: 10.1080/13854046.2018.1454511] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The Alzheimer's disease assessment scale-Cognitive Subscale (ADAS-Cog) is a battery to assess cognitive performance in Alzheimer's disease (AD) and was developed according to the core characteristics of cognitive decline in AD: memory, language, praxis, constructive ability, and orientation. The aim of this study was to explore the diagnostic accuracy and discriminative capacity of the ADAS-Cog for Mild Cognitive Impairment (MCI) and AD, using cut-off points for the Portuguese population. METHOD The European Portuguese version of the ADAS-Cog was administrated to 650 participants, divided into a control group (n = 210), an MCI group (n = 240), and an AD group (n = 200). The clinical groups fulfilled standard international diagnostic criteria. Controls were healthy cognitive participants actively integrated in the community. The neuropsychological assessment protocol included the ADAS-Cog, the Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Adults and Older Adults Functional Assessment Inventory (IAFAI). RESULTS The ADAS-Cog revealed good psychometric indicators, and the total scores were significantly different between the three groups (p < .001: Control < MCI < AD). The optimal cut-off points established were: MCI > 9 points (AUC = .835; sensitivity = 58% and specificity = 91%) and AD > 12 points (AUC = .996; sensitivity = 94% and specificity = 98%). CONCLUSIONS Our findings confirmed the capacity of the ADAS-Cog total score to identify cognitive impairment in AD patients, with poor sensitivity for MCI, in a Portuguese cohort.
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Affiliation(s)
- Joana Nogueira
- a Faculty of Psychology and Educational Sciences , University of Coimbra (FPCEUC) , Coimbra , Portugal.,b Centro de Investigação em Neuropsicologia e Intervenção Cognitivo Comportamental (CINEICC) , University of Coimbra , Coimbra , Portugal.,c Psychological Assessment Lab , FPCEUC , Coimbra , Portugal.,d Proaction Laboratory (Perception and Recognition of Objects and Actions Laboratory) , FPCEUC , Coimbra , Portugal
| | - Sandra Freitas
- a Faculty of Psychology and Educational Sciences , University of Coimbra (FPCEUC) , Coimbra , Portugal.,b Centro de Investigação em Neuropsicologia e Intervenção Cognitivo Comportamental (CINEICC) , University of Coimbra , Coimbra , Portugal.,c Psychological Assessment Lab , FPCEUC , Coimbra , Portugal.,e Centre for Neuroscience and Cell Biology (CNC) , University of Coimbra , Coimbra , Portugal
| | - Diana Duro
- b Centro de Investigação em Neuropsicologia e Intervenção Cognitivo Comportamental (CINEICC) , University of Coimbra , Coimbra , Portugal.,e Centre for Neuroscience and Cell Biology (CNC) , University of Coimbra , Coimbra , Portugal.,f Faculty of Medicine , University of Coimbra , Coimbra , Portugal
| | - Jorge Almeida
- a Faculty of Psychology and Educational Sciences , University of Coimbra (FPCEUC) , Coimbra , Portugal.,b Centro de Investigação em Neuropsicologia e Intervenção Cognitivo Comportamental (CINEICC) , University of Coimbra , Coimbra , Portugal.,d Proaction Laboratory (Perception and Recognition of Objects and Actions Laboratory) , FPCEUC , Coimbra , Portugal
| | - Isabel Santana
- e Centre for Neuroscience and Cell Biology (CNC) , University of Coimbra , Coimbra , Portugal.,f Faculty of Medicine , University of Coimbra , Coimbra , Portugal.,g Neurology Department and Dementia Clinic , Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
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O'Caoimh R, Gao Y, Svendovski A, Gallagher P, Eustace J, Molloy DW. Comparing Approaches to Optimize Cut-off Scores for Short Cognitive Screening Instruments in Mild Cognitive Impairment and Dementia. J Alzheimers Dis 2018; 57:123-133. [PMID: 28222528 PMCID: PMC5345649 DOI: 10.3233/jad-161204] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although required to improve the usability of cognitive screening instruments (CSIs), the use of cut-off scores is controversial yet poorly researched. OBJECTIVE To explore cut-off scores for two short CSIs: the Standardized Mini-Mental State Examination (SMMSE) and Quick Mild Cognitive Impairment (Qmci) screen, describing adjustments in scores for diagnosis (MCI or dementia), age (≤, >75 years), and education (<, ≥12 years), comparing two methods: the maximal accuracy approach, derived from receiver operating characteristic curves, and Youden's Index. METHODS Pooled analysis of assessments from patients attending memory clinics in Canada between 1999-2010 : 766 with mild cognitive impairment (MCI) and 1,746 with dementia, and 875 normal controls. RESULTS The Qmci was more accurate than the SMMSE in differentiating controls from MCI or cognitive impairment (MCI and dementia). Employing the maximal accuracy approach, the optimal SMMSE cut-off for cognitive impairment was <28/30 (AUC 0.86, sensitivity 74%, specificity 88%) versus <63/100 for the Qmci (AUC 0.93, sensitivity 85%, specificity 85%). Using Youden's Index, the optimal SMMSE cut-off remained <28/30 but fell slightly to <62/100 for the Qmci (sensitivity 83%, specificity 87%). The optimal cut-off for MCI was <29/30 for the SMMSE and <67/100 for the Qmci, irrespective of technique. The maximal accuracy approach generally produced higher Qmci cut-offs than Youden's Index, both requiring adjustment for age and education. There were no clinically meaningful differences in SMMSE cut-off scores by age and education or method employed. CONCLUSION Caution should be exercised selecting cut-offs as these differ by age, education, and method of derivation, with the extent of adjustment varying between CSIs.
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Affiliation(s)
- Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork City, Ireland.,Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - Yang Gao
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork City, Ireland
| | | | - Paul Gallagher
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork City, Ireland
| | - Joseph Eustace
- Health Research Board, Clinical Research Facility Cork, Mercy Univeristy Hospital, Cork City, Ireland
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork City, Ireland
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Liang S, Wang WL, Zhu FL, Duan SW, Sun XF, Chen XM, Cai GY. Chinese observational prospective study of ageing population with chronic kidney disease (C-OPTION): a study protocol. BMJ Open 2018; 8:e019457. [PMID: 29478020 PMCID: PMC5855281 DOI: 10.1136/bmjopen-2017-019457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The proportion of elderly people is steadily rising worldwide, especially in low-income and middle-income countries, including China. Chronic kidney disease (CKD) is a common disorder in older people. However, little is known about the epidemiology of CKD and its consequences among the elderly. Improvements on clinical guidelines and healthcare policies for this population are required. This study aims to examine the risk factors for progression of CKD among the elderly and develop models to identify subgroups who are at high risk. METHODS AND ANALYSIS This is a prospective, multicentre, cohort study. The study population comprises ~3000 patients with predialysis CKD, aged ≥65 years, recruited between March 2016 and December 2017. After the baseline assessments, these patients will be followed for 5 years or until the occurrence of primary outcomes. Assessments that include anthropomorphic measures, laboratory tests, questionnaires, and blood and urine specimen collection will be performed at baseline and at follow-ups. Data on demographic information, cognitive function, depression, risk of malnutrition, physical activity and quality of life will be collected. The primary outcomes are incidence of end-stage renal disease, loss of renal function (≥40% decline in glomerular filtration rate from baseline), and death. The secondary outcomes are acute coronary syndrome, hospitalisation for heart failure or unstable angina, cerebrovascular events, and peripheral arterial disease. ETHICS AND DISSEMINATION This study protocol has been approved by the ethics committees of the Chinese People's Liberation Army General Hospital and the participating centres. All the participants gave written informed consent before data collection. The findings of the study will be published in peer-reviewed journals and will be presented at national or international conferences. TRIAL REGISTRATION NUMBER NCT03246204; Pre-results.
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Affiliation(s)
- Shuang Liang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease., Beijing, China
| | - Wen-Ling Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease., Beijing, China
| | - Fang-Lei Zhu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease., Beijing, China
| | - Shu-Wei Duan
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease., Beijing, China
| | - Xue-Feng Sun
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease., Beijing, China
| | - Xiang-Mei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease., Beijing, China
| | - Guang-Yan Cai
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease., Beijing, China
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Carson N, Leach L, Murphy KJ. A re-examination of Montreal Cognitive Assessment (MoCA) cutoff scores. Int J Geriatr Psychiatry 2018; 33:379-388. [PMID: 28731508 DOI: 10.1002/gps.4756] [Citation(s) in RCA: 416] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/30/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) is a cognitive screening tool that aims to differentiate healthy cognitive aging from Mild Cognitive Impairment (MCI). Several validation studies have been conducted on the MoCA, in a variety of clinical populations. Some studies have indicated that the originally suggested cutoff score of 26/30 leads to an inflated rate of false positives, particularly for those of older age and/or lower education. We conducted a systematic review and meta-analysis of the literature to determine the diagnostic accuracy of the MoCA for differentiating healthy cognitive aging from possible MCI. METHODS Of the 304 studies identified, nine met inclusion criteria for the meta-analysis. These studies were assessed across a range of cutoff scores to determine the respective sensitivities, specificities, positive and negative predictive accuracies, likelihood ratios for positive and negative results, classification accuracies, and Youden indices. RESULTS Meta-analysis revealed a cutoff score of 23/30 yielded the best diagnostic accuracy across a range of parameters. CONCLUSIONS A MoCA cutoff score of 23, rather than the initially recommended score of 26, lowers the false positive rate and shows overall better diagnostic accuracy. We recommend the use of this cutoff score going forward. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Nicole Carson
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Larry Leach
- Department of Psychology, Glendon College, Toronto, Ontario, Canada
| | - Kelly J Murphy
- Department of Neuropsychology and Cognitive Health, Baycrest Health Sciences and Departments of Psychology, University of Toronto and York University, Toronto, Ontario, Canada
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Huang L, Chen KL, Lin BY, Tang L, Zhao QH, Lv YR, Guo QH. Chinese version of Montreal Cognitive Assessment Basic for discrimination among different severities of Alzheimer's disease. Neuropsychiatr Dis Treat 2018; 14:2133-2140. [PMID: 30174426 PMCID: PMC6110265 DOI: 10.2147/ndt.s174293] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To find out whether the Chinese version of Montreal Cognitive Assessment Basic (MoCA-BC) and its subtests could be applied in discrimination among cognitively normal controls (NC), mild cognitive impairment (MCI), mild and moderate Alzheimer's Disease (AD), and furthermore, to determine the optimal cutoffs most sensitive to distinguish between them. DESIGN A cross-sectional validation study. SETTING Huashan Hospital, Shanghai, China. PARTICIPANTS There was a total of 1,969 participants: individuals with MCI (n=663), mild (n=345), moderate (n=441) AD, and cognitively NC (n=520) were recruited from the Memory Clinic, Huashan Hospital, Shanghai, China. MEASUREMENTS Baseline MoCA-BC scores were collected from firsthand data. Two subtests were calculated from MoCA-BC: the Memory Index Score of MoCA-BC (MoCA-BC-MIS) and the Non-memory Index Score of MoCA-BC (MoCA-BC-NM). RESULTS MoCA-BC was an effective cognitive tool to discriminate among NC, MCI, mild and moderate AD in the Chinese elderly across all education groups, implying that it was efficient not only for detecting MCI, but for different severities of AD as well. For MCI screening, the total score of MoCA-BC (MoCA-BC-T) and MoCA-BC-MIS had similar high sensitivity and specificity. For discrimination among MCI, mild and moderate AD, the MoCA-BC-T and MoCA-BC-NM had similar performance. CONCLUSION MoCA-BC is an effective cognitive test to distinguish between NC, MCI, mild and moderate AD among the Chinese elderly with various levels of education.
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Affiliation(s)
- Lin Huang
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Ke-Liang Chen
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Bi-Ying Lin
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Le Tang
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Qian-Hua Zhao
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Ying-Ru Lv
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China,
| | - Qi-Hao Guo
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China,
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Alves AF, Gomes CMA, Martins A, Almeida LDS. Cognitive performance and academic achievement: How do family and school converge? EUROPEAN JOURNAL OF EDUCATION AND PSYCHOLOGY 2017. [DOI: 10.1016/j.ejeps.2017.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Rao D, Luo X, Tang M, Shen Y, Huang R, Yu J, Ren J, Cheng X, Lin K. Prevalence of mild cognitive impairment and its subtypes in community-dwelling residents aged 65 years or older in Guangzhou, China. Arch Gerontol Geriatr 2017; 75:70-75. [PMID: 29197258 DOI: 10.1016/j.archger.2017.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 10/26/2017] [Accepted: 11/12/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Prevalence of mild cognitive impairment (MCI) has been reported substantial variations, and mostly in Western countries. Less is known about MCI in the south of China. The study is to estimate the prevalence of MCI and its subtypes in residents aged 65year or older in community-dwelling residents of Guangzhou, China. METHODS The study was a community-based, cross-sectional study conducted in rural and urban areas of Guangzhou between April and October 2009. Eight communities were randomly selected using a cluster sampling method. Each elderly was interviewed with Montreal Cognitive Assessment, the Mini-Mental state examination, Auditory Verbal Learning Test, the Clinical Dementia Rating scale et al. MCI was classified as amnestic MCI (a-MCI) or nonamnestic MCI (na-MCI). RESULTS 2427 individuals were contacted, but in-person interviews were conducted with 2111 participants. 299 participants with MCI were identified. The prevalence of MCI, a-MCI and na-MCI was 14.2%, 12.2%, 2.0% respectively. The prevalence of MCI and a-MCI increased with age, decreased with education level, and was higher in rural areas than in urban areas. The difference of prevalence of MCI and a-MCI between women with men wasn't statistically significant(MCIχ2=1.0, OR 0.9, 95%CI=0.6-1.2; a-MCIχ2=1.0, OR 0.9, 95%CI=0.6-1.2), when controlling for education by logistic regression analysis. CONCLUSIONS The results suggest that 14.2% of elderly individuals are affected by MCI in Guangzhou, China. And MCI was dominated by a-MCI. The prevalence of MCI and a-MCI increased with age, decreased with education level, and was higher in the rural population compared to the urban population.
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Affiliation(s)
- Dongping Rao
- Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xiong Luo
- Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Muni Tang
- Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
| | - Yin Shen
- Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Ruoyan Huang
- Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Junchang Yu
- Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Jianjuan Ren
- Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xiaoying Cheng
- Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Kangguang Lin
- Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
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Ihle-Hansen H, Vigen T, Berge T, Einvik G, Aarsland D, Rønning OM, Thommessen B, Røsjø H, Tveit A, Ihle-Hansen H. Montreal Cognitive Assessment in a 63- to 65-year-old Norwegian Cohort from the General Population: Data from the Akershus Cardiac Examination 1950 Study. Dement Geriatr Cogn Dis Extra 2017; 7:318-327. [PMID: 29118784 PMCID: PMC5662994 DOI: 10.1159/000480496] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/21/2017] [Indexed: 11/24/2022] Open
Abstract
Aims To investigate Montreal Cognitive Assessment (MoCA) test scores in a cohort aged 63–65 years from a general population in relation to the proposed cut-off score of 26 for mild cognitive impairment (MCI) and to explore the impact of education. Methods MoCA scores were assessed in the Akershus Cardiac Examination 1950 Study, a cross-sectional cohort study of all men and women born in 1950 living in Akershus County, Norway. The participants were aged 63–65 at the time of data collection. Results MoCA scores were available in 3,413 participants, of which 47% had higher education (>12 years). The mean MoCA score was 25.3 (95% confidence interval [CI] 25.2–25.4), and 49% had a score below the suggested cut-off of 26 points. Those with higher education had significantly higher scores (mean 26.2, 95% CI 26.1–26.3 vs. 24.4, 95% CI 24.3–24.6, p < 0.001). Conclusions Approximately 50% scored below the cut-off score of 26 points, suggesting that the cut-off score may have been set too high to distinguish normal cognitive function from MCI. Educational level had a significant impact on MoCA scores.
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Affiliation(s)
- Håkon Ihle-Hansen
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thea Vigen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Trygve Berge
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gunnar Einvik
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ole Morten Rønning
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Bente Thommessen
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Arnljot Tveit
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege Ihle-Hansen
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
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Pereiro A, Ramos-Lema S, Lojo-Seoane C, Guàrdia-Olmos J, Facal-Mayo D, Juncos-Rabadán O. Normative data for the Montreal Cognitive Assessment (MOCA) in a Spanish sample of community-dweller adults. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Huang L, Juan Dong H, Wang X, Wang Y, Xiao Z. Duration and frequency of migraines affect cognitive function: evidence from neuropsychological tests and event-related potentials. J Headache Pain 2017; 18:54. [PMID: 28477306 PMCID: PMC5419957 DOI: 10.1186/s10194-017-0758-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the changes in the cognitive performance of migraine patients using a comprehensive series of cognitive/behavioral and electrophysiological tests. METHOD A randomized, cross-sectional, within subject approach was used to compare neuropsychological and electrophysiological evaluations from migrane-affected and healthy subjects. RESULTS Thirty-four patients with migraine (6 males, 28 females, average 36 years old) were included. Migraineurs performed worse in the majority of the Montreal Cognitive Assessment (MoCA) (p = 0.007) compared to the healthy subjects, significantly in language (p = 0.005), memory (p = 0.006), executive functions (p = 0.042), calculation (p = 0.018) and orientation (p = 0.012). Migraineurs had a lower score on the memory trial of the Rey-Osterrieth complex figure test (ROCF) (p = 0.012). The P3 latency in Fz, Cz, Pz was prolonged in migraineurs compared with the normal control group (P < 0.001). In addition, we analyzed significant correlations between MoCA score and the duration of migraine. We also observed that a decrease in the MoCA-executive functions and calculation score and in the ROCF-recall score were both correlated to the frequency of migraine. Migraineurs were more anxious than healthy subjects (p = 0.001), which is independent of cognitive testing. Differences were unrelated to age, gender and literacy. CONCLUSIONS Cognitive performance decreases during migraine, and cognitive dysfunction can be related to the duration and frequency of a migraine attack.
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Affiliation(s)
- Lifang Huang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Hong Juan Dong
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Xi Wang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Yan Wang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Zheman Xiao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, People's Republic of China.
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Abstract
BACKGROUND The National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) 5-minute neuropsychology protocol consists of only verbal tasks, and is proposed as a brief screening method for vascular cognitive impairment. We evaluated its feasibility within two weeks after stroke and ability to predict the development of post-stroke dementia (PSD) at 3 months after stroke. METHOD We prospectively enrolled subjects with ischemic stroke within seven days of symptom onset who were consecutively admitted to 12 university hospitals. Neuropsychological assessments using the NINDS-CSN 5-minute and 60-minute neuropsychology protocols were administered within two weeks and at 3 months after stroke onset, respectively. PSD was diagnosed with reference to the American Heart Association/American Stroke Association statement, requiring deficits in at least two cognitive domains. RESULTS Of 620 patients, 512 (82.6%) were feasible for the NINDS-CSN 5-minute protocol within two weeks after stroke. The incidence of PSD was 16.2% in 308 subjects who had completed follow-up at 3 months after stroke onset. The total score of the NINDS-CSN 5-minute protocol differed significantly between those with and without PSD (4.0 ± 2.7, 7.4 ± 2.7, respectively; p < 0.01). A cut-off value of 6/7 showed reasonable discriminative power (sensitivity 0.82, specificity 0.67, AUC 0.74). The NINDS-CSN 5-minute protocol score was a significant predictor for PSD (adjusted odds ratio 6.32, 95% CI 2.65-15.05). DISCUSSION The NINDS-CSN 5-minute protocol is feasible to evaluate cognitive functions in patients with acute ischemic stroke. It might be a useful screening method for early identification of high-risk groups for PSD.
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Salzwedel A, Heidler MD, Haubold K, Schikora M, Reibis R, Wegscheider K, Jöbges M, Völler H. Prevalence of mild cognitive impairment in employable patients after acute coronary event in cardiac rehabilitation. Vasc Health Risk Manag 2017; 13:55-60. [PMID: 28260915 PMCID: PMC5328136 DOI: 10.2147/vhrm.s121086] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Adequate cognitive function in patients is a prerequisite for successful implementation of patient education and lifestyle coping in comprehensive cardiac rehabilitation (CR) programs. Although the association between cardiovascular diseases and cognitive impairments (CIs) is well known, the prevalence particularly of mild CI in CR and the characteristics of affected patients have been insufficiently investigated so far. METHODS In this prospective observational study, 496 patients (54.5 ± 6.2 years, 79.8% men) with coronary artery disease following an acute coronary event (ACE) were analyzed. Patients were enrolled within 14 days of discharge from the hospital in a 3-week inpatient CR program. Patients were tested for CI using the Montreal Cognitive Assessment (MoCA) upon admission to and discharge from CR. Additionally, sociodemographic, clinical, and physiological variables were documented. The data were analyzed descriptively and in a multivariate stepwise backward elimination regression model with respect to CI. RESULTS At admission to CR, the CI (MoCA score < 26) was determined in 182 patients (36.7%). Significant differences between CI and no CI groups were identified, and CI group was associated with high prevalence of smoking (65.9 vs 56.7%, P = 0.046), heavy (physically demanding) workloads (26.4 vs 17.8%, P < 0.001), sick leave longer than 1 month prior to CR (28.6 vs 18.5%, P = 0.026), reduced exercise capacity (102.5 vs 118.8 W, P = 0.006), and a shorter 6-min walking distance (401.7 vs 421.3 m, P = 0.021) compared to no CI group. The age- and education-adjusted model showed positive associations with CI only for sick leave more than 1 month prior to ACE (odds ratio [OR] 1.673, 95% confidence interval 1.07-2.79; P = 0.03) and heavy workloads (OR 2.18, 95% confidence interval 1.42-3.36; P < 0.01). CONCLUSION The prevalence of CI in CR was considerably high, affecting more than one-third of cardiac patients. Besides age and education level, CI was associated with heavy workloads and a longer sick leave before ACE.
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Affiliation(s)
- Annett Salzwedel
- Center for Rehabilitation Research, University of Potsdam, Potsdam
| | - Maria-Dorothea Heidler
- Center for Rehabilitation Research, University of Potsdam, Potsdam; Brandenburg Klinik, Bernau
| | - Kathrin Haubold
- Center for Rehabilitation Research, University of Potsdam, Potsdam
| | | | - Rona Reibis
- Cardiological Outpatient Clinic, Am Park Sanssouci, Potsdam
| | - Karl Wegscheider
- Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg
| | | | - Heinz Völler
- Center for Rehabilitation Research, University of Potsdam, Potsdam; Klinik am See, Rüdersdorf, Germany
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Chen KL, Xu Y, Chu AQ, Ding D, Liang XN, Nasreddine ZS, Dong Q, Hong Z, Zhao QH, Guo QH. Validation of the Chinese Version of Montreal Cognitive Assessment Basic for Screening Mild Cognitive Impairment. J Am Geriatr Soc 2016; 64:e285-e290. [PMID: 27996103 DOI: 10.1111/jgs.14530] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of the Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC) as a screening tool for detecting mild cognitive impairment (MCI) in Chinese elderly adults. DESIGN Cross-sectional. SETTING Huashan Hospital, Shanghai, China. PARTICIPANTS Individuals with MCI (n = 264) and mild Alzheimer's disease (AD) (n = 160) were recruited from the Memory Clinic, Huashan Hospital; cognitively normal controls were recruited from Jinshan Community, Shanghai, China (n = 280). MEASUREMENTS MoCA-BC scores. RESULTS The MoCA-BC had good criterion-related validity (Pearson correlation coefficient MoCA-BC vs MMSE = 0.787) and reliable internal consistency (Cronbach alpha = 0.807). The optimal cutoff scores for MCI screening were 19 for individuals with no more than 6 years of education, 22 for individuals with 7 to 12 years of education, and 24 for individuals with more than 12 years of education. The MoCA-BC was superior to the MMSE for detecting MCI, with optimal sensitivity and specificity across all education groups using the above cutoff scores. CONCLUSION The MoCA-BC is a reliable cognitive screening test across all education levels in Chinese elderly adults, with high acceptance and good reliability.
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Affiliation(s)
- Ke-Liang Chen
- Department of Neurology, Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan Xu
- Department of Neurology, Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ai-Qun Chu
- Community Health Service Center of Jinshan Shihua, Shanghai, China
| | - Ding Ding
- Department of Neurology, Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiao-Niu Liang
- Department of Neurology, Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | | | - Qiang Dong
- Department of Neurology, Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhen Hong
- Department of Neurology, Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qian-Hua Zhao
- Department of Neurology, Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qi-Hao Guo
- Department of Neurology, Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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