Detecting cognitive impairment at the early stages: The challenge of first line assessment

The utility of the Cognitive Reserve Index questionnaire in chronic traumatic brain injury

Objective: This study examined the relationship between cognitive reserve measured with the Cognitive Reserve Index questionnaire (CRIq) and cognitive and functional outcomes in a chronic traumatic brain injury (TBI) cohort compared to a non-TBI cohort. The utility of the CRIq was compared to common proxies of cognitive reserve (premorbid IQ and years of education) in TBI and non-TBI cohorts. Method: Participants were 105 individuals with moderate-severe TBI (10-33 years post injury) and 91 participants without TBI. Cognitive outcome was examined across four cognitive factors; verbal memory, visual ability and memory, executive attention, and episodic memory. Functional outcome was measured using the Glasgow Outcome Scale Extended. The CRIq total score and three subscale scores (education, work, leisure) were examined. Results: In the TBI cohort, associations were identified between two CRIq subscales and cognitive factors (CRIq education and verbal memory; CRIq work and executive attention). There were no associations between CRIq leisure and cognitive outcomes, or between CRIq and functional outcome. Model selection statistics suggested premorbid IQ and years of education provided a better fit than the CRIq for the relationship between cognitive reserve with two cognitive factors and functional outcome, with neither model providing an improved fit for the remaining two cognitive factors. This finding was broadly consistent in the non-TBI cohort. Conclusion: Cognitive reserve contributes significantly to long-term clinical outcomes following moderate-severe TBI. The relationship between cognitive reserve and long-term cognitive and functional outcomes following TBI is best characterised with traditional proxies of cognitive reserve, mainly premorbid IQ, rather than the CRIq.

A cross-sectional study exploring cognitive impairment in kidney failure

BACKGROUND

Little is known of the prevalence or associated factors of cognitive impairment in people with kidney failure. Assessment of cognition is necessary to inform comprehension of healthcare information, aptitude for dialysis modality and informed decision making.

OBJECTIVES

This study sought to determine the prevalence and factors associated with cognitive impairment in people with kidney failure.

DESIGN

Prospective cross-sectional.

PARTICIPANTS

Participants (n = 222) with chronic kidney disease grade 5 (CKD G5) including those not treated with dialysis, those undertaking dialysis independently or in a facility (CKD 5D), and those with a kidney transplant (CKD 5T).

MEASUREMENTS

Data were collected using the Montreal Cognitive Assessment tool, the Hospital Anxiety and Depression Scale (only the depression subscale), and a demographic questionnaire. Type of kidney disease and comorbidities were extracted from participants' hospital records.

RESULTS

Participants were 61 ± 13.63 years old; most were male (61.26%), and diabetes was the primary cause of kidney disease (34%). Prevalence of cognitive impairment was 34% although it was significantly higher for those in CKD G5 compared with other groups. A number of factors were found to be associated with cognitive impairment including, age, diabetes, hypertension, education, haemoglobin, albumin, parathyroid hormone, CKD G5, and length of time on treatment.

CONCLUSIONS

Cognitive impairment in kidney failure is common and it has significant implications for informed decision making and treatment choices. Routine assessment of cognitive function is an important part of clinical practice.

Impact of Cognitive Reserve and Premorbid IQ on Cognitive and Functional Status in Older Outpatients

The study aimed to investigate cross-sectionally the associations of cognitive reserve (CR) and premorbid IQ with cognitive and functional status in a cohort of older outpatients. Additionally, we evaluated the association of CR and premorbid IQ with the worsening of patients' cognitive status at one-year follow-up. We originally included 141 outpatients (mean age 80.31 years); a telephone-based cognitive follow-up was carried out after one year, including 104 subjects (mean age 80.26 years). CR (β = 0.418), premorbid IQ (β = 0.271) and handgrip strength (β = 0.287) were significantly associated with the MMSE score. The cognitive worsening at follow-up was associated with lower CR, lower MMSE score, reduced gait speed and frailty exhibited at baseline. Univariate linear regressions showed that CR was associated with handgrip strength (β = 0.346), gait speed (β = 0.185), autonomy in basic (β = 0.221) and instrumental (β = 0.272) daily activities, and frailty (β = -0.290); premorbid IQ was significantly associated with autonomy in instrumental daily activities (β = 0.211). These findings highlight the need for integrating CR and premorbid IQ with physical and motor measures when appraising predictors of cognitive decline in the elderly population. The study also newly extends the link of CR and premorbid IQ to the functional status in older adults.

The Turkish translation study of the Cognitive Reserve Index Questionnaire (CRIq)

BACKGROUND

Cognitive reserve (CR) is defined as the ability of individuals to use their brain in a flexible way to cope with brain pathologies and find alternative cognitive strategies.

AIM

The aim of this study was to adapt Cognitive Reserve Index Questionnaire (CRIq) for Turkish population.

METHODS

The CRIq was administered to 178 healthy participants from 18 to 80 years old.

RESULTS

The mean score of total CRI was found to be 97.7 indicating a medium level of CR. In line with the mean score, 68.6% of participants (n = 120) were found to have a medium level of CRI. The elderly group showed lowest total CRI as well as CRI-education, CRI-work, and CRI-leisure scores compared to young and middle-aged groups (p < .05, for all scores).

CONCLUSIONS

This study provided the first translated measure to assess CR in Turkish population.

Relationship between Cognitive Reserve and Cognitive Impairment in Autonomous and Institutionalized Older Adults

It is necessary to determine which variables help prevent the presence of decline or deterioration during the aging process as a function of advancing age. This research analyses the relations between cognitive reserve (CR) and cognitive impairment in 300 individuals. It also aims to confirm the influence of different variables (gender, age, level of studies and institutionalization) in CR and in deterioration in a population of older adults. The results indicate that people with higher CR present less deterioration. Regarding the role of the sociodemographic variables in the level of deterioration and CR, there are no differences between men and women, but there are differences in the variables age, level of studies and institutionalization, in such a way that the older age the greater the cognitive deterioration, the higher the level of studies, the more RC and less deterioration and it was found that the non-institutionalized people present less deterioration and greater CR. It is affirmed that two people with similar clinical characteristics may present different levels of pathology, being the CR the explanation of this fact. The results obtained allow us to affirm that the measurement of CR is considered an essential variable for the diagnosis of neurodegenerative diseases.

Music Therapy in the Treatment of Dementia: A Systematic Review and Meta-Analysis

Background: Dementia is a neurological condition characterized by deterioration in cognitive, behavioral, social, and emotional functions. Pharmacological interventions are available but have limited effect in treating many of the disease's features. Several studies have proposed therapy with music as a possible strategy to slow down cognitive decline and behavioral changes associated with aging in combination with the pharmacological therapy. Objective: We performed a systematic review and subsequent meta-analysis to check whether the application of music therapy in people living with dementia has an effect on cognitive function, quality of life, and/or depressive state. Methods: The databases used were Medline, PubMed Central, Embase, PsycINFO, and the Cochrane Library. The search was made up of all the literature until present. For the search, key terms, such as "music," "brain," "dementia," or "clinical trial," were used. Results: Finally, a total of eight studies were included. All the studies have an acceptable quality based on the score on the Physiotherapy Evidence Database (PEDro) and Critical Appraisal Skills Program (CASP) scales. After meta-analysis, it was shown that the intervention with music improves cognitive function in people living with dementia, as well as quality of life after the intervention and long-term depression. Nevertheless, no evidence was shown of improvement of quality of life in long-term and short-term depression. Conclusion: Based on our results, music could be a powerful treatment strategy. However, it is necessary to develop clinical trials aimed to design standardized protocols depending on the nature or stage of dementia so that they can be applied together with current cognitive-behavioral and pharmacological therapies.

Measuring Cognitive Reserve (CR) - A systematic review of measurement properties of CR questionnaires for the adult population

Aim

The aim of this systematic review was to summarize and critically appraise the quality of published literature on measurement properties of questionnaires assessing Cognitive Reserve (CR) in adults (>18 years).

Methods

We systematically searched for published studies on MEDLINE, PsycINFO, and Web of Science through August 2018. We evaluated the methodological quality of the included studies and the results on measurement properties based on a consensus-based standard checklist.

Results

The search strategy identified 991 publications, of which 37 were selected evaluating the measurement properties of six different questionnaires. Construct validity of the Cognitive Reserve Index questionnaire was most extensively evaluated, while evaluation of the remaining measurement properties of this questionnaire was scarce. Measurement properties of the Cognitive Reserve Questionnaire and the Cognitive Reserve Scale were assessed more completely. While the Lifetime of Experience Questionnaire seems to be the most thorough instrument, a finale recommendation for one specific questionnaire cannot be drawn, since about half of the measurement properties for each questionnaire were poorly or not assessed at all.

Conclusions

There is a need of high quality methodological studies assessing measurement properties of CR questionnaires, especially regarding content validity, structural validity, and responsiveness.

Trial registration

PROSPERO Registration number CRD42018107766.