Comparing Approaches to Optimize Cut-off Scores for Short Cognitive Screening Instruments in Mild Cognitive Impairment and Dementia

Domain-Specific Evaluation of Exergame Metrics Among Older Adults With Mild Neurocognitive Disorder: Secondary Analysis of 2 Randomized Controlled Trials

BACKGROUND

Exergame-based training enhances physical and cognitive performance in older adults, including those with mild neurocognitive disorder (mNCD). In-game metrics generated from user interactions with exergames enable individualized adjustments. However, there is a need to systematically investigate how well such game metrics capture true cognitive and motor-cognitive performance to provide a more robust basis for personalized training.

OBJECTIVE

The primary objective was to identify valid game metrics as indicators for in-game domain-specific cognitive performance during exergaming in individuals with mNCD. We also aimed to explore game metric performance changes over time during exergame-based training.

METHODS

Data were analyzed from individuals with mNCD who completed a 12-week home-based, exergame-based intervention following the Brain-IT training concept. A cross-sectional analysis was conducted by correlating game metrics with standardized neurocognitive reference assessments. To confirm the alternative hypothesis, we predetermined the following criteria: (1) statistically significant correlation (P≤.05; uncorrected; 1-sided) with (2) a correlation coefficient (Pearson r or Spearman ρ) of ≥0.4. Visual and curve-fitting longitudinal analyses were conducted to explore game performance changes over time.

RESULTS

Data were available from 31 participants (mean age 76.4, SD 7.5 y; n=9, 29% female). In total, 33% (6/18) of the game metrics were identified as valid indicators for in-game cognitive performance during exergaming. In the neurocognitive domain of learning and memory, these metrics included the mean reaction time (ρ=-0.747), the number of collected items (ρ=0.691), and the precision score (r=-0.607) for the game Shopping Tour (P<.001 in all cases), as well as the point rate (P=.008; r=0.471) for the game Simon. In addition, point rate was a valid indicator for executive function (P=.006; r=0.455) and visuospatial skills (P=.02; r=0.474) for the games Targets and Gears, respectively. The exploratory longitudinal analysis revealed high interindividual variability, with a general trend of the expected typical curvilinear curves of rapid initial improvements followed by a plateau in performance.

CONCLUSIONS

This study demonstrated that metrics reflecting the precision of responses generally performed better than metrics reflecting the speed of responses. These observations highlight the importance of selecting valid game metrics for implementation in exergame designs. Further research is needed to explore the potential of game metrics and identify factors contributing to individual variability in in-game performance and performance progression, as well as identifying and adopting strategies that facilitate individual learning success and thus promote effectiveness in improving health outcomes.

Frailty in motion: Amnestic mild cognitive impairment and Alzheimer's disease cohorts display heterogeneity in multimorbidity classification and longitudinal transitions

BackgroundData-driven examination of multiple morbidities and deficits are informative for clinical and research applications in aging and dementia. Resulting profiles may change longitudinally according to dynamic alterations in extent, duration, and pattern of risk accumulation. Do such frailty-related changes include not only progression but also stability and reversion?ObjectiveWith cognitively impaired and dementia cohorts, we employed data-driven analytics to (a) detect the extent of heterogeneity in frailty-related multimorbidity and deficit burden subgroups and (b) identify key person characteristics predicting differential transition patterns.MethodsWe assembled baseline and 2-year follow-up data from the National Alzheimer's Coordinating Center for amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD) cohorts. We applied factor analyses to 43 multimorbidity and deficit indicators. Latent Transition Analysis (LTA) was applied to the resulting domains in order to detect subgroups differing in transition patterns for multimorbidity and deficit burden. We characterized heterogeneity in change patterns by evaluating key person characteristics as differential predictors.ResultsFactor analyses revealed five domains at two time points. LTA showed that two latent burden subgroups at Time 1 (Low, Moderate) differentiated into an additional two subgroups at Time 2 (adding Mild, Severe). Transition analyses detected heterogeneous changes, including progression, stability, and reversion. Baseline classifications and transitions varied according to clinical cohort, global cognition, sex, age, and education.ConclusionsHeterogeneous frailty-related subgroup transitions can be (a) detected in aging adults living with aMCI and AD, (b) characterized as not only progression but also stability and reversion, and (c) predicted by precision characteristics.

Comparing Short Cognitive Screening Instruments in an Outreach Memory Clinic in Primary Care

Few studies have investigated the possibility of offering outreach from hospital-based memory clinic services to primary care. Such models could potentially improve access to specialised mental healthcare. We report on the reliability and validity of a pilot cognitive screening pathway in general practice (GP) in Ireland. Consecutive patients with memory complaints attending two primary care clinics were screened and diagnosed clinically by a physician-run memory clinic in GP. Follow-up in secondary care confirmed the diagnosis. Inter-rater reliability (IRR) and diagnostic validity of the Quick Mild Cognitive Impairment (Qmci) screen was compared to the Montreal Cognitive Assessment (MoCA) and General Practitioner Assessment of Cognition (GPCOG). In all, 63 patients, 31 with subjective memory complaints (SMC), 16 with mild cognitive impairment and 16 with dementia were screened. Their median age was 73 and 67% were female. The IRR of the Qmci screen between GP and clinic was excellent (r = 0.89). The Qmci was more accurate than the GPCOG in identifying cognitive impairment; the area under the curve (AUC) was 0.95 versus 0.80 (p = 0.008). The Qmci and MoCA had similar accuracy, with an AUC of 0.95 versus 0.91 (p = 0.117), respectively, but was significantly shorter (p < 0.001), suggesting it may be a useful instrument in this setting. Based on these results, a definitive study is now planned to examine the benefits and challenges of utilizing these instruments as part of establishing an outreach memory clinic service in primary care.

Exergaming for dementia and mild cognitive impairment

BACKGROUND

Dementia and mild cognitive impairment are significant contributors to disability and dependency in older adults. Current treatments for managing these conditions are limited. Exergaming, a novel technology-driven intervention combining physical exercise with cognitive tasks, is a potential therapeutic approach.

OBJECTIVES

To assess the effects of exergaming interventions on physical and cognitive outcomes, and activities of daily living, in people with dementia and mild cognitive impairment.

SEARCH METHODS

On 22 December 2023, we searched the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (Clarivate), LILACS (BIREME), ClinicalTrials.gov, and the WHO (World Health Organization) meta-register the International Clinical Trials Registry Portal.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that recruited individuals diagnosed with dementia or mild cognitive impairment (MCI). Exergaming interventions involved participants being engaged in physical activity of at least moderate intensity, and used immersive and non-immersive virtual reality (VR) technology and real-time interaction. We planned to classify comparators as inactive control group (e.g. no treatment, waiting list), active control group (e.g. standard treatment, non-specific active control), or alternative treatment (e.g. physical activity, computerised cognitive training). Outcomes were to be measured using validated instruments.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies for inclusion, extracted data, assessed the risk of bias using the Cochrane risk of bias tool RoB 2, and assessed the certainty of the evidence using GRADE. We consulted a third author if required. Where possible, we pooled outcome data using a fixed-effect or random-effects model. We expressed treatment effects as standardised mean differences (SMDs) for continuous outcomes and as risk ratios (RRs) for dichotomous outcomes, along with 95% confidence intervals (CIs). When data could not be pooled, we presented a narrative synthesis.

MAIN RESULTS

We included 11 studies published between 2014 and 2023. Six of these studies were pre-registered. Seven studies involved 308 participants with mild cognitive impairment, and five studies included 228 individuals with dementia. One of the studies presented data for both MCI and dementia separately. Most comparisons exhibited a high risk or some concerns of bias. We have only low or very low certainty about all the results presented below. Effects of exergaming interventions for people with dementia Compared to a control group Exergaming may improve global cognitive functioning at the end of treatment, but the evidence is very uncertain (SMD 1.47, 95% 1.04 to 1.90; 2 studies, 113 participants). The evidence is very uncertain about the effects of exergaming at the end of treatment on global physical functioning (SMD -0.20, 95% -0.57 to 0.17; 2 studies, 113 participants) or activities of daily living (ADL) (SMD -0.28, 95% -0.65 to 0.09; 2 studies, 113 participants). The evidence is very uncertain about adverse effects due to the small sample size and no events. Findings are based on two studies (113 participants), but data could not be pooled; both studies reported no adverse reactions linked to the intervention or control group. Compared to an alternative treatment group At the end of treatment, the evidence is very uncertain about the effects of exergaming on global physical functioning (SMD 0.14, 95% -0.30 to 0.58; 2 studies, 85 participants) or global cognitive functioning (SMD 0.11, 95% -0.33 to 0.55; 2 studies, 85 participants). For ADL, only one study was available (n = 67), which provided low-certainty evidence of little to no difference between exergaming and exercise. The evidence is very uncertain about adverse effects of exergaming compared with alternative treatment (RR 7.50, 95% CI 0.41 to 136.52; 2 studies, 2/85 participants). Effects of exergaming interventions for people with mild cognitive impairment (MCI) Compared to a control group Exergaming may improve global cognitive functioning at the end of treatment for people with MCI, but the evidence is very uncertain, (SMD 0.79, 95% 0.05 to 1.53; 2 studies, 34 participants). The evidence is very uncertain about the effects of exergaming at the end of treatment on global physical functioning (SMD 0.27, 95% -0.41 to 0.94; 2 studies, 34 participants) and ADL (SMD 0.51, 95% -0.01 to 1.03; 2 studies, 60 participants). The evidence is very uncertain about the effects of exergaming on adverse effects due to a small sample size and no events (0/14 participants). Findings are based on one study. Compared to an alternative treatment group The evidence is very uncertain about global physical functioning at the end of treatment. Only one study was included (n = 45). For global cognitive functioning, we included four studies (n = 235 participants), but due to considerable heterogeneity (I² = 96%), we could not pool results. The evidence is very uncertain about the effects of exergaming on global cognitive functioning. No study evaluated ADL outcomes. The evidence is very uncertain about adverse effects of exergaming due to the small sample size and no events (n = 123 participants). Findings are based on one study.

AUTHORS' CONCLUSIONS

Overall, the evidence is very uncertain about the effects of exergaming on global physical and cognitive functioning, and ADL. There may be an improvement in global cognitive functioning at the end of treatment for both people with dementia and people with MCI, but the evidence is very uncertain. The potential benefit is observed only when exergaming is compared with a control intervention (e.g. usual care, listening to music, health education), and not when compared with an alternative treatment with a specific effect, such as physical activity (e.g. standing and sitting exercises or cycling). The evidence is very uncertain about the effects of exergaming on adverse effects. All sessions took place in a controlled and supervised environment. Therefore, we do not know if exergaming can be safely used in a home environment, unsupervised.

Diagnostic accuracy, reliability, and construct validity of the German quick mild cognitive impairment screen

BACKGROUND

Early detection of cognitive impairment is among the top research priorities aimed at reducing the global burden of dementia. Currently used screening tools have high sensitivity but lack specificity at their original cut-off, while decreasing the cut-off was repeatedly shown to improve specificity, but at the cost of lower sensitivity. In 2012, a new screening tool was introduced that aims to overcome these limitations - the Quick mild cognitive impairment screen (Qmci). The original English Qmci has been rigorously validated and demonstrated high diagnostic accuracy with both good sensitivity and specificity. We aimed to determine the optimal cut-off value for the German Qmci, and evaluate its diagnostic accuracy, reliability (internal consistency) and construct validity.

METHODS

We retrospectively analyzed data from healthy older adults (HOA; n = 43) and individuals who have a clinical diagnosis of 'mild neurocognitive disorder' (mNCD; n = 37) with a biomarker supported characterization of the etiology of mNCD of three studies of the 'Brain-IT' project. Using Youden's Index, we calculated the optimal cut-off score to distinguish between HOA and mNCD. Receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic accuracy based on the area under the curve (AUC). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Reliability (internal consistency) was analyzed by calculating Cronbach's α. Construct validity was assessed by analyzing convergent validity between Qmci-G subdomain scores and reference assessments measuring the same neurocognitive domain.

RESULTS

The optimal cut-off score for the Qmci-G was ≤ 67 (AUC = 0.96). This provided a sensitivity of 91.9% and a specificity of 90.7%. The PPV and NPV were 89.5% and 92.9%, respectively. Cronbach's α of the Qmci-G was 0.71 (CI95% [0.65 to 0.78]). The Qmci-G demonstrated good construct validity for subtests measuring learning and memory. Subtests that measure executive functioning and/or visuo-spatial skills showed mixed findings and/or did not correlate as strongly as expected with reference assessments.

CONCLUSION

Our findings corroborate the existing evidence of the Qmci's good diagnostic accuracy, reliability, and construct validity. Additionally, the Qmci shows potential in resolving the limitations of commonly used screening tools, such as the Montreal Cognitive Assessment. To verify these findings for the Qmci-G, testing in clinical environments and/or primary health care and direct comparisons with standard screening tools utilized in these settings are warranted.

Screening for Cognitive Impairment in Movement Disorders: Comparison of the Montreal Cognitive Assessment and Quick Mild Cognitive Impairment Screen in Parkinson's Disease and Lewy Body Dementia

Background

The Montreal Cognitive Assessment (MoCA) is recommended by the Movement Disorder Society for cognitive testing in movement disorders including Parkinson's disease (PD) and lewy body dementia. Few studies have compared cognitive screening instruments in these diseases, which overlap clinically.

Objective

To compare the MoCA and Quick Mild Cognitive Impairment (Qmci) screen in this population.

Methods

Patients attending memory and movement disorder clinics associated with a university hospital had the MoCA and Qmci screen performed and diagnostic accuracy compared with the area under the receiver operating characteristic curve (AUC). Duration and severity of movement disorders was assessed using the Unified PD Rating Scale (UPDRS).

Results

In total, 133 assessments were available, median age 74±5. Median education was 11±4 years and 65% were male. Median total UPDRS score was 37±26. Median Qmci screen was 51±27, median MoCA was 19±10. There were statistically significant differences in test scores between those with subjective symptoms but normal cognition, mild cognitive impairment (MCI) and dementia (p < 0.001). The Qmci screen had significantly greater accuracy differentiating normal cognition from MCI versus the MoCA (AUC 0.90 versus 0.72, p = 0.01). Both instruments had similar accuracy in identifying cognitive impairment and separating MCI from dementia. The median administration time for the Qmci screen and MoCA were 5.19 and 9.24 minutes (p < 0.001), respectively.

Conclusions

Both the MoCA and Qmci screen have good to excellent accuracy in a population with movement disorders experiencing cognitive symptoms. The Qmci screen was significantly more accurate for those with early symptoms and had a shorter administration time.

Protein fibril aggregation on red blood cells: a potential biomarker to distinguish neurodegenerative diseases from healthy aging

Neurodegenerative diseases like Alzheimer's disease are characterized by the accumulation of misfolded proteins into fibrils in the brain. Atomic force microscopy is a nanoscale imaging technique that can be used to resolve and quantify protein aggregates from oligomers to fibrils. Recently, we characterized protein fibrillar aggregates adsorbed on the surface of red blood cells with atomic force microscopy from patients with neurocognitive disorders, suggesting a novel Alzheimer's disease biomarker. However, the age association of fibril deposits on red blood cells has not yet been studied in detail in healthy adults. Here, we used atomic force microscopy to visualize and quantify fibril coverage on red blood cells in 50 healthy adults and 37 memory clinic patients. Fibrillar protein deposits sporadically appeared in healthy individuals but were much more prevalent in patients with neurodegenerative disease, especially those with Alzheimer's disease as confirmed by positive CSF amyloid beta 1-42/1-40 ratios. The prevalence of fibrils on the red blood cell surface did not significantly correlate with age in either healthy individuals or Alzheimer's disease patients. The overlap in fibril prevalence on red blood cells between Alzheimer's disease and amyloid-negative patients suggests that fibril deposition on red blood cells could occur in various neurodegenerative diseases. Quantifying red blood cell protein fibril morphology and prevalence on red blood cells could serve as a sensitive biomarker for neurodegeneration, distinguishing between healthy individuals and those with neurodegenerative diseases. Future studies that combine atomic force microscopy with immunofluorescence techniques in larger-scale studies could further identify the chemical nature of these fibrils, paving the way for a comprehensive, non-invasive biomarker platform for neurodegenerative diseases.

Psychometric Evaluation of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Mixed Methods Study

BACKGROUND

With the rapid aging of the global population, the prevalence of mild cognitive impairment (MCI) and dementia is anticipated to surge worldwide. MCI serves as an intermediary stage between normal aging and dementia, necessitating more sensitive and effective screening tools for early identification and intervention. The BrainFx SCREEN is a novel digital tool designed to assess cognitive impairment. This study evaluated its efficacy as a screening tool for MCI in primary care settings, particularly in the context of an aging population and the growing integration of digital health solutions.

OBJECTIVE

The primary objective was to assess the validity, reliability, and applicability of the BrainFx SCREEN (hereafter, the SCREEN) for MCI screening in a primary care context. We conducted an exploratory study comparing the SCREEN with an established screening tool, the Quick Mild Cognitive Impairment (Qmci) screen.

METHODS

A concurrent mixed methods, prospective study using a quasi-experimental design was conducted with 147 participants from 5 primary care Family Health Teams (FHTs; characterized by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants included health care practitioners, patients, and FHT administrative executives. Individuals aged ≥55 years with no history of MCI or diagnosis of dementia rostered in a participating FHT were eligible to participate. Participants were screened using both the SCREEN and Qmci. The study also incorporated the Geriatric Anxiety Scale-10 to assess general anxiety levels at each cognitive screening. The SCREEN's scoring was compared against that of the Qmci and the clinical judgment of health care professionals. Statistical analyses included sensitivity, specificity, internal consistency, and test-retest reliability assessments.

RESULTS

The study found that the SCREEN's longer administration time and complex scoring algorithm, which is proprietary and unavailable for independent analysis, presented challenges. Its internal consistency, indicated by a Cronbach α of 0.63, was below the acceptable threshold. The test-retest reliability also showed limitations, with moderate intraclass correlation coefficient (0.54) and inadequate κ (0.15) values. Sensitivity and specificity were consistent (63.25% and 74.07%, respectively) between cross-tabulation and discrepant analysis. In addition, the study faced limitations due to its demographic skew (96/147, 65.3% female, well-educated participants), the absence of a comprehensive gold standard for MCI diagnosis, and financial constraints limiting the inclusion of confirmatory neuropsychological testing.

CONCLUSIONS

The SCREEN, in its current form, does not meet the necessary criteria for an optimal MCI screening tool in primary care settings, primarily due to its longer administration time and lower reliability. As the number of digital health technologies increases and evolves, further testing and refinement of tools such as the SCREEN are essential to ensure their efficacy and reliability in real-world clinical settings. This study advocates for continued research in this rapidly advancing field to better serve the aging population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/25520.

Feasibility, usability, and acceptance of "Brain-IT"-A newly developed exergame-based training concept for the secondary prevention of mild neurocognitive disorder: a pilot randomized controlled trial

Background

Exergames provide a promising new approach to implement simultaneous motor-cognitive training, which may support preventing the decline in cognitive functioning in older adults who have a mild neurocognitive disorder (mNCD).

Objectives

To evaluate feasibility, system usability, and acceptance of "Brain-IT", a newly developed training concept combining exergame-based motor-cognitive training and heart rate variability (HRV) guided resonance breathing for the secondary prevention of mNCD.

Methods

A pilot randomized controlled trial (RCT) with an allocation ratio of 2:1 (i.e., intervention:control) was conducted. The control group proceeded with usual care. The intervention group performed a 12-week training according to the "Brain-IT" training concept implemented with the "Senso Flex" (Dividat AG) exergaming system in addition to usual care. Feasibility and usability outcomes were analyzed using descriptive statistics. User acceptance was analyzed qualitatively and using Friedman analysis of variance (ANOVA), as well as Wilcoxon signed-rank tests.

Results

Eighteen participants (77.3 ± 9.8 years; 44.4% females) were included. On average, we recruited 2.2 participants per month, and 35.3% of the individuals contacted were included. The intervention group had an attrition rate of 20% and mean adherence and compliance rates of 85.0 and 84.1%, respectively. The mean system usability score, measured with the system usability scale, was 71.7. High levels of exergame enjoyment, an increase in exergame enjoyment, and internalization of training motivation with large effect sizes (p = 0.03, r = 0.75 and p = 0.03, r = 0.74, respectively), as well as acceptable perceived usefulness, were observed. Preliminary data on the effects of the "Brain-IT" training are promising.

Conclusion

The feasibility and usability of the "Brain-IT" training are acceptable. However, frequent occurrences of technical problems and difficulties in using the exergame training system were identified as barriers to performing the "Brain-IT" training. To optimize feasibility, either improvements or alternative solutions are required in the hardware and software of the exergame used to implement the "Brain-IT" training. The "Brain-IT" training itself was well-accepted by older adults who have mNCD. Therefore, the effectiveness of the "Brain-IT" training concept should be investigated in future studies.

Trial registration

clinicaltrials.gov/ct2/show/NCT04996654.

Association between endocrine therapy and cognitive decline in older women with early breast cancer: Findings from the prospective CLIMB study

INTRODUCTION

Studies investigating the long-term effects of breast cancer treatment on cognition in older women with breast cancer are lacking, even though preserving cognition is highly valued by the older population. Specifically, concerns have been raised regarding the detrimental effects of endocrine therapy (ET) on cognition. Therefore, we investigated cognitive functioning over time and predictors for cognitive decline in older women treated for early breast cancer.

METHODS

We prospectively enrolled Dutch women aged ≥70 years with stage I-III breast cancer in the observational CLIMB study. The Mini-Mental State Examination (MMSE) was performed before ET initiation and after 9, 15 and 27 months. Longitudinal MMSE scores were analysed and stratified for ET. Linear mixed models were used to identify possible predictors of cognitive decline.

RESULTS

Among the 273 participants, the mean age was 76 years (standard deviation 5), and 48% received ET. The mean baseline MMSE score was 28.2 (standard deviation 1.9). Cognition did not decline to clinically meaningful differences, irrespective of ET. MMSE scores of women with pre-treatment cognitive impairments slightly improved over time (significant interaction terms) in the entire cohort and in women receiving ET. High age, low educational level and impaired mobility were independently associated with declining MMSE scores over time, although the declines were not clinically meaningful.

CONCLUSION

Cognition of older women with early breast cancer did not decline in the first two years after treatment initiation, irrespective of ET. Our findings suggest that the fear of declining cognition does not justify the de-escalation of breast cancer treatment in older women.

Comparison of the Six Item Cognitive Impairment Test (6CIT) to Commonly-Used Short Cognitive Screening Instruments in a Memory Clinic Population

Background: Short cognitive screening instruments (CSI) are required to identify cognitive impairment in busy outpatient clinics. While the Six Item Cognitive Impairment Test (6CIT) is commonly used, its accuracy in those with mild cognitive impairment (MCI) and subjective cognitive decline (SCD) and against more widely-used CSIs is less established. Objective: To examine the diagnostic accuracy of the 6CIT against the Montreal Cognitive Assessment (MoCA) and Quick Mild Cognitive Impairment (Qmci) screen across the cognitive spectrum in a memory clinic population. Methods: In total, 142 paired assessments were available (21 with SCD, 32 MCI, and 89 with dementia). Consecutive patients underwent a comprehensive assessment and were screened using the 6CIT, Qmci, and MoCA. Accuracy was determined from the area under receiver operating characteristic curves (AUC). Results: The median age of patients was 76 (±11) years; 68% were female. The median 6CIT score was 10/28 (±14). The 6CIT was strongly, negatively, and statistically significantly correlated with the Qmci (r = –0.84) and MoCA (r = –0.86). The 6CIT had good accuracy for separating cognitive impairment (MCI or dementia) from SCD, (AUC:0.88; 0.82–0.94), similar to the MoCA (AUC:0.92; 0.87–0.97, p = 0.308), but statistically lower than the Qmci (AUC:0.96; 0.94–0.99, p = 0.01). The 6CIT was faster to administer, median time 2.05 minutes versus 4.38 and 9.5 for the Qmci and MoCA, respectively. Conclusion: While the Qmci was more accurate than the 6CIT, the shorter administration time of the 6CIT, suggests it may be useful when assessing or monitoring cognitive impairment in busy memory clinics, though larger samples are required to evaluate.

Olfactory function changes and the predictive performance of the Chinese Smell Identification Test in patients with mild cognitive impairment and Alzheimer's disease

Objectives

Olfactory disorder is one of the sensory features that reflects a decline in cognitive function. However, olfactory changes and the discernibility of smell testing in the aging population have yet to be fully elucidated. Therefore, this study aimed to examine the effectiveness of the Chinese Smell Identification Test (CSIT) in distinguishing individuals with cognitive decline from those with normal aging and to determine whether the patients with MCI and AD show changes in their olfactory identification abilities.

Methods

This cross-sectional study included eligible participants aged over 50 years between October 2019 and December 2021. The participants were divided into three groups: individuals with mild cognitive impairment (MCI), individuals with Alzheimer's disease (AD), and cognitively normal controls (NCs). All participants were assessed using neuropsychiatric scales, the Activity of Daily Living scale, and the 16-odor cognitive state test (CSIT) test. The test scores and the severity of olfactory impairment were also recorded for each participant.

Results

In total, 366 eligible participants were recruited, including 188 participants with MCI, 42 patients with AD, and 136 NCs. Patients with MCI achieved a mean CSIT score of 13.06 ± 2.05, while patients with AD achieved a mean score of 11.38 ± 3.25. These scores were significantly lower than those of the NC group (14.6 ± 1.57; P < 0.001). An analysis showed that 19.9% of NCs exhibited mild olfactory impairment, while 52.7% of patients with MCI and 69% of patients with AD exhibited mild to severe olfactory impairment. The CSIT score was positively correlated with the MoCA and MMSE scores. The CIST score and the severity of olfactory impairment were identified as robust indicators for MCI and AD, even after adjusting for age, gender, and level of education. Age and educational level were identified as two important confounding factors that influence cognitive function. However, no significant interactive effects were observed between these confounders and CIST scores in determining the risk of MCI. The area under the ROC curve (AUC) generated from the ROC analysis was 0.738 and 0.813 in distinguishing patients with MCI and patients with AD from NCs based on the CIST scores, respectively. The optimal cutoff for distinguishing MCI from NCs was 13, and for distinguishing AD from NCs was 11. The AUC for distinguishing AD from MCI was 0.62.

Conclusions

The olfactory identification function is frequently affected in patients with MCI and patients with AD. CSIT is a beneficial tool for the early screening of cognitive impairment among elderly patients with cognitive or memory issues.

Effectiveness of an Individualized Exergame-Based Motor-Cognitive Training Concept Targeted to Improve Cognitive Functioning in Older Adults With Mild Neurocognitive Disorder: Study Protocol for a Randomized Controlled Trial

BACKGROUND

Simultaneous motor-cognitive training is considered promising for preventing the decline in cognitive functioning in older adults with mild neurocognitive disorder (mNCD) and can be highly motivating when applied in the form of exergaming. The literature points to opportunities for improvement in the application of exergames in individuals with mNCD by developing novel exergames and exergame-based training concepts that are specifically tailored to patients with mNCD and ensuring the implementation of effective training components.

OBJECTIVE

This study systematically explores the effectiveness of a newly developed exergame-based motor-cognitive training concept (called "Brain-IT") targeted to improve cognitive functioning in older adults with mNCD.

METHODS

A 2-arm, parallel-group, single-blinded randomized controlled trial with a 1:1 allocation ratio (ie, intervention: control), including 34 to 40 older adults with mNCD will be conducted between May 2022 and December 2023. The control group will proceed with the usual care provided by the (memory) clinics where the patients are recruited. The intervention group will perform a 12-week training intervention according to the "Brain-IT" training concept, in addition to usual care. Global cognitive functioning will be assessed as the primary outcome. As secondary outcomes, domain-specific cognitive functioning, brain structure and function, spatiotemporal parameters of gait, instrumental activities of daily living, psychosocial factors, and resting cardiac vagal modulation will be assessed. Pre- and postintervention measurements will take place within 2 weeks before starting and after completing the intervention. A 2-way analysis of covariance or the Quade nonparametric analysis of covariance will be computed for all primary and secondary outcomes, with the premeasurement value as a covariate for the predicting group factor and the postmeasurement value as the outcome variable. To determine whether the effects are substantive, partial eta-squared (η²_p) effect sizes will be calculated for all primary and secondary outcomes.

RESULTS

Upon the initial submission of this study protocol, 13 patients were contacted by the study team. Four patients were included in the study, 2 were excluded because they were not eligible, and 7 were being informed about the study in detail. Of the 4 included patients, 2 already completed all premeasurements and were in week 2 of the intervention period. Data collection is expected to be completed by December 2023. A manuscript of the results will be submitted for publication in a peer-reviewed open-access journal in 2024.

CONCLUSIONS

This study contributes to the evidence base in the highly relevant area of preventing disability because of cognitive impairment, which has been declared a public health priority by the World Health Organization.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05387057; https://clinicaltrials.gov/ct2/show/NCT05387057.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41173.

Design Considerations for an Exergame-Based Training Intervention for Older Adults With Mild Neurocognitive Disorder: Qualitative Study Including Focus Groups With Experts and Health Care Professionals and Individual Semistructured In-depth Patient Interviews

BACKGROUND

Exergames have attracted growing interest in the prevention and treatment of neurocognitive disorders. The most effective exergame and training components (ie, exercise and training variables such as frequency, intensity, duration, or volume of training and type and content of specific exergame scenarios) however remain to be established for older adults with mild neurocognitive disorders (mNCDs). Regarding the design and development of novel exergame-based training concepts, it seems of crucial importance to explicitly include the intended users' perspective by adopting an interactive and participatory design that includes end users throughout different iterative cycles of development.

OBJECTIVE

This study aimed to determine the capabilities, treatment preferences, and motivators for the training of older adults with mNCD and the perspectives of individuals on training goals and settings and requirements for exergame and training components.

METHODS

A qualitative study including expert focus groups and individual semistructured in-depth patient interviews was conducted. Data were transcribed to a written format to perform qualitative content analysis using QCAmap software.

RESULTS

In total, 10 experts and health care professionals (80% females) and 8 older adults with mNCD (38% females; mean age 82.4, SD 6.2 years) were recruited until data saturation was observed.

CONCLUSIONS

The psychosocial consequences of patients' self-perceived cognitive deterioration might be more burdensome than the cognitive changes themselves. Older adults with mNCD prefer integrative forms of training (such as exergaming) and are primarily motivated by enjoyment or fun in exercising and the effectiveness of the training. Putting the synthesized perspectives of training goals, settings, and requirements for exergames and training components into context, our considerations point to opportunities for improvement in research and rehabilitation, either by adapting existing exergames to patients with mNCDs or by developing novel exergames and exergame-based training concepts specifically tailored to meet patient requirements and needs.

Comparison of the Greek Version of the Quick Mild Cognitive Impairment Screen and Montreal Cognitive Assessment in Older Adults

Objective: Cognitive screening instruments (CSIs) are essential for everyday practice. The Quick Mild Cognitive Impairment (Qmci) screen, a short instrument designed to identify mild cognitive impairment, was recently translated into Greek (Qmci-Gr). The present study compared its diagnostic value against the Montreal Cognitive Assessment (MoCA) screen and examined its optimal cutoffs. Method: We recruited consecutive patients aged ≥55 years that presented with cognitive complaints from two outpatient clinics in Greece. The Qmci-Gr and MoCA were completed by all patients. Furthermore, they were assessed independently with a comprehensive flexible neuropsychological battery to establish a diagnostic classification. Results: In the current study, we assessed a total of 145 patients, with a median age of 70 years; 44 were classified as having Subjective Memory Complaints (SMC) but normal cognition, 32 with MCI and 69 with dementia. The Qmci-Gr had a higher accuracy compared to the MoCA in discriminating MCI from dementia, area under the curve (AUC) of 0.81 versus 0.75, respectively; however, this finding was marginally significant (p = 0.08). Its accuracy was marginally higher for distinguishing SMC from dementia, AUC of 0.94 versus 0.89 (p = 0.03). However, Qmci-Gr presented a lower accuracy than MoCa in differentiating SMC from MCI, AUC of 0.76 versus 0.94 (p = 0.006). Conclusions: The Qmci-Gr has comparable diagnostic accuracy to the MoCA regarding MCI and dementia groups. Further research, with larger and more diverse samples, may be necessary to ensure generalizability.

Comparison of the Accuracy of Short Cognitive Screens Among Adults With Cognitive Complaints in Turkey

BACKGROUND

Cutoff values of cognitive screen tests vary according to age and educational levels.

OBJECTIVE

The objective of this study was to compare the accuracy and determine cutoffs for 3 short cognitive screening instruments: the Mini-Mental State Examination, Montreal Cognitive Assessment (MoCA), and Quick Mild Cognitive Impairment Screen-Turkish version (Qmci-TR), in older adults with low literacy in Turkey.

METHODS

In all 321 patients, 133 with subjective cognitive complaints (SCC), 88 amnestic-type mild cognitive impairment (aMCI), and 100 with probable Alzheimer disease (AD) with a median of 5 years education were included. Education and age-specific cutoffs were determined.

RESULTS

For the overall population, the Qmci-TR was more accurate than the MoCA in distinguishing between aMCI and AD (area under the curve=0.83 vs. 0.76, P=0.004) and the Qmci-TR and Mini-Mental State Examination were superior to the MoCA in discriminating SCC from aMCI and AD. All instruments had similar accuracy among those with low literacy (primary school and lower educational level or illiterate).

CONCLUSIONS

To distinguish between SCC, aMCI, and AD in a sample of older Turkish adults, the Qmci-TR may be preferable. In very low literacy, the choice of the instrument appears less important.

The Persian Version of the Quick Mild Cognitive Impairment Screen (Qmci-Pr): Psychometric Properties among Middle-Aged and Older Iranian Adults

Brief cognitive screening instruments are used to identify patients presenting with cognitive symptoms that warrant further assessment. This study aimed to evaluate the reliability and validity of the Persian version of the Quick Mild Cognitive Impairment (Qmci-Pr) among middle-aged and older Iranian adults. Consecutive patients aged ≥55 years and caregivers attending with them as normal controls (NCs) were recruited from geriatric outpatient clinics and a hospital in Tehran, Iran. All patients completed the Qmci-Pr before completing an independent detailed neuropsychological assessment and staging using the Clinical Dementia Rating (CDR) Scale. NCs underwent the same assessment. In all, 92 participants with a median age of 70 years (±13) were available. Of these, 20 participants were NCs, 24 had subjective memory complaints (SMC), 24 had mild cognitive impairment (MCI), and 24 had Alzheimer's disease (AD). The Qmci-Pr had good accuracy in differentiating SMC and NC from MCI (area under the curve (AUC): 0.80 (0.69-0.91)) and in identifying cognitive impairment (MCI and mild AD) (AUC: 0.87 (0.80-0.95)) with a sensitivity of 88% and specificity of 80%, at an optimal cut-off of <53/100. The Qmci-Pr is an accurate short cognitive screening impairment for separating NC and patients with SMC from MCI and identifying cognitive impairment. Further research with larger samples and comparison with other widely used instruments such as the Montreal Cognitive Assessment is needed. Given its established brevity, the Qmci-Pr is a useful screen for Iranian adults across the spectrum of cognitive decline.

Association between childhood parental involvement and late-life cognitive function: A population-based cross-sectional study among cognitively intact community-dwelling older adults in Japan

AIM

Although poor childhood rearing environment is known to negatively impact late-life cognitive function, there is a scarcity of evidence on the contribution of positive parenting behaviors. The present study investigates the association between parental involvement in childhood and late-life cognitive function.

METHODS

A total of 266 older adults aged between 65 and 88 years living in Wakuya City, Miyagi Prefecture, Japan, without indication of mild cognitive impairment or dementia, participated in a survey. Parental involvement in childhood was assessed by a questionnaire, and late-life cognitive function was measured by the Japanese version of the Quick Mild Cognitive Impairment (QMCI) screening test (range: 0-100). Multiple regression analysis was performed to investigate the association, adjusting for potential confounders and mediators.

RESULTS

After adjusting for age, sex, other child-rearing environment, and academic performance in grade 6, older adults with a high level of positive parental involvement in childhood scored 6.00 (95% CI: 2.39, 9.61) points higher for the QMCI total score than those without. Parental involvement in childhood showed significant dose-response positive associations with the QMCI total score (P < 0.001), clock-drawing test score (P < 0.05), and verbal fluency score (P < 0.001). Among the six types of positive parental involvement, book reading showed a significant independent positive association with QMCI total score (P < 0.01) and logical memory score (P < 0.01).

CONCLUSIONS

Greater parental involvement in childhood, particularly book reading, was associated with better late-life cognitive function. Geriatr Gerontol Int 2021; 21: 794-801.

Comparison of the Greek Version of the Quick Mild Cognitive Impairment Screen and Standardised Mini-Mental State Examination

INTRODUCTION

Short cognitive screening instruments (CSIs) are widely used to stratify patients presenting with cognitive symptoms. The Quick Mild Cognitive Impairment (Qmci) screen is a new, brief (<5mins) CSI designed to identify mild cognitive impairment (MCI), which can be used across the spectrum of cognitive decline. Here we present the translation of the Qmci into Greek (Qmci-Gr) and its validation against the widely-used Standardised Mini-Mental State Examination (SMMSE).

METHODS

Consecutive patients aged ≥55 years presenting with cognitive complaints were recruited from two outpatient clinics in Greece. All patients completed the Qmci-Gr and SMMSE and underwent an independent detailed neuropsychological assessment to determine a diagnostic classification.

RESULTS

In total, 140 patients, median age 75 years, were included; 30 with mild dementia (median SMMSE 23/30), 76 with MCI and 34 with subjective memory complaints (SMC) but normal cognition. The Qmci-Gr had similar accuracy in differentiating SMC from cognitive impairment (MCI & mild dementia) compared with SMMSE, area under the curve (AUC) of 0.84 versus 0.79, respectively; while accuracy was higher for the Qmci-Gr, this finding was not significantly different, (p = .19). Similarly, the Qmci-Gr had similar accuracy in separating SMC from MCI, AUC of 0.79 versus 0.73 (p = .23).

CONCLUSIONS

The Qmci-Gr compared favorably with the SMMSE. Further research with larger samples and comparison with other instruments such as the Montreal Cognitive Assessment is needed to confirm these findings but given its established brevity, it may be a better choice in busy clinical practice in Greece.

Psychometric Evaluation and Workflow Integration Study of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Protocol for a Mixed Methods Study

BACKGROUND

With the rapid aging of the global population, experts anticipate a surge in the prevalence of mild cognitive impairment (MCI) and dementia worldwide. It is argued that developing more sensitive, easy to administer, and valid MCI screening tools for use in primary care settings may initiate timely clinical and personal care planning and treatment, enabling early access to programs and services. Including functional competence measures in screening tests makes them more ecologically valid and may help to identify cognitive deficits at an earlier stage.

OBJECTIVE

We aim to conduct a preliminary evaluative study comparing the sensitivity, specificity, and reliability of the BrainFx Screen (referred to as SCREEN hereafter), a novel digital tool designed to assess functional competence and detect early signs of cognitive impairment, with the Quick Mild Cognitive Impairment, a validated and highly sensitive tool that detects MCI in the older adult population. We will also investigate the perceived usefulness and integration of the SCREEN into primary care practice to identify demonstrable impacts on clinical workflow and health care providers' (HCP) perceptions of its success as a screening tool. Patients' perceptions of completing the SCREEN and its impact on their quality of life will also be explored.

METHODS

This study has a concurrent, mixed methods, prospective, and quasi-experimental design. Participants will be recruited from 5 primary care family health teams (FHTs; defined by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants will include HCPs, patients, care partners, and FHT administrative executives. Patients 55 years and older with no history of diagnoses for MCI, dementia, or Alzheimer disease rostered in one of the FHTs participating in the study will be eligible to participate. Their care partners will help triangulate the qualitative data collected from patients. Participating FHTs will identify an occupational therapist from their site to participate in the study; this HCP will both administer the research protocol and participate in semistructured in-depth interviews and questionnaires. Principal component analysis will be conducted on the SCREEN data to understand the test components better. Tests comparing sensitivity, specificity, and test-retest reliability will assess the validity of SCREEN as a screening tool for MCI.

RESULTS

This paper describes the study protocol and its activities to date. Data collection was halted early because of COVID-19 restrictions on research activity, and data analysis is currently in progress.

CONCLUSIONS

At the end of the project, we anticipate having an initial comparative evaluation of the SCREEN as a tool for early detection of MCI in primary care older adult patient populations. Resource constraints on this research study limit our ability to conduct a randomized controlled trial; however, the results will assist developers of the SCREEN in determining whether rigorous controlled testing is warranted.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/25520.

Social connectedness and dementia prevention: Pilot of the APPLE-Tree video-call intervention during the Covid-19 pandemic

Background and Objectives

The Covid-19 pandemic reduced access to social activities and routine health care that are central to dementia prevention. We developed a group-based, video-call, cognitive well-being intervention; and investigated its acceptability and feasibility; exploring through participants’ accounts how the intervention was experienced and used in the pandemic context.

Research Design and Method

We recruited adults aged 60+ years with memory concerns (without dementia). Participants completed baseline assessments and qualitative interviews/focus groups before and after the 10-week intervention. Qualitative interview data and facilitator notes were integrated in a thematic analysis.

Results

12/17 participants approached completed baseline assessments, attended 100/120 (83.3%) intervention sessions and met 140/170 (82.4%) of goals set. Most had not used video calling before. In the thematic analysis, our overarching theme was social connectedness. Three sub-themes were as follows: Retaining independence and social connectedness: social connectedness could not be at the expense of independence; Adapting social connectedness in the pandemic: participants strived to compensate for previous social connectedness as the pandemic reduced support networks; Managing social connections within and through the intervention: although there were tensions, for example, between sharing of achievements feeling supportive and competitive, participants engaged with various lifestyle changes; social connections supported group attendance and implementation of lifestyle changes.

Discussion and Implications

Our intervention was acceptable and feasible to deliver by group video-call. We argue that dementia prevention is both an individual and societal concern. For more vulnerable populations, messages that lifestyle change can help memory should be communicated alongside supportive, relational approaches to enabling lifestyle changes.

Screening for Cognitive Impairment After Stroke: Validation of the Chinese Version of the Quick Mild Cognitive Impairment Screen

Background: Screening for post-stroke cognitive impairment (PSCI) is necessary because stroke increases the incidence of and accelerates premorbid cognitive decline. The Quick Mild Cognitive Impairment (Qmci) screen is a short, reliable and accurate cognitive screening instrument but is not yet validated in PSCI. We compared the diagnostic accuracy of a Chinese version of the Qmci screen (Qmci-CN) compared with the widely-used Chinese versions of the Montreal Cognitive Assessment (MoCA-CN) and Mini-Mental State Examination (MMSE-CN).

Methods: We recruited 34 patients who had recovered from a stroke in rehabilitation unit clinics in 2 university hospitals in China: 11 with post-stroke dementia (PSD), 15 with post-stroke cognitive impairment no dementia (PSCIND), and 8 with normal cognition (NC). Classification was made based on clinician assessment supported by a neuropsychological battery, independent of the screening test scores. The Qmci-CN, MoCA-CN, and MMSE-CN screens were administered randomly by a trained rater, blind to the diagnosis.

Results: The mean age of the sample was 63 ± 13 years and 61.8% were male. The Qmci-CN had statistically similar diagnostic accuracy in differentiating PSD from NC, an area under the curve (AUC) of 0.94 compared to 0.99 for the MoCA-CN (p = 0.237) and 0.99 for the MMSE-CN (p = 0.293). The Qmci-CN (AUC 0.91), MoCA-CN (AUC 0.94), and MMSE-CN (AUC 0.79) also had statistically similar accuracy in separating PSD from PSCIND. The MoCA-CN more accurately distinguished between PSCIND and normal cognition than the Qmci-CN (p = 0.015). Compared to the MoCA-CN, the administration times of the Qmci-CN (329s vs. 611s, respectively, p < 0.0001) and MMSE-CN (280 vs. 611s, respectively, p < 0.0001) were significantly shorter.

Conclusion: The Qmci-CN is accurate in identifying PSD and separating PSD from PSCIND in patients post-stroke following rehabilitation and is comparable to the widely-used MoCA-CN, albeit with a significantly shorter administration time. The Qmci-CN had relatively poor accuracy in identifying PSCIND from NC and hence may lack accuracy for certain subgroups. However, given the small sample size, the study is under-powered to show superiority of one instrument over another. Further study is needed to confirm these findings in a larger sample size and in other settings (countries and languages).

Association between Sour Taste SNP KCNJ2-rs236514, Diet Quality and Mild Cognitive Impairment in an Elderly Cohort

Differences in sour-taste thresholds have been identified in cognition-related diseases. Diet is a modulator of cognitive health, and taste perception influences dietary preferences and habits. Heritable genetics and polymorphisms in the KCNJ2 gene involved in the transduction of sour taste have been linked to variations in sour taste and non-gustatory functions. However, relationships between sour taste genetics, mild cognitive impairment, and diet quality are yet to be elucidated. This study investigated the associations between the presence of the KCNJ2-rs236514 variant (A) allele, diet quality indices, and mild cognitive impairment evaluated by the Mini-Mental State Examination (MMSE), in a secondary cross-sectional analysis of data from the Retirement Health & Lifestyle Study. Data from 524 elderly Australians (≥65y) were analyzed, using standard least squares regression and nominal logistic regression modeling, with demographic adjustments applied. Results showed that the presence of the KCNJ2-A allele is associated with increased proportions of participants scoring in the range indicative of mild or more severe cognitive impairment (MMSE score of ≤26) in the total cohort, and males. These associations remained statistically significant after adjusting for age, sex, and diet quality indices. The absence of association between the KCNJ2-A allele and cognitive impairment in women may be related to their higher diet quality scores in all indices. The potential link between sour taste genotype and cognitive impairment scores may be due to both oral and extra-oral functions of sour taste receptors. Further studies are required on the role and relationship of neurotransmitters, sour taste genotypes and sour taste receptors in the brain, and dietary implications, to identify potential risk groups or avenues for therapeutic or prophylactic interventions.

Evaluating the Real-World Representativeness of Participants with Mild Cognitive Impairment in Canadian Research Protocols: a Comparison of the Characteristics of a Memory Clinic Patients and Research Samples

Background

Studies of mild cognitive impairment (MCI) employ rigorous eligibility criteria, resulting in sampling that may not be representative of the broader clinical population.

Objective

To compare the characteristics of MCI patients in a Calgary memory clinic to those of MCI participants in published Canadian studies.

Methods

Clinic participants included 555 MCI patients from the PROspective Registry of Persons with Memory SyMPToms (PROMPT) registry in Calgary. Research participants included 4,981 individuals with MCI pooled from a systematic literature review of 112 original, English-language peer-reviewed Canadian studies. Both samples were compared on baseline sociodemographic variables, medical and psychiatric comorbidities, and cognitive performance for MCI due to Alzheimer’s disease and Parkinson’s disease.

Results

Overall, clinic patients tended to be younger, more often male, and more educated than research participants. Psychiatric disorders, traumatic brain injury, and sensory impairment were commonplace in PROMPT (up to 83% affected) but > 80% studies in the systematic review excluded these conditions. PROMPT patients also performed worse on global cognition measures than did research participants.

Conclusion

Stringent eligibility criteria in Canadian research studies excluded a considerable subset of MCI patients with comorbid medical or psychiatric conditions. This exclusion may contribute to differences in cognitive performance and outcomes compared to real-world clinical samples.

Effect of Visit-to-Visit Blood Pressure Variability on Cognitive and Functional Decline in Mild to Moderate Alzheimer's Disease

BACKGROUND

Visit-to-visit blood pressure (BP) variability (VVV) is increasingly recognized as a marker of cardiovascular risk. Although implicated in cognitive decline, few studies are currently available assessing its effects on established dementia.

OBJECTIVE

To investigate if VVV is associated with one-year rate of decline in measures of cognition and function in patients with mild to moderate Alzheimer's disease (AD) in the Doxycycline And Rifampicin for Alzheimer's Disease study.

METHODS

Patients were included if ≥3 BP readings were available (n = 392). VVV was defined using different approaches including the coefficient of variation (CV) in BP readings between visits. Outcomes included rates of decline in the Standardized Alzheimer's Disease Assessment Scale-Cognitive Subscale (SADAS-cog), Standardized MMSE, Clinical Dementia Rating Scale, the Quick Mild Cognitive Impairment screen and the Lawton-Brody activities of daily living (ADL) scale.

RESULTS

Half of the patients (196/392) had a ≥4-point decline in the SADAS-cog over one-year. Using this cut-off, there were no statistically significant associations between any measures of VVV, for systolic or diastolic BP, with and without adjustment for potential confounders including treatment allocation, history of hypertension and use of anti-hypertensive and cognitive enhancing medications. Multiple regression models examining the association between systolic BP CV by quartile and decline over one-year likewise showed no clinically significant effects, apart from a U-shaped pattern of ADL decline of borderline clinical significance.∥Conclusions: This observational study does not support recent research showing that VVV predicts cognitive decline in AD. Further studies are needed to clarify its effects on ADL in AD.

Defining 'optimal' test cut-off using global test metrics: evidence from a cognitive screening instrument

Aim: To examine the variation of several global metrics of test accuracy with test cut-off for the diagnosis of dementia. These metrics included some based on the receiver operating characteristic curve, such as Youden index, and some independent of receiver operating characteristic curve, such as correct classification accuracy. Materials & methods: Data from a test accuracy study of Mini-Addenbrooke's Cognitive Examination were used to calculate and plot each global measure against test cut-off. Results: Different 'optimal' cut-points were identified for the different global measures, with a spread of ten points in observed optimal cut-off in the 30-point Mini-Addenbrooke's Cognitive Examination scale. Using these optima gave a large variation in test sensitivity from very high (diagnostic odds ratio) to very low (likelihood to be diagnosed or misdiagnosed), but all had high negative predictive value. Conclusion: The method used to determine the cut-off of cognitive screening instruments may have significant implications for test performance.

Incidence of Mild Cognitive Impairment with Ascending Altitude

Background: This study aimed to longitudinally quantify the prevalence of mild cognitive impairment (MCI) in individual trekkers at three different ascending altitudes (Site 1: ∼3500 m, Site 2: ∼4400 m, and Site 3: ∼5100 m). We correlated these findings with the presence of acute mountain sickness (AMS). Materials and Methods: We performed serial assays using the environmental quick mild cognitive impairment (eQMCI) score on 103 English-speaking 18- to 65-year-old volunteers trekking to Everest Base Camp in Nepal during spring 2016. We defined MCI as a score less than 67 (lower scores indicating more cognitive impairment). Additional data collected included the Lake Louise Score, demographics, and other possible confounders. Results: eQMCI scores significantly decreased with ascent from Site 1 to 2 (a score of 78.95 [SD = 7.96] to 74.67 [SD = 8.8] [Site 1-2 p = 0.04]), but then increased on ascent to Site 3 to 83.68 (SD = 8.67) (Site 1-3 p = <0.0001, Site 2-3 p = <0.0001). However, subjects who fulfilled eQMCI criteria for MCI increased despite the overall improvement in score: 6.8% (N = 7) at Site 1, 18.7% (N = 14) at Site 2, and 3.3% (N = 2) at Site 3. Incidence of AMS at Sites 1, 2, and 3 was 22.3% (N = 23), 21.3% (N = 16), and 48.3% (N = 29), respectively. Of those with MCI, 1.94% met criteria for AMS at Site 1 (p = 0.0017), 2.67% at Site 2 (p = 0.6949), and 3.33% at Site 3 (p = <0.0001). Conclusions: There is a significant incidence of MCI at high altitude, even in those without subjective findings of AMS. Interestingly, subjects with a decline in cognitive function show an increasing trend for developing AMS at higher altitude. Future research on the clinical impact of MCI on a subject's health, judgment, and performance remains to be elucidated.

Screening for Cognitive Frailty Using Short Cognitive Screening Instruments: Comparison of the Chinese Versions of the MoCA and Qmci Screen

Background

Cognitive frailty describes cognitive impairment associated with physical decline. Few studies have explored whether short cognitive screens identify frailty. We examined the diagnostic accuracy of the Chinese versions of the Quick Mild Cognitive Impairment (Qmci-CN) screen and Montreal Cognitive Assessment (MoCA-CN) in identifying cognitive frailty.

Methods

Ninety-five participants with cognitive symptoms [47 with mild cognitive impairment (MCI), 34 with subjective cognitive disorder, and 14 with dementia] were included from two outpatient rehabilitation clinics. Energy (work intensity) and physical activity levels were recorded. Cognitive frailty was diagnosed by an interdisciplinary team using the IANA/IAGG consensus criteria, stratified on the Clinical Frailty Scale (CFS). Instruments were administered sequentially and randomly by trained assessors, blind to the diagnosis.

Results

The mean age of the sample was 62.6 ± 10.2 years; median CFS score was 4 ± 1 and 36 (38%) were cognitively frail. The Qmci-CN had similar accuracy in differentiating the non-frail from cognitively frail compared to the MoCA-CN, AUC 0.82 versus 0.74, respectively (p = 0.19). At its optimal cut-off (≤55/100), the Qmci-CN provided a sensitivity of 83% and specificity of 67% versus 91% and 51%, respectively, for the MoCA-CN (≤23/30). Neither was accurate in separating MCI from cognitive frailty but both accurately separated cognitive frailty from dementia.

Conclusion

Established short cognitive screens may be useful in identifying cognitive frailty in Chinese adults with cognitive complaints but not in separating MCI from cognitive frailty. The Qmci-CN had similar accuracy to the MoCA-CN and a shorter administration time in this small and under-powered study, necessitating the need for adequately powered studies in different healthcare settings.

A Reliable Tool for Assessing MCI and Dementia: Validation Study of DemTect for Turkish Population

BACKGROUND AND AIM

Mild cognitive impairment (MCI) and dementia prevalence are expected to increase with aging. The DemTect is a very quick and easy tool to administer and recognize the early stages of dementia and MCI. In this study we aimed to evaluate the reliability and validity of a Turkish version of the DemTect and define cut off values for different age and educational levels. One of our aims is also to compare the sensitivity and specifity of the DemTect to other common screening tools.

PATIENTS AND METHODS

Fifty-four patients with MCI, 55 patients with dementia and 91 patients with subjective memory complaints (SMC) were enrolled in the study. The DemTect was translated into Turkish by forward-backward translation and compared with the Mini Mental State Examination (MMSE), the Quick Mild Cognitive Impairment Turkish version (QMCI-TR) and the Montreal Cognitive Assessment (MoCA). In order to test interrater reliability, the DemTect was administered to 11 patients, on the same day, by 2 trained raters. To establish test-retest reliability, the same rater scored the tool a second time on 11 patients within 2 weeks.

RESULTS

The median age of the patients was 73 (min-max: 65-90) years, 54.5% were female. We found a strong correlation between DemTect scores and the MMSE, the QMCI, and the MoCA (r = 0.725, r = 0.816, r = 0.821, respectively; p < 0.001). In ROC analysis, the cut-off point of the DemTect to differentiate MCI from SMC was 11.5 with 92.6% sensitivity, 91.2% specificity, AUC 0.973 and the cut-off point of the DemTect to differentiate dementia from SMC was 9.5 with 96.4% sensitivity, 100% specificity, AUC 0.916. Cronbach α was 0.823. Intraclass correlation coefficient was 0.873 (95% CI: 0.598-0.964) for interrater reliability and 0.966 (95% 0.777-0.982) for test-retest reliability (Cronbach α = 0.932, 0.966 respectively).

CONCLUSION

The DemTect is a very reliable tool to assess Turkish patients with MCI and dementia.

Is the Quick Mild Cognitive Impairment Screen (QMCI) more accurate at detecting mild cognitive impairment than existing short cognitive screening tests? A systematic review of the current literature

OBJECTIVES

Differentiating normal cognition, mild cognitive impairment (MCI), and dementia is important, as these conditions differ in terms of their prognosis and treatment. Existing short cognitive screening tests vary widely in their accuracy, sensitivity, and specificity at detecting MCI and dementia. The Quick Mild Cognitive Impairment Screen (QMCI) was developed in 2012 as a fast and accurate "MCI specific" screening test. The aim of the current study was to conduct a literature review to compare the accuracy, sensitivity, and specificity of the QMCI at differentiating normal cognition, MCI, and dementia to existing short cognitive screening tests at their optimal cut-off scores.

METHODS

A search of the electronic journal databases EBSCO, Psych info, and Science Direct was undertaken using the keywords "Quick Mild Cognitive Impairment Screen," "QMCI," "accuracy," "sensitivity," and "specificity." Results of individual studies were examined, and 2 × 2 tables were drawn up to obtain the overall accuracy, sensitivity, and specificity of each test across the studies included.

RESULTS

Results from individual studies show that the QMCI has higher accuracy at detecting MCI and dementia than these cognitive screens. Pooled analysis shows that it also has greater sensitivity and specificity at optimal cut-off points for each test.

CONCLUSIONS

Based in the current review, the QMCI represents a more accurate, sensitive, and specific screening test for MCI and dementia than the SMMSE or the MoCA. This has important implications in screening for cognitive impairment.

Risk Factors Associated with Mild Cognitive Impairment among Apparently Healthy People and the Role of MicroRNAs

BACKGROUND

Mild cognitive impairment (MCI) is a stage between the expected cognitive decline of normal ageing and the serious decline of dementia.

AIM

To identify risk factors and role of miRNAs associated with mild cognitive impairment (MCI) among employees.

SUBJECTS AND METHOD

A cross-sectional study was carried out on 186 employees aged between 40 and 65 years. Cognitive function was evaluated using ACEIII, MoCA, and Quick cognitive tests. Medical history and lifestyle were assessed. Family 132 & 134 miRNA expressions were assessed by real-time PCR.

RESULTS

MCI was detected among 14 / 186 (7.5%). miRNA 132 expression was the only significant miRNAs to detect MCI with low sensitivity and specificity (70%). The logistic analysis revealed that higher miRNA132 expressions, low monthly intake of; vegetables, unroasted nuts, low education and higher ALT levels were predicting factors for MCI with AOR 1.1 (1.01-3.3), 1.2 (1.04-1.43), 0.8 (0.8-0.98), 2.7 (1.9-7.4) and 1.6 (1.1-2.3) respectively.

CONCLUSION

MiRNAs expression showed low sensitivity and specificity in detecting MCI; only miRNA 132 might be used. Several modifiable factors seem to reduce the risk of MCI.

Sleep Disturbance in Older Patients in the Emergency Department: Prevalence, Predictors and Associated Outcomes

Impaired sleep is common in hospital. Despite this, little is known about sleep disturbance among older adults attending Emergency Departments (ED), particularly overnight-boarders, those admitted but housed overnight while awaiting a bed. Consecutive, medically-stable patients aged ≥70, admitted through a university hospital ED were evaluated for overnight sleep quality (Richards Campbell Sleep Questionnaire/RCSQ) and baseline sleep (Pittsburgh Sleep Quality Index/PSQI). Additional variables included frailty, functional and cognitive status, trolley location, time in ED and night-time noise levels. Over four-weeks, 152 patients, mean age 80 (± 6.8) years were included; 61% were male. Most (68%) were ED boarders (n = 104) and 43% were frail. The majority (72%) reported impaired sleep quality at baseline (PSQI ≥ 5) and 13% (20/152) had clinical insomnia. The median time spent in ED for boarders was 23 h (Interquartile ± 13). After adjusting for confounders, median RCSQ scores were significantly poorer for ED boarders compared with non-boarders: 22 (± 45) versus 71 (± 34), respectively, (p = 0.003). There was no significant difference in one-year mortality (p = 0.08) length of stay (LOS) (p = 0.84), 30-day (p = 0.73) or 90-day (p = 0.64) readmission rates between boarders and non-boarders. Sleep disturbance is highly prevalent among older adults admitted through ED. ED boarders experienced significantly poorer sleep, without this impacting upon mortality, LOS or re-admission rates.

Selecting a Bedside Cognitive Vital Sign to Monitor Cognition in Hospital: Feasibility, Reliability, and Responsiveness of Logical Memory

Although there is a high prevalence of delirium and cognitive impairment among hospitalised older adults, short, reliable cognitive measures are rarely used to monitor cognition and potentially alert healthcare professionals to early changes that might signal delirium. We evaluated the reliability, responsiveness, and feasibility of logical memory (LM), immediate verbal recall of a short story, compared to brief tests of attention as a bedside “cognitive vital sign” (CVS). Trained nursing staff performed twice-daily cognitive assessments on 84 clinically stable inpatients in two geriatric units over 3–5 consecutive days using LM and short tests of attention and orientation including months of the year backwards. Scores were compared to those of an expert rater. Inter-rater reliability was excellent with correlation coefficients for LM increasing from r = 0.87 on day 1 to r = 0.97 by day 4 (p < 0.0001). A diurnal fluctuation of two points from a total of 30 was deemed acceptable in clinically stable patients. LM scores were statistically similar (p = 0.98) with repeated testing (suggesting no learning effect). All nurses reported that LM was feasible to score routinely. LM is a reliable measure of cognition showing diurnal variation but minimal learning effects. Further study is required to define the properties of an ideal CVS test, though LM may satisfy these.

Dementia Prevalence in the United States in 2000 and 2012: Estimates Based on a Nationally Representative Study

Objectives

Age- and sex-specific rates of dementia are estimated in the U.S. population aged 65 or older in 2000 and 2012 using a large nationally representative dataset, the Health and Retirement Study (HRS), and accounting for mortality selection and specificities of the interview protocol.

Method

A latent cognitive ability model is estimated by maximum simulated likelihood. Prevalence of dementia is identified using HRS cognition measures and the Aging, Demographics and Memory Study (ADAMS), a subset of the HRS (n = 856) with clinical assessment for dementia. Different cognitive measures are collected in self and proxy interviews. From 2006 onward, the HRS collected fewer interviews by proxy. Selection into proxy interviews is modeled as well as survival into the ADAMS sample from the previous HRS interview.

Results

The prevalence of dementia decreased from 12.0% (SE = 0.48%) in 2000 to 10.5% (SE = 0.49%) in 2012 in the 65+ population, a statistically significant decline of 12.6% (p < .01). The percentage change in prevalence was larger among males (16.6% vs 9.5%), and younger individuals.

Discussion

The prevalence of dementia among those 65 or older decreased between 2000 and 2012, although less rapidly than reported in other studies. The difference is primarily due to our modeling selection into proxy interviews.

Comparing the Diagnostic Accuracy of Two Cognitive Screening Instruments in Different Dementia Subtypes and Clinical Depression

Short but accurate cognitive screening instruments are required in busy clinical practice. Although widely-used, the diagnostic accuracy of the standardised Mini-Mental State Examination (SMMSE) in different dementia subtypes remains poorly characterised. We compared the SMMSE to the Quick Mild Cognitive Impairment (Qmci) screen in patients (n = 3020) pooled from three memory clinic databases in Canada including those with mild cognitive impairment (MCI) and Alzheimer’s, vascular, mixed, frontotemporal, Lewy Body and Parkinson’s dementia, with and without co-morbid depression. Caregivers (n = 875) without cognitive symptoms were included as normal controls. The median age of patients was 77 (Interquartile = ±9) years. Both instruments accurately differentiated cognitive impairment (MCI or dementia) from controls. The SMMSE most accurately differentiated Alzheimer’s (AUC 0.94) and Lewy Body dementia (AUC 0.94) and least accurately identified MCI (AUC 0.73), vascular (AUC 0.74), and Parkinson’s dementia (AUC 0.81). The Qmci had statistically similar or greater accuracy in distinguishing all dementia subtypes but particularly MCI (AUC 0.85). Co-morbid depression affected accuracy in those with MCI. The SMMSE and Qmci have good-excellent accuracy in established dementia. The SMMSE is less suitable in MCI, vascular and Parkinson’s dementia, where alternatives including the Qmci screen may be used. The influence of co-morbid depression on scores merits further investigation.

Cognitive screening instruments to identify vascular cognitive impairment: A systematic review

INTRODUCTION

Vascular cognitive impairment (VCI) is common and important to detect as controlling risk factors, particularly hypertension, may slow onset and progression. There is no consensus as to which cognitive screening instrument (CSI) is most suitable for VCI. We systematically reviewed the psychometric properties of brief CSIs for vascular mild cognitive impairment (VMCI) and vascular dementia (VaD).

METHODS

Literature searches were performed using scholarly databases from inception until 31 May 2018. Studies were eligible if participants were aged 18 or older, interviewed face-to-face, and standard diagnostic criteria for VCI were applied, excluding those specifically identifying post-stroke dementia. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool.

RESULTS

Fifteen studies were identified including eight types of CSIs (27 subtests/variants) and 4575 participants (1015 with VCI), mean age range: 51.6 to 75.5 years. Most studies compared more than one instrument. Five papers examined clock-drawing; four, the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE); and three used the Brief Memory and Executive Test (BMET). The MoCA (AUC > 0.90) and MMSE (AUC: 0.86-0.99) had excellent accuracy in differentiating VaD from controls; the MoCA had good internal consistency (Cronbach's α: .83-.88). The MoCA (AUC: 0.87-0.93) and BMET (AUC: 0.94) had the greatest accuracy in separating VMCI from controls. Most studies had low to moderate risk of bias in all domains of the QUIPS. Data were heterogeneous, precluding a meta-analysis.

CONCLUSIONS

Although few studies were available and further research is required, data suggests that the MoCA is accurate and reliable for differentiating VaD and VMCI from controls.

MACE for Diagnosis of Dementia and MCI: Examining Cut-Offs and Predictive Values

The definition of test cut-offs is a critical determinant of many paired and unitary measures of diagnostic or screening test accuracy, such as sensitivity and specificity, positive and negative predictive values, and correct classification accuracy. Revision of test cut-offs from those defined in index studies is frowned upon as a potential source of bias, seemingly accepting any biases present in the index study, for example related to sample bias. Data from a large pragmatic test accuracy study examining the Mini-Addenbrooke's Cognitive Examination (MACE) were interrogated to determine optimal test cut-offs for the diagnosis of dementia and mild cognitive impairment (MCI) using either the maximal Youden index or the maximal correct classification accuracy. Receiver operating characteristic (ROC) and precision recall (PR) curves for dementia and MCI were also plotted, and MACE predictive values across a range of disease prevalences were calculated. Optimal cut-offs were found to be a point lower than those defined in the index study. MACE had good metrics for the area under the ROC curve and for the effect size (Cohen's d) for both dementia and MCI diagnosis, but PR curves suggested the superiority for MCI diagnosis. MACE had high negative predictive value at all prevalences, suggesting that a MACE test score above either cut-off excludes dementia and MCI in any setting.

Identification of community-dwelling older adults at risk of frailty using the PERSSILAA screening pathway: a methodological guide and results of a large-scale deployment in the Netherlands

Background

Among community-dwelling older adults, frailty is highly prevalent and recognized as a major public health concern. To prevent frailty it is important to identify those at risk of becoming frail, but at present, no accepted screening procedure is available.

Methods

The screening process developed as part of the PERSSILAA project is a two-step screening pathway. First, older adults are asked to complete a self-screening questionnaire to assess their general health status and their level of decline on physical, cognitive and nutritional domains. Second, older adults who, according to step one, are at risk of becoming frail, are invited for a face-to-face assessment focusing on the domains in depth. We deployed the PERSSILAA screening procedure in primary care in the Netherlands.

Results

In total, baseline data were available for 3777 community-dwelling older adults (mean age 69.9 (SD ± 3.8)) who completed first step screening. Based on predefined cut-off scores, 16.8% of the sample were classified as frail (n = 634), 20.6% as pre-frail (n = 777), and 62.3% as robust (n = 2353). Frail subjects were referred back to their GP without going through the second step. Of the pre-frail older adults, 69.7% had evidence of functional decline on the physical domain, 67% were overweight or obese and 31.0% had evidence of cognitive decline.

Conclusion

Pre-frailty is common among community-dwelling older adults. The PERSSILAA screening approach is a multi-factor, two-step screening process, potentially useful for primary prevention to identify those at risk of frailty and who will benefit most from preventive strategies.

Validity of the Japanese Version of the Quick Mild Cognitive Impairment Screen

Early detection of dementia provides opportunities for interventions that could delay or prevent its progression. We developed the Japanese version of the Quick Mild Cognitive Impairment (Qmci-J) screen, which is a performance-based, easy-to-use, valid and reliable short cognitive screening instrument, and then we examined its validity. Community-dwelling adults aged 65–84 in Niigata prefecture, Japan, were concurrently administered the Qmci-J and the Japanese version of the standardized Mini-Mental State Examination (sMMSE-J). Mild cognitive impairment (MCI) and dementia were categorized using established and age-adjusted sMMSE-J cut-offs. The sample (n = 526) included 52 (9.9%) participants with suspected dementia, 123 (23.4%) with suspected MCI and 351 with likely normal cognition. The Qmci-J showed moderate positive correlation with the sMMSE-J (r = 0.49, p < 0.001) and moderate discrimination for predicting suspected cognitive impairment (MCI/dementia) based on sMMSE-J cut-offs, area under curve: 0.74, (95%CI: 0.70–0.79), improving to 0.76 (95%CI: 0.72 to 0.81) after adjusting for age. At a cut-off of 60/61/100, the Qmci-J had a 73% sensitivity, 68% specificity, 53% positive predictive value, and 83% negative predictive value for cognitive impairment. Normative data are presented, excluding those with any sMMSE-J < 27. Though further research is required, the Qmci-J screen may be a useful screening tool to identify older adults at risk of cognitive impairment.

The Italian version of the quick mild cognitive impairment (Qmci-I) screen: normative study on 307 healthy subjects

OBJECTIVE

To devise an Italian version of the quick mild cognitive impairment screen (Qmci) and to obtain normative data.

METHODS

An Italian version of the Qmci screen (Qmci-I) was administered to 307 subjects free from cognitive impairment. The normative sample was divided into three age levels (50-59; 60-69 and 70-80 years) and four education levels (3-5; 6-8; 9-13; >13 years of school attendance). Multiple regression analyses were used to evaluate the effect of age, sex and schooling on Qmci-I scores (overall and by domains) and to calculate cut-off values, with reference to the confidence interval on the fifth centile.

RESULTS

The mean Qmci-I score was 64/100 (SD = 11). The age variable showed a significant negative effect on the overall Qmci-I score, with older people performing worse than younger ones. Conversely, education was associated with higher scores. Significant effects of age and education affected logical memory alone. For the other domains, the following effects were found: (1) higher age associated with lower scores on delayed recall; (2) higher education levels associated with higher scores on immediate recall, clock drawing and word fluency. The adjusted cut-off score for the Qmci-I screen in this sample was 49.4. Qmci-I scores were weakly correlated with those of MMSE (rho = 0.20).

CONCLUSIONS

The Qmci-I is a rapid and multi-domain short cognitive screening instrument useful for evaluating cognitive functions. However, like other screening tools, it is significantly influenced by age and education, requiring normative data and correction of values when used in the clinical practice.

Innovative Approaches to Active and Healthy Ageing: Campania Experience to Improve the Adoption of Innovative Good Practices

The demographic projections on the European population predict that people aged over 60 will increase by about two million/year in the next decades. Since 2012, the Campania Reference Site of the European Innovation Partnership on Active and Healthy Ageing supports the innovation of the Regional Health System, to face up demographic changes and sustainability. Campania Reference Site provides the opportunity to connect loco-regional stakeholders in social and health care services (universities, healthcare providers, social services, local communities and municipalities), with international organizations, in order to adopt and scale up innovative solutions and approaches. This paper describes the building process of Campania Reference Site and the main results achieved, that have been allowing it to become a hub for open innovation in the field of active and healthy aging at regional, national and international level.

The RAPid COmmunity COGnitive screening Programme (RAPCOG): Developing the Portuguese version of the Quick Mild Cognitive Impairment (Qmci-P) screen as part of the EIP on AHA Twinning Scheme

As populations age and the prevalence of cognitive impairment increases, healthcare professionals and researchers require short, validated cognitive screening instruments (CSIs). As part the EIP-on-AHA Twinning Support Scheme (2016), four reference sites developed the RAPid COmmunity COGnitive screening Programme (RAPCOG) twinning project to validate translated versions of the Quick Mild Cognitive Impairment (Qmci) screen that could be adapted quickly for use with future eHealth screening and assessment programmes. Here we present the cultural adaption and translation of the Qmci-Portuguese (Qmci-P) screen as part of RAPCOG and explore its subsequent validation against two commonly-used CSIs (MMSE-P and MoCA-P) with 93 participants aged ≥65, attending ten day care centres or resident in two long-term care institutions; median age 74 (+/-15), 66% female. The Qmci-P's internal consistency was high (Cronbach's Alpha 0.82), compared with the MoCA (0.79) and SMMSE (0.54). Qmci-P screen scores moderately correlated with the SMMSE (r=0.61, 95% CI:0.45-0.72, p<0.001) and MoCA (r=0.63, 95% CI:0.36-0.80, p<0.001). The Qmci-P screen demonstrates high internal consistency and concurrent validity against more established CSIs and given its brevity (3-5mins), may be preferable for use in community settings. This project shows the potential of the EIP-on-AHA Twinning initiative to promote the scaling-up of innovative good practices.

Brain magnetic resonance spectroscopy and cognitive impairment in chronic hepatitis C patients

Background

Cognitive dysfunction in patients with chronic hepatitis C virus (HCV) infection may appear long before the development of severe liver cirrhosis. These alterations are not ascribed to hepatic encephalopathy; however, early detection is always difficult.

Objective

The aim of this study was to assess the changes of magnetic resonance spectroscopy (MRS) metabolites among chronic hepatitis C virus patients with and without cognitive impairment.

Patients and methods

A cross-sectional study was conducted in Suez Canal University Hospital. Forty-six HCV patients was included and divided into two groups: patients with and without cognitive impairment. Assessment of cognitive function was done using mini-mental state examination and Wechsler Memory Scale - Revised. Both groups were subjected to single-voxel MRS to evaluate metabolites in three brain regions: the basal ganglia, hippocampus, and posterior cingulate gyrus.

Results

The CHO/Cr was significantly higher, and NAA/Cr was significantly lower in group with cognitive impairment in the basal ganglia and posterior cingulate gyrus. Mini-mental state score had negative significant correlation with PCR of HCV. Mini-mental state score had significant negative and positive correlation with CHO/Cr and NAA/Cr, respectively, in the basal ganglia. All values of the Wechsler Memory Scale were statistically higher in the group without cognitive impairment except verbal memory score.

Conclusion

There were changes at brain metabolites associated with cognitive impairment in chronic hepatitis C patients regarding a decrease of NAA/Cr ratio and an increase of CHO/Cr ratio at the basal ganglia.

Screening for cognitive impairment in an Australian aged care assessment team as part of comprehensive geriatric assessment

Accurate detection of mild cognitive impairment (MCI) is important to stratify and address risk. Yet, few short cognitive screening instruments are validated for this. . In Australia, all clients referred to an Aged Care Assessment Team (ACAT) receive comprehensive geriatric assessment (CGA) including the Standardized Mini-Mental State Examination (SMMSE). We compared the accuracy of the quick mild cognitive impairment (Qmci) screen to the SMMSE in 283 participants: 195 with dementia, 47 with MCI, and 41 with subjective cognitive decline (SCD) in an Australian community-based ACAT. Both had similar accuracy in identifying dementia, AUC of 0.86 for the Qmci versus 0.93 for the SMMSE (p = 0.10), but the Qmci was more accurate than the SMMSE in differentiating MCI from SCD, AUC of 0.84 versus 0.71, respectively, p = 0.046. These suggest that the new, short (3-5 min) Qmci screenis appropriate for use in an ACAT or other units conducting CGA.

Validation of the Turkish Version of the Quick Mild Cognitive Impairment Screen

BACKGROUND

The objective of this study was to validate the Turkish version of the Quick Mild Cognitive Impairment (Q mci-TR) screen.

METHODS

In total, 100 patients aged ≥65 years referred to a geriatric outpatient clinic with memory loss were included. The Q mci was compared to the Turkish versions of the standardized Mini-Mental State Examination and the Montreal Cognitive Assessment (MoCA).

RESULTS

The Q mci-TR had higher accuracy than the MoCA in discriminating subjective memory complaints (SMCs) from cognitive impairment (mild cognitive impairment [MCI] or dementia), of borderline significance after adjusting for age and education ( P = .06). The Q mci-TR also had higher accuracy than the MoCA in differentiating MCI from SMC, which became nonsignificant after adjustment ( P = .15). A similar pattern was shown for distinguishing MCI from dementia. Test reliability for the Q mci-TR was strong.

CONCLUSION

The Q mci-TR is a reliable and useful screening tool for discriminating MCI from SMC and dementia in a Turkish population.