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Del Brutto OH, Rumbea DA, Costa AF, Patel M, Sedler MJ, Mera RM. Cognitive performance and all-cause mortality in community dwellers of Amerindian ancestry living in rural Ecuador: A population-based, longitudinal prospective study. Clin Neurol Neurosurg 2024; 236:108053. [PMID: 37992533 DOI: 10.1016/j.clineuro.2023.108053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE There is limited information on mortality risk in individuals with cognitive impairment living in rural Latin America. In this study, we assess the association between cognitive impairment and all-cause mortality in adults of Amerindian ancestry living in rural Ecuador. PATIENTS AND METHODS Middle-aged and older adults enrolled in the population-based Three Villages Study cohort were followed prospectively in order to estimate mortality risk according to their baseline cognitive performance as determined by the Montreal Cognitive Assessment (MoCA). Results were adjusted for demographics, level of education, traditional cardiovascular risk factors, symptoms of depression, severe tooth loss, and oily fish intake (factors previously associated with mortality in the study population). RESULTS Analysis included 1022 individuals followed for an average of 7.8 ± 3.4 years. Mean MoCA score was 21.2 ± 5.4 points (median: 22 points), with 334 (32.7%) individuals showing cognitive impairment, as evidenced by a MoCA score ≤ 19 points (the cutoff for poor cognitive performance based on previous studies in the same population). A total of 150 (14.7%) individuals died during the follow-up. Crude mortality rate was 2.87 per 100 person-years (95% C.I.: 2.08 - 3.96). For individuals with normal cognition, the mortality rate was 1.21 (95% C.I.: 0.92 - 1.50) while for those with cognitive impairment the rate increased to 3.48 (95% C.I.: 2.73 - 4.23). A multivariate Cox-proportional hazards model, confirmed that individuals with cognitive impairment had a significantly higher mortality risk than those without cognitive impairment (HR: 1.52; 95% C.I.: 1.05 - 2.18). CONCLUSIONS Cognitive impairment is associated with mortality in the study population.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador.
| | - Denisse A Rumbea
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Aldo F Costa
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Maitri Patel
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Mark J Sedler
- Renaissance School of Medicine, Stony Brook University, New York, NY, USA
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, CA, USA
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Koshimoto BHB, Brandão PRDP, Borges V, Ferraz HB, Schumacher-Schuh AF, Rieder CRDM, Olchik MR, Mata IF, Tumas V, Santos-Lobato BL. Floor and ceiling effects on the Montreal Cognitive Assessment in patients with Parkinson's disease in Brazil. Dement Neuropsychol 2023; 17:e20230022. [PMID: 38053643 PMCID: PMC10695441 DOI: 10.1590/1980-5764-dn-2023-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/10/2023] [Accepted: 07/30/2023] [Indexed: 12/07/2023] Open
Abstract
Parkinson's disease (PD) is a common neurodegenerative disease associated with cognitive impairment. The Montreal Cognitive Assessment (MoCA) has been used as a recommended global cognition scale for patients with PD, but there are some concerns about its application, partially due to the floor and ceiling effects. Objective To explore the floor and ceiling effects on the MoCA in patients with PD in Brazil. Methods Cross-sectional study with data from patients with PD from five Brazilian Movement Disorders Clinics, excluding individuals with a possible diagnosis of dementia. We analyzed the total score of the MoCA, as well as its seven cognitive domains. The floor and ceiling effects were evaluated for the total MoCA score and domains. Multivariate analyses were performed to detect factors associated with floor and ceiling effects. Results We evaluated data from 366 patients with PD and approximately 19% of individuals had less than five years of education. For the total MoCA score, there was no floor or ceiling effect. There was a floor effect in the abstraction and delayed memory recall domains in 20% of our sample. The ceiling effect was demonstrated in all domains (80.8% more common in naming and 89% orientation), except delayed recall. Education was the main factor associated with the floor and ceiling effects, independent of region, sex, age at evaluation, and disease duration. Conclusion The floor and ceiling effects are present in specific domains of the MoCA in Brazil, with a strong impact on education. Further adaptations of the MoCA structure for underrepresented populations may reduce these negative effects.
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Affiliation(s)
| | - Pedro Renato de Paula Brandão
- Universidade de Brasília, Laboratório de Neurociências e Comportamento, Brasília DF, Brazil
- Hospital Sírio-Libanês, Instituto de Ensino e Pesquisa, Brasília DF, Brazil
| | - Vanderci Borges
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | - Henrique Ballalai Ferraz
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | - Artur Francisco Schumacher-Schuh
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Universidade Federal do Rio Grande do Sul, Departamento de Farmacologia, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil
| | - Carlos Roberto de Mello Rieder
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil
| | - Maira Rozenfeld Olchik
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil
- Universidade Federal do Rio Grande do Sul, Departamento de Cirurgia e Ortopedia, Porto Alegre RS, Brazil
| | - Ignacio Fernandez Mata
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Vitor Tumas
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil
| | - Bruno Lopes Santos-Lobato
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Hospital Ophir Loyola, Serviço de Neurologia, Belém PA, Brazil
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Li Y, Chen X, Zhou R, Xu W, Wang X, Chao W, Xue S. Correlation Between Cognitive Impairment and Homocysteine and S100B Protein in Patients with Progressive Ischemic Stroke. Neuropsychiatr Dis Treat 2023; 19:209-217. [PMID: 36714163 PMCID: PMC9875579 DOI: 10.2147/ndt.s393624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/13/2023] [Indexed: 01/21/2023] Open
Abstract
PURPOSE This study aimed to investigate the relationship between cognitive impairment and homocysteine (Hcy) and S100B protein in patients with progressive ischemic stroke (PIS). PATIENTS AND METHODS A total of 158 patients with PIS hospitalized in the Department of Neurology in Taixing People's Hospital from January 2020 to March 2022 were enrolled in the study. After 90 days of follow-up, the patients were divided into two groups according to the MoCA score-99 cases with cognitive impairment group (observation group) and 59 cases with cognitive normal group (control group). Causal diagram was drawn to assess the association between risk factors and PIS with observation group. The risk factors indicators of cognitive impairment in patients with PIS were screened. The related predictive indicators were screened by multivariate logistic regression analysis, and Pearson correlation analysis. The predictive value was analyzed by Receiver Operating Characteristic (ROC) curve. RESULTS Multivariate logistic regression analysis showed that age, hypertension, lesion position, Hcy and S100B protein were related risk factors for cognitive impairment in patients with PIS. Pearson correlation analysis was conducted between Hcy and S100 B protein and MoCA score, and revealed that Hcy and S100 B protein were negatively correlated with MoCA score. ROC curve analysis showed that the Area Under the Curve (AUC) of S100 B protein and Hcy in identifying cognitive impairment after PIS was 0.709 and 0.673, respectively, and the combined AUC of Hcy and S100B protein in predicting cognitive impairment after PIS was 0.739. CONCLUSION Hcy and S100B protein are related risk factors for cognitive impairment in patients with PIS, and may be used as in a prediction model to predict cognitive impairment after PIS in the future.
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Affiliation(s)
- Yan Li
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Department of Neurology, The Taixing People's Hospital, Taixing, People's Republic of China
| | - Xiaopeng Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Department of Neurology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, People's Republic of China
| | - Rujuan Zhou
- Department of Neurology, The Taixing People's Hospital, Taixing, People's Republic of China
| | - Wu Xu
- Department of Neurology, The Taixing People's Hospital, Taixing, People's Republic of China
| | - Xiaorong Wang
- Department of Neurology, The Taixing People's Hospital, Taixing, People's Republic of China
| | - Wa Chao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Shouru Xue
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
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Suchy-Dicey AM, Oziel K, Sawyer C, Olufadi Y, Ali T, Fretts AM, Umans JG, Shibata DK, Longstreth WT, Rhoads K, Buchwald DS, Grabowski TJ. Educational and Clinical Associations With Longitudinal Cognitive Function and Brain Imaging in American Indians: The Strong Heart Study. Neurology 2022; 99:e2637-e2647. [PMID: 36289000 PMCID: PMC9757873 DOI: 10.1212/wnl.0000000000201261] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about incidence of vascular and Alzheimer dementias in American Indians. METHODS We conducted a large, heterogeneous, population-based, longitudinal cohort study of brain aging in community-dwelling American Indians aged 64-95 years from 11 tribes across 3 states, with neurologic examinations, 1.5T MRI, and extensive cognitive testing. Visit 1 in 2010-2013 (n = 817) and visit 2 in 2017-2019 (n = 403) included all willing, surviving participants. Standardized cognitive tests at both visits included Modified Mini-Mental Status Examination (MMSE), Wechsler Adult Intelligence Scale digit symbol coding (WAIS), Controlled Oral Word Association (COWA), and California Verbal Learning Test short form (CVLT). Test materials added at follow-up included Wide Range Achievement (reading) Test (WRAT) and National Alzheimer Coordinating Center Uniform Data Set cognitive battery (v3 form C2), including Montreal Cognitive Assessment (MoCA). MRI neuroradiologists coded infarcts, hemorrhages, white matter hyperintensities, sulcal atrophy, and ventricle enlargement. RESULTS The mean time between examinations was 6.7 years (SD 1.1, range 3.8-9.1 years). Years of formal education had modest correlation with WRAT reading score (r = 0.45). Prevalence and incidence (respectively) of infarcts were 32% and 12.8/1,000 person-years (PYs) hemorrhages 6% and 4.4/1000 PY worsening sulci 74% and 19.0/1000 PY worsening ventricle 79% and 30.1/1000 PY worsening leukoaraiosis 44% and 26.1/1000 PY. Linear losses per year in cognitive scores were 0.6% MMSE, 1.2% WAIS, 0.6% COWA, and 2.2% CVLT. The mean MoCA scores were 18.9 (SD 4.3). DISCUSSION These are the first data on longitudinal cognitive and imaging changes in American Indians and first reports of Alzheimer disease-related features. The mean scores in MoCA were similar or lower than standard cutoffs used to diagnose dementia in other racial/ethnic groups, suggesting that standardized cognitive tests may not perform well in this population. Test validation, adaptation, and score adjustment are warranted. Years of education were a poor proxy for premorbid function, suggesting novel methods for cognitive score contextualization is also needed in this population. Evaluation of selective survival suggests attrition from death, and frailty should be accounted for in causal analyses. Overall, these data represent a unique opportunity to examine neurology topics of critical importance to an understudied population.
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Affiliation(s)
- Astrid M Suchy-Dicey
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle.
| | - Kyra Oziel
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Charles Sawyer
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Yunusa Olufadi
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Tauqeer Ali
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Amanda M Fretts
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Jason G Umans
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Dean K Shibata
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - W T Longstreth
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Kristoffer Rhoads
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Dedra S Buchwald
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
| | - Thomas J Grabowski
- From the Elson S. Floyd College of Medicine (A.M.S.-D., K.O., C.S., Y.O., D.S.B.), Washington State University, Spokane; Oklahoma University Health Sciences Center (T.A.), Oklahoma City; Epidemiology (A.M.F., M.D.J.), School of Public Health, University of Washington, Seattle; MedStar Health Research Institute (J.G.U.), Washington, DC; Neuroradiology (D.K.S.) and Neurology (M.D.J., K.R., T.J.G.), School of Medicine, University of Washington, Seattle
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Abstract
OBJECTIVES We investigated the utility of traditional neuropsychological tests in older uneducated/illiterate individuals without dementia to determine the possibility that they are likely not appropriate for this group. METHODS We assessed the neuropsychological performance of 1122 older adults [≥65 years old; mean age: 74.03 (SD = 5.46); mean education: 4.76 (SD = 2.5) years; women: n = 714], in the context of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD), a population-based study conducted in Greece. RESULTS We based our analyses on three groups: high-functioning/cognitively healthy (i.e., without dementia) uneducated/illiterate individuals (n = 80), high-functioning/cognitively healthy educated/literate individuals (n = 932), and low-functioning/cognitively impaired educated/literate individuals (presumably with dementia; n = 110). We used binary regression analyses with Bonferroni correction to investigate whether test performance differentiated uneducated/illiterate from educated/literate individuals. Models were adjusted for age and sex; raw test scores were the predictor variables. The uneducated/illiterate cohort was at a disadvantage relative to the healthy educated/literate group on all variables but verbal memory recognition and consolidation, congruent motor responses, and phonological fluency clustering (p > .002). Moreover, only word list learning immediate and delayed free recall and delayed cued recall differentiated the high-functioning/cognitively healthy uneducated/illiterate from the low-functioning/cognitively impaired educated/literate group, favoring the former (p's < .002). CONCLUSIONS Our findings suggest that only particular verbal memory test variables are fair in determining whether older uneducated/illiterate individuals have functional/cognitive impairment suggestive of a neurodegenerative process. On all other neuropsychological variables, this cohort was at a disadvantage. Therefore, we highlight the need for identifying appropriate methods of assessment for older uneducated/illiterate individuals.
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Huang W, Liu T, Chen H, Fu Q, Fu L, Xu X, Liu L, Guo Y, Balasubramanian PS, Chen F. Mapping white matter structural and network alterations in betel quid-dependent chewers using high angular resolution diffusion imaging. Front Psychiatry 2022; 13:1036728. [PMID: 36545042 PMCID: PMC9760978 DOI: 10.3389/fpsyt.2022.1036728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To evaluate brain white matter diffusion characteristics and anatomical network alterations in betel quid dependence (BQD) chewers using high angular resolution diffusion imaging (HARDI). METHODS The current study recruited 53 BQD chewers and 37 healthy controls (HC) in two groups. We explored regional diffusion metrics alternations in the BQD group compared with the HC group using automated fiber quantification (AFQ). We further employed the white matter (WM) anatomical network of HARDI to explore connectivity alterations in BQD chewers using graph theory. RESULTS BQD chewers presented significantly lower FA values in the left and right cingulum cingulate, the left and right thalamic radiation, and the right uncinate. The BQD has a significantly higher RD value in the right uncinate fasciculus than the HC group. At the global WM anatomical network level, global network efficiency (p = 0.008) was poorer and Lp (p = 0.016) was greater in the BQD group. At the nodal WM anatomical network level, nodal efficiency (p < 0.05) was lower in the BQD group. CONCLUSION Our findings provide novel morphometric evidence that brain structural changes in BQD are characterized by white matter diffusivity and anatomical network connectivity among regions of the brain, potentially leading to the enhanced reward system and impaired inhibitory control.
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Affiliation(s)
- Weiyuan Huang
- Department of Radiology, Hainan General Hospital, Hainan, China
| | - Tao Liu
- Department of Geriatric Center, Hainan General Hospital, Hainan, China
| | - Huijuan Chen
- Department of Radiology, Hainan General Hospital, Hainan, China
| | - Qingqing Fu
- Department of Radiology, Hainan General Hospital, Hainan, China
| | - Lili Fu
- Department of Radiology, Hainan General Hospital, Hainan, China
| | - Xiaolin Xu
- Department of Radiology, Hainan General Hospital, Hainan, China
| | - Liting Liu
- Department of Radiology, Yueyang Central Hospital, Shanghai, China
| | - Yihao Guo
- Department of Radiology, Hainan General Hospital, Hainan, China
| | - Priya S Balasubramanian
- Department of Electrical and Computer Engineering, Cornell University, Ithaca, NY, United States
| | - Feng Chen
- Department of Radiology, Hainan General Hospital, Hainan, China
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Del Brutto OH, Mera RM, Rumbea DA, Recalde BY, Sedler MJ. Social determinants of health and cognitive performance of older adults living in rural communities: The Three Villages Study. Int J Geriatr Psychiatry 2022; 37. [PMID: 35015319 DOI: 10.1002/gps.5671] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/21/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES There is limited information on factors associated with poor cognitive performance in rural settings of Low- and Middle-Income Countries. Using the Three Villages Study Cohort, we assessed whether social determinants of health (SDH) play a role in cognitive performance among older adults living in rural Ecuador. METHODS Atahualpa, El Tambo and Prosperidad residents aged ≥60 years received measurement of SDH by means of the Gijon Scale together with a Montreal Cognitive Assessment (MoCA). The association between SDH and cognitive performance (dependent variable) was assessed by generalized linear models, adjusted for demographics, years of education, cardiovascular risk factors, symptoms of depression and biomarkers of structural brain damage. RESULTS We included 513 individuals (mean age: 67.9 ± 7.3 years; 58% women). The mean score on the Gijon scale was 9.9 ± 2.9 points, with 237 subjects classified as having a high social risk (≥10 points). The mean MoCA score was 19.6 ± 5.4 points. Locally weighted scatterplot smoothing showed an inverse linear relationship between SDH and MoCA scores. SDH and MoCA scores were inversely associated in linear models adjusted for clinical covariates (β: -0.17; 95% C.I.: -0.32 to -0.02; p = 0.020), neuroimaging covariates (β: -0.17; 95% C.I.: -0.31 to -0.03; p = 0.018), as well as in the most parsimonious model (β: -0.16; 95% C.I.: -1.30 to -0.02; p = 0.026). CONCLUSIONS Study results provide robust evidence of an inverse association between SDH and cognitive performance. Interventions and programs aimed to reduce disparities in the social risk of older adults living in underserved rural populations may improve cognitive performance in these individuals.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, California, USA
| | - Denisse A Rumbea
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Bettsy Y Recalde
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Mark J Sedler
- Renaissance School of Medicine, Stony Brook University, New York, New York, USA
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Montaño-Lozada JM, López N, Espejo-Zapata LM, Soto-Añari M, Ramos-Henderson M, Caldichoury-Obando N, Camargo L. Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation. Epilepsy Behav 2021; 122:108158. [PMID: 34182417 DOI: 10.1016/j.yebeh.2021.108158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Epilepsy is a chronic neurological disorder that may occur alongside cognitive changes, with effects on multiple cognitive domains. OBJECTIVE To compare the cognitive performance of patients with epilepsy and healthy controls through Montreal Cognitive Assessment (MoCA) during outpatient consultation at a reference diagnostic center in Colombia and analyze and the influencing factors. MATERIALS AND METHODOLOGY One-hundred and four patients during neurology outpatient consultation in the city of Cartagena, Colombia, were assessed with the (MoCA) test, i.e., 54 people who consulted for headache and have not been diagnosed with epilepsy (NEP) and 50 with a diagnosis of epilepsy (EPs) according to the diagnostic criteria of the International League Against Epilepsy (ILAE). RESULTS Significant differences were found in the total mean scores of the (MoCA) between (EPs) and (NPE) groups (t = 4.72; p < 0.01), particularly in attention (t = 3.22; p < 0.02) and memory (t = 5.04; p < 0.01) dimensions. Additionally, a significant association was observed between years of schooling and (MoCA) scores (p = 0,019) but not between socioeconomic level (p = 0,510), age (p = 0,452) and the frequency of seizures (p = 0,471). DISCUSSION Patients with epilepsy show lower scores in several cognitive domains in respect of the control group. The (MoCA) has proven its appropriateness for cognitive screening in the contexts of clinical neurology outpatient consultation.
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Affiliation(s)
- J M Montaño-Lozada
- Medico, Residente IV año de Neurología Clínica, Universidad del Sinú EBZ. Cartagena, Colombia
| | | | - L M Espejo-Zapata
- Medico, Especialista en Salud Mental del niño y Adolescente. Universidad CES. Medellín, Colombia
| | | | - Miguel Ramos-Henderson
- Escuela de Psicología, Facultad de Ciencias Sociales y de la Comunicación, Universidad Santo Tomás, Antofagasta, Chile
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9
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Khaw J, Subramaniam P, Abd Aziz NA, Ali Raymond A, Wan Zaidi WA, Ghazali SE. Current Update on the Clinical Utility of MMSE and MoCA for Stroke Patients in Asia: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178962. [PMID: 34501552 PMCID: PMC8431226 DOI: 10.3390/ijerph18178962] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022]
Abstract
Objective: Primary care clinicians in Asia employed the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) to aid dementia diagnosis post-stroke. Recent studies questioned their clinical utility in stroke settings for relying on verbal abilities and education level, as well as lack of consideration for aphasia and neglect. We aimed to review the clinical utility of the MMSE and MoCA for stroke patients in Asia and provide recommendations for clinical practice. Methods: PubMed, Scopus, Web of Science, and Science Direct were searched for relevant articles. Included studies were assessed for risk of bias. RevMan 5.4 was used for data synthesis (sensitivity and specificity) and covariates were identified. Results: Among the 48 full-text articles reviewed, 11 studies were included with 3735 total subjects; of these studies, 7 (77%) were conducted in China, 3 (27%) in Singapore, and 1 (9%) in South Korea. Both the MMSE and MoCA generally showed adequate sensitivity and specificity. Education was identified as a covariate that significantly affected detection accuracy. Due to heterogeneity in cutoff scores, methodologies, and languages, it was not feasible to suggest a single cutoff score. One additional point is recommended for MoCA for patients with <6 years of education. Conclusion: Clinicians in Asia are strongly recommended to consider the education level of stroke patients when interpreting the results of the MMSE and MoCA. Further studies in other Asian countries are needed to understand their clinical value in stroke settings.
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Affiliation(s)
- Julia Khaw
- Clinical Psychology and Behavioral Health Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (J.K.); (S.E.G.)
| | - Ponnusamy Subramaniam
- Clinical Psychology and Behavioral Health Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (J.K.); (S.E.G.)
- Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
- Correspondence:
| | - Noor Azah Abd Aziz
- Department of Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
| | - Azman Ali Raymond
- Neurology Unit, Department of Internal Medicine, Universiti Teknologi MARA, Shah Alam, Selangor 40450, Malaysia;
| | - Wan Asyraf Wan Zaidi
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
| | - Shazli Ezzat Ghazali
- Clinical Psychology and Behavioral Health Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (J.K.); (S.E.G.)
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10
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Masika GM, Yu DSF, Li PWC. Accuracy of the Montreal Cognitive Assessment in Detecting Mild Cognitive Impairment and Dementia in the Rural African Population. Arch Clin Neuropsychol 2021; 36:371-380. [PMID: 31942599 DOI: 10.1093/arclin/acz086] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/22/2019] [Accepted: 12/22/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The incidence of dementia in the sub-Saharan Africa is rising. However, screening tools for cognitive decline that fits their linguistic and cultural context are lacking. The aim of this study was to determine the accuracy of the Kiswahili version of Montreal Cognitive Assessment (K-MoCA) to detect mild cognitive impairment or dementia among older adults in the rural Tanzania. METHODS We recruited 259 community-dwelling older adults in Chamwino district, Tanzania. The concurrent validity and discriminatory power of K-MoCA were examined by comparing its score with IDEA cognitive screening and psychiatrist's diagnosis using DSM-V, respectively. All the questionnaires were administered in face-to-face interview. RESULTS K-MoCA demonstrated acceptable reliability (Cronbach's alpha = 0.780). Concurrent validity was evident by its significant correlation with the IDEA screening test (Pearson's r = 0.651, p < 0.001). Using the psychiatrist's rating as the reference, the optimal cut-off score for MCI and dementia was 19 and 15, respectively, which yielded the sensitivity of 70% and specificity of 60% for MCI, and sensitivity of 72% and specificity of 60% for dementia. Further analysis indicated that education and age influence performance on K-MoCA. CONCLUSION Overall, the K-MoCA is a reliable and valid tool for measuring cognitive decline. However, its limited discriminatory power for MCI and dementia may be compromised by the cultural irrelevance of some items.
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Affiliation(s)
- Golden M Masika
- The Nethersole School of Nursing, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong.,Department of Nursing and Midwifery, College of Health Sciences, University of Dodoma, Dodoma, Tanzania
| | - Doris S F Yu
- The Nethersole School of Nursing, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong.,School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Polly W C Li
- The Nethersole School of Nursing, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong.,School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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11
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Del Brutto OH, Wu S, Mera RM, Costa AF, Recalde BY, Issa NP. Cognitive decline among individuals with history of mild symptomatic SARS-CoV-2 infection: A longitudinal prospective study nested to a population cohort. Eur J Neurol 2021; 28:3245-3253. [PMID: 33576150 PMCID: PMC8014083 DOI: 10.1111/ene.14775] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Neurological complications of SARS-CoV-2 infection are noticed among critically ill patients soon after disease onset. Information on delayed neurological sequelae of SARS-CoV-2 infection is nil. Following a longitudinal study design, the occurrence of cognitive decline among individuals with a history of mild symptomatic SARS-CoV-2 infection was assessed. METHODS Stroke- and seizure-free Atahualpa residents aged ≥40 years, who had pre-pandemic cognitive assessments as well as normal brain magnetic resonance imaging and electroencephalogram recordings, underwent repeated evaluations 6 months after a SARS-CoV-2 outbreak infection in Atahualpa. Patients requiring oxygen therapy, hospitalization, and those who had initial neurological manifestations were excluded. Cognitive decline was defined as a reduction in the Montreal Cognitive Assessment (MoCA) score between the post-pandemic and pre-pandemic assessments that was ≥4 points greater than the reduction observed between two pre-pandemic MoCAs. The relationship between SARS-CoV-2 infection and cognitive decline was assessed by fitting logistic mixed models for longitudinal data as well as exposure-effect models. RESULTS Of 93 included individuals (mean age 62.6 ± 11 years), 52 (56%) had a history of mild symptomatic SARS-CoV-2 infection. Post-pandemic MoCA decay was worse in seropositive individuals. Cognitive decline was recognized in 11/52 (21%) seropositive and 1/41 (2%) seronegative individuals. In multivariate analyses, the odds for developing cognitive decline were 18.1 times higher among SARS-CoV-2 seropositive individuals (95% confidence interval 1.75-188; p = 0.015). Exposure-effect models confirmed this association (β = 0.24; 95% confidence interval 0.07-0.41; p = 0.006). CONCLUSIONS This study provides evidence of cognitive decline among individuals with mild symptomatic SARS-CoV-2 infection. The pathogenesis of this complication remains unknown.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Samborondón, Ecuador
| | - Shasha Wu
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Robertino M Mera
- Department of Epidemiology, Gilead Sciences, Inc, Foster City, CA, USA
| | - Aldo F Costa
- Department of Neurology, Hospital Universitario Reina Sofía, Cordoba, Spain
| | | | - Naoum P Issa
- Department of Neurology, University of Chicago, Chicago, IL, USA
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12
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Masika GM, Yu DSF, Li PWC, Wong A, Lin RSY. Psychometrics and diagnostic properties of the Montreal Cognitive Assessment 5-min protocol in screening for Mild Cognitive Impairment and dementia among older adults in Tanzania: A validation study. Int J Older People Nurs 2020; 16:e12348. [PMID: 32920984 DOI: 10.1111/opn.12348] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 08/02/2020] [Accepted: 08/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prevalence of dementia in Tanzania, as in other developing countries, is progressively increasing. Yet international screening instruments for mild cognitive impairment are lacking. OBJECTIVES The aim of this study was to determine the psychometrics and the diagnostic ability of the Montreal Cognitive Assessment 5 minutes protocol (MoCA-5-min) among older adults in the rural Tanzania. METHODS The MoCA-5-min and the Identification and Intervention for Dementia in Elderly Africans (IDEA) cognitive screening were concurrently administered through face to face to 202 community-dwelling older adults in Chamwino district. Exploratory factor analysis (EFA) using principal component method and oblique rotation was performed to determine the underlying factor structure of the scale. The concurrent and construct as well as predictive validities of the MoCA-5-min were examined by comparing its score with IDEA cognitive screening and psychiatrist's diagnosis using DSM-V criteria, respectively. RESULTS The EFA found that all the MoCA-5-min items highly loaded into one component, with factor loading ranging from 0.550 to 0.879. The intraclass correlation coefficient for 6 weeks test-retest reliability was 0.85. Its strong significant correlation with the IDEA screening (Pearson's r = 0.614, p < 0.001) demonstrated a good concurrent validity. Using the psychiatrist's rating as the gold standard, MoCA-5-min demonstrated the optimal cut-off score for MCI at 22, which yielded the sensitivity of 80% and specificity of 74%; and dementia at score of 16 giving a sensitivity of 90% and specificity of 80%. Upon stratifying the sample into different age groups, the optimal cut-off scores tended to decrease with the increase in age. CONCLUSION The MoCA-5-min is reliable and provides a valid and accurate measure of cognitive decline among older population in the rural settings of Tanzania. The use of varying cut-off scores across age groups may ensure more precise discriminatory power of the MoCA-5-min. IMPLICATIONS FOR PRACTICE Availability of the MoCA-5-min in Tanzania will facilitate clinicians to timely detect dementia at both pre-clinical and clinical stages. Its availability will also encourage further research and international collaborations in dementia prevention programs.
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Affiliation(s)
- Golden M Masika
- The Nethersole School of Nursing, Chinese University of Hong Kong, New Territories, Hong Kong.,Department of Nursing and Midwifery, College of Health Sciences, University of Dodoma, Dodoma, Tanzania
| | - Doris S F Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Polly W C Li
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Adrian Wong
- Department of Medicine and Therapeutics, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Rose S Y Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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13
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Custodio N, Duque L, Montesinos R, Alva-Diaz C, Mellado M, Slachevsky A. Systematic Review of the Diagnostic Validity of Brief Cognitive Screenings for Early Dementia Detection in Spanish-Speaking Adults in Latin America. Front Aging Neurosci 2020; 12:270. [PMID: 33101004 PMCID: PMC7500065 DOI: 10.3389/fnagi.2020.00270] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/04/2020] [Indexed: 12/25/2022] Open
Abstract
Objectives: The aim of this study was to evaluate the validity of brief cognitive screening (BCS) tools designed to diagnose mild cognitive impairment (MCI) or dementia in Spanish-speaking individuals over the age of 50 years from Latin America (LA). Methods: A systematic search of titles and abstracts in Medline, Biomed Central, Embase, Scopus, Scirus, PsycINFO, LILACS, and SciELO was conducted. Inclusion criteria were papers written in English or Spanish involving samples from Spanish-speaking Latin American individuals published until 2018. Standard procedures were applied for reviewing the literature. The data related to the study sample, methodology, and procedures applied, as well as the performance obtained with the corresponding BCS, were collected and systematized. Results: Thirteen of 211 articles met the inclusion criteria. The studies primarily involved memory clinic-based samples, with the exception of two studies from an adult day-care center, one from a primary care clinic, and one from a community-based sample. All the studies originated from five of the 20 countries of LA and all used standardized diagnostic criteria for the diagnosis of dementia and MCI; however, the diagnostic protocols applied differed. Most studies reported samples with an average of 10 years of education and only one reported a sample with an average of <5 years of education. No publication to date has included an illiterate population. Although the Montreal cognitive assessment (MoCA) is the most widely-used BCS tool in LA, it is significantly influenced by education level. Conclusions: Although evidence is still limited, the findings from studies on LA populations suggest that MoCA requires cultural adaptations and different cutoff points according to education level. Moreover, the diagnostic validity of the INECO frontal screening (IFS) test should be evaluated in populations with a low level of education. Given the heterogeneity that exists in the levels of education in LA, more studies involving illiterate and indigenous populations are required.
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Affiliation(s)
- Nilton Custodio
- Research Unit, Instituto Peruano de Neurociencias, Lima, Peru.,Cognitive Decline and Dementia Diagnostic and Prevention Services Unit, Instituto Peruano de Neurociencias, Lima, Peru.,Neurology Department, Instituto Peruano de Neurociencias, Lima, Peru
| | | | - Rosa Montesinos
- Research Unit, Instituto Peruano de Neurociencias, Lima, Peru.,Cognitive Decline and Dementia Diagnostic and Prevention Services Unit, Instituto Peruano de Neurociencias, Lima, Peru
| | - Carlos Alva-Diaz
- Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru
| | - Martin Mellado
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department, ICBM, Neurosciences and East Neuroscience Departments, University of Chile School of Medicine, Santiago, Chile
| | - Andrea Slachevsky
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department, ICBM, Neurosciences and East Neuroscience Departments, University of Chile School of Medicine, Santiago, Chile.,Geroscience Center for Brain Health and Metabolism (GERO), University of Chile School of Medicine, Santiago, Chile.,Memory and Neuropsychiatric Clinic (CMYN), Neurology Department, Del Salvador Hospital and University of Chile School of Medicine, Santiago, Chile.,Neurology Unit, Department of Medicine, Alemana Clinic, Universidad del Desarrollo, Santiago, Chile
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14
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Serrano CM, Sorbara M, Minond A, Finlay JB, Arizaga RL, Iturry M, Martinez P, Heinemann G, Gagliardi C, Serra A, Magliano FC, Yacovino D, Rojas MMEY, Ruiz AS, Graviotto HG. Validation of the Argentine version of the Montreal Cognitive Assessment Test (MOCA): A screening tool for Mild Cognitive Impairment and Mild Dementia in Elderly. Dement Neuropsychol 2020; 14:145-152. [PMID: 32595883 PMCID: PMC7304280 DOI: 10.1590/1980-57642020dn14-020007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The MoCA is a brief useful test to diagnose mild cognitive impairment (MCI) and mild dementia (MD). To date, no Argentine cross-cultural adapted validations of the Spanish version have been reported. Objective To validate the MoCA in the elderly and study its usefulness in MCI and MD. Methods This study included 399 individuals over 60 years old evaluated in the Cognitive-Behavioral Department (2017-2018). Patients with<3 years of education, sensory disturbances, psychiatric disorders, or moderate-severe dementia were excluded. The control group comprised cognitively normal subjects. Participants were classified according to neuropsychological assessment and clinical standard criteria into Control, MCI or MD groups. A locally adapted MoCA (MOCA-A) was administered to the patients and controls. Results Mean educational level was 10.34 years (SD 3.5 years). MoCA-A score differed significantly among groups (p<0.0001). MoCA-A performance correlated with educational level (r: 0.406 p<0.00001). Adopting a cut-off score ≥25 (YI=0.55), the sensitivity for MCI was 84.8% and for MD 100%, with specificity of 69.7%. When adding a single point to the score in patients with ≤12 years of education, the specificity of the test reached 81%. Conclusion The MoCA-A is an accurate reliable screening test for MCI and MD in Argentina.
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Affiliation(s)
- Cecilia M Serrano
- Neurología Cognitiva y Neuropsicología. Hospital Dr. Cesar Milstein, Buenos Aires, Argentina.,Laboratorio de Memoria y Equilibrio, Buenos Aires, Argentina
| | - Marcos Sorbara
- Neurología Cognitiva y Neuropsicología. Hospital Dr. Cesar Milstein, Buenos Aires, Argentina
| | - Alexander Minond
- Carrera Interdisciplinaria de Especialización en Neuropsicología Clínica, Facultad de Psicologia, UBA, Buenos Aires, Argentina
| | - John B Finlay
- Duke University School of Medicine, North Carolina, USA
| | - Raul L Arizaga
- Neurología Cognitiva y Neuropsicología. Hospital Dr. Cesar Milstein, Buenos Aires, Argentina
| | - Monica Iturry
- Carrera de Investigador Clínico del Gobierno de la Ciudad de Buenos Aires, Argentina
| | - Patricia Martinez
- Neurología Cognitiva y Neuropsicología. Hospital Dr. Cesar Milstein, Buenos Aires, Argentina
| | - Gabriela Heinemann
- Neurología Cognitiva y Neuropsicología. Hospital Dr. Cesar Milstein, Buenos Aires, Argentina
| | - Celina Gagliardi
- Neurología Cognitiva y Neuropsicología. Hospital Dr. Cesar Milstein, Buenos Aires, Argentina
| | - Andrea Serra
- Neurología Cognitiva y Neuropsicología. Hospital Dr. Cesar Milstein, Buenos Aires, Argentina
| | - Florencia Ces Magliano
- Neurología Cognitiva y Neuropsicología. Hospital Dr. Cesar Milstein, Buenos Aires, Argentina
| | - Darío Yacovino
- Neurología Cognitiva y Neuropsicología. Hospital Dr. Cesar Milstein, Buenos Aires, Argentina.,Laboratorio de Memoria y Equilibrio, Buenos Aires, Argentina
| | | | - Adelaida Susana Ruiz
- Carrera Interdisciplinaria de Especialización en Neuropsicología Clínica, Facultad de Psicologia, UBA, Buenos Aires, Argentina
| | - Héctor Gastón Graviotto
- Neurología Cognitiva y Neuropsicología. Hospital Dr. Cesar Milstein, Buenos Aires, Argentina
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15
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Turuba R, Pirkle C, Bélanger E, Ylli A, Gomez Montes F, Vafaei A. Assessing the relationship between multimorbidity and depression in older men and women: the International Mobility in Aging Study (IMIAS). Aging Ment Health 2020; 24:747-757. [PMID: 30724575 DOI: 10.1080/13607863.2019.1571018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objectives: Our study aims to assess whether multimorbidity is an independent risk factor for the development of depression in older adults living in Canada, Brazil, Colombia, and Albania and examines differences in incidence of depression regarding social and psychosocial characteristics.Methods: The longitudinal International Mobility Aging Study (IMIAS) collected information from adults between 65-74 years old. Depression was defined by a 16 or higher score assessed by the Centre for Epidemiological Studies Depression (CES-D) Scale. Multimorbidity was defined as having two or more chronic conditions, which were self-reported by participants using a list of eight physical chronic conditions. Poisson regression was performed to estimate the relative risk of depression in older adults with multimorbidity compared to those living with 0-1 chronic conditions, adjusting for sex, age, education, number of doctor visits, degree of assistance needed, social support, and smoking status. The analysis was stratified by study region (Canada; Latin America; Albania).Results: Crude and adjusted models showed no statistically significant associations between multimorbidity and the incidence of depression in any of the study regions, confirmed by sensitivity analyses. However, the incidence of depression varied across study region, confirmed by the intra-class correlation coefficient which indicated that 13% of variations in depression incidence were due to geographic differences.Conclusion: Multimorbidity does not appear to increase the risk of developing depression in older adults between 65-74. Higher rates of depression in Latin America and Albania (compared to Canada) may be attributed to lifecourse exposures to social and economic adversity in these regions.
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Affiliation(s)
- Roxanne Turuba
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Catherine Pirkle
- Office of Public Health Studies, University of Hawaii, Honolulu, HI, USA
| | - Emmanuelle Bélanger
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Alban Ylli
- Institute of Public Health, Tirana, Albania
| | - Fernando Gomez Montes
- Research Group on Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia
| | - Afshin Vafaei
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
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Ortega LDFV, Aprahamian I, Borges MK, Cação JDC, Yassuda MS. Screening for Alzheimer's disease in low-educated or illiterate older adults in Brazil: a systematic review. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 77:279-288. [PMID: 31090809 DOI: 10.1590/0004-282x20190024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/18/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Cognitive screening instruments are influenced by education and/or culture. In Brazil, as illiteracy and low education rates are high, it is necessary to identify the screening tools with the highest diagnostic accuracy for Alzheimer's disease (AD). OBJECTIVE To identify the cognitive screening instruments applied in the Brazilian population with greater accuracy, to detect AD in individuals with a low educational level or who are illiterate. METHODS Systematic search in SciELO, PubMed and LILACS databases of studies that used cognitive screening tests to detect AD in older Brazilian adults with low or no education. RESULTS We found 328 articles and nine met the inclusion criteria. The identified instruments showed adequate or high diagnostic accuracy. CONCLUSION For valid cognitive screening it is important to consider sociocultural and educational factors in the interpretation of results. The construction of specific instruments for the low educated or illiterate elderly should better reflect the difficulties of the Brazilian elderly in different regions of the country.
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Affiliation(s)
- Luciane de Fátima Viola Ortega
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Gerontologia, Campinas SP, Brasil
| | - Ivan Aprahamian
- Faculdade de Medicina de Jundiaí, Grupo de Investigação em Multimorbidades e Saúde Mental em Idosos, Disciplina de Geriatria e Gerontologia, Jundiaí SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Psiquiatria, São Paulo SP, Brasil
| | - Marcus Kiiti Borges
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Psiquiatria, São Paulo SP, Brasil
| | - João de Castilho Cação
- Faculdade de Medicina de São José do Rio Preto, Unidade de Geriatria, São José do Rio Preto SP, Brasil
| | - Mônica Sanches Yassuda
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Gerontologia, Campinas SP, Brasil.,Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, São Paulo SP, Brasil
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17
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Del Brutto OH, Mera RM, Recalde BY, Del Brutto VJ. Carotid Intima-media Thickness, Cognitive Performance and Cognitive Decline in Stroke-free Middle-aged and Older Adults. The Atahualpa Project. J Stroke Cerebrovasc Dis 2020; 29:104576. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104576] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 11/24/2019] [Indexed: 12/16/2022] Open
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18
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Pinto TCC, Machado L, Costa MLG, Santos MSP, Bulgacov TM, Rolim APP, Silva GA, Rodrigues-Júnior AL, Sougey EB, Ximenes RCC. Accuracy and Psychometric Properties of the Brazilian Version of the Montreal Cognitive Assessment as a Brief Screening Tool for Mild Cognitive Impairment and Alzheimer's Disease in the Initial Stages in the Elderly. Dement Geriatr Cogn Disord 2020; 47:366-374. [PMID: 31466064 DOI: 10.1159/000501308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the applicability and the psychometric properties of Montreal Cognitive Assessment Brazilian Version (MoCA-BR) in the elderly, as well as comparing its accuracy as a tracking test for mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) with the accuracy of Mini-Mental State Examination (MMSE). METHOD A transversal study was performed in 4 reference medical centers that care for the elderly. In all, 229 elderly participated in the study. To select the sample, the clinical history of the elderly, Pfeffer Functional Activities Questionnaire, and neuropsychological battery, apart from MMSE and MoCA-BR cognitive tests, were selected. The elderly were classified into control, MCI, and mild AD groups. RESULTS There was a significant statistical difference between the MoCA-BR scores of the elderly and the control group, MCI, and mild AD (p < 0.001). The Cronbach alpha for MoCA-BR was 0.77, indicating a good internal consistency. The test-retest reliability was elevated, with intraclass correlation coefficient (ICC) 0.91. The inter-examiner reliability was excellent (ICC 0.96). The area under curve of the receiver operating characteristics curve was 0.95, when evaluating the ability of MoCA-BR to discriminate between the elderly with cognitive impairment and cognitively healthy elderly. CONCLUSIONS The results of the study show that the Brazilian version of MoCA is a reliable cognitive tracking tool and is accurate for the detection of MCI and early stage AD, with good applicability on the elderly with education equal to or more than 4 years and adequate to discriminate between cognitively healthy elderly, and those with MCI and mild, proving to be superior to MMSE in tracking MCI and similar to this test when tracking mild AD.
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Affiliation(s)
- Tiago Coimbra Costa Pinto
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil, .,University Hospital Doctor Washington Antônio de Barros of Universidade Federal do Vale do São Francisco, Petrolina, Brazil, .,Faculdade de Medicina da Estácio de Juazeiro, Juazeiro, Brazil,
| | - Leonardo Machado
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Maria Lúcia G Costa
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil.,Post-Graduate Program in Gerontology at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Marilia S P Santos
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Tatiana M Bulgacov
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Ana Paula P Rolim
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Gabriela A Silva
- Post-Graduate Program in Nutrition Clinical at the Universidade de Pernambuco, Recife, Brazil
| | - Antônio L Rodrigues-Júnior
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil.,Busca Vida Clinical Gerontology, Recife, Brazil
| | - Everton B Sougey
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Rosana C C Ximenes
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
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Wu G, Li RR, Balasubramanian PS, Li MM, Yang K, Huang WY, Chen F. Temporal lobe microstructural abnormalities in patients with nasopharyngeal carcinoma quantitatively evaluated by high-resolution DWI and DKI after concurrent chemoradiotherapy. Clin Transl Radiat Oncol 2019; 21:36-43. [PMID: 31970294 PMCID: PMC6965203 DOI: 10.1016/j.ctro.2019.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/19/2019] [Accepted: 12/22/2019] [Indexed: 02/06/2023] Open
Abstract
DKI could detect early radiation-induced microstructural abnormalities after CCRT. The ADC, Dmean, and FA of temporal lobe showed a unique time-dependent trajectory. Kmean might be more sensitive to detection of effects in the late delayed phases. White and grey matter all underwent microstructural changes after radiotherapy.
Purpose To investigate temporal lobe microstructural abnormalities and neurocognitive function impairment after concurrent chemoradiotherapy (CCRT) in patients with nasopharyngeal carcinoma (NPC). Methods NPC patients who underwent CCRT were enrolled. High-resolution diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) and diffusion-kurtosis imaging (DKI) MRI, were performed 5 times per patient (once pre-CCRT, 1 week post-CCRT, 3 months post-CCRT, 6 months post-CCRT, and 12 months post-CCRT). Neurocognitive function was evaluated by Montreal Neurocognitive Assessment (MoCA) twice per patient, once pre-CCRT, and once 12-months after CCRT. Results Of 111 patients, 56 completed the entire protocol. The MRI derived apparent diffusion coefficient (ADC), mean of diffusion coefficient (Dmean) and fractional anisotropy (FA) values were significantly decreased (p < 0.05) over the 0–3 month period following CCRT and significantly increased (p < 0.05) over the 3–12 month period following CCRT. The mean of kurtosis coefficient (Kmean) continued to decline over a year post-CCRT. All parameters reveal more pronounced changes in white matter (WM) than in grey matter (GM). MoCA also declined after CCRT (p < 0.001). MoCA showed significant positive correlation with Kmean-WM-6 m, Kmean-WM-12 m and ΔKmean-WM. Conclusions High-resolution DWI and DKI should be considered as a promising method for the investigation of temporal lobe microstructural change in NPC patients after CCRT.
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Affiliation(s)
- Gang Wu
- Department of Radiation Oncology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Rui-Rui Li
- Department of Radiology, Hainan Hospital of Hainan Medical College (Hainan General Hospital), Haikou, China
| | | | - Meng-Meng Li
- Department of Research and Education, Hainan Hospital of Hainan Medical College (Hainan General Hospital), Haikou, China
| | - Kai Yang
- Department of Radiology, Hainan Hospital of Hainan Medical College (Hainan General Hospital), Haikou, China
| | - Wei-Yuan Huang
- Department of Radiology, Hainan Hospital of Hainan Medical College (Hainan General Hospital), Haikou, China.,Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Feng Chen
- Department of Radiology, Hainan Hospital of Hainan Medical College (Hainan General Hospital), Haikou, China
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Cesar KG, Yassuda MS, Porto FHG, Brucki SMD, Nitrini R. MoCA Test: normative and diagnostic accuracy data for seniors with heterogeneous educational levels in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:775-781. [DOI: 10.1590/0004-282x20190130] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/01/2019] [Indexed: 11/21/2022]
Abstract
ABSTRACT The Montreal Cognitive Assessment (MoCA) has been described as a good tool to detect cognitive impairment. The ideal MoCA cutoff score is still under debate. The aim was to provide MoCA norms and accuracy data for seniors with a lower education level, including illiterates. Methods: Data originated from an epidemiological study conducted in the municipality of Tremembe, Brazil. The Brazilian MoCA test was applied as part of the cognitive assessment in all participants. Of the 630 participants, 385 were classified as cognitively normal (CN) and were included in the normative data set, 110 individuals were diagnosed with dementia and 135 were classified as having cognitive impairment no dementia (CIND). Results: The total scores varied significantly according to age and education among the three diagnostic groups: CN, CIND and dementia (p < 0.001). To distinguish participants with CN from dementia, the best MoCA cutoff was 15 points (sensitivity 90%, specificity 77%) and to differentiate those with CN from CIND, the MoCA cutoff was 19 points (sensitivity 84%, specificity 49%). Those scores varied according to education level. Conclusions: The MoCA test did not have a high accuracy for detecting CIND in the population with a low educational level. Nevertheless, this tool may be used to detect dementia, especially in individuals with more than five years of education, if a lower cutoff score is adopted.
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Narme P, Maillet D, Palisson J, Le Clésiau H, Moroni C, Belin C. How to Assess Executive Functions in a Low-Educated and Multicultural Population Using a Switching Verbal Fluency Test (the TFA-93) in Neurodegenerative Diseases? Am J Alzheimers Dis Other Demen 2019; 34:469-477. [PMID: 30827122 PMCID: PMC10653371 DOI: 10.1177/1533317519833844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Few neuropsychological tests are available to assess executive dysfunction in low-educated and multicultural populations. To address this issue, the TFA-93, a switching verbal fluency test to assess cognitive flexibility, was administered to 70 healthy controls, 57 patients with a clinical diagnosis of Alzheimer's disease, and 21 with a clinical diagnosis of a neurodegenerative disease associated with frontal disorders. Most of the participants were low-educated and nonnative French speakers. The TFA-93 comprises 2 categorical fluency tasks (animals and fruits) and a fluency task in which participants have to switch between animals and fruits. Correct responses and errors were collected, and a flexibility index expressed the switching cost. Results showed that correct responses were lower, and the switching cost was greater in both patient groups. In low-educated and multicultural populations, the TFA-93 seems to be a good alternative to assess flexibility compared to the standard neuropsychological tools based on academic abilities.
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Affiliation(s)
- Pauline Narme
- Equipe Neuropsychologie du Vieillissement (EA 4468), Institut de Psychologie, Université Paris Descartes, Boulogne-Billancourt, France
- Laboratoire Mémoire, Cerveau et Cognition (EA 7536), Institut de Psychologie, Université Paris Descartes, Boulogne-Billancourt, France
| | - Didier Maillet
- Service de Neurologie, Hôpital Saint-Louis APHP, Université Paris Diderot, Paris, France
- Laboratoire PSITEC, EA 4072, UFR de psychologie, Université de Lille, Pont de Bois, Villeneuve d’Ascq, France
| | - Juliette Palisson
- Unité Fonctionnelle Mémoire et Maladies Neurodégénératives, Service de Neurologie, CHU Avicenne, Assistance Publique des Hôpitaux de Paris (AP-HP), Bobigny, France
| | - Hervé Le Clésiau
- Centre d’Examens de Santé de la Caisse primaire d’Assurance Maladie de la Seine-Saint-Denis, Bobigny, France
| | - Christine Moroni
- Laboratoire PSITEC, EA 4072, UFR de psychologie, Université de Lille, Pont de Bois, Villeneuve d’Ascq, France
| | - Catherine Belin
- Equipe Neuropsychologie du Vieillissement (EA 4468), Institut de Psychologie, Université Paris Descartes, Boulogne-Billancourt, France
- Service de Neurologie, Hôpital Saint-Louis APHP, Université Paris Diderot, Paris, France
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22
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Borda MG, Reyes-Ortiz C, Pérez-Zepeda MU, Patino-Hernandez D, Gómez-Arteaga C, Cano-Gutiérrez CA. Educational level and its Association with the domains of the Montreal Cognitive Assessment Test. Aging Ment Health 2019; 23:1300-1306. [PMID: 30449144 DOI: 10.1080/13607863.2018.1488940] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To explore the association between educational level and the scores obtained in each of the domains of the Montreal Cognitive Assessment test. Methods: This is a secondary analysis of the SABE/2012 Bogotá survey; a cross-sectional study including 2000 subjects aged ≥60years. The MoCA test was the dependent variable and was stratified by cognitive domains, incorrect answers and scores were considered. Educational level was assessed through years of formal education. Age, sex and selected medical conditions were also included to adjust the multivariate models. Bivariate analyses, fitted logistic and linear regression models were employed for analyzing association between these variables. Results: The proportion of incorrect answers increased as schooling years decreased and as age increased. In the multivariate analysis, visuospatial and executive function were the most affected domains. Educational level displayed less influence than age on short memory-recall task (standardized beta 0.19 vs -0.24). Educational level showed a greater influence than age on no-memory tasks (the sum of all other domains; standardized beta 0.50 vs -0.29). Conclusions: It seems logical to consider that performance in most domains of the MoCA is influenced by years of education. Therefore, low scores on these tasks could lead to low total MoCA scores and thus to bias and over diagnosis of cognitive impairment in patients with lower educational levels. Memory-recall domain is not affected much by education and applying it separately could be useful in patients with low educational level in whom we suspect memory impairment.
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Affiliation(s)
- Miguel Germán Borda
- a Semillero de Neurociencias y Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana , Bogotá , Colombia.,b Instituto de Envejecimiento, Pontificia Universidad Javeriana , Bogotá , Colombia.,c Unidad de Geriatría, Hospital Universitario San Ignacio , Bogotá , Colombia.,d Centre for Age-Related Medicine (SESAM) , Stavanger University Hospital , Stavanger , Norway
| | - Carlos Reyes-Ortiz
- e The University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Mario Ulises Pérez-Zepeda
- a Semillero de Neurociencias y Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana , Bogotá , Colombia.,f Geriatric Epidemiology Research Department, Instituto Nacional De Geriatría , Mexico City , Mexico.,g School of Medicine, Health Sciences Faculty, Universidad Anáhuac del Norte , Mexico City , Mexico
| | - Daniela Patino-Hernandez
- a Semillero de Neurociencias y Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana , Bogotá , Colombia.,b Instituto de Envejecimiento, Pontificia Universidad Javeriana , Bogotá , Colombia
| | - Camilo Gómez-Arteaga
- b Instituto de Envejecimiento, Pontificia Universidad Javeriana , Bogotá , Colombia.,c Unidad de Geriatría, Hospital Universitario San Ignacio , Bogotá , Colombia
| | - Carlos Alberto Cano-Gutiérrez
- a Semillero de Neurociencias y Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana , Bogotá , Colombia.,b Instituto de Envejecimiento, Pontificia Universidad Javeriana , Bogotá , Colombia.,c Unidad de Geriatría, Hospital Universitario San Ignacio , Bogotá , Colombia
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Poptsi E, Moraitou D, Eleftheriou M, Kounti-Zafeiropoulou F, Papasozomenou C, Agogiatou C, Bakoglidou E, Batsila G, Liapi D, Markou N, Nikolaidou E, Ouzouni F, Soumpourou A, Vasiloglou M, Tsolaki M. Normative Data for the Montreal Cognitive Assessment in Greek Older Adults With Subjective Cognitive Decline, Mild Cognitive Impairment and Dementia. J Geriatr Psychiatry Neurol 2019; 32:265-274. [PMID: 31159629 DOI: 10.1177/0891988719853046] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of the study was to provide normative data for the MoCA in a Greek cohort of people older than 60 years who meet criteria for subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia in order to optimize cutoff scores for each diagnostic group. METHOD Seven hundred forty-six community-dwelling older adults, visitors of the Day Center of Alzheimer Hellas were randomly chosen. Three hundred seventy-nine of them met the criteria for dementia, 245 for MCI and 122 for SCD. RESULTS Initial statistical analyses showed that the total MoCA score is not affected by gender (P = .164), or age (P = .144) but is affected by educational level (P < .001). A cutoff score of 23 for low educational level (≤6 years) can distinguish people with SCD from MCI (sensitivity 71.4%, specificity 84.2%), while 26 is the cutoff score for middle educational level (7-12 years; sensitivity 73.2%, specificity 67.0%) and high educational level (≥13 years; sensitivity 77.6%, specificity 74.7%). Montreal Cognitive Assessment can discriminate older adults with SCD from dementia, with a cutoff score of 20 for low educational level (sensitivity 100%, specificity 92.3%) and a cutoff score 23 for middle educational level (sensitivity 97.6%, specificity 92.7%) and high educational level (sensitivity 98.5%, specificity 100%). CONCLUSION Montreal Cognitive Assessment is not affected by age or gender but is affected by the educational level. The discriminant potential of MoCA between SCD and MCI is good, while the discrimination of SCD from dementia is excellent.
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Affiliation(s)
- Eleni Poptsi
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece.,2 Laboratory of Psychology, Section of Cognitive and Experimental Psychology, School of Psychology, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece
| | - Despina Moraitou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece.,2 Laboratory of Psychology, Section of Cognitive and Experimental Psychology, School of Psychology, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece
| | - Marina Eleftheriou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | | | - Chrysa Papasozomenou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Christina Agogiatou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Evaggelia Bakoglidou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Georgia Batsila
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Despina Liapi
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Nefeli Markou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Evdokia Nikolaidou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Fani Ouzouni
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Aikaterini Soumpourou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Maria Vasiloglou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Magda Tsolaki
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece.,4 1st Department of Neurology, Medical School, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece
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24
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Del Brutto OH, Mera RM, Zambrano M. Cognitive decline is not influenced by the marital status or living arrangements in community-dwelling adults living in a rural setting. A population-based prospective cohort study. J Clin Neurosci 2019; 69:109-113. [PMID: 31466904 DOI: 10.1016/j.jocn.2019.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/04/2019] [Indexed: 01/30/2023]
Abstract
Little is known on factors influencing cognitive decline in rural communities. Using the Atahualpa Project cohort, we aimed to assess whether the marital status or living arrangements influenced cognitive decline in community-dwelling adults living in an Ecuadorian rural village. The study included 629 Atahualpa residents aged ≥40 years who had a follow-up Montreal Cognitive Assessment (MoCA) repeated at least one year after baseline. Multivariate longitudinal linear models were fitted to assess differences between the marital status and living arrangements and cognitive decline (as the outcome). A total of 411 participants were married. The remaining 218 were either single, divorced or widowed (191 of them lived with family members and the others lived alone). Enrolled individuals contributed 2088.4 person-years of follow-up (mean: 3.3 ± 1.1 years). The mean baseline MoCA was 22.1 ± 4.5 points and the follow-up MoCA was 20.6 ± 4.8 points (p = 0.001). Overall, 394 (63%) individuals had lower MoCA scores at follow-up. A fully-adjusted longitudinal linear model showed no differences in MoCA decline across married and non-married individuals (β: -0.15; 95% C.I.: -0.55 - 0.26; p = 0.477). When the subset of non-married individuals was taken into account for analyses, multivariate longitudinal linear models showed no differences in the severity of cognitive decline across individuals living alone versus those living with family members (β: 0.28; 95% C.I.: -0.68 - 1.24; p = 0.572). In this study, the marital status or living arrangements had no influence on cognitive decline in the follow-up.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador.
| | - Robertino M Mera
- Department of Epidemiology, Gilead Sciences, Inc., Foster City, CA, USA
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25
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Delgado C, Araneda A, Behrens M. Validación del instrumento Montreal Cognitive Assessment en español en adultos mayores de 60 años. Neurologia 2019; 34:376-385. [DOI: 10.1016/j.nrl.2017.01.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/09/2017] [Accepted: 01/14/2017] [Indexed: 10/19/2022] Open
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26
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Delgado C, Araneda A, Behrens M. Validation of the Spanish-language version of the Montreal Cognitive Assessment test in adults older than 60 years. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2018.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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27
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Gomez F, Zunzunegui MV, Alvarado B, Curcio CL, Pirkle CM, Guerra R, Ylli A, Guralnik J. Cohort Profile: The International Mobility In Aging Study (IMIAS). Int J Epidemiol 2019; 47:1393-1393h. [PMID: 29746698 DOI: 10.1093/ije/dyy074] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Fernando Gomez
- Research Group on Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia
| | | | - Beatriz Alvarado
- Departments of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Carmen L Curcio
- Research Group on Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia
| | - Catherine M Pirkle
- Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Ricardo Guerra
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Alban Ylli
- Institute of Public Health, Tirana, Albania
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Del Brutto OH, Mera RM, Del Brutto VJ, Zambrano M, Wright CB, Rundek T. Clinical and neuroimaging risk factors for cognitive decline in community-dwelling older adults living in rural Ecuador. A population-based prospective cohort study. Int J Geriatr Psychiatry 2019; 34:447-452. [PMID: 30474242 PMCID: PMC6372307 DOI: 10.1002/gps.5037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/14/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE There is limited information on factors influencing cognitive decline in rural settings from low- and middle-income countries. Using the Atahualpa Project cohort, we aimed to assess the burden of cognitive decline in older adults living in a rural Ecuadorian village. METHODS The study included Atahualpa residents aged greater than or equal to 60 years who had a follow-up Montreal Cognitive Assessment (MoCA) repeated at least 1 year after baseline. MoCA decline was assessed by multivariable longitudinal linear models, adjusted for demographics, days between MoCA tests, cardiovascular risk factors, and neuroimaging signatures of structural brain damage. RESULTS We included 252 individuals who contributed 923.7 person-years of follow-up (mean: 3.7 ± 0.7 years). The mean baseline MoCA was 19.5 ± 4.5 points, and the follow-up MoCA was 18.1 ± 4.9 points (P = 0.001). Overall, 154 individuals (61%) had lower MoCA scores at follow-up. The best fitted longitudinal linear model showed a decline of follow-up MoCA from baseline (β: 0.14; 95% CI, 0.0-0.21; P < 0.001). High glucose levels, global cortical atrophy, and white matter hyperintensities were independently and significantly associated with greater MoCA decline. CONCLUSION This study provides evidence of cognitive decline in older adults living in a rural setting. Main targets for prevention should include glucose control and the control of factors that are deleterious for the development of cortical atrophy and white matter hyperintensities.
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Affiliation(s)
- Oscar H. Del Brutto
- School of Medicine, Universidad Espíritu Santo – Ecuador, Guayaquil, Ecuador
| | | | - Victor J. Del Brutto
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Fl, USA
| | | | - Clinton B. Wright
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Fl, USA
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Pinto TCC, Santos MSP, Machado L, Bulgacov TM, Rodrigues-Junior AL, Silva GA, Costa MLG, Ximenes RCC, Sougey EB. Optimal Cutoff Scores for Dementia and Mild Cognitive Impairment in the Brazilian Version of the Montreal Cognitive Assessment among the Elderly. Dement Geriatr Cogn Dis Extra 2019; 9:44-52. [PMID: 31043963 PMCID: PMC6477465 DOI: 10.1159/000495562] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/16/2018] [Indexed: 11/19/2022] Open
Abstract
Objective To propose cutoff scores for the Brazilian version of the Montreal Cognitive Assessment (MoCA-BR) stratified by education in order to detect mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) in the elderly. Method A transversal study in health centers was performed on 159 elderly people with 4–12 years of education and 70 of their peers with over 12 years of schooling. The MoCA-BR cutoff scores for screening cognitive impairment were determined based on an ROC curve analysis. Results The ROC curve analysis indicated that cutoff scores under 20 were good for screening elderly people with cognitive impairment with more than 12 years of education, and scores under 21 were good for screening those with 4–12 years of education. Conclusions MoCA-BR scores under 21 points (after adding 1 point to the elderly with ≤12 years of education) indicate a need to continue the diagnostic investigation with regular follow-ups.
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Affiliation(s)
- Tiago C C Pinto
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil.,University Hospital Doctor Washington Antônio de Barros of Universidade Federal do Vale do São Francisco (UNIVASF), Petrolina, Brazil
| | - Marília S P Santos
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Leonardo Machado
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Tatiana M Bulgacov
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Antônio L Rodrigues-Junior
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil.,Busca Vida Clinical Gerontology, Recife, Brazil
| | - Gabriela A Silva
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Maria Lúcia G Costa
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil.,Post-graduate program in Gerontology at the Federal University of Pernambuco, Recife, Brazil
| | - Rosana C C Ximenes
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Everton B Sougey
- Postgraduate Program in Neuropsychiatry and Behavioral Science at the Universidade Federal de Pernambuco (UFPE), Recife, Brazil
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Magklara E, Stephan BCM, Robinson L. Current approaches to dementia screening and case finding in low- and middle-income countries: Research update and recommendations. Int J Geriatr Psychiatry 2019; 34:3-7. [PMID: 30247787 DOI: 10.1002/gps.4969] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 08/06/2018] [Indexed: 12/21/2022]
Abstract
Approximately 47 million people have dementia worldwide, with this figure, it is expected to almost triple by 2050. Most people with dementia (approximately two-thirds) live in low- and middle-income countries (LMICs). This presents a significant challenge for such countries that often have limited financial resources and less well-developed health and social care systems. In the absence of a cure, reducing the future costs of dementia care and burden of disease may be best achieved by a greater emphasis on (1) more timely diagnosis with earlier intervention to maintain functional independence and (2) undertaking "screening" in groups at high risk of developing dementia, case finding, and using brief cognitive assessment instruments. In clinical settings, a wide range of instruments for dementia screening and diagnosis are currently available; however, few cognitive assessment tools have been developed specifically for clinical use within LMIC settings. Screening for dementia and cognitive impairment in LMICs largely relies on tools adapted from high-income countries (HICs); these often lack validation in these settings leading to education, literacy, and cultural biases. Research is urgently needed to develop cognitive assessment tools and dementia diagnostic approaches that are appropriate and feasible for clinical use in LMIC settings.
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Affiliation(s)
- Eleni Magklara
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Blossom C M Stephan
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
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Del Brutto OH, Mera RM, Zambrano M, Sedler MJ. Influence of Frailty on Cognitive Decline: A Population-Based Cohort Study in Rural Ecuador. J Am Med Dir Assoc 2018; 20:213-216. [PMID: 30455048 DOI: 10.1016/j.jamda.2018.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the influence of frailty on cognitive decline. DESIGN Population-based prospective cohort study. SETTINGS/PARTICIPANTS Community-dwelling older adults living in a rural Ecuadorian village, fulfilling the following criteria: age ≥60 years at baseline Montreal Cognitive Assessment (MoCA) and frailty assessment, a baseline brain magnetic resonance imaging, and a follow-up MoCA performed at least 12 months after the baseline. MEASURES Frailty was evaluated by the Edmonton Frailty Scale (EFS) and cognitive performance by MoCA. The relationship between baseline EFS and MoCA decline was assessed by longitudinal linear and fractional polynomial models, adjusted for relevant confounders. The score of the cognitive component of the EFS was subtracted, and an alternative fractional polynomial model was fitted to settle the impact of such cognitive question on the model. RESULTS A total of 252 individuals, contributing 923.7 person-years of follow-up (mean: 3.7 ± 0.7 years) were included. The mean EFS score was 4.7 ± 2.5 points. The mean baseline MoCA score was 19.5 ± 4.5 points, and that of the follow-up MoCA was 18.1 ± 4.9 points (P = .001). Overall, 154 (61%) individuals had lower MoCA scores in the follow-up. The best fitted longitudinal linear model showed association between baseline EFS score and MoCA decline (P = .027). There was a continuous increase in MoCA decline in persons with an EFS ≥7 points (nonlinear relationship). Fractional polynomials explained the effect of the EFS on MoCA decline. For the complete EFS score, the β coefficient was 2.43 (95% confidence interval 1.22-3.63). For the effect of the EFS (without its cognitive component) on MoCA decline, the relationship was still significant (β 4.86; 95% confidence interval 2.6-7.13). CONCLUSIONS/IMPLICATIONS Over a 3.7-year period, 61% of older adults living in Atahualpa experienced cognitive decline. Such decline was significantly associated with frailty status at baseline. Region-specific risk factors influencing this relationship should be further studied to reduce its burden in rural settings.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador.
| | | | | | - Mark J Sedler
- School of Medicine, Stony Brook University, New York, NY
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Curcio CL, Pineda A, Quintero P, Rojas Á, Muñoz S, Gómez F. Successful Aging in Colombia: The Role of Disease. Gerontol Geriatr Med 2018; 4:2333721418804052. [PMID: 30397638 PMCID: PMC6207973 DOI: 10.1177/2333721418804052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/18/2018] [Accepted: 08/29/2018] [Indexed: 11/25/2022] Open
Abstract
Objective: This study aimed to determine the prevalence of successful aging (SA) and identify its predictive factors in a cohort of older people in the Colombian Andes Mountain. Method: Data were drawn from a prospective longitudinal study of community-dwelling elderly people in Manizales. SA encompassed indicators in four domains: physical, cognitive, emotional, and social functioning. Results: The prevalence of SA was 24.4%. The independent predictors were good and very good self-rated health, middle–high/high-income level, absence of chronic conditions, married status, high educational level, and very high spirituality. Discussion: The prevalence of SA was low: One of 10 people older than 65 years showed SA when presence of diseases was included in the criteria, compared with one of four when such an item was excluded. The identification of predictive factors allows distinguishing this population in primary care services and promoting strategies that ensure high functionality levels for as long as possible.
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Li X, Zhang S, Zhang J, Zhu J, He H, Zhang Y, Zhang W, Tian D. Construct validity and reliability of the Test Your Memory Chinese version in older neurology outpatient attendees. Int J Ment Health Syst 2018; 12:64. [PMID: 30386423 PMCID: PMC6203987 DOI: 10.1186/s13033-018-0240-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/13/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Early distinguishing the cognitive impairment from healthy population is crucial to delay the progression of mild cognitive impairment (MCI) and Alzheimer disease (AD). Test Your Memory (TYM) has been proved to be a valid and reliable screening instrument for AD and MCI. This study aimed to develop a culturally appropriate and functional Standard Mandarin Chinese translation of the TYM, and to evaluate its reliability and validity in detecting AD and MCI in Chinese. METHODS 182 subjects with AD/MCI and 55 healthy controls were recruited to participate in this study, and everyone undergo the test of Standard Mandarin Chinese version of the TYM (TYM-CN), Mini-mental State Examination (MMSE), Montreal cognitive assessment (MoCA-BJ), and Clinical Dementia Rating (CDR) Scale. Concurrently, all the subjects with AD/MCI received the general physical and neurologic examinations, extensive laboratory tests, and brain computed tomography/magnetic resonance imaging (MRI). Of which, 90 subjects were asked to complete the re-test of TYM-CN at 3 weeks after the initial visit. Intra-class correlation coefficient (ICC) and Cronbach's alpha was used to assess the test-retest reliability and the internal consistency. The validity, sensitivity and specificity were also analyzed. One-way analysis of variance, χ2 test, correlation analysis, and receiver operating characteristic curve (ROC) analysis were employed, as needed. RESULTS The total scores of TYM-CN was 43.89 ± 3.44, 40.88 ± 4.38, and 29.12 ± 7.44 (p < 0.01) for healthy controls group, MCI group, and AD group, respectively. The ICC for 11 items of TYM-CN ranged from 0.863 (copying) to 0.994 (anterograde), and that of the total scale was 0.993, suggesting an excellent reliability. Furthermore, the significant correlation was also found between TYM-CN and MMSE (r = 0.76), MoCA-BJ (r = 0.74), and CDR scores (r = 0.76), indicating a good validity. A TYM-CN scores ≤ 39.5 had 95% sensitivity and 95% specificity in differentiating AD from healthy controls, and that ≤ 43.5 had 75% sensitivity and 91% specificity in distinguishing MCI from healthy controls, respectively. CONCLUSION The reliability and validity of the TYM-CN are statistically acceptable for the evaluation of cognitive impairment, which may contribute to neuropsychological tests for the diagnosis of AD and MCI from healthy controls in China.
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Affiliation(s)
- Xuemei Li
- Clinics of Cadre, Department of Outpatient, General Hospital of the People’s Liberation Army (301 Hospital), Beijing, 100853 China
| | - Shengfa Zhang
- School of Social Development and Public Policy, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875 China
| | - Jinsui Zhang
- School of Social Development and Public Policy, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875 China
| | - Jingru Zhu
- School of Social Development and Public Policy, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875 China
| | - Huan He
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, 611130 China
| | - Yurong Zhang
- School of Social Development and Public Policy, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875 China
| | - Weijun Zhang
- School of Social Development and Public Policy, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875 China
| | - Donghua Tian
- School of Social Development and Public Policy, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing, 100875 China
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Del Brutto OH, Mera RM, Zambrano M, Costa AF. The value of the Evans and bicaudate indices for predicting poor cognitive performance and central atrophy. Results from the Atahualpa Project. J Clin Neurosci 2018; 59:245-247. [PMID: 30279117 DOI: 10.1016/j.jocn.2018.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/13/2018] [Indexed: 11/26/2022]
Abstract
Recent studies suggested that both the Evans index (EI) and the bicaudate index (BI) are predictive markers of central atrophy and, as such, have been inversely associated with cognitive performance. This study investigated whether the EI and the BI (independently and combined) correlated with the MoCA score by means of generalized linear models adjusted for relevant confounders. Using a population-based design, 618 Atahualpa residents aged ≥40 underwent a head CT and MoCA testing. Both, the EI and the BI, were independently calculated by two readers, and a mean of the two values for each index was calculated for analysis. Generalized linear models showed inverse significant relationships between the EI and the BI with the MoCA score (p = 0.034, and p < 0.001, respectively). When both predictive variables (EI and BI) were included in a generalized linear model adjusted for all confounders, the BI remained significantly associated with the MoCA score (p = 0.004) but the EI did not (p = 0.677). This study shows that only the BI has and explanatory power outside the endogenous construct (central atrophy) for which both, the BI and the EI are part and parcel of.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador.
| | | | | | - Aldo F Costa
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador
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Del Brutto OH, Mera RM, Zambrano M, Costa AF. The association between earlobe crease (Frank's sign) and cognitive performance is related to age. Results from the Atahualpa Project. Arch Gerontol Geriatr 2018; 79:104-107. [PMID: 30179743 DOI: 10.1016/j.archger.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Earlobe crease (ELC) has been linked to cardiovascular diseases, but information on its association with cognitive decline is limited. We aimed to assess the association between ELC and cognitive performance in community-dwelling adults living in rural Ecuador. METHODS Of 863 individuals aged ≥40 years enrolled in the Atahualpa Project, 629 (73%) were included. ELC were visually identified by two independent raters, and cognitive performance was measured by the Montreal Cognitive Assessment (MoCA). Using generalized linear and interaction models, adjusted for demographics, cardiovascular risk factors and edentulism, we assessed the association between ELC and cognitive performance, as well as the influence of age in this association. RESULTS ELC was present in 246 (39%) individuals, and the mean MoCA score in the entire population was 21.9 ± 4.7 points. A generalized linear model showed no relationship between ELC presence and the MoCA score (p = 0.449). In this model, covariates remaining significant were age (p < 0.001), physical activity (p = 0.014) and edentulism (p < 0.001). When participants were stratified according of quartiles of age, the MoCA score did not differ according to the presence or absence of ELC. Weighted exposure-effect models - using ELC and the MoCA score as the exposure and outcome (respectively) - revealed no association between both variables. CONCLUSIONS The association between ELC and the MoCA score is mainly related to age. These findings might be explained by the high prevalence of ELC and cognitive decline in older adults.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador.
| | | | | | - Aldo F Costa
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador
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Apolinario D, Dos Santos MF, Sassaki E, Pegoraro F, Pedrini AVA, Cestari B, Amaral AH, Mitt M, Müller MB, Suemoto CK, Aprahamian I. Normative data for the Montreal Cognitive Assessment (MoCA) and the Memory Index Score (MoCA-MIS) in Brazil: Adjusting the nonlinear effects of education with fractional polynomials. Int J Geriatr Psychiatry 2018; 33:893-899. [PMID: 29430766 DOI: 10.1002/gps.4866] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To provide age-corrected and education-corrected norms for the Montreal Cognitive Assessment (MoCA) and the Memory Index Score (MoCA-MIS) in Brazil. METHODS Community-dwelling outpatients were enrolled if they had no history of neurologic or psychiatric diseases and were not taking any drugs with effects on the central nervous system. Dementia has been excluded with the Functional Activities Questionnaire. The final sample consisted of 597 cognitively healthy Brazilians aged 50 to 90 years. To account for nonlinear relationships, we have used fractional polynomials that provide a flexible parameterization for continuous variables. RESULTS According to the original proposed cutoff (≤25 points), 87% of our sample would be considered impaired. Even using a more conservative suggestion (≤22 points), 67% of our normative sample would be regarded as impaired. These data reinforce the need of adjusting cutoffs for schooling in populations with heterogeneous educational backgrounds. MoCA scores presented a nonlinear positive association with education tending to a plateau at higher levels (P < 0.001). On the other hand, MoCA-MIS scores presented a nonlinear negative relationship with age, with an accelerated pattern at higher age levels (P < 0.001). CONCLUSIONS We presented normative data for the MoCA and the MoCA-MIS that will facilitate the use of the test in Brazil and, potentially, in other populations with substantial proportions of low-educated individuals. Moreover, we described a systematic approach for adjusting the effects of age and education using fractional polynomials and provided suggestions on how to account for the nonlinear relationship that is frequently encountered between demographic factors and measures of cognitive performance.
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Affiliation(s)
- Daniel Apolinario
- Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Marília Funchal Dos Santos
- Department of Internal Medicine and Investigation on Multimorbidity and Mental Health in Aging (IMMA) group, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | - Eduardo Sassaki
- Department of Internal Medicine and Investigation on Multimorbidity and Mental Health in Aging (IMMA) group, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | - Fernanda Pegoraro
- Department of Internal Medicine and Investigation on Multimorbidity and Mental Health in Aging (IMMA) group, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | - Anna Vitoria Alves Pedrini
- Department of Internal Medicine and Investigation on Multimorbidity and Mental Health in Aging (IMMA) group, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | - Bruna Cestari
- Department of Internal Medicine and Investigation on Multimorbidity and Mental Health in Aging (IMMA) group, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | - Ana Helena Amaral
- Department of Internal Medicine and Investigation on Multimorbidity and Mental Health in Aging (IMMA) group, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | - Mayra Mitt
- Department of Internal Medicine and Investigation on Multimorbidity and Mental Health in Aging (IMMA) group, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | - Marina Bellatti Müller
- Department of Internal Medicine and Investigation on Multimorbidity and Mental Health in Aging (IMMA) group, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | - Claudia Kimie Suemoto
- Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Ivan Aprahamian
- Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.,Department of Internal Medicine and Investigation on Multimorbidity and Mental Health in Aging (IMMA) group, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
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Del Brutto OH, Mera RM, Gladstone D, Sarmiento-Bobadilla M, Cagino K, Zambrano M, Costa AF, Sedler MJ. Inverse relationship between the evans index and cognitive performance in non-disabled, stroke-free, community-dwelling older adults. A population-based study. Clin Neurol Neurosurg 2018; 169:139-143. [DOI: 10.1016/j.clineuro.2018.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/03/2018] [Accepted: 03/23/2018] [Indexed: 10/17/2022]
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Feeney J, Savva GM, O'Regan C, King-Kallimanis B, Cronin H, Kenny RA. Measurement Error, Reliability, and Minimum Detectable Change in the Mini-Mental State Examination, Montreal Cognitive Assessment, and Color Trails Test among Community Living Middle-Aged and Older Adults. J Alzheimers Dis 2018; 53:1107-14. [PMID: 27258421 DOI: 10.3233/jad-160248] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Knowing the reliability of cognitive tests, particularly those commonly used in clinical practice, is important in order to interpret the clinical significance of a change in performance or a low score on a single test. OBJECTIVE To report the intra-class correlation (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) for the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Color Trails Test (CTT) among community dwelling older adults. METHODS 130 participants aged 55 and older without severe cognitive impairment underwent two cognitive assessments between two and four months apart. Half the group changed rater between assessments and half changed time of day. RESULTS Mean (standard deviation) MMSE was 28.1 (2.1) at baseline and 28.4 (2.1) at repeat. Mean (SD) MoCA increased from 24.8 (3.6) to 25.2 (3.6). There was a rater effect on CTT, but not on the MMSE or MoCA. The SEM of the MMSE was 1.0, leading to an MDC (based on a 95% confidence interval) of 3 points. The SEM of the MoCA was 1.5, implying an MDC95 of 4 points. MoCA (ICC = 0.81) was more reliable than MMSE (ICC = 0.75), but all tests examined showed substantial within-patient variation. CONCLUSION An individual's score would have to change by greater than or equal to 3 points on the MMSE and 4 points on the MoCA for the rater to be confident that the change was not due to measurement error. This has important implications for epidemiologists and clinicians in dementia screening and diagnosis.
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Affiliation(s)
- Joanne Feeney
- Centre for Public Health, Queens University Belfast, Royal Victoria Hospital, Belfast, UK.,The Irish Longitudinal Study on Ageing, Lincoln Gate, University of Dublin, Trinity College, Dublin, Ireland
| | - George M Savva
- The Irish Longitudinal Study on Ageing, Lincoln Gate, University of Dublin, Trinity College, Dublin, Ireland.,School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Claire O'Regan
- The Irish Longitudinal Study on Ageing, Lincoln Gate, University of Dublin, Trinity College, Dublin, Ireland
| | - Bellinda King-Kallimanis
- The Irish Longitudinal Study on Ageing, Lincoln Gate, University of Dublin, Trinity College, Dublin, Ireland
| | - Hilary Cronin
- The Irish Longitudinal Study on Ageing, Lincoln Gate, University of Dublin, Trinity College, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Lincoln Gate, University of Dublin, Trinity College, Dublin, Ireland
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Del Brutto OH, Mera RM, de Amador AR, Zambrano M, Castillo PR. Symptoms of Neurotoxicity among Carpenters Living in Rural Ecuador: A Population-based Study (The Atahualpa Project). J Neurosci Rural Pract 2017; 8:649-652. [PMID: 29204030 PMCID: PMC5709893 DOI: 10.4103/jnrp.jnrp_286_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: There is no information on the prevalence of symptoms related to neurotoxicity among carpenters working in underserved populations. To assess the magnitude of the problem, we conducted a population-based study in Atahualpa, a rural Ecuadorian village, where most men work as carpenters under poor safety conditions. Methods: All men aged 40–75 years living in Atahualpa were identified during a door-to-door survey and evaluated with a general demographic questionnaire, the Q16 questionnaire, the depression axis of the Depression Anxiety Stress Scale-21, and the Montreal Cognitive Assessment (MoCA). Results: Among 230 participants, 63% were carpenters. Seventy participants (30%) had a positive Q16 questionnaire (≥6 points), which suggested neurotoxicity. In a logistic regression model adjusted for age, education, alcohol intake, symptoms of depression, and MoCA score, the proportion of Q16 positive persons was 39.1% for carpenters and 15.9% for noncarpenters (odds ratio: 3.53, 95% confidence interval: 1.75–7.15, P < 0.0001). In a generalized linear model, adjusted mean scores in the Q16 questionnaire were 4.9 for carpenters and 3.6 for noncarpenters (β: 1.285, standard error: 0.347, P < 0.0001). There was no correlation between scores in the Q16 questionnaire and the MoCA (Pearson correlation coefficient = −0.02), and the only significant covariate in the multivariate linear model was age, with every 10 years of age difference contributing 0.64 points in the Q16 questionnaire. Conclusion: This study shows a high prevalence of symptoms associated with neurotoxicity among carpenters after adjusting for a number of confounders. Long-term exposure to toxic solvents is the most likely explanation to this finding.
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Affiliation(s)
| | | | | | | | - Pablo R Castillo
- Sleep Disorders Center, Mayo Clinic College of Medicine, Jacksonville, FL, USA
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Aguilar-Navarro SG, Mimenza-Alvarado AJ, Palacios-García AA, Samudio-Cruz A, Gutiérrez-Gutiérrez LA, Ávila-Funes JA. Validity and Reliability of the Spanish Version of the Montreal Cognitive Assessment (MoCA) for the Detection of Cognitive Impairment in Mexico. ACTA ACUST UNITED AC 2017; 47:237-243. [PMID: 30286846 DOI: 10.1016/j.rcp.2017.05.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/04/2017] [Accepted: 05/08/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To establish the validity and reliability of the Montreal Cognitive Assessment in Spanish (MoCA-S) to identify mild cognitive impairment (MCI) and dementia in the Mexican elderly population. MATERIAL AND METHODS 168 participants from a memory clinic in Mexico City were enrolled and divided into 3 groups: 59 cognitively healthy (CHG), 52 with mild cognitive impairment (MCI) (DSM-5 criteria) and 57 with dementia (NINCDS-ADRDA criteria). The MoCA-S and Mini-Mental State Evaluation (MMSE) were applied at baseline and during the last months to establish intra-observer reliability. ROC curves and a multinomial regression model were constructed to evaluate the effect of age and education on MoCA-S performance. RESULTS The mean age of the participants was 76±8.1 years and the education rate was 10.7±5.2. The MoCA-S scores by group were: CHG, 27.3±1.9; MCI, 22.9±2.9; and dementia, 13.7±4.9 (p<0.001). The reliability of the MoCA-S was 0.89 and the intraclass correlation coefficient was 0.955. Sensitivity was 80% and specificity was 75%, with a cut-off point of 26 points for MCI (area under the curve, 0.886; p<0.001). For the dementia group, the sensitivity was 98% and specificity was 93%, with a cut-off point of 24points (area under the curve, 0.998; p<0.001). The multinomial regression showed no association with education and age for both the MCI and dementia groups. CONCLUSIONS The MoCA-S is a valid and reliable instrument for MCI and dementia screening in the Mexican population, even after adjusting for age and education.
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Affiliation(s)
- Sara G Aguilar-Navarro
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
| | - Alberto J Mimenza-Alvarado
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Alberto A Palacios-García
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Alejandra Samudio-Cruz
- Facultad de Psicología Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Lidia A Gutiérrez-Gutiérrez
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - José A Ávila-Funes
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México; Centre de recherche INSERM, Burdeos, Francia
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Tumas V, Borges V, Ballalai-Ferraz H, Zabetian CP, Mata IF, Brito MMC, Foss MP, Novaretti N, Santos-Lobato BL. Some aspects of the validity of the Montreal Cognitive Assessment (MoCA) for evaluating cognitive impairment in Brazilian patients with Parkinson's disease. Dement Neuropsychol 2016; 10:333-338. [PMID: 29213478 PMCID: PMC5619274 DOI: 10.1590/s1980-5764-2016dn1004013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The Montreal Cognitive Assessment (MoCA) is a short global cognitive scale,
and some studies suggest it is useful for evaluating cognition in patients
with Parkinson's disease (PD). However, its accuracy has been questioned in
studies involving patients with low education. Objective We sought to assess whether some of the MoCA subtests contribute to the low
accuracy of the test. Methods We performed a cross-sectional retrospective analysis of clinical data in a
cohort of 71 patients with PD, most with less than 8 years of education.
Patients were examined using the MDS-UPDRS, Hoehn and Yahr and the MoCA. The
data were analyzed using mainly descriptive statistics. Results We analyzed the data of 66 patients that were not demented according to the
clinical evaluation and classified them using the proposed cut-off MoCA
scores for diagnosis of MCI and dementia. Thirteen patients (19.7%) were
classified as having normal cognition, 24 (36.3%) MCI and 29 (43.9%)
dementia. Patients with dementia had longer disease duration (p=0.016) and
lower education (p=0.0001). Total MoCA scores had a an almost normal
distribution with a wide range of scores and only one maximum score.
Performance on the MoCA was highly correlated with education (correlation
coefficient=0.66, p=0.0001). At least five of the 10 MoCA subtests showed
significant floor effects. Conclusion We believe that some of the MoCA subtests may be too difficult to be
completed by PD patients with low educational level, thus contributing to
the test's poor diagnostic accuracy.
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Affiliation(s)
- Vitor Tumas
- Universidade de Ribeirão Preto, Faculdade de Medicina, Departamento de Neurologia, Ribeirão Preto, SP, Brazil
| | - Vanderci Borges
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia , São Paulo, SP, Brazil
| | - Henrique Ballalai-Ferraz
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia , São Paulo, SP, Brazil
| | - Cyrus P Zabetian
- University of Washington School of Medicine, Seattle, Washington - Department of Neurology - Seattle, Washington, United States
| | - Ignácio F Mata
- University of Washington School of Medicine, Seattle, Washington - Department of Neurology - Seattle, Washington, United States
| | - Manuelina M C Brito
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Neuroscience and Behavior, Ribeirão Preto, SP, Brazil
| | - Maria Paula Foss
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Neuroscience and Behavior, Ribeirão Preto, SP, Brazil
| | - Nathalia Novaretti
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Neuroscience and Behavior, Ribeirão Preto, SP, Brazil
| | - Bruno Lopes Santos-Lobato
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Neuroscience and Behavior, Ribeirão Preto, SP, Brazil
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Del Brutto OH, Mera RM, Del Brutto VJ, Sedler MJ. The bicaudate index inversely associates with performance in the Montreal Cognitive Assessment (MoCA) in older adults living in rural Ecuador. The Atahualpa project. Int J Geriatr Psychiatry 2016; 31:944-50. [PMID: 26833914 DOI: 10.1002/gps.4419] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 12/03/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Assessment of cognitive impairment in rural areas of developing countries is complicated by illiteracy and cross-cultural factors. A better way to estimate the usefulness of cognitive screening instruments is to evaluate their correlation with imaging biomarkers. The bicaudate index (a marker of central atrophy) correlates with cognitive performance. We assessed the relationship of the bicaudate index with the MoCA to estimate the usefulness of this test to detect individuals with cognitive decline in these regions. METHODS Atahualpa residents aged ≥60 years identified during door-to-door surveys were evaluated with the MoCA and invited to undergo brain MRI. Using generalized linear models, we estimated whether the bicaudate index correlates with MoCA scores, after adjusting for demographics and relevant clinical and neuroimaging confounders. RESULTS Out of 385 eligible persons, 290 (75%) were enrolled. Mean bicaudate index was 0.14 ± 0.03, and mean total MoCA score was 19 ± 5 points. Locally weighted scatterplot smoothing showed a nearly linear inverse relationship between the bicaudate index and the total MoCA score. In the fully adjusted generalized linear model, the bicaudate index was inversely associated with the total MoCA score (p < 0.001), which dropped by 5.3% (95% C.I.: 1.7%-8.8%) for every standard deviation of the bicaudate index. In addition, most domain-specific MoCA scores were inversely associated with the bicaudate index. CONCLUSIONS The inverse relationship between the bicaudate index and the MoCA score provides evidence that the MoCA is reliable to detect structural brain damage and useful to assess cognitive performance in less educated individuals. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo, Ecuador, Guayaquil, Ecuador
| | | | | | - Mark J Sedler
- School of Medicine, Stony Brook University, New York, NY, USA
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Del Brutto OH, Mera RM, Zambrano M. Metabolic syndrome correlates poorly with cognitive performance in stroke-free community-dwelling older adults: a population-based, cross-sectional study in rural Ecuador. Aging Clin Exp Res 2016; 28:321-5. [PMID: 26142624 DOI: 10.1007/s40520-015-0404-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 06/22/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Studies investigating a possible correlation between metabolic syndrome and cognitive decline have been inconsistent. AIMS To determine whether metabolic syndrome or each of its components correlate with cognitive performance in community-dwelling older adults in rural Ecuador. METHODS Stroke-free Atahualpa residents aged ≥60 years were identified during a door-to-door survey. Metabolic syndrome was defined according to the International Diabetes Federation criteria. Cognition was evaluated by the use of the Montreal Cognitive Assessment (MoCA). Multivariate logistic regression models estimated the association between metabolic syndrome and each of its components with cognitive performance. RESULTS A total of 212 persons (mean age: 69.2 ± 7.2 years, 64 % women) were enrolled. Of these, 120 (57 %) had metabolic syndrome. Mean scores in the MoCA were 18.2 ± 4.6 for persons with and 19 ± 4.7 for those without metabolic syndrome. In fully adjusted logistic models, MoCA scores were not associated with metabolic syndrome (p = 0.101). After testing individual components of metabolic syndrome with the MoCA score, we found that only hypertriglyceridemia was independently associated with the MoCA score (p = 0.009). CONCLUSIONS This population-based study showed a poor correlation of metabolic syndrome with cognitive performance after adjusting for relevant confounders. Of the individual components of metabolic syndrome, only hypertriglyceridemia correlated with worse cognitive performance.
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Lim PA, McLean AM, Kilpatrick C, DeForge D, Iverson GL, Silverberg ND. Temporal stability and responsiveness of the Montreal Cognitive Assessment following acquired brain injury. Brain Inj 2015; 30:29-35. [DOI: 10.3109/02699052.2015.1079732] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ng TP, Feng L, Lim WS, Chong MS, Lee TS, Yap KB, Tsoi T, Liew TM, Gao Q, Collinson S, Kandiah N, Yap P. Montreal Cognitive Assessment for screening mild cognitive impairment: variations in test performance and scores by education in Singapore. Dement Geriatr Cogn Disord 2015; 39:176-85. [PMID: 25572449 DOI: 10.1159/000368827] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) was developed as a screening instrument for mild cognitive impairment (MCI). We evaluated the MoCA's test performance by educational groups among older Singaporean Chinese adults. METHOD The MoCA and Mini-Mental State Examination (MMSE) were evaluated in two independent studies (clinic-based sample and community-based sample) of MCI and normal cognition (NC) controls, using receiver operating characteristic curve analyses: area under the curve (AUC), sensitivity (Sn), and specificity (Sp). RESULTS The MoCA modestly discriminated MCI from NC in both study samples (AUC = 0.63 and 0.65): Sn = 0.64 and Sp = 0.36 at a cut-off of 28/29 in the clinic-based sample, and Sn = 0.65 and Sp = 0.55 at a cut-off of 22/23 in the community-based sample. The MoCA's test performance was least satisfactory in the highest (>6 years) education group: AUC = 0.50 (p = 0.98), Sn = 0.54, and Sp = 0.51 at a cut-off of 27/28. Overall, the MoCA's test performance was not better than that of the MMSE. In multivariate analyses controlling for age and gender, MCI diagnosis was associated with a <1-point decrement in MoCA score (η(2) = 0.010), but lower (1-6 years) and no education was associated with a 3- to 5-point decrement (η(2) = 0.115 and η(2) = 0.162, respectively). CONCLUSION The MoCA's ability to discriminate MCI from NC was modest in this Chinese population, because it was far more sensitive to the effect of education than MCI diagnosis.
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Affiliation(s)
- Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Gil L, Ruiz de Sánchez C, Gil F, Romero SJ, Pretelt Burgos F. Validation of the Montreal Cognitive Assessment (MoCA) in Spanish as a screening tool for mild cognitive impairment and mild dementia in patients over 65 years old in Bogotá, Colombia. Int J Geriatr Psychiatry 2015; 30:655-62. [PMID: 25320026 DOI: 10.1002/gps.4199] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 07/31/2014] [Accepted: 07/31/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The Montreal Cognitive Assessment (MoCA) was developed as a simple screening tool for cognitive impairment. This study is the first validation in Latin America of the MoCA in Spanish (MoCA-S), which was developed in Colombia (South America). METHODS Aiming to perform the first validation of the MoCA-S, we developed a study of concordance by conformity to assess the MoCA-S compared with diagnostic consensus by interdisciplinary assessment in the Memory Clinic (the best diagnostic method available) and to evaluate the psychometric properties of the MoCA-S. A total of 193 subjects were evaluated, 109 of whom were patients, including 26 who met the mild cognitive impairment (MCI) clinical criteria, based on neuropsychological testing, and 83 who had mild dementia (MD). The remaining 84 participants were healthy subjects from the community. RESULTS The psychometric evaluation of the MoCA-S was appropriate. Using a cutoff score of ≥ 23, the MoCA had sensitivities of 76.0% to detect MCI and 92.7% to detect MD and a specificity of 79.8%. The percentage of patients clearly labeled by the MoCA-S was 85%. CONCLUSION The MoCA-S is a valid screening tool and is useful for identifying MCI and MD in Colombia. The MoCA-S is valid and adequate for application in Colombia with good internal consistency, inter-observer reliability, and content validity. However, the average educational level was high in this study; thus, caution should be exercised when extrapolating these results to individuals with lower educational levels.
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Affiliation(s)
- Laura Gil
- Neurosciences Department, Hospital San Ignacio, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
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Del Brutto OH, Mera RM, Del Brutto VJ, Maestre GE, Gardener H, Zambrano M, Wright CB. Influence of depression, anxiety and stress on cognitive performance in community-dwelling older adults living in rural Ecuador: results of the Atahualpa Project. Geriatr Gerontol Int 2015; 15:508-14. [PMID: 25155360 PMCID: PMC11006020 DOI: 10.1111/ggi.12305] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2014] [Indexed: 12/01/2022]
Abstract
AIM To assess the relationship between cognitive status and self-reported symptoms of depression, anxiety and stress of older adults living in an underserved rural South American population. METHODS Community-dwelling Atahualpa residents aged ≥60 years were identified during a door-to-door census, and evaluated with the Depression Anxiety Stress Scale-21 (DASS-21) and the Montreal Cognitive Assessment (MoCA). We explored whether positivity in each of the DASS-21 axes was related to total and domain-specific MoCA performance after adjustment for age, sex and education. RESULTS A total of 280 persons (59% women; mean age, mean age 70 ± 8 years) were included. Based on established cut-offs for the DASS-21, 12% persons had depression, 15% had anxiety and 5% had stress. Mean total MoCA scores were significantly lower for depressed than for not depressed individuals (15.9 ± 5.5 vs 18.9 ± 4.4, P < 0.0001). Depressed participants had significantly lower total and domain-specific MoCA scores for abstraction, short-term memory and orientation. Anxiety was related to significantly lower total MoCA scores (17 ± 4.7 vs 18.8 ± 4.5, P = 0.02), but not to differences in domain-specific MoCA scores. Stress was not associated with significant differences in MoCA scores. CONCLUSION The present study suggests that depression and anxiety are associated with poorer cognitive performance in elderly residents living in rural areas of developing countries.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo – Ecuador
- Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil
| | - Robertino M Mera
- Gastroenterology Department, Vanderbilt University, Nashville, Tennessee
| | | | - Gladys E Maestre
- Departments of Psychiatry and Neurology, and Gertrude H. Sergievsky Center, Columbia University, New York, New York
| | - Hannah Gardener
- McKnight Brain Institute and Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | | | - Clinton B Wright
- McKnight Brain Institute and Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Zhou Y, Ortiz F, Nuñez C, Elashoff D, Woo E, Apostolova LG, Wolf S, Casado M, Caceres N, Panchal H, Ringman JM. Use of the MoCA in Detecting Early Alzheimer's Disease in a Spanish-Speaking Population with Varied Levels of Education. Dement Geriatr Cogn Dis Extra 2015; 5:85-95. [PMID: 25873930 PMCID: PMC4376923 DOI: 10.1159/000365506] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/24/2014] [Indexed: 01/18/2023] Open
Abstract
Background/Aims Performance on the Montreal Cognitive Assessment (MoCA) has been demonstrated to be dependent on the educational level. The purpose of this study was to identify how to best adjust MoCA scores and to identify MoCA items most sensitive to cognitive decline in incipient Alzheimer's disease (AD) in a Spanish-speaking population with varied levels of education. Methods We analyzed data from 50 Spanish-speaking participants. We examined the pattern of diagnosis-adjusted MoCA residuals in relation to education and compared four alternative score adjustments using bootstrap sampling. Sensitivity and specificity analyses were performed for the raw and each adjusted score. The interval reliability of the MoCA as well as item discrimination and item validity were examined. Results We found that with progressive compensation added for those with lower education, unexplained residuals decreased and education-residual association moved to zero, suggesting that more compensation was necessary to better adjust MoCA scores in those with a lower educational level. Cube copying, sentence repetition, delayed recall, and orientation were most sensitive to cognitive impairment due to AD. Conclusion A compensation of 3-4 points was needed for <6 years of education. Overall, the Spanish version of the MoCA maintained adequate psychometric properties in this population.
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Affiliation(s)
- Yan Zhou
- Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, University of California, Los Angeles (UCLA)., USA
| | - Freddy Ortiz
- Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, University of California, Los Angeles (UCLA)., USA
| | - Christopher Nuñez
- Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, University of California, Los Angeles (UCLA)., USA ; Keck School of Medicine, University of Southern California Division of Research on Children, Youth and Families., USA ; Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, Calif., USA
| | - David Elashoff
- Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, University of California, Los Angeles (UCLA)., USA ; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA)., USA
| | - Ellen Woo
- Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, University of California, Los Angeles (UCLA)., USA
| | - Liana G Apostolova
- Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, University of California, Los Angeles (UCLA)., USA
| | - Sheldon Wolf
- Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, University of California, Los Angeles (UCLA)., USA
| | - Maria Casado
- Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, University of California, Los Angeles (UCLA)., USA
| | - Nenette Caceres
- Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, University of California, Los Angeles (UCLA)., USA
| | - Hemali Panchal
- Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, University of California, Los Angeles (UCLA)., USA
| | - John M Ringman
- Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, University of California, Los Angeles (UCLA)., USA
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Lim ML, Gomez R, Koopman C. A review of amnestic MCI screening in east/southeast Asian older adults with low education: implications for early informant-clinician collaboration. Int J Geriatr Psychiatry 2015; 30:144-55. [PMID: 25384754 DOI: 10.1002/gps.4225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study is to review the recent literature on established cognitive tests and appropriate screening methods for amnestic mild cognitive impairment (MCI) in East/Southeast Asian older adults with a focus on those with low education. DESIGN Peer-reviewed empirical studies conducted in Asia (China, Hong Kong, Japan, Korea, Singapore, and Taiwan) were identified using databases in psychology and medicine with combinations of the search terms "mild cognitive impairment," "dementia," "screening," "literacy," "illiteracy," "low education," "informant," "family," "cognitive test," "memory complaints," "activities of daily living," and "clinical dementia rating," limiting articles to those published in English since 1 January 2002. Of note, is that the term "amnestic mild cognitive impairment" was not used for searching the articles because the related cognitive impairment were often categorized non-specifically as MCI, but participants included those with amnestic cognitive challenges. Hence, the general term "MCI" has been used often throughout the text. RESULTS Twelve studies that examined MCI screens were identified. An integrative approach using a combination of cognitive test and informant-based measure may be more sensitive or accurate than using any single screening method alone. CONCLUSION MCI misdiagnosis may be prevalent, highlighting the need for early collaborative work between informants and clinicians to improve the accuracy of this diagnosis in older Asian adults with low education. Findings were suggestive, although restricted in generalizability even within similar cultural groups or neighboring regions. Clinical application is limited, but some findings provide guidance for future research.
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Affiliation(s)
- Magdalene L Lim
- University of Rochester Medical Center, Rochester, New York, USA
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Del Brutto OH, Wright C. Animal naming in the Spanish version of the Montreal Cognitive Assessment in rural Latin American communities: A cautionary note. Geriatr Gerontol Int 2015; 15:126-7. [DOI: 10.1111/ggi.12223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Oscar H Del Brutto
- School of Medicine; Universidad Espíritu Santo - Ecuador; Guayaquil Ecuador
- Department of Neurological Sciences; Hospital-Clínica Kennedy; Guayaquil Ecuador
| | - Clinton Wright
- McKnight Brain Institute and Department of Neurology; Miller School of Medicine; University of Miami; Miami FL USA
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