Validity and reliability of two alternate versions of the Montreal Cognitive Assessment (Hong Kong version) for screening of Mild Neurocognitive Disorder

TECH preserves global cognition of older adults with MCI compared with a control group: a randomized controlled trial

BACKGROUND

Cognitive training using touchscreen tablet casual game applications (apps) has potential to be an effective treatment method for people with mild cognitive impairment (MCI).

AIMS

This study aimed to establish the effectiveness of 'Tablet Enhancement of Cognition and Health' (TECH), a novel cognitive intervention for improving/preserving cognition in older adults with MCI.

METHODS

A single-blind randomized controlled trial with assessments pre-, post-, and at 6-month follow-up was conducted. TECH entailed 5 weeks of daily self-training utilizing tablet apps, facilitated by weekly group sessions. Global cognition was assessed by the Montreal Cognitive Assessment (MoCA), and specific cognitive components were assessed using WebNeuro computerized battery. Short Form Health Survey (SF-12) assessed health-related quality of life (HRQoL). Intention-to-treat analysis was conducted and the %change was calculated between pre-post and between pre-follow-up. Cohen's d effect size was also calculated.

RESULTS

Sixty-one participants aged 65-89 years were randomly allocated to TECH (N = 31, 14 women) or to standard care (N = 30, 14 women). Pre-post and pre-follow-up MoCA %change scores were significantly higher in TECH than control (U = 329.5, p < .05; U = 294.5, p < .05) with intermediate effect size values (Cohen's d = .52, Cohen's d = .66). Forty percent of TECH participants versus 6.5% of control participants achieved a minimal clinical important difference in MoCA. Pre-post between-group differences for specific cognitive components were not found and HRQoL did not change.

DISCUSSION AND CONCLUSIONS

TECH encouraged daily self-training and showed to preserve global cognition of older adults with MCI. The implementation of TECH is recommended for older adults with MCI, who are at risk for further cognitive decline.

Gender differences in interactions and depressive symptoms among hospitalized older patients living with dementia

Alzheimer's disease or a related dementia (ADRD) disproportionately affects women with two-thirds of individuals with ADRD comprised of women. This study examined gender-related differences in the quality of staff-patient interactions and depressive symptoms among hospitalized older patients living with dementia. This secondary analysis utilized baseline data of 140 hospitalized older patients with dementia who participated in the final cohort of a randomized controlled trial (ClinicalTrials.gov identifier: NCT03046121) implementing Family centered Function-focused Care (Fam-FFC). On average, the participants (male = 46.1%, female = 52.9%) were 81.43 years old (SD = 8.29), had positive interactions with staff and lower depressive symptoms based on Quality of Interaction Schedule (QUIS) scores and Cornell Scale for Depression in Dementia (CSDD) scores, respectively. Although males had more positive interactions (male = 6.06, SD = 1.13; female = 5.59, SD = 1.51) and lesser depressive symptoms (male = 7.52, SD = 4.77; female = 8.03, SD = 6.25) than females, no statistically significant gender differences were observed in linear models with appropriate covariates or multivariant analysis of covariant (MANCOVA). However, the multigroup regression conducted to further probe marginally significant moderation effect of gender and pain on staff-patient interactions demonstrated that greater pain was significantly related to lower quality or less positive staff-patient interactions for females compared to males (χ2diff (1) = 4.84, p = .03). Continued evaluation of gender differences is warranted to inform care delivery and interventions to improve care for hospitalized older patients with dementia.

Baseline Function and Rehabilitation Are as Important as Stroke Severity as Long-term Predictors of Cognitive Performance Post-stroke

OBJECTIVE

Although individuals with low stroke severity tend to recover well, cognitive impairment is common independent of stroke size or location. In this study, the patterns of recovery for individual cognitive domains and factors associated with outcome were examined.

DESIGN

A prospectively enrolled cohort of patients with minor stroke was administered cognitive testing at 1, 6, and 12 mos postinfarct. Composite T scores were generated for global cognition and well as independent cognitive domains at each time point. Paired t tests compared changes in scores over time. Regression models identified factors associated with improvement.

RESULTS

A total of 46 patients, with an average NIH Stroke Scale score of 2.7, were enrolled. Average age was 61.3 yrs. Patients improved overall between 1 and 6 mos; however, distinct patterns of recovery were seen for different cognitive domains. The most significant improvement was in spatial memory. Verbal memory scores remained low longitudinally. Motor speed and executive function increased, then plateaued. Despite a mean education of 13.6 yrs, only 36% of global cognition scores were higher than or equal to the normative mean at 12 mos, and only 57% of patients improved their global scores from 6 to 12 mos. Late recovery was associated with lower NIH Stroke Scale scores, higher 1-mo Montreal Cognitive Assessment scores, and rehabilitation. Baseline function predicted overall long-term recovery.

CONCLUSION

Patterns of recovery are distinct for individual cognitive domains for patients with minor stroke. Stroke severity and rehabilitation influence trajectory. Premorbid baseline predicts long-term outcome.

Longitudinal measurement properties of the Montreal Cognitive Assessment

INTRODUCTION

The Montreal Cognitive Assessment (MoCA) has started to be used in longitudinal investigations to measure cognition trends but its measurement properties over time are largely unknown. This study aimed to examine the longitudinal measurement invariance of individual MoCA items.

METHOD

We used four waves of data collected between 2014 and 2017 from a cohort study on health and well-being of older adults from twelve public housing estates in Hong Kong. We identified people aged 65 years or older at baseline who answered the MoCA items across all time points and had a valid indicator of educational level. A total of 1028 participants were included. We applied confirmatory factor analysis of ordinal variables to examine measurement invariance of the Chinese (Cantonese) MoCA (version 7.0) items across four time points, stratified by educational level, where invariant items were identified by sequential model comparisons.

RESULTS

Four items exhibited a lack of measurement invariance across the four time points in both education groups (Clock Hand, abstraction, Delayed Recall, and Orientation). The items Cube and Sentence Repetition lacked longitudinal measurement invariance only in the "some education" group and the items Clock Shape and Clock Number only in the "no education" group. However, accounting for the lack of measurement invariance did not substantially affect classification properties for major neurocognitive disorder and mild cognitive impairment.

CONCLUSIONS

Our findings support using MoCA to assess changes in cognition over time in the study population while calling for future research in other populations.

Transcranial direct current stimulation over the primary motor cortex improves speech production in post-stroke dysarthric speakers: A randomized pilot study

PURPOSE

The current study investigated the therapeutic potential of transcranial direct current stimulation (tDCS) on speech intelligibility, speech-related physiological and vocal functions among post-stroke dysarthric patients.

METHOD

Nine chronic post-stroke dysarthric patients were randomly assigned to the stimulation or sham group. The stimulation group received 2mA of anodal tDCS over the left inferior primary motor cortex for 15 minutes, while the sham group received 30s of stimulation under the same settings. All the participants received 10 daily 15 minutes of individualized speech therapy targeting their dominant phonological process or phonemes with the greatest difficulty. The outcome measures included (1) perceptual analysis of single words, passage reading and diadochokinetic rate, (2) acoustic analysis of a sustained vowel, and (3) kinematic analysis of rapid syllable repetitions and syllable production in sentence, conducted before and after the treatment.

RESULTS

The results revealed that both the stimulation and sham groups had improved perceptual speech intelligibility at the word level, reduced short rushes of speech during passage reading, improved rate during alternating motion rate, AMR-kha1, and improved articulatory kinematics in AMR-tha1 and syllables /tha1/ and /kha1/ production in sentence. Compared to the sham group, the stimulation group showed significant improvement in articulatory kinematics in AMR-kha1 and syllable /kha1/ production in sentence. The findings also showed that anodal stimulation led to reduced shimmer value in sustained vowel /a/ phonation, positive changes in articulatory kinematics in AMR-tha1 and syllables /pha1/ and /kha1/ production in sentence at the post treatment measure. In addition to positive effects on articulatory control, reduced perturbation of voice amplitude documented in the stimulation group post treatment suggests possible tDCS effects on the vocal function.

CONCLUSIONS

The current study documented the beneficial effects of anodal tDCS over the primary motor cortex on speech production and suggested that combined tDCS and speech therapy may promote recovery from post-stroke dysarthria.

Acute disease induced cognitive dysfunction in older patients - an unrecognized syndrome

Background

It is unknown, how many older hospitalized patients experience cognitive changes independently from delirium.

Methods

In this retrospective study, cognitive function was assessed with the Montreal Cognitive Assessment on admission and discharge in 103 acute care geriatric hospital patients.

Results

Mean age was 80.8 ± 7.3 years. The total MoCA score on admission was 17.8 (±4.5) and at discharge 17.7 (±4.4). The mean difference of the total MoCA score was − 0.1 (±3.5). 12 (11.7%) patients suffered from delirium. 46 (44.7%) patients experienced significant changes of cognitive function <− 2 or > 2 MoCA points without delirium. There was no significant association between delirium during hospital stay and the prevalence and magnitude of changes in total MoCA score.

Conclusion

Cognitive changes frequently occur during acute disease of geriatric patients independently from delirium. We propose the term “acute disease induced cognitive dysfunction” (ADICD) for this entity.

Trial registration

German Clinical trial register (DRKS-ID: DRKS00025157 on 28.04.2021).

"Train Your Brain" Cognitive Intervention Group Program for Singaporean Older Adult Patients With Mild Cognitive Impairment: A Pilot Feasibility Study

The "Train Your Brain" (TYB) cognitive intervention group program was developed based on previous research with the goal of remediating cognitive impairments for elderly Singaporean people with mild cognitive impairment (MCI). This study reports a pilot evaluation of feasibility (defined as participant attendance, retention rate, satisfaction and usefulness) and preliminary efficacy of the TYB program. Nineteen participants with MCI aged ≥ 50 years were recruited from a memory clinic in Singapore, with 14 receiving the TYB intervention. Participants were allocated in order of recruitment into consecutive identical groups for a 9-session program on brain health and cognitive training. Participants received pre- and post-intervention measures of cognition and completed feedback forms reporting on satisfaction with, and utility of, the TYB program. TYB was well attended (85% attendance for the first 6 sessions; 83% for the full 9-session TYB program). Participant satisfaction was high, with positive participant feedback reporting that TYB offered useful cognitive strategies which participants could implement in their daily life. Despite the small sample size and absence of control group, repeated-measures t-tests revealed significant pre- to post-intervention intra-individual improvement in global cognition measured by the Montreal Cognitive Assessment, and in executive function on the Brixton Spatial Anticipation Test. This pilot study provides supportive preliminary evidence for feasibility of TYB, with suggestions of efficacy of this program as a culturally and linguistically appropriate intervention for English-speaking older adults with MCI in Singapore.

Comparison of Montreal Cognitive Assessment in Korean Version for Predicting Mild Cognitive Assessment in 65-Year and Over Individuals

Objectives

The purpose of this study was to compare the validity and reliability of the two Korean versions of the MoCA for individuals aged ≥65 years.

Methods

A total of 185 participants aged ≥65 years were included in this cross-sectional study. This study investigated the reliability of the two Korean versions of the MoCA (the MoCA-K and MoCA-K2) by having each participant complete both assessments twice and comparing them to their Korean version of the Mini-Mental State Exam (MMSE-K) scores. The participants either completed the tests in order A (MoCA-K2 before MoCA-K) then B (MoCA-K before MoCA-K2) or vice versa. The tests were then completed in the opposite order. This study conducted all experiments at 3-day intervals.

Results

Of the 185 total participants analyzed, 95 indicated cognitive impairment, while 90 had normal in MoCA-K scores; 50 demonstrated cognitive impairment, while 135 had normal in MMSE-K scores; and 101 and 84 participants showed cognitive impairment and normal in MoCA-K2 scores, respectively. Cronbach's α values were 0.929 for the MoCA-K, 0.774 for the MMSE-K, and 0.919 for the MoCA-K2. The mean scores were 22.37, 25.29, and 21.96 points for the MoCA-K, MMSE-K, and MoCA-K2, respectively. The sensitivity and the specificity of the MoCA-K were 77.0% and 78.0%, respectively, while those of the MoCA-K2 were 68.9% and 80.0%, respectively.

Conclusions

These results suggest that both the MoCA-K and MoCA-K2 are suitable and reliable evaluation tools for MCI screening; however, the MoCA-K had better overall sensitivity and specificity.

Developing guidelines for the translation and cultural adaptation of the Montreal Cognitive Assessment: scoping review and qualitative synthesis

BACKGROUND

Ethnic minorities in countries such as the UK are at increased risk of dementia or minor cognitive impairment. Despite this, cognitive tests used to provide a timely diagnosis for these conditions demonstrate performance bias in these groups, because of cultural context. They require adaptation that accounts for language and culture beyond translation. The Montreal Cognitive Assessment (MoCA) is one such test that has been adapted for multiple cultures.

AIMS

We followed previously used methodology for culturally adapting cognitive tests to develop guidelines for translating and culturally adapting the MoCA.

METHOD

We conducted a scoping review of publications on different versions of the MoCA. We extracted their translation and cultural adaptation procedures. We also distributed questionnaires to adaptors of the MoCA for data on the procedures they undertook to culturally adapt their respective versions.

RESULTS

Our scoping review found 52 publications and highlighted seven steps for translating the MoCA. We received 17 responses from adaptors on their cultural adaptation procedures, with rationale justifying them. We combined data from the scoping review and the adaptors' feedback to form the guidelines that state how each question of the MoCA has been previously adapted for different cultural contexts and the reasoning behind it.

CONCLUSIONS

This paper details our development of cultural adaptation guidelines for the MoCA that future adaptors can use to adapt the MoCA for their own languages or cultures. It also replicates methods previously used and demonstrates how these methods can be used for the cultural adaptation of other cognitive tests.

The Auditory P50 Gating in Mild Cognitive Impairment: A Case-Control Study

Objective: Auditory P50 gating changed might be a neurophysiological biomarker of the diagnosis of Mild Cognitive Impairment (MCI). We aimed to determine the impact of MCI in auditory P50 gating. Methods: All recruited participants completed structured questionnaires and finished auditory P50 gating measure. Results: A total of 20 MCI patients and 17 controls had been recruited. MCI patients had a significant higher reduction of P50 gating at Fz site, when compared to controls (1.21 ± .68 vs .66 ± .37, P = .00). Zero point five was the best cut off point to distinguish MCI and control of auditory P50 gating S2/S1 at Fz site. The P50 average amplitude at Pz site in MCI patients was significantly higher than controls (2.62 ± 1.20 vs 1.70 ± .74, P = .01). Conclusion: MCI patients might have impaired the ability of inhibiting the repeated stimulus.

Dual-Task Performance in Hearing-Impaired Older Adults-Study Protocol for a Cross-Sectional Mobile Brain/Body Imaging Study

Background: Hearing impairments are associated with reduced walking performance under Dual-task (DT) conditions. Little is known about the neural representation of DT performance while walking in this target group compared to healthy controls or younger adults. Therefore, utilizing the Mobile Brain/Body Imaging approach (MoBI), we aim at gaining deeper insights into the brain dynamics underlying the interaction of cognitive and motor processes during different DT conditions (visual and auditory) controlling for age and the potential performance decrements of older adults with hearing impairments.

Methods: The cross-sectional study integrates a multifactorial mixed-measure design. Between-subject factors grouping the sample will be age (younger vs. older adults) and hearing impairment (mild vs. not hearing impaired). The within-subject factors will be the task complexity (single- vs. DT) and cognitive task modality (visual vs. auditory). Stimuli of the cognitive task will vary according to the stimulus modality (visual vs. auditory), presentation side (left vs. right), and presentation-response compatibility (ipsilateral vs. contralateral). Analyses of DT costs and underlying neuronal correlates focus either on gait or cognitive performance. Based on an a priori sample size calculation 96 (48 healthy and 48 mildly hearing impaired) community-dwelling older adults (50–70 years) and 48 younger adults (20–30 years) will be recruited. Gait parameters of speed and rhythm will be captured. EEG activity will be recorded using 64 active electrodes.

Discussion: The study evaluates cognitive-motor interference (CMI) in groups of young and older adults as well as older adults with hearing impairment. The underlying processes of the interaction between motor and cognitive tasks will be identified at a behavioral and neurophysiological level comparing an auditory or a visual secondary task. We assume that performance differences are linked to different cognitive-motor processes, i.e., stimulus input, resource allocation, and movement execution. Moreover, for the different DT conditions (auditory vs. visual) we assume performance decrements within the auditory condition, especially for older, hearing-impaired adults. Findings will provide evidence of general mechanisms of CMI (ST vs. DT walking) as well as task-specific effects in dual-task performance while over ground walking.

MRI-based Alzheimer's disease-resemblance atrophy index in the detection of preclinical and prodromal Alzheimer's disease

Alzheimer's Disease-resemblance atrophy index (AD-RAI) is an MRI-based machine learning derived biomarker that was developed to reflect the characteristic brain atrophy associated with AD. Recent study showed that AD-RAI (≥0.5) had the best performance in predicting conversion from mild cognitive impairment (MCI) to dementia and from cognitively unimpaired (CU) to MCI. We aimed to validate the performance of AD-RAI in detecting preclinical and prodromal AD. We recruited 128 subjects (MCI=50, CU=78) from two cohorts: CU-SEEDS and ADNI. Amyloid (A+) and tau (T+) status were confirmed by PET (¹¹C-PIB, ¹⁸F-T807) or CSF analysis. We investigated the performance of AD-RAI in detecting preclinical and prodromal AD (i.e. A+T+) among MCI and CU subjects and compared its performance with that of hippocampal measures. AD-RAI achieved the best metrics among all subjects (sensitivity 0.74, specificity 0.91, accuracy 85.94%) and among MCI subjects (sensitivity 0.92, specificity 0.81, accuracy 86.00%) in detecting A+T+ subjects over other measures. Among CU subjects, AD-RAI yielded the best specificity (0.95) and accuracy (85.90%) over other measures, while hippocampal volume achieved a higher sensitivity (0.73) than AD-RAI (0.47) in detecting preclinical AD. These results showed the potential of AD-RAI in the detection of early AD, in particular at the prodromal stage.

A comparison of test-retest reliability of four cognitive screening tools in people with dementia

PURPOSE

This study aimed to compare the test-retest reliability and minimal detectable change (MDC) of the Mini-Mental State Examination (MMSE), the Short Portable Mental Status Questionnaire (SPMSQ), the Montreal Cognitive Assessment (MoCA), and the Saint Louis University Status Examination (SLUMS) in a single sample of people with dementia.

METHODS

Sixty people with dementia were assessed twice two weeks apart, and the test-retest reliability was examined using the intraclass correlation coefficient (ICC) for four screening tools. The MDC₉₅ value was calculated based on the standard error of measurement to estimate the random measurement error.

RESULTS

The ICC values for screening tools were 0.86-0.90. The MDC₉₅ values (MDC₉₅%) were 5.0 (17.2%), 2.74 (27%), 4.71(20%), and 6.26 (24%) for the MMSE, SPMSQ, MoCA, and SLUMS, respectively.

CONCLUSIONS

Overall, the four screening tools were similar in test-retest reliability which imply that the MMSE, MoCA, SPMSQ, and SLUMS were reliable in monitoring cognitive function in people with dementia. The results of the direct comparisons of test-retest reliability of the four screening tools provide useful information for both clinicians and researchers to select an appropriate cognitive screening tool.Implications for RehabilitationThe MMSE, MoCA, SPMSQ, and SLUMS are equally reliable and thus they could be used to monitor the cognitive function in people with dementia.The MDC values are useful in determining whether a real change has occurred between repeated assessments for people with dementia.

Association of acne, hirsutism, androgen, anxiety, and depression on cognitive performance in polycystic ovary syndrome: A cross-sectional study

Background

While polycystic ovary syndrome (PCOS) is often associated with psychological distress, its most frequent clinical characteristics include acne, hirsutism and increased level of androgen hormones.

Objective

To evaluate the level of depression and anxiety, hirsutism, acne, and level of androgen hormones in PCOS and control group and its association with cognitive function.

Materials and Methods

This cross-sectional study was conducted on 53 women with PCOS and 50 healthy women as a control group. Data were collected using a questionnaire including the samples' demographic information, clinical features, clinical findings of hyperandrogenism, and the Beck Depression and Anxiety questionnaire. In addition, the acne and hirsutism levels of the subjects were evaluated using the global acne grading system and the Ferriman-Gallwey scoring system, respectively. The Montreal Cognitive Assessment (MoCA) is a screening test for cognitive impairment that covers major cognitive domains.

Results

A significant difference was found between the two groups in the mean levels of acne, hirsutism, total testosterone, free androgen index, depression, and anxiety. However, some mean values of the MoCA were lower in the women of case group compared to the control group. Additionally, a significant difference was observed between the two groups in the domains of visual-spatial ability (p = 0.009), executive function (p = 0.05), attention (p = 0.03), and total MoCA scores (p = 0.002).

Conclusion

The PCOS women demonstrated significantly lower performance on the tests of executive function, attention, and visual-spatial function than the healthy control women.

A three-armed cognitive-motor exercise intervention to increase spatial orientation and life-space mobility in nursing home residents: study protocol of a randomized controlled trial in the PROfit project

Background

In nursing home residents, the combination of decreasing mobility and declining cognitive abilities, including spatial orientation, often leads to reduced physical activity (PA) and life-space (LS) mobility. As a consequence of sedentary behavior, there is a lack of social interaction and cognitive stimulation, resulting in low quality of life. It has not yet been examined whether cognitive-motor training including spatial cognitive tasks is suitable to improve spatial orientation and, as a consequence, to enlarge LS mobility, and increase well-being and general cognitive-motor functioning. Therefore, the overall goal of this multicentric randomized controlled trial (RCT) is to compare the effect of three different intervention approaches including functional exercise and orientation tasks on PA, LS and spatial orientation in nursing home residents.

Methods

A three-arm single-blinded multicenter RCT with a wait-list control group will be conducted in a sample of 513 individuals (needed according to power analysis) in three different regions in Germany. In each nursing home, one of three different intervention approaches will be delivered to participating residents for 12 weeks, twice a week for 45 min each: The PROfit basic group will perform functional strength, balance, flexibility, and walking exercises always at the same location, whereas the PROfit plus group changes the location three times while performing similar/the same exercises as the PROfit basic group. The PROfit orientation group receives navigation tasks in addition to the relocation during the intervention. Physical and cognitive functioning as well as psychological measures will be assessed in all study groups at baseline. Participants will then be randomized into either the intervention group or the wait-list control group. After 12 weeks, and after 24 weeks the measures will be repeated.

Discussion

This study evaluates whether the three different interventions are feasible to reduce the decline of or even improve PA, LS, and spatial orientation in nursing home residents. By adding different training locations in PROfit plus, the program is expected to be superior to PROfit basic in increasing physical and cognitive parameters. Moreover, we expect the PROfit orientation intervention to be most effective in terms of PA, LS, and spatial orientation due to two mechanisms: (1) increased physical and cognitive activity will enhance cognitive-motor capacity and (2) the spatial training will help to build up cognitive strategies to compensate for age-related loss of spatial orientation abilities and related limitations.

Trial registration

The trial was prospectively registered at DRKS.de with registration number DRKS00021423 on April 16, 2020 and was granted permission by the Technical University Berlin local ethics committee (No. GR_14_20191217).