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

The risk of cognitive decline and dementia in older adults diagnosed with COVID-19: A systematic review and meta-analysis

BACKGROUND

Cognitive impairment can be caused by infections with various pathogens, including SARS-CoV-2. Research has yet to determine the true incidence and course of cognitive impairment in older adults following COVID-19. Furthermore, research has theorised that COVID-19 is associated with dementia progression and diagnosis but this association has yet to be fully described.

METHODS

A systematic review was registered in Prospero and conducted on the databases PubMed, Embase, Ovid, CENTRAL and Cochrane Library. Studies reporting cognitive impairment and dementia outcomes in post-acute and post-COVID-19 patients aged ≥65 years, and which included control data, were included in this review.

RESULTS

15,124 articles were identified by the search strategy. After eliminating duplicate titles and completing title, abstracts and full-text review, 18 studies were included comprising of 412,957 patients with COVID-19 (46.63% male) and 411,929 patients without COVID-19 (46.59% male). The overall mean Montreal Cognitive Assessment (MoCA) score in COVID-19 patients was 23.34 out of 30 (95% CI [22.24, 24.43]). indicating cognitive impairment. The overall proportion of patients identified as having new onset cognitive impairment was 65% (95% CI [44, 81]). Subgroup analyses indicated that time since infection significantly improves overall MoCA score and reduces proportion of patients with cognitive impairment.

CONCLUSION

This study indicates that cognitive impairment may be an important sequela of COVID-19. Further research with adequate sample sizes is warranted regarding COVID-19's association with new-onset dementia and dementia progression, and the effect of repeat infections. There is a need for development of diagnostic and management protocols for COVID-19 patients with cognitive impairment.

Psychometric Reliability, Validity, and Generalizability of MoCA in American Indian Adults: The Strong Heart Study

Standardized neuropsychological instruments are used to evaluate cognitive impairment, but few have been psychometrically evaluated in American Indians. We collected Montreal Cognitive Assessment (MoCA) in 403 American Indians 70 to 95 years, as well as age, sex, education, bilingual status, depression symptoms, and other neuropsychological instruments. We evaluated inferences of psychometric validity, including scoring inference using confirmatory factor analysis and structural equation modeling, generalizability inference using reliability coefficient, and extrapolation inference by examining performance across different contexts and substrata. The unidimensional (total score) model had good fit criteria. Internal consistency reliability was high. MoCA scores were positively associated with crystallized cognition (ρ = 0.48, p < .001) and inversely with depression symptoms (ρ = -0.27, p < .001). Significant differences were found by education (d = 0.79, p < .05) depression (d = 0.484, p < .05), and adjudicated cognitive status (p = .0001) strata; however, MoCA was not sensitive or specific in discriminating cognitive impairment from normal cognition (area under the curve <0.5). MoCA scores had psychometric validity in older American Indians, but education and depression are important contextual features for score interpretability. Future research should evaluate cultural or community-specific adaptations, to improve test discriminability in this underserved population.

Validation of the Slovenian version of the Montreal Cognitive Assessment Scale as a screening tool for the detection of mild cognitive impairment

OBJECTIVE

The Montreal cognitive assessment scale (MoCA) is commonly used for detecting individuals with mild cognitive impairment (MCI). The aim of the present study was to evaluate the validity of the Slovenian MoCA as a screening tool for MCI and to determine the optimal cut-off point to detect MCI in the elderly population.

METHODS

Mini-Mental State Examination (MMSE), MoCA, and neuropsychological testing assessment were conducted on 93 individuals aged ≥ 60 years. MCI was found in 35 individuals with 58 cognitively asymptomatic controls. Cut-off values, sensitivity, and specificity of MoCA were calculated with the receiver operating characteristic curve.

RESULTS

MCI and healthy individuals did not differ with respect to age and education. Healthy individuals (M = 24.5, SD = 1.7) performed significantly better on MoCA compared to MCI individuals (M = 21.4, SD = 3.2) (p < 0.001). The Cronbach's α of MoCA as an index of internal consistency was 0.64. MoCA distinguished between healthy controls and MCI individuals with a sensitivity of 77% and specificity of 74%, using a cut-off of 23/24 points.

CONCLUSION

The Slovenian version of MoCA demonstrates an optimal cut-off value of 23/24 points for detecting older individuals with MCI. As a screening tool for MCI, its better diagnostic accuracy makes it preferable to using MMSE.

Translation and validation of the audiovisual version of the Montreal cognitive assessment in older adults in Brazil

BACKGROUND

The use of a reliable remote cognitive screening test for older adults is crucial for the diagnosis of cognitive impairment. This study aimed to translate and validate the audiovisual Montreal Cognitive Assessment (MoCA)for older adults in Brazil.

METHODS

One hundred and fourteen older adults were recruited from the community and demographic, functional, mood, and cognitive data were collected. Participants were classified into two groups: cognitively healthy or mild cognitive impairment (MCI). Statistical analyses were performed in order to assess the validity of the test and the cutoff score.

RESULTS

The psychometric properties of the audiovisual MoCA showed good convergent validity. The audiovisual MoCA was represented as a unifactorial adjusted model, the composite reliability value was acceptable and a cutoff point of ≥23 reached adequate sensitivity and specificity at 0.77 and 0.92, respectively.

CONCLUSIONS

The translated audiovisual MoCA is a valid and reliable cognitive screening test that can be administered remotely in older adults in Brazil. The test demonstrated a great ability to discriminate older adults with MCI from cognitively healthy adults. Future studies should focus on validating the audiovisual MoCA using other target population groups in order to expand the use of this remote screening test.

Associations between afternoon napping, left amygdala volume and cognitive performance in elderly with normal cognitive function

BACKGROUND

The relationship between afternoon napping and cognitive function in the elderly is very complex and the mechanism is unknown.

METHODS

In the current study, 194 community elders with normal cognitive functions were included. All subjects completed baseline clinical assessment, baseline neuropsychological test as well as baseline structural MRI. Based on their napping status, these 194 participants were divided into the napping group (n = 88) and the non-napping group (n = 106). We then compared the differences in cognitive performance and structural magnetic resonance between the two groups.

RESULTS

In the intergroup analysis, we found that the nappers showed poorer cognitive performance on both overall cognitive function and domain specific cognitive function; while on the whole sample, we found a significant negative association (F = 20.27, p<0.001) between afternoon napping and left amygdala volume. However, we did not find any effect of night sleep length or napping frequency on cognitive performance or left amygdala volume.

CONCLUSIONS

In community elders with normal cognitive functions, afternoon napping is associated with cognitive performance, and left amygdala may play an important role in this process.

Clinical factors associated with the quality of interactions between staff and hospitalized older patients with dementia

This study examines the clinical factors associated with the quality of interactions between staff and hospitalized older patients with dementia. Following examination of bivariate associations, we conducted multiple linear regression in a sample of 140 hospitalized older patients with dementia who participated in the final cohort of an intervention study implementing Family-centered Function-focused Care (Fam-FFC). On average, the participants (male = 46.1%, female = 52.9%) were 81.43 years old (SD = 8.29) and had positive interactions with staff (mean QUIS score = 5.84, SD = 1.36). Accounting for 17.8% of variance in the model, non-pharmacological intervention use (b= 0.170; p<.001) and pain (b= -0.198; p<.01) were significantly associated with the quality of staff-patient interactions. To optimize care of hospitalized patients with dementia, staff should be encouraged to use non-pharmacological interventions. It is also important for staff to assess pain among the patients with dementia and prioritize pain management.

Subjective Cognitive and Communicative Complaints and Health-Related Quality of Life in Parkinson's Disease with and without Mild Cognitive Impairment

INTRODUCTION

Mild Cognitive Impairment (MCI) is common in Parkinson's Disease (PD). Few studies have compared the Health-Related Quality of Life (HRQoL) in patients with and without MCI due to PD (PD-MCI), and its correlation to patients' subjective cognitive and communicative difficulties has not been explored.

OBJECTIVE

We aimed to compare HRQoL in PD-MCI and PD without MCI (PD-nMCI), and explore its possible relationship to subjective cognitive and communicative complaints.

METHODS

We included 29 PD-nMCI and 11 PD-MCI patients. The HRQoL was assessed with the Parkinson's Disease Questionnaire-39 (PDQ-39): its Cognition dimension was used as a measure of subjective cognitive complaints, its Communication dimension for subjective communicative complaints, and the summary index (PDQ-39 SI) as an indicator of HRQoL. Non-parametric partial correlations between the Cognition and Communication dimensions, and the adjusted PDQ-39 SI were conducted.

RESULTS

PD-MCI patients had greater subjective cognitive and communicative complaints and worse HRQoL than PD-nMCI patients. In the PD-MCI group, both subjective cognitive and communicative complaints exhibited significant direct correlations with the adjusted HRQoL scores.

CONCLUSIONS

HRQoL seems to be affected in PD-MCI, and it might be influenced by greater subjective cognitive and communicative complaints. Including patient-reported outcome measures of HRQoL, and providing cognitive and speech rehabilitation, as well as psychotherapeutic strategies to face these deficits can enhance the patient-centred approach in PD.

NEUROCANTRIAL: study protocol for a randomised controlled trial of a pain neuroscience education programme in adults with cancer pain

INTRODUCTION

Pain is the second most frequent symptom reported in patients with cancer among the main reasons for consultation. The incorporation of educational modalities in pain intervention processes has been suggested. This study aims to examine the efficacy of neuroscience pain education (PNE) in relation to pain, biopsychosocial variables and functional capacity in comparison with conventional treatment. It is hypothesised that an intervention based on PNE achieves better outcomes than conventional management, in terms of pain, biopsychosocial variables and functional capacity in adults with oncological pain.

METHODS AND ANALYSIS

This will be a single-blind, controlled clinical trial in which two groups will be compared using changes in pain as the primary measure. The first group will receive conventional treatment in addition to PNE, and participants will undergo an intervention of nine sessions (one session per week, for a total of 9 weeks), each lasting 30-40 min. Specifically, these sessions will teach biophysiological elements using metaphors that allow the adoption of these concepts related to pain. The second group will receive conventional treatment (pharmacological treatment). For this study, a sample size calculation was made based on the background, where 80 adults with oncological pain were required. An initial evaluation will be made to establish the baseline characteristics, and then, according to the randomisation, the assignment to the PNE group or the control group will be made and the two groups will be summoned again. Ten weeks later, for the intervention evaluation, the statistical analysis plan will be established by protocol and by intention-to-treat.

ETHICS AND DISSEMINATION

This protocol complies with all ethical considerations. The authors commit to presenting the study's results. This study was approved by the ethics committees of the Universidad Santiago de Cali, Clínica de Occidente/Angiografía de Occidente. The authors commit to presenting the study's results.

TRIAL REGISTRATION NUMBER

NCT05581784.

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

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

Temporal Irreversibility of Large-Scale Brain Dynamics in Alzheimer's Disease

Healthy brain dynamics can be understood as the emergence of a complex system far from thermodynamic equilibrium. Brain dynamics are temporally irreversible and thus establish a preferred direction in time (i.e., arrow of time). However, little is known about how the time-reversal symmetry of spontaneous brain activity is affected by Alzheimer's disease (AD). We hypothesized that the level of irreversibility would be compromised in AD, signaling a fundamental shift in the collective properties of brain activity toward equilibrium dynamics. We investigated the irreversibility from resting-state fMRI and EEG data in male and female human patients with AD and elderly healthy control subjects (HCs). We quantified the level of irreversibility and, thus, proximity to nonequilibrium dynamics by comparing forward and backward time series through time-shifted correlations. AD was associated with a breakdown of temporal irreversibility at the global, local, and network levels, and at multiple oscillatory frequency bands. At the local level, temporoparietal and frontal regions were affected by AD. The limbic, frontoparietal, default mode, and salience networks were the most compromised at the network level. The temporal reversibility was associated with cognitive decline in AD and gray matter volume in HCs. The irreversibility of brain dynamics provided higher accuracy and more distinctive information than classical neurocognitive measures when differentiating AD from control subjects. Findings were validated using an out-of-sample cohort. Present results offer new evidence regarding pathophysiological links between the entropy generation rate of brain dynamics and the clinical presentation of AD, opening new avenues for dementia characterization at different levels.SIGNIFICANCE STATEMENT By assessing the irreversibility of large-scale dynamics across multiple brain signals, we provide a precise signature capable of distinguishing Alzheimer's disease (AD) at the global, local, and network levels and different oscillatory regimes. Irreversibility of limbic, frontoparietal, default-mode, and salience networks was the most compromised by AD compared with more sensory-motor networks. Moreover, the time-irreversibility properties associated with cognitive decline and atrophy outperformed and complemented classical neurocognitive markers of AD in predictive classification performance. Findings were generalized and replicated with an out-of-sample validation procedure. We provide novel multilevel evidence of reduced irreversibility in AD brain dynamics that has the potential to open new avenues for understating neurodegeneration in terms of the temporal asymmetry of brain dynamics.

Moral Emotions and Their Brain Structural Correlates Across Neurodegenerative Disorders

BACKGROUND

Although social cognition is compromised in patients with neurodegenerative disorders such as behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD), research on moral emotions and their neural correlates in these populations is scarce. No previous study has explored the utility of moral emotions, compared to and in combination with classical general cognitive state tools, to discriminate bvFTD from AD patients.

OBJECTIVE

To examine self-conscious (guilt and embarrassment) and other-oriented (pity and indignation) moral emotions, their subjective experience, and their structural brain underpinnings in bvFTD (n = 31) and AD (n = 30) patients, compared to healthy controls (n = 37). We also explored the potential utility of moral emotions measures to discriminate bvFTD from AD.

METHODS

We used a modified version of the Moral Sentiment Task measuring the participants' accuracy scores and their emotional subjective experiences.

RESULTS

bvFTD patients exhibited greater impairments in self-conscious and other-oriented moral emotions as compared with AD patients and healthy controls. Moral emotions combined with general cognitive state tools emerged as useful measures to discriminate bvFTD from AD patients. In bvFTD patients, lower moral emotions scores were associated with lower gray matter volumes in caudate nucleus and inferior and middle temporal gyri. In AD, these scores were associated with lower gray matter volumes in superior and middle frontal gyri, middle temporal gyrus, inferior parietal lobule and supramarginal gyrus.

CONCLUSION

These findings contribute to a better understanding of moral emotion deficits across neurodegenerative disorders, highlighting the potential benefits of integrating this domain into the clinical assessment.

Three verbal fluency tasks: Normative data and convergent validity in Argentines over 50 years

Abstract Verbal fluency tasks are frequently used in neuropsychological assessment, standing out for their easy application and good sensitivity to early cognitive impairment. However, in Argentina, the availability of updated norms is limited, especially for the action fluency variant. There is also little evidence of validity. Objectives: The aim of this study was to obtain Argentine norms for three verbal fluency tasks and to analyze their convergent validity. Methods: Using a nonprobability sampling method, 303 Argentines from a nonclinical population (age mean=66.8, 50–91 years) were recruited to participate in this study. Those with medical conditions that could compromise neuropsychological performance were excluded. Three verbal fluency tasks (i.e., phonological, semantic, and action), the Montreal Cognitive Assessment (MoCA) test, and the Digit Span-WAIS III test were administered. Correlations and multiple regressions were subsequently performed. Results: Education and age significantly explained 11.8% of the variance in phonological fluency, 15.8% of the variance in semantic fluency, and 20.2% of the variance in action fluency. Hence, the normative data varied according to educational level and age group, with normal performance limit values between 9 and 14 for phonological fluency, 11 and 18 for semantic fluency, and 8 and 17 for action fluency. Positive correlations were obtained between all verbal fluency tasks, as well as between the MoCA test and the Digit Span test. Conclusions: This study supports the applicability of three verbal fluency tasks in an Argentine context by providing age- and education-corrected norms and acceptable evidence of convergent validity.

Psychometric properties and construct validity of the Parkinson’s Disease-Cognitive Rating Scale (PD-CRS) in Colombia

Background

Cognitive impairment is frequent among people living with Parkinson’s disease: up to 40% of patients exhibit symptoms of mild cognitive impairment and 25% meet the criteria for dementia. Parkinson’s Disease Cognitive Rating Scale (PD-CRS) is one of the recommended scales by the Movement Disorders Society Task Force for level 1 screening of dementia. However, its psychometric properties have not been studied in the Colombian population.

Methods

A cross-sectional study was conducted on 100 patients with Parkinson’s disease diagnosed by a movement disorders neurologist. Patients were evaluated with PD-CRS and MoCA. Principal component analysis was conducted, and then confirmatory factor analysis was implemented through the maximum-likelihood method. Internal consistency was evaluated using Cronbach α. Convergent and divergent validity were also calculated and concurrent validity with the MoCA was assessed.

Results

62% were males. Their median age was 68 years (IQR 57–74) and the median disease duration was 4 years (IQR 2–9). 77% were classified in early stages (Hoehn and Yahr stage ≤ 2), while the MDS-UPDRS part III score was 25 (IQR 15.5–38). In the principal component factor analysis, the pattern matrix unveiled a mnesic and a non-mnesic domain. Confirmatory factor analysis showed similar explanatory capacity (λ ≥ 0.50) for items other than naming (λ = 0.34). Cronbach’s α for the full 9-items instrument was 0.74. MoCA and PD-CRS total scores were correlated (ρ = 0.71, p = 0.000). Assuming a cut-off score of 62 points, there is an agreement of 89% with the definition of dementia by MoCA for Colombia (κ = 0.59; p = 0.000).

Conclusion

PD-CRS has acceptable psychometric properties for the Colombian population and has significant correlation and agreement with a validated scale (MoCA).

MoCA in five Indian languages: A brief screening tool to diagnose dementia and MCI in a linguistically diverse setting

INTRODUCTION AND OBJECTIVES

Early dementia diagnosis in low and middle-income countries (LMIC) is challenging due to limited availability of brief, culturally appropriate, and psychometrically validated tests. Montreal Cognitive Assessment (MoCA) is one of the most widely used cognitive screening tests in primary and secondary care globally. In the current study, we adapted and validated MoCA in five Indian languages (Hindi, Bengali, Telugu, Kannada, and Malayalam) and determined the optimal cut-off points that correspond to screening for clinical diagnosis of dementia and MCI.

METHODS

A systematic process of adaptation and modifications of MoCA was fulfilled. A total of 446 participants: 214 controls, 102 dementia, and 130 MCI were recruited across six centers.

RESULTS

Across five languages, the area under the curve for diagnosis of dementia varied from 0.89 to 0.98 and MCI varied from 0.73 to 0.96. The sensitivity, specificity and optimum cut-off scores were established separately for five Indian languages.

CONCLUSIONS

The Indian adapted MoCA is standardized and validated in five Indian languages for early diagnosis of dementia and MCI in a linguistically and culturally diverse population.

Genetic Variants and Haplotypes of TOMM40, APOE, and APOC1 are Related to the Age of Onset of Late-onset Alzheimer Disease in a Colombian Population

BACKGROUND

The Apolipoprotein E (APOE) gene is the main risk factor for late-onset Alzheimer disease (LOAD). Genetic variants and haplotypes in regions near the APOE locus may be associated with LOAD in the Colombian population.

OBJECTIVE

We evaluated frequencies and risk of genetic variants and haplotypes in APOE, TOMM40, and APOC1 promoters, also in putative regulatory enhancer elements (TOMM40 IVS2-4 and TOMM40 IVS6), and in cis-regulatory elements (ME1 and BCR).

MATERIALS AND METHODS

Our case-control association study was carried out in 50 patients with LOAD and 50 controls. We determined frequencies and odd ratios for genetic variants and haplotypes.

RESULTS

We found a significant association between LOAD and genetic variants at the TOMM40 promoter, at TOMM40 IVS2-4 and TOMM40 IVS6 regulatory enhancer elements, and at the APOC1 promoter. Particularly, variants of Poly-T and APOC1 promoter could anticipate the age of onset of LOAD in our population. We identified three risk haplotypes in TOMM40 (ACGGAG, ACGGGG, and ATAGGC) related to LOAD's age of onset. We also found other risk or protection haplotypes at the TOMM40 and APOE promoters, at TOMM40 IVS2-4, TOMM40 IVS6 regulatory enhancer elements, and at ME1.

CONCLUSION

Genetic variants and haplotypes near the APOE locus are related to LOAD risk and accelerated onset of LOAD in the Colombian population.

Subjective cognitive decline is associated with a higher risk of objective cognitive decline: A cross-sectional and longitudinal study

BACKGROUND

Subjective cognitive decline (SCD) is considered as an independent risk factor for objective cognitive impairment, such as dementia and mild cognitive impairment (MCI), but the mechanism is unclear.

METHODS

The current study consisted of two parts, the first of which included 1,010 older adults with SCD and 535 normal controls and was followed for 1 year. The second cross-sectional study included 94 older adults with SCD and 64 healthy controls. Unlike the first cohort, subjects in the second study underwent magnetic resonance imaging and had more detailed neuropsychological tests, such as Mini- mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Digit Span, Auditory Verbal Learning Test (AVLT), Associative Learning Test (ALT), Verbal Fluency (VF), Wechsler's filling and Wechsler's building blocks.

RESULTS

In cohort 1, we found that SCD had a higher risk of objective cognitive impairment compared to normal controls (X² = 20.354, p = 0.002), and the results of Cox Regression analysis also suggest that SCD was a risk factor for objective cognitive decline (p < 0.001, HR = 2.608, 95%CI: 2.213-3.075). In study 2, we found that the scores of MoCA, digit span, verbal fluency, and Wechsler's filling of SCD elderly were significantly lower than those of normal controls, but the cortical thickness of the rostral middle frontal gyrus (RMFG) was significantly higher than that of normal controls (p < 0.05).

CONCLUSIONS

SCD is a cognition-related disease with multi-cognitive domain impairment, which is associated with a higher risk of objective cognitive impairment. Moreover, the increased cortical thickness of the left rostral middle frontal gyrus (RMFG) might be an important mechanism of cognitive decline in SCD.

Psychometric Properties of the Montreal Cognitive Assessment (MoCA) to Detect Major Neurocognitive Disorder Among Older People in Ethiopia: A Validation Study

BACKGROUND

Cognition is one of the most complex functions of the human brain, and major neurocognitive disorders affect this function causing a wide array of problems in an individual's life. Screening for major neurocognitive disorders can be helpful in designing and implementing early interventions.

PURPOSE

This study was designed to assess the reliability and validity of the Montreal Cognitive Assessment (MoCA) tool to detect major neurocognitive disorders among older people in Ethiopia.

METHODS

One hundred and sixteen randomly selected older adults in Ethiopia were involved in a cross-sectional study. The Diagnostic and Statistical Manual of Mental Disorders criteria for major neurocognitive disorders was used as a gold standard. Data were analyzed using STATA v16 statistical software. Receiver operating curve analysis was performed, and inter-rater, internal consistency reliabilities, content, criterion and construct validities were determined. Statistically significance was declared at a p-value of <0.05.

RESULTS

The study had a 100% response rate. The mean age of the study participants was 69.87 ± 7.8. The inter-rater reliability value was 0.96, and Cronbach's alpha was 0.79. The optimal cutoff value was ≤21, and Montreal Cognitive Assessment has an area under curve value of 0.89. The sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values of MoCA are 87.18%, 74.03%, 3.35, 0.17, 63%, and 91.9%, respectively. The tool also has good concurrent and construct validities.

CONCLUSION

The Montreal Cognitive Assessment tool was a reliable and valid tool to detect major neurocognitive disorder. It can be incorporated into the clinical and research practices in developing countries.

Diagnostic accuracy of brief cognitive screening tools to diagnose vascular cognitive impairment in Peru

INTRODUCTION

To evaluate the diagnostic accuracy of three brief cognitive screening (BCS) tools, Peruvian version of Addenbrooke's Cognitive Examination (ACE-Pe), of INECO Frontal Screening (IFS-Pe) and of the Mini-Mental State Examination (MMSE-Pe), for the diagnosis of vascular cognitive impairment (VCI) and its non-dementia stages (VCI-ND) and vascular dementia (VD) in patients with cerebral stroke in Lima-Peru.

MATERIALS AND METHODS

A cohort analysis to evaluate the diagnostic accuracy of three BCS for VCI.

RESULTS

Two hundred and four patients were evaluated: 61% Non-VCI, 30% VCI-ND and 9% VD. To discriminate patients with VCI from controls, the area under the curve (AUC) of ACE-Pe, IFS-Pe and MMs-Pe were 0.99 (95% confidence interval [CI] 0.98-0.99), 0.99 (95%CI 0.98-0.99) and 0.87 (95%CI 0.82-0.92), respectively. Of the three BCS, the IFS-Pe presented a larger AUC to discriminate VCI-ND from VD (AUC = 0.98 [95%CI 0.95-1]) compared to ACE-Pe (AUC = 0.84 [95%CI 0.74-0.95]) and MMSE-Pe (0.92 [95%CI 0.86-0.99]). The IFS-Pe presented a higher sensitivity (S), specificity (Sp), and positive (+LR) and negative likelihood ratios (-LR) (S = 96.72%, Sp = 89.47%, +LR = 9.1 and -LR = 0.03) than ACE-Pe (S = 96.72%, Sp = 63.16%, +LR = 2.62 and -LR = 0.05) and MMSE-Pe (S = 90.16%, Sp = 78.95%, +LR = 4.28 and -LR = 0.12). In the multiple regression analysis, the IFS-Pe was not affected by age, sex or years of schooling.

CONCLUSION

The IFS-Pe has the best diagnostic accuracy for detecting VCI and discriminating between pre-dementia (VCI-ND) and dementia (VD) stages.

Association between Apoϵ4 allele and cardiometabolic and social risk factors with cognitive impairment in elderly population from Bogota

Being an ϵ4 carrier in the Apoϵ gene has been suggested as a modifying factor for the interaction between cardio-metabolic, social risk factors, and the development of cognitive impairment.

Validation of the Spanish-language version of the Montreal Cognitive Assessment as a screening test for cognitive impairment in multiple sclerosis

BACKGROUND

The neuropsychological batteries traditionally used for the assessment of cognitive impairment (CI) in patients with multiple sclerosis are complex tests requiring a long time to administer. Simpler tests are needed to detect cognitive impairment in daily clinical practice.

OBJECTIVE

We aimed to evaluate the diagnostic validity and reliability of the Montreal Cognitive Assessment (MoCA) test as a screening tool for CI in patients with multiple sclerosis, as compared against the Brief Neuropsychological Battery.

MATERIAL AND METHODS

We recruited 52 patients with multiple sclerosis (61.5% women; mean age [standard deviation]: 41.7 [11.5] years). We analysed the reliability (internal consistency, interobserver reliability, and test-retest reliability), construct validity (factor analysis, Pearson correlation coefficient, and coefficient of determination), and criterion validity (ROC curve, sensitivity, specificity, total agreement, positive and negative predictive values, positive and negative likelihood ratios, and Fagan nomogram) of the MoCA test in this population.

RESULTS

The prevalence of CI was 21.2% according to findings from the Brief Neuropsychological Battery, and 25% according to the MoCA test. The MoCA test showed good internal consistency (Cronbach alpha, 0.822) and interobserver and test-retest reliability (intraclass correlation coefficient 0.80 and 0.96, respectively). The correlation coefficient between total Brief Neuropsychological Battery and MoCA test scores was 0.82. The optimal cut-off point on the ROC curve was 25-26, yielding 91% sensitivity and 93% specificity.

CONCLUSION

The MoCA test is a valid and reliable tool for screening for CI in patients with multiple sclerosis.

Cognitive Assessment Tools Recommended in Geriatric Oncology Guidelines: A Rapid Review

Cognitive assessment is a cornerstone of geriatric care. Cognitive impairment has the potential to significantly impact multiple phases of a person's cancer care experience. Accurately identifying this vulnerability is a challenge for many cancer care clinicians, thus the use of validated cognitive assessment tools are recommended. As international cancer guidelines for older adults recommend Geriatric Assessment (GA) which includes an evaluation of cognition, clinicians need to be familiar with the overall interpretation of the commonly used cognitive assessment tools. This rapid review investigated the cognitive assessment tools that were most frequently recommended by Geriatric Oncology guidelines: Blessed Orientation-Memory-Concentration test (BOMC), Clock Drawing Test (CDT), Mini-Cog, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Short Portable Mental Status Questionnaire (SPMSQ). A detailed appraisal of the strengths and limitations of each tool was conducted, with a focus on practical aspects of implementing cognitive assessment tools into real-world clinical settings. Finally, recommendations on choosing an assessment tool and the additional considerations beyond screening are discussed.

Decreased Plasma Level of Lipoprotein Lipase Predicted Verbal Disfluency in Chinese Type 2 Diabetes Mellitus Patients with Early Cognitive Deficits

BACKGROUND

Lipoprotein Lipase (LPL) is the rate-limiting enzyme catalyzing the hydrolysis of triglycerides and contributes to the amyloid-β formation, which shows promise as a pathological factor of cognitive decline in Type 2 Diabetes Mellitus (T2DM). This study aimed to investigate the pathogenetic roles of LPL and rs328 polymorphism in Mild Cognitive Impairment (MCI) in patients with T2DM.

METHODS

Chinese patients with T2DM were recruited and divided into two groups based on the Montreal Cognitive Assessment score. Demographic data were collected, LPL was measured and neuropsychological test results were examined.

RESULTS

Seventy-nine patients with diabetes and MCI had significantly decreased plasma LPL levels (p = 0.007) when compared with health-cognition controls (n = 91). Correlation analysis revealed that LPL was positively correlated with clock drawing test (r = 0.158, p = 0.043) and logical memory test (r = 0.162, p = 0.037), while lipoprotein a (r = -0.214, p = 0.006) was inversely associated with LPL. Logistic regression analysis further demonstrated that LPL concentration was an independent factor for diabetic MCI (p = 0.036). No significant differences were observed in the distributions of rs328 variants between patients with MCI and the controls. Moreover, no remarkable association was found among plasma LPL levels, cognitive performances, and lipid levels between the genotypic subgroups. The trail making test A was increased in the GC group when compared with the CC genotype in the control group.

CONCLUSION

Decreased plasma level of LPL could probably predict early cognitive deficits, especially verbal disfluency.

Subjective Cognitive and Communicative Complaints and Health-Related Quality of Life in Parkinson's Disease with and without Mild Cognitive Impairment

INTRODUCTION

Mild Cognitive Impairment (MCI) is common in Parkinson's Disease (PD). Few studies have compared the Health-Related Quality of Life (HRQoL) in patients with and without MCI due to PD (PD-MCI), and its correlation to patients' subjective cognitive and communicative difficulties has not been explored.

OBJECTIVE

We aimed to compare HRQoL in PD-MCI and PD without MCI (PD-nMCI), and explore its possible relationship to subjective cognitive and communicative complaints.

METHODS

We included 29 PD-nMCI and 11 PD-MCI patients. The HRQoL was assessed with the Parkinson's Disease Questionnaire-39 (PDQ-39): its Cognition dimension was used as a measure of subjective cognitive complaints, its Communication dimension for subjective communicative complaints, and the summary index (PDQ-39 SI) as an indicator of HRQoL. Non-parametric partial correlations between the Cognition and Communication dimensions, and the adjusted PDQ-39 SI were conducted.

RESULTS

PD-MCI patients had greater subjective cognitive and communicative complaints and worse HRQoL than PD-nMCI patients. In the PD-MCI group, both subjective cognitive and communicative complaints exhibited significant direct correlations with the adjusted HRQoL scores.

CONCLUSIONS

HRQoL seems to be affected in PD-MCI, and it might be influenced by greater subjective cognitive and communicative complaints. Including patient-reported outcome measures of HRQoL, and providing cognitive and speech rehabilitation, as well as psychotherapeutic strategies to face these deficits can enhance the patient-centred approach in PD.

Diagnostic accuracy of the UDS 3.0 neuropsychological battery in a cohort with Alzheimer's disease in Colombia

BACKGROUND

Alzheimer's disease (AD) is a neurodegenerative disease that causes a gradual loss of cognitive functions and limits daily activities performance. Early diagnosis of AD is essential to start timely treatment. This study aimed to validate the Uniform Data Set neuropsychological battery version 3.0 (UDS 3.0) in a Colombian cohort.

METHODS

This study is a cross-sectional type, consecutive, incidental, with 143 persons, divided into two groups: 48 diagnosed AD cases and 95 healthy controls, between the ages of 50 and 80+, and between 1 and 19+ years of education.

RESULTS

The results indicate differences between the control group and the AD group in most battery tests. A significant correlation was found between the Montreal Cognitive Assessment (MoCA), Multilingual Naming Test (MINT), Craft Story, Benson Figure Test, P-word and F-word Phonemic Fluency Test, and their respective reference tests. Cutoff points were found based on the Youden index for each sub-test. The results indicate that all sub-tests are above the reference line of the ROC curve.

CONCLUSION

The use of the UDS 3.0 in Colombia would help improving clinical diagnostic routes because of its high accuracy and high correlation with tests that measure general impairment; it has good sensitivity and specificity, and it can be a useful tool for AD.

El Sistema de Salud Colombiano y el reconocimiento de la enfermedad de Alzheimer

La enfermedad de Alzheimer (EA) es la más común de las demencias; es un problema de salud pública en el Mundo, pero en Colombia no hace parte de las prioridades del Estado. El presente ensayo aborda cómo el sistema de salud colombiano reconoce, identifica y provee servicios a los pacientes con EA, desde una óptica de la Justicia Social. En primera medida se evalúa la información generada por la academia, su correlato con la normativa vigente y su articulación. Se explora la lógica utilitarista del sistema de salud colombiano y el incentivo a la maximización de ganancias de los aseguradores y cómo esto ha llevado a los pacientes a exigir la restitución de derechos a través de la acción de tutela. Se explora el sistema de codificación y diagnostico usado para la generación de información y como esta es imprecisa en los canales de información consolidada. Por otra parte, se valora como el rol de la familia se hace parte fundamental del proceso, y cómo esta termina siendo víctima del mismo.  Finalmente, se plantea reflexiones de cómo pueden abordarse las dificultades identificadas desde una perspectiva de la Justicia Social.

The Utility of Cognitive Screeners in the Detection of Dementia Spectrum Disorders in Spanish-Speaking Populations

Increasing rates of dementia spectrum disorders among Spanish-speaking geriatric populations necessitate the development of culturally appropriate cognitive screening tests that can identify neurodegenerative disorders in their earliest stages when emerging disease-modifying treatments are most likely to be effective. This scoping review identified 26 brief Spanish language cognitive screening tools (<20 minutes) by searching academic databases using a combination of search terms. Results suggest that the Mini-Mental Status Examination and Montreal Cognitive Assessment appear to be less valid than other screeners. Instruments such as the 7-Minute Screen and Mini-Cog evidence higher classification rates of dementia, while Phototest detected mild cognitive impairment at higher rates more consistently than other screeners. Different sensitivity and specificity outcomes and cutoffs were observed when the same cognitive screener was evaluated in different countries. Results indicate that it is imperative to increase nation-specific validation and normative data for these instruments to best serve diverse populations.

Resting-state EEG alpha/theta ratio related to neuropsychological test performance in Parkinson's Disease

OBJECTIVE

To determine possible associations of hemispheric-regional alpha/theta ratio (α/θ) with neuropsychological test performance in Parkinson's Disease (PD) non-demented patients.

METHODS

36 PD were matched to 36 Healthy Controls (HC). The α/θ in eight hemispheric regions was computed from the relative power spectral density of the resting-state quantitative electroencephalogram (qEEG). Correlations between α/θ and performance in several neuropsychological tests were conducted, significant findings were included in a moderation analysis.

RESULTS

The α/θ in all regions was lower in PD than in HC, with larger effect sizes in the posterior regions. Right parietal, and right and left occipital α/θ had significant positive correlations with performance in Judgement of Line Orientation Test (JLOT) in PD. Adjusted moderation analysis indicated that right, but not left, occipital α/θ influenced the JLOT performance related to PD.

CONCLUSIONS

Reduction of the occipital α/θ, in particular on the right side, was associated with visuospatial performance impairment in PD.

SIGNIFICANCE

Visuospatial impairment in PD, which is highly correlated with the subsequent development of dementia, is reflected in α/θ in the right posterior regions. The right occipital α/θ may represent a useful qEEG marker for evaluating the presence of early signs of cognitive decline in PD and the subsequent risk of dementia.

Clinical value of the Montreal Cognitive Assessment (MoCA) in patients suspected of cognitive impairment in old age psychiatry. Using the MoCA for triaging to a memory clinic

Objectives: Diagnostic pathways are limited. A validated instrument that can triage patients when they are suspected of mild dementia (MD) is necessary to optimise referrals. Method: The MoCA is validated for identifying MD and mild cognitive impairment (MCI) in a cohort of patients suspected of cognitive impairment (CI) after initial assessment in old age psychiatry. The reference standard was the consensus-based diagnoses for MD and MCI, adhering to the international criteria and using suspected patients, but without CI as comparisons (NoCI). Results: The mean MoCA scores differ significantly between the groups: 24(SE: .59) in NoCI, 21(SE: .31) in MCI and 16,7(SE: .45) in MD (p < .05). The AUC of MD against non-demented (MCI + NoCI) was 0.83(95%CI: 0.78-0.88) resulting in 90% sensitivity, 65% specificity, 50%PPV and 94%NPV at a "best" cutoff of <21 according the Youden index and respectively 0.77(95%CI: 0.69-0.85), 56%, 73%, 90%, 28% for CI (MD + MCI) against NoCI at <21. Conclusion: 90% of individuals with a MoCA of <21 will have CI (MD + MCI), while 94% with a MoCA of ≥21 will not have dementia. The MoCA can reduce referrals substantially (50%) by selecting who don't need further work up in a memory clinic, even if they were suspected of CI after initial assessment.

Empatía y Teoría de la Mente: comparación entre deportistas y no deportistas

Objetivo. Comparar la dimensión de cognición social de la Teoría de la Mente (ToM, por sus siglas en inglés) y la empatía entre deportistas y no deportistas. Método. Se ejecutó un diseño transversal con muestreo intencional, en el que 46 deportistas (Medad = 18.2, DE = 4.5) y 48 no deportistas (Medad = 20.2, DE = 3.5) completaron la Tarea de Empatía por el Dolor y el Test de las Miradas. Resultados. No se hallaron diferencias en la ToM, t(92) = 1.21, p = 0.228, d = 0.25. El Anova factorial mixto 3x2 indicó que el comportamiento de empatía es homogéneo por las condiciones (neutral, accidental e intencional) y grupos (deportistas vs no deportistas), F(2, 92) = 0.127, p = 0.881, ηp2 = 0.001. Sin embargo, la comparación de medias mostró diferencias favorables para deportistas en la condición de estímulos neutrales (p < 0.05). Conclusión. No hay variabilidad de la ToM, ni en las condiciones de accidentalidad e intencionalidad en el aspecto empático; mientras que en estímulos neutrales, el promedio difiere favorablemente para los deportistas.

Montreal Cognitive Assessment as Screening Measure for Mild and Major Neurocognitive Disorder in a Chilean Population

Background

The Montreal Cognitive Assessment (MoCA) is a sensitive screening instrument for mild neurocognitive disorder (mild NCD). However, cut-off scores and accuracy indices should be established using representative samples of the population. In this context, the aim of this study was to update the normative values, and diagnostic efficiency statistics of the MoCA to detect mild NCD in the Chilean population.

Methods

This study included 226 participants from the north, center, and south of the country, classified into 3 groups: healthy elderly (HE; n = 113), mild NCD (n = 65), and major neurocognitive disorder (major NCD; n = 48).

Results

The optimal cut-off score to discriminate mild NCD from HE participants was 20 points with a sensitivity of 82.8% and a specificity of 84.1%. The observed balance between sensitivity and specificity shows a good test performance either to confirm or discard a diagnosis. The cut-off between mild NCD and major NCD from HE participants was 19 points with 85.6% of sensitivity and 90.3% of specificity.

Conclusion

Overall diagnostic accuracy can be considered as outstanding (AUC ≥0.904) when discriminating HE from both mild NCD and major NCD. These results showed that the MoCA is a suitable tool to identify mild NCD and major NCD.

The Psychometric Properties of the Montreal Cognitive Assessment (MoCA)

Abstract. The Montreal Cognitive Assessment (MoCA) is a test assessing global cognition in older adults which is often used by researchers and clinicians worldwide, although some of its psychometric properties have yet to be established. We focus on three fundamental aspects: the factorial structure of the MoCA, its general factor saturation, and the measurement invariance of the test. We administered the MoCA to a large sample of Japanese older adults clustered in three cohorts (69–71-year-olds, 79–81-year-olds, and 89–91-year-olds; N = 2,408). Our results show that the test has an overall stable hierarchical factorial structure with a general factor at its apex and satisfactory general-factor saturation. We also found measurement invariance across participants of different ages, educational levels, economic status, and sex. This comprehensive investigation thus supports the idea that the MoCA is a valid tool to assess global cognition in older adults of different socioeconomic status and age ranges.

Socioeconomic Disparities and Gender Inequalities in Dementia: a Community-Dwelling Population Study from a Middle-Income Country

The proportion of the world's older adults and of its dementia cases is increasing in low and middle-income countries. This is particularly true in Colombia. There, the number of individuals with dementia may increase five-fold by 2050. Yet research is lacking on dementia in such settings. This work estimates the prevalence of dementia in a community-dwelling population in Colombia. It also assesses how gender-based differences in cardiovascular conditions and socioeconomic disparities affect dementia. This work analyzes data on 2000 respondents at least 60 years of age in the Health, Well-Being, And Aging (SABE) study in Bogota. Respondents with dementia are those who have cognitive impairment and at least two limitations in instrumental activities of daily living. The SABE study finds 8.4% of respondents have dementia. Age, cardiovascular risks, and socioeconomic disparities contributed to higher odds of dementia. The contributors to dementia can differ for men and women. For example, socioeconomic disparities were a larger contributor to dementia for women than men. The findings support the cognitive reserve hypothesis on dementia. This holds that pre-existing cognitive processes and compensatory mechanisms influence dementia. Women in Latin America are more likely to suffer from socioeconomic disparities that limit their cognitive reserve. This research points to several policy implications that can help offset these disparities and reduce the prevalence of dementia.

Validation of the Russian Version of the MoCA Test as a Cognitive Screening Instrument in Cognitively Asymptomatic Older Individuals and Those With Mild Cognitive Impairment

Background: Cognitive impairment is a common condition in older people, and age-related cognitive symptoms may progress to Mild Cognitive Impairment and Dementia. Physical exercise and cognitive training may be useful in maintaining cognitive function, and those developing impaired cognitive function should be advised to plan for the future. The MoCA test is a useful cognitive screening instrument, but the Russian version of this test has not yet been validated. The aim of the present study was to validate the Russian version of the MoCA test.

Methods: The study population included 160 residents of Israel aged 65 years and older with Russian as their mother tongue, 80 of whom were cognitively asymptomatic (AC) and 80 with a clinical diagnosis of MCI. All participants underwent cognitive screening using the Russian version of the MoCA test (MoCA-Ru) as well as evaluation by means of a validated computerized cognitive assessment battery (Neurotrax).

Results: The mean age of the study population was 78 ± 6.6 years and 123 (76.9%) were women. The MoCA-Ru score was higher in the AC group than in those with MCI (24.3 ± 3.74 vs. 20.2 ± 3.07, P < 0.0001). At a cutoff value of ≥25, sensitivity was 0.99 and specificity 0.54, with area under the curve (AUC) of 0.81.

Conclusions: We found the Russian language version of the MoCA test to be a useful cognitive screening instrument for older people with mild cognitive impairment.

Systematic Review of the Diagnostic Validity of Brief Cognitive Screenings for Early Dementia Detection in Spanish-Speaking Adults in Latin America

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.

Differential Methylation Levels in CpGs of the BIN1 Gene in Individuals With Alzheimer Disease

INTRODUCTION

Late-onset Alzheimer disease (LOAD) is the most common dementia worldwide. APOE-[Latin Small Letter Open E]4 and BIN1 (Bridging Integrator 1) have been implicated in the pathogenesis of this disease, but, although DNA methylation of dinucleotide CpGs in the BIN1 gene influences alterations, it has not been studied in Hispanics.

OBJECTIVE

The objective of this study was to evaluate the BIN1 3' intergenic region DNA methylation patterns in a Colombian sample of LOAD patients.

METHODS

A case-control study was conducted in 50 individuals with LOAD and 50 age-sex matched controls to determine associations of LOAD with DNA methylation. DNA was isolated from peripheral blood, and methylation levels of 8 CpGs were estimated by bisulfite conversion followed by Sanger sequencing with direct PCR analysis. Logistic regression models adjusted by age, sex, and APOE were used to calculate risk associations between methylation levels and LOAD.

RESULTS

Overall, participants with LOAD had significantly lower methylation levels on CpG26 (0.86±0.11 vs. 0.95±0.05; P>0.001), CpG44 (0.84±0.09 vs. 0.94±0.06; P=0.001), and CpG87 (0.64±0.12 vs. 0.82±0.10; P>0.001). Adjusted regression models showed that decreased methylation levels of these CpGs remained as risk factors for LOAD (P<0.05).

CONCLUSIONS

Hypomethylation of CpGs in BIN1 might play an important role in the expression of BIN1 and may be a biomarker for identifying individuals at high risk of developing LOAD.

Validation of the Argentine version of the Montreal Cognitive Assessment Test (MOCA): A screening tool for Mild Cognitive Impairment and Mild Dementia in Elderly

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.

Comparing the Montreal Cognitive Assessment and Rowland Universal Dementia Assessment Scale in a multicultural rehabilitation setting

In Australia it is recommended that all older people undergoing rehabilitation have a cognitive screen. We performed a longitudinal study comparing the correlation of two cognitive screening tools - the Rowland Universal Dementia Assessment Scale (RUDAS) and Montreal Cognitive Assessment (MoCA) with discharge outcomes in a geriatric inpatient setting. The RUDAS cut-off (<23/30) was associated with discharge to a nursing home (sensitivity 52%, specificity 70%). This was also noted with a MoCA cut-off <18/30 (sensitivity 57%, specificity 69%). Furthermore the association between the RUDAS and discharge destination was independent of its association with the Functional Independence Measure (r = 0.116; P = 0.275) and had a shorter administration time. Both RUDAS and MoCA scores could be used as predictors of discharge destination in a multicultural population.

Diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) for cognitive screening in old age psychiatry: Determining cutoff scores in clinical practice. Avoiding spectrum bias caused by healthy controls

OBJECTIVE/METHODS

The Montreal Cognitive Assessment (MoCA) is an increasingly used screening tool for cognitive impairment. While it has been validated in multiple settings and languages, most studies have used a biased case-control design including healthy controls as comparisons not representing a clinical setting. The purpose of the present cross-sectional study is to test the criterion validity of the MoCA for mild cognitive impairment (MCI) and mild dementia (MD) in an old age psychiatry cohort (n = 710). The reference standard consists of a multidisciplinary, consensus-based diagnosis in accordance with international criteria. As a secondary outcome, the use of healthy community older adults as additional comparisons allowed us to underscore the effects of case-control spectrum-bias.

RESULTS

The criterion validity of the MoCA for cognitive impairment (MCI + MD) in a case-control design, using healthy controls, was satisfactory (area under the curve [AUC] 0.93; specificity of 73% less than 26), but declined in the cross-sectional design using referred but not cognitive impaired as comparisons (AUC 0.77; specificity of 37% less than 26). In an old age psychiatry setting, the MoCA is valuable for confirming normal cognition (greater than or equal to 26, 95% sensitivity), excluding MD (greater than or equal to 21; negative predictive value [NPV] 98%) and excluding MCI (greater than or equal to 26;NPV 94%); but not for diagnosing MD (less than 21; positive predictive value [PPV] 31%) or MCI (less than 26; PPV 33%).

CONCLUSIONS

This study shows that validating the MoCA using healthy controls overestimates specificity. Taking clinical and demographic characteristics into account, the MoCA is a suitable screening tool-in an old age psychiatry setting-for distinguishing between those in need of further diagnostic investigations and those who are not but not for diagnosing cognitive impairment.

Validation of the Spanish-language version of the Montreal Cognitive Assessment as a screening test for cognitive impairment in multiple sclerosis

INTRODUCTION

The neuropsychological batteries traditionally used for the assessment of cognitive impairment (CI) in patients with multiple sclerosis are complex tests requiring a long time to administer. Simpler tests are needed to detect cognitive impairment in daily clinical practice.

OBJECTIVE

We aimed to evaluate the diagnostic validity and reliability of the Montreal Cognitive Assessment (MoCA) test as a screening tool for CI in patients with multiple sclerosis, as compared against the Brief Neuropsychological Battery.

MATERIAL AND METHODS

We recruited 52 patients with multiple sclerosis (61.5% women; mean age [standard deviation]: 41.7 [11.5] years). We analysed the reliability (internal consistency, interobserver reliability, and test-retest reliability), construct validity (factor analysis, Pearson correlation coefficient, and coefficient of determination), and criterion validity (ROC curve, sensitivity, specificity, total agreement, positive and negative predictive values, positive and negative likelihood ratios, and Fagan nomogram) of the MoCA test in this population.

RESULTS

The prevalence of CI was 21.2% according to findings from the Brief Neuropsychological Battery, and 25% according to the MoCA test. The MoCA test showed good internal consistency (Cronbach alpha, 0.822) and interobserver and test-retest reliability (intraclass correlation coefficient 0.80 and 0.96, respectively). The correlation coefficient between total Brief Neuropsychological Battery and MoCA test scores was 0.82. The optimal cut-off point on the ROC curve was 25-26, yielding 91% sensitivity and 93% specificity.

CONCLUSION

The MoCA test is a valid and reliable tool for screening for CI in patients with multiple sclerosis.

Prevalence, Incidence, Influence Factors, and Cognitive Characteristics of Amnestic Mild Cognitive Impairment Among Older Adult: A 1-Year Follow-Up Study in China

BACKGROUND

The risk and protective factors of amnestic mild cognitive impairment (aMCI) and its prevalence as well as incidence among old adult in Chinese community are still unclear.

METHODS

We carried out this 1-year longitudinal study to survey a random sample of 3,246 community elders aged 60 and over in China. All subjects were required to complete a comprehensive clinical assessment, physical examination and several neuropsychological tests at baseline and follow-up. What's more, we also collected their lifestyle information by a standardized questionnaire.

RESULTS

We found that the prevalence of aMCI was 17.1%, while the incidence of aMCI among Chinese old adult was 70.57 per 1,000 person-years. By using Cox regression analysis, we found that male sex (p = 0.001, OR = 0.489, 95%CI 0.319~0.751) and reading (p = 0.023, OR = 0.533, 95%CI 0.310~0.917) were protective factors for against aMCI. Old adult who developed aMCI in the future showed multiple cognitive impairments (such as immediate memory, associative learning memory and executive function) in their early stage, and Wechsler's Block Design (p = 0.027, OR = 0.969, 95%CL 0.943~0.996) could predict whether subjects would turn into aMCI in the future.

CONCLUSIONS

The present study suggests that aMCI is a considerable health problem in China. Executive dysfunction may be an indicator of future development of aMCI in the old normal adult.

Effect of Acute Physical Exercise on Executive Functions and Emotional Recognition: Analysis of Moderate to High Intensity in Young Adults

Physical exercise (PE) is associated with cognitive changes and brain function. However, it is required to clarify the effect of PE in different intensities, population groups conditions and the EF duration over different cognitive domains. Besides, no studies are known to have evaluated the contextual emotional recognition. Therefore, we studied the effect of acute PE of moderate intensities up to higher ones to the executive functions and the contextual emotional recognition. The participants were evaluated and classified in two experiments according to the IPAQ short form self-report and control measures. In both experiments, the groups were randomized, controlled, and exposed to one session of indoor cycling through intervals of high measure intensity (75–85% HRmax). Experiment 1 comprised young adults who were physically active (PA) and healthy, apparently (n = 54, M_age = 20.7, SD = 2.5). Experiment 2 involved young adults who were physically inactive (IP) and healthy, apparently (n = 36, M_age = 21.6, SD = 1.8). The duration was the only factor that varied: 45 min for PA and 30 min for PI. The executive functions were evaluated by the Stroop, TMT A/B, and verbal fluency, and the emotional recognition through a task that includes body and facial emotions in context, simultaneously. The analysis of factorial mixed ANOVA showed effects on the right choices of the indoor cycling groups in the PA, and the time response in PI. Also, other effects were observed in the controlled groups. TMT-A/B measures showed changes in the pre-test–post-test measures for both experiments. Verbal fluency performance favored the control group in both experiments. Meanwhile, the emotional recognition showed an effect of the PE in error-reduction and enhanced the scores in the right choices of body emotions. These results suggest that the EF with intensities favored cognitive processes such as inhibitory control and emotional recognition in context. We took into account the importance of high-complexity tasks design that avoid a ceiling effect. This study is the first on reporting a positive effect of PE over the emotional contextual recognition. Important clinical and educational implications are presented implications which highlight the modulatory role of EF with moderate to high intensities.

The Montreal Cognitive Assessment Test: A Useful Tool in Screening of Cognitive Impairment in Patients With Systemic Lupus Erythematosus

BACKGROUND/OBJECTIVE

Systemic lupus erythematosus (SLE) is an inflammatory, chronic, and multisystemic disease, which may be associated with a wide range of neuropsychiatric manifestations, including cognitive impairment. Cognitive evaluations based on screening tests might identify early SLE-related cognitive alterations. The aim of this study was to evaluate and to compare the efficacy of three screening tests (Montreal Cognitive Assessment [MoCA], Mini Mental State Examination [MMSE], Cognitive Symptom Inventory [CSI]) against the gold standard (neuropsychological battery), in order to identify the most efficient screening test for cognitive impairment in patients with SLE.

METHODS

This observational cross-sectional study recruited 44 patients, from August to December 2017, who were diagnosed with SLE according to the Systemic Lupus International Collaborating Clinics (SLICC) Criteria 2012, and had no medical or psychiatric comorbidities. The patients were evaluated using the MoCA, MMSE, CSI, and the gold standard. Spearman's correlation and area under the curve analysis were performed; p < 0.05 was considered significant.

RESULTS

The MoCA test showed the highest correspondence with the gold standard (AUC = 99.4%, p < 0.001), sensitivity (84%), and specificity (100%). This was followed by the MMSE (AUC = 92.6%, p < 0.001; sensitivity, 54.8%; specificity, 100%) and the CSI (AUC = 30.6%, p < 0.05; sensitivity, 54.8%; specificity, 30.76%).

CONCLUSION

The MoCA is a brief, easily applied screening test that is highly effective for detecting cognitive impairment in SLE patients. It could be useful in clinical follow-up as a tool for early detection of cognitive alterations.

Validation of the RUDAS in Patients With a Middle-Level Education in Lima, Peru

OBJECTIVES

To assess the psychometric properties of the Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) to discriminate controls from patients with mild cognitive impairment (MCI) and early dementia (ED) in a population with a mid-level education.

METHODS

A total of 133 patients from a memory clinic were administered the RUDAS-PE, INECO Frontal Screening, Addenbrooke's Cognitive Examination, and Mini-Mental State Examination. Results were compared against a neuropsychological evaluation (gold standard). Validity measures, internal consistency, and concurrent validity were calculated.

RESULTS

Cronbach's α was 0.68; Pearson's ratio was 0.79 (P < .01). The area under the receiver-operating characteristics curve of the RUDAS to discriminate between ED and MCI was 89.0% (optimal cutoff at <21), whereas between MCI and controls, it was 99.0% (optimal cutoff at <24).

CONCLUSIONS

The RUDAS-PE has acceptable psychometric properties performing well in its ability to discriminate controls from patients with MCI and ED.

Educational level and its Association with the domains of the Montreal Cognitive Assessment Test

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.

Normative Data for the Montreal Cognitive Assessment in Greek Older Adults With Subjective Cognitive Decline, Mild Cognitive Impairment and Dementia

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.

Networks Disrupted in Linguistic Variants of Frontotemporal Dementia

The non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) and semantic variant (svPPA) of frontotemporal dementia (FTD) are neurodegenerative diseases. Previous works have shown alterations of fractional anisotropy (FA) and mean diffusivity (MD) from diffusion tensor images (DTIs). This manuscript is aimed at using DTI images to build a global tractography and to identify atrophy patterns of white matter in each variant. Twenty patients with svPPA, 20 patients with nfvPPA, 26 patients with behavioral variant of FTD (bvFTD) and, 33 controls were included. An analysis based on the connectivity of structural networks showed changes in FA and MD in svPPA and nfvPPA with respect to bvFTD. Much damage in the internal networks of the left temporal lobe was found in svPPA patients; in contrast, patients with nfvPPA showed atrophy in networks from the basal ganglia to motor and premotor areas. Those findings support the dual stream model of speech and language.

Prevalence, Influence Factors and Cognitive Characteristics of Mild Cognitive Impairment in Type 2 Diabetes Mellitus

Background: Type 2 diabetes mellitus (T2DM) is considered as an independent risk factor for mild cognitive impairment (MCI). This study was performed to investigate the prevalence, influencing factors and cognitive characteristics of MCI in elderly patients with T2DM in China.

Methods: In the cross-sectional study, we performed cluster random sampling of 3,246 people age 60 years and older across the country. All participants were interviewed and screened for T2DM and MCI. A total of 341 subjects were diagnosed of MCI according to the criteria of Petersen, and a total of 256 subjects were diagnosed of T2DM by using the American Diabetes Association criteria Among the 256 T2DM people, 56 were also diagnosed with MCI. Logistic regression analyses were performed to evaluate risk and protective factor for MCI with T2DM. We also assessed their cognitive function by using the Mini-mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Digit span, Associative Learning Test (ALT), Visual Identification Test (VIT), Verbal Fluency (VF), Wechsler Adult Intelligence Scale (WAIS)-III Block Design, WAIS-III picture completion and Auditory Verbal Learning Test (AVLT).

Results: Among the 256 T2DM patients, 56 were diagnosed with MCI, and the prevalence of MCI in T2DM was 21.8%. Multivariate logistic regression analyses showed that depression (p = 0.002, OR = 6.220, 95% CI: 2.005–19.290) was a risk factor for MCI among T2DM patients, while education (p < 0.001, OR = 0.869, 95% CI: 0.805–0.983) was a protective one. All the scores of neuropsychological tests (except for MMSE) in T2DM patients with MCI were lower than those without MCI (p < 0.05), but there was no statistical difference (p > 0.05) in neuropsychological tests between T2DM-MCI group and No-T2DM-MCI group. Linear regression analysis showed that the drug treatment of diabetes was positively correlated (t = 2.263, p = 0.025) with the total score of auditory word tests.

Conclusions: The present study suggests a high prevalence of MCI among Chinese T2DM patients. Depression is a risk factor for MCI, while education is a protective one. T2DM patients with MCI often show comprehensive cognitive impairment, and the drug treatment of diabetes might help to improve cognitive function.