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Ye R, Goodheart AE, Locascio JJ, Peterec E, Properzi M, Thibault EG, Chuba E, Johnson KA, Brickhouse MJ, Touroutoglou A, Growdon JH, Dickerson BC, Gomperts SN. Differential Vulnerability of Hippocampal Subfields to Amyloid and Tau Deposition in the Lewy Body Diseases. Neurology 2024; 102:e209460. [PMID: 38815233 PMCID: PMC11244748 DOI: 10.1212/wnl.0000000000209460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/11/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Alzheimer disease (AD) copathologies of β-amyloid and tau are common in the Lewy body diseases (LBD), dementia with Lewy bodies (DLB) and Parkinson disease (PD), and target distinct hippocampal subfields compared with Lewy pathology, including subiculum and CA1. We investigated the hypothesis that AD copathologies impact the pattern of hippocampal subregion volume loss and cognitive function in LBD. METHODS This was a cross-sectional and longitudinal, single-center, observational cohort study. Participants underwent neuropsychological testing and 3T-MRI with hippocampal segmentation using FreeSurferV7. PiB-PET and flortaucipir-PET imaging of comorbid β-amyloid (A) and tau (T) were acquired. The association of functional cognition, β-amyloid, and tau loads with hippocampal subregion volume was assessed. The contribution of subregion volumes to the relationship of AD-related deposits on functional cognition was examined with mediation analysis. The effects of AD-related deposits on the rate of subregion atrophy were evaluated with mixed-effects models. RESULTS Of 103 participants (mean age: 70.3 years; 37.3% female), 52 had LBD with impaired cognition (LBD-I), 26 had normal cognition (LBD-N), and 25 were A- healthy controls (HCs). Volumes of hippocampal subregions prone to AD copathologies, including subiculum (F = 6.9, p = 0.002), presubiculum (F = 7.3, p = 0.001), and parasubiculum (F = 5.9, p = 0.004), were reduced in LBD-I compared with LBD-N and HC. Volume was preserved in CA2/3, Lewy pathology susceptible subregions. In LBD-I, reduced CA1, subiculum, and presubiculum volumes were associated with greater functional cognitive impairment (all p < 0.05). Compared with HC, subiculum volume was reduced in A+T+ but not A-T- participants (F = 2.62, p = 0.043). Reduced subiculum volume mediated the effect of amyloid on functional cognition (0.12, 95% CI: 0.005 to 0.26, p = 0.040). In 26 longitudinally-evaluated participants, baseline tau deposition was associated with faster CA1 (p = 0.021) and subiculum (p = 0.002) atrophy. DISCUSSION In LBD, volume loss in hippocampal output subregions-particularly the subiculum-is associated with functional cognition and AD-related deposits. Tau deposition appears to accelerate subiculum and CA1 atrophy, whereas Aβ does not. Subiculum volume may have value as a biomarker of AD copathology-mediated neurodegeneration and disease progression.
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Affiliation(s)
- Rong Ye
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Anna E Goodheart
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Joseph J Locascio
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Erin Peterec
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Michael Properzi
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Emma G Thibault
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Erin Chuba
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Keith A Johnson
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Michael J Brickhouse
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Alexandra Touroutoglou
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - John H Growdon
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Bradford C Dickerson
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Stephen N Gomperts
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
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Mamo B, Feyissa AM, Mengesha T, Ayele BA, Mamushet Yifru Y. Association between cognitive impairment and antiseizure medication adherence among people with epilepsy in Addis Ababa, Ethiopia. Epilepsy Behav 2024; 152:109651. [PMID: 38295505 DOI: 10.1016/j.yebeh.2024.109651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 12/12/2023] [Accepted: 01/15/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Cognitive impairment is one of the most common and most troublesome comorbidities among people with epilepsy (PWE). Adherent use of antiseizure medications (ASM) can control seizure episodes in 70% of the cases. However, the relationship between adherent use of ASMs and cognitive impairment in epilepsy is complex. OBJECTIVE To assess the association between adherence to ASMs and cognitive status among PWE. METHODS We performed a cross-sectional observational study with prospective data collection from PWE using translated and content-validated Amharic versions of the Montreal cognitive assessment tool (MOCA-B) and a four-item Morisky Medication Adherence Scale (Morski-4). Ordinal logistic regression analysis was performed to evaluate the potential risk factors for cognitive impairment, including ASM adherence, physical exercise, and level of education. RESULTS A total of 214 individuals with epilepsy were included in this study; 53.7 % were female, and the mean age was 34 years ± 12. The mean age at seizure occurrence was 19 years ± 9. The most common epilepsy type among participants was generalized epilepsy (69 %). The prevalence of poor medication adherence to ASM was 54.2 %. The prevalence of mild cognitive impairment was 65.4 %, and 18.2 % had moderate cognitive impairment, particularly affecting verbal fluency (60.8 %) and memory (43.9 %). Cognitive impairment was significantly associated with poor ASM adherence (AOR = 12.0, 95 %CI, (1.53, 93.75), lower level of physical exercise (AOR = 16.30, 95 %CI (1.24, 214.99), and poor educational attainment with both no formal education (AOR = 0.04, 95 %CI (0.02, 0.14)) and primary or secondary level education (AOR = 0.32, 95 %CI, (0.15, 0.70). CONCLUSIONS There is a high rate of cognitive impairment and non-adherence to ASMs in PWE living in Addis Ababa, Ethiopia. Poor ASM adherence is a possible risk factor for cognitive impairment. PWE can benefit from interventions to improve ASM adherence, physical exercise, and better educational attainment.
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Affiliation(s)
- Blen Mamo
- Neurologist, Department of Neurology, College of Health Sciences, Addis Ababa University, Liberia Street, Addis Ababa, Ethiopia.
| | - Anteneh M Feyissa
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32256, USA.
| | - Tariku Mengesha
- Saint Peter Specialized Hospital, Liberia Street, Addis Ababa, Ethiopia.
| | - Biniyam A Ayele
- Neurologist, Department of Neurology, College of Health Sciences, Addis Ababa University, Liberia Street, Addis Ababa, Ethiopia; Global Brain Health Institute, UCSF, USA.
| | - Yared Mamushet Yifru
- Neurologist, Department of Neurology, College of Health Sciences, Addis Ababa University, Liberia Street, Addis Ababa, Ethiopia.
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Kim JS, Park H, Lee JH, Shin J, Cha B, Kwon KS, Shin YW, Kim Y, Kim Y, Bae JS, Lee JH, Choi SJ, Kim TJ, Ko SB, Park SH. Effect of altered gene expression in lipid metabolism on cognitive improvement in patients with Alzheimer's dementia following fecal microbiota transplantation: a preliminary study. Ther Adv Neurol Disord 2024; 17:17562864231218181. [PMID: 38250318 PMCID: PMC10799597 DOI: 10.1177/17562864231218181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/12/2023] [Indexed: 01/23/2024] Open
Abstract
Background The brain-gut axis has emerged as a potential target in neurodegenerative diseases, including dementia, as individuals with dementia exhibit distinct gut microbiota compositions. Fecal microbiota transplantation (FMT), the transfer of fecal solution from a healthy donor to a patient, has shown promise in restoring homeostasis and cognitive enhancement. Objective This study aimed to explore the effects of FMT on specific cognitive performance measures in Alzheimer's dementia (AD) patients and investigate the relationship between cognition and the gut microbiota by evaluating changes in gene expression following FMT. Methods Five AD patients underwent FMT, and their cognitive function [Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB)] was assessed before and after FMT. The patients' fecal samples were analyzed with 16S rRNA to compare the composition of their gut microbiota. We also assessed modifications in the serum mRNA expression of patients' genes related to lipid metabolism using serum RNA sequencing and quantitative real-time polymerase chain reaction. Results Significant improvements in cognitive function, as measured by the MMSE (pre- and post-FMT was 13.00 and 18.00) and MoCA were seen. The MoCA scores at 3 months post-FMT (21.0) were the highest (12.0). The CDR-SOB scores at pre- and post-FMT were 10.00 and 5.50, respectively. Analysis of the gut microbiome composition revealed changes via 16S rRNA sequencing with an increase in Bacteroidaceae and a decrease in Enterococcaceae. Gene expression analysis identified alterations in lipid metabolism-related genes after FMT. Conclusion These findings suggest a link between alterations in the gut microbiome, gene expression related to lipid metabolism, and cognitive function. The study highlights the importance of gut microbiota in cognitive function and provides insights into potential biomarkers for cognitive decline progression. FMT could complement existing therapies and show potential as a therapeutic intervention to mitigate cognitive decline in AD.
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Affiliation(s)
- Jun-Seob Kim
- Department of Nano-Bioengineering, Incheon National University, Incheon, Republic of Korea
| | - Hyelim Park
- Inha Research Institute for Aerospace Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Jung-Hwan Lee
- Division of Gastroenterology, Department of Hospital Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Jongbeom Shin
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Boram Cha
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Kye Sook Kwon
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Yong Woon Shin
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Yerim Kim
- Department of Neurology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - YeoJin Kim
- Department of Neurology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jong Seok Bae
- Department of Neurology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Ju-Hun Lee
- Department of Neurology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae Jung Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Bae Ko
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soo-Hyun Park
- Department of Neurology, Hallym University Kangdong Sacred Heart Hospital, Seoul 05355, Republic of Korea
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Garcia Castro J, Méndez Del Sol H, Rodríguez Fraga O, Hernández Barral M, Serrano López S, Frank García A, Martín Montes Á. CSF Aβ40 Levels Do Not Correlate with the Clinical Manifestations of Alzheimer's Disease. NEURODEGENER DIS 2023; 22:151-158. [PMID: 37231965 DOI: 10.1159/000530907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/11/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Cerebrospinal fluid (CSF) biomarker quantification provides physicians with a reliable diagnosis of Alzheimer's disease (AD). However, the relationship between their concentration and disease course has not been clearly elucidated. This work aimed to investigate the clinical and prognostic significance of Aβ40 CSF levels. METHODS A retrospective cohort of 76 patients diagnosed with AD using a decreased Aβ42/Aβ40 ratio was subclassified into hyposecretors (Aβ40 <7,755 pg/mL), normosecretors (Aβ40 7,755-16,715 pg/mL), and hypersecretors (Aβ40 >16,715 pg/mL). Potential differences in AD phenotype, Montreal Cognitive Assessment (MoCA) scores, and Global Deterioration Scale (GDS) stages were assessed. Correlation tests for biomarker concentrations were also performed. RESULTS Participants were classified as hyposecretors (n = 22, median Aβ40 5,870.500 pg/mL, interquartile range [IQR] 1,431), normosecretors (n = 47, median Aβ40 10,817 pg/mL, IQR 3,622), and hypersecretors (n = 7, 19,767 pg/mL, IQR 3,088). The distribution of positive phosphorylated Tau (p-Tau) varied significantly between subgroups and was more common in the normo- and hypersecretor categories (p = 0.003). Aβ40 and p-Tau concentrations correlated positively (ρ = 0.605, p < 0.001). No significant differences were found among subgroups regarding age, initial MoCA score, initial GDS stage, progression to the dementia stage, or changes in the MoCA score. CONCLUSION In this study, we found no significant differences in clinical symptoms or disease progression in AD patients according to their CSF Aβ40 concentration. Aβ40 was positively correlated with p-Tau and total Tau concentrations, supporting their potential interaction in AD pathophysiology.
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Affiliation(s)
- Jesús Garcia Castro
- Department of Neurology, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research - IdiPAZ, Madrid, Spain,
| | | | | | - María Hernández Barral
- Department of Neurology, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research - IdiPAZ, Madrid, Spain
| | - Soledad Serrano López
- Department of Neurology, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research - IdiPAZ, Madrid, Spain
| | - Ana Frank García
- Department of Neurology, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research - IdiPAZ, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - Ángel Martín Montes
- Department of Neurology, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research - IdiPAZ, Madrid, Spain
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Fasnacht JS, Wueest AS, Berres M, Thomann AE, Krumm S, Gutbrod K, Steiner LA, Goettel N, Monsch AU. Conversion between the Montreal Cognitive Assessment and the Mini-Mental Status Examination. J Am Geriatr Soc 2023; 71:869-879. [PMID: 36346002 DOI: 10.1111/jgs.18124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/20/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Early and accurate detection of cognitive changes using simple tools is essential for an appropriate referral to a more detailed neurocognitive assessment and for the implementation of therapeutic strategies. The Mini-Mental Status Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are two commonly used psychometric tests for cognitive screening. Both tests have different strengths and weaknesses. Preferences regarding test selection may therefore differ among clinicians. The aim of this retrospective observational cohort study was to define corresponding scores for the MMSE and the MoCA. METHODS We examined the relationship between the cognitive screening tests in 803 German-speaking Memory Clinic outpatients, encompassing a wide range of neurocognitive disorders. We produced a conversion table using the equipercentile equating method with log-linear smoothing. In addition, we conducted a systematic review of existing MMSE-MoCA conversions to create a table allowing for the conversion of MoCA scores into MMSE scores and vice versa using the weighted mean method. RESULTS The Memory Clinic sample showed that the prediction of MMSE to MoCA was overall less accurate compared to the conversion from MoCA to MMSE. The 19 studies included after thorough literature search showed that MoCA scores were consistently lower than MMSE scores. Eleven of 19 conversion studies had addressed the conversion of the MoCA to the MMSE, while two studies converted MMSE to MoCA scores. Another six studies applied bi-directional conversions. We provide an easy-to-use table covering the entire range of scores and taking into account all currently existing conversion formulas. CONCLUSION The comprehensive MMSE-MoCA conversion table enables a direct comparison of cognitive test scores at screening examinations and over the course of disease in patients with neurocognitive disorders.
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Affiliation(s)
- Jael S Fasnacht
- From the Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
| | - Alexandra S Wueest
- From the Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
- Department of Anesthesiology, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Manfred Berres
- Department of Mathematics and Technology, University of Applied Sciences Koblenz, Germany
| | - Alessandra E Thomann
- From the Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
- Department of Anesthesiology, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Sabine Krumm
- From the Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Klemens Gutbrod
- Neurozentrum Bern and Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Luzius A Steiner
- Department of Anesthesiology, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Nicolai Goettel
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Andreas U Monsch
- From the Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Faculty of Psychology, University of Basel, Basel, Switzerland
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