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Ning Y, Guo J, Pan D, Wu S, Song L, Wang C, Guo J, Gao X, Zhang J, Guo L, Gu Y. The Effects of Carotid Revascularization on 1-Year Cognitive Performance in Patients With Carotid Artery Stenosis. J Endovasc Ther 2024:15266028241252007. [PMID: 38733298 DOI: 10.1177/15266028241252007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
PURPOSE The impact of carotid revascularization on cognitive function for patients with severe carotid artery stenosis remains uncertain. This study is aimed to investigate the 1-year neurocognitive outcomes of patients who accept carotid revascularization and identify the risk factors associated with postoperative cognitive decline. METHODS From April 2019 to April 2021, patients with ≥70% carotid artery stenosis who were treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS) were recruited for this study. The Montreal Cognitive Assessment (MoCA) instrument was used to evaluate cognitive function preoperatively and at 3, 6, and 12 months postoperatively. Logistic regression analysis was built to identify potential risk factors for postoperative long-term cognitive decline. RESULTS A total of 89 patients who met the criteria were enrolled and completed 1-year follow-up. At 3, 6, and 12 months after carotid revascularization, the total MoCA score, attention, language fluency, and delayed recall score were significantly improved compared with the baseline scores (p<0.05). At 12 months, there was also a significant improvement in cube copying compared with baseline (p=0.034). Logistic regression analysis showed that the advancing age, left side, and symptomatic carotid artery stenosis were independent risk factors for cognitive deterioration at 12 months after surgery. CONCLUSIONS Overall, carotid revascularization has a beneficial effect on cognition function in patients with severe carotid artery stenosis, while advancing age, left side, and symptomatic carotid artery stenosis were significantly related to a decreased cognitive score after carotid revascularization. CLINICAL IMPACT This study focused on the changes in cognitive function within 1 year after carotid revascularization in patients with severe carotid stenosis. Of course, carotid revascularization can improve the cognition function in these patients. On the other hand, we found the advancing age, left side and symptomatic carotid artery stenosis were significantly associated with decreased cognitive scores at 1 year after carotid revascularization, which suggests that clinicians may need to be aware of patients with these characteristics.
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Affiliation(s)
- Yachan Ning
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
- Department of Intensive Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Julong Guo
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Dikang Pan
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Sensen Wu
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Lipo Song
- Department of Intensive Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chunmei Wang
- Department of Intensive Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianming Guo
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Xixiang Gao
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Jian Zhang
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Lianrui Guo
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
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Islam N, Hashem R, Gad M, Brown A, Levis B, Renoux C, Thombs BD, McInnes MD. Accuracy of the Montreal Cognitive Assessment tool for detecting mild cognitive impairment: A systematic review and meta-analysis. Alzheimers Dement 2023. [PMID: 36934438 DOI: 10.1002/alz.13040] [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: 09/06/2022] [Revised: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 03/20/2023]
Abstract
INTRODUCTION This systematic review evaluates the accuracy of the Montreal Cognitive Assessment (MoCA) for detecting mild cognitive impairment (MCI). METHODS We searched MEDLINE, PSYCInfo, EMBASE, and Cochrane CENTRAL (1995-2021) for studies comparing the MoCA with validated diagnostic criteria to identify MCI in general practice. Screening, data extraction, and risk of bias assessment were performed independently, in duplicate. Pooled sensitivity and specificity for MoCA cutoffs were estimated using bivariate meta-analysis. RESULTS Thirteen studies [2158 participants, 948(44%) with MCI] were included; 10 used Petersen criteria as the reference standard. Risk of bias of studies were high or unclear for all domains except reference standard. Sensitivity and specificity were 73.5%(95% confidence interval: 56.7-85.5) and 91.3%(84.6-95.3) at cutoff <23; 79.5%(67.1-88.0) and 83.7%(75.4-89.6) at cutoff <24; and 83.8%(75.6-89.6) and 70.8(62.1-78.3) at cutoff <25. DISCUSSION MoCA cutoffs <23 to <25 maximized the sum of sensitivity and specificity for detecting MCI. The risk of bias of included studies limits confidence in these findings.
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Affiliation(s)
- Nayaar Islam
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Rola Hashem
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Maryse Gad
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Aime Brown
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Brooke Levis
- Centre for Prognosis Research, School of Medicine, Keele University, Newcastle, UK.,Lady Davis Institute for Medical Research, Jewish General Hospital, and McGill University, Montreal, Quebec, Canada
| | - Christel Renoux
- Lady Davis Institute for Medical Research, Jewish General Hospital, and McGill University, Montreal, Quebec, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, and McGill University, Montreal, Quebec, Canada
| | - Matthew Df McInnes
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Department of Radiology, University of Ottawa, Ottawa, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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Combining Neuropsychological Assessment with Neuroimaging to Distinguish Early-Stage Alzheimer's Disease from Frontotemporal Lobar Degeneration in Non-Western Tonal Native Language-Speaking Individuals Living in Taiwan: A Case Series. J Clin Med 2023; 12:jcm12041322. [PMID: 36835856 PMCID: PMC9961761 DOI: 10.3390/jcm12041322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/25/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
Neuropsychological tests (NPTs), which are routinely used in clinical practice for assessment of dementia, are also considered to be essential for differential diagnosis of Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD), especially the behavioral variants of frontotemporal dementia (bvFTD) and primary progressive aphasia (PPA) at their initial clinical presentations. However, the heterogeneous features of these diseases, which have many overlapping signs, make differentiation between AD and FTLD highly challenging. Moreover, NPTs were primarily developed in Western countries and for native speakers of non-tonal languages. Hence, there is an ongoing dispute over the validity and reliability of these tests in culturally different and typologically diverse language populations. The purpose of this case series was to examine which of the NPTs adjusted for Taiwanese society may be used to distinguish these two diseases. Since AD and FTLD have different effects on individuals' brain, we combined NPTs with neuroimaging. We found that participants diagnosed with FTLD had lower scores in NPTs assessing language or social cognition than AD participants. PPA participants also had lower measures in the Free and Cued Selective Reminding Test than those diagnosed with bvFTD, while bvFTD participants showed poorer performances in the behavioral measures than PPA participants. In addition, the initial diagnosis was supported by the standard one-year clinical follow-up.
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Ning Y, Dardik A, Song L, Guo J, Wang C, Gu Y, Guo L, Ji X, Guo J, Zhang J. Carotid revascularization improves cognitive function in patients with asymptomatic carotid artery stenosis. Ann Vasc Surg 2022; 85:49-56. [PMID: 35568326 DOI: 10.1016/j.avsg.2022.04.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/15/2022] [Accepted: 04/24/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To investigate cognitive changes after carotid revascularization in elderly patients with asymptomatic carotid artery stenosis. We also compared cognitive outcomes of carotid endarterectomy with stenting in asymptomatic patients. METHODS From April 2019 to December 2019, patients with ≥70% asymptomatic carotid stenosis who were treated with CEA or CAS were recruited for this study. The Montreal cognitive assessment (MoCA) instrument was used to evaluate cognitive function preoperatively and postoperatively at 3, 6, and 12 months. The incidence of ipsilateral ischemic cerebrovascular events and restenosis were analyzed within 12 months. RESULTS In 50 patients treated with CEA or CAS, baseline cognitive function was not different between CEA and CAS groups (P > 0.05). There was no difference in the incidence of ipsilateral ischemic cerebrovascular events and restenosis within the first 12 months between the two groups. There was a significant improvement in the total MoCA score, scores of attention, and delayed recall at 3, 6 and 12 months after revascularization compared with scores at baseline (all p<0.001). At 12 months, scores of cube copying and clock drawing were significantly improved (P=0.014, P=0.020). The clock drawing score was improved at 12 months after CAS compared with CEA (P=0.040). CONCLUSIONS Carotid revascularization has a beneficial effect on cognition in asymptomatic patients within 12 months of the procedure. Compared with CEA, CAS show improved test scores of executive functioning by 1 year.
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Affiliation(s)
- Yachan Ning
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Alan Dardik
- Division of Vascular Surgery and Endovascular Therapy, Yale School of Medicine, New Haven, CT, USA
| | - Lipo Song
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Julong Guo
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Chunmei Wang
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Lianrui Guo
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianming Guo
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China.
| | - Jian Zhang
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China.
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Normative Data for Adult Mandarin-Speaking Populations: A Systematic Review of Performance-Based Neuropsychological Instruments. J Int Neuropsychol Soc 2022; 28:520-540. [PMID: 34372960 DOI: 10.1017/s1355617721000667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Normative data are essential for neuropsychological evaluations, but they are scarce for Mandarin-speaking populations, despite Mandarin being the language with the most native speakers. Several normative data studies have been reported in recent years for Mandarin speakers, who reside in different countries/regions (e.g., mainland China, Taiwan, and Singapore, etc.). This review aims to serve as a reference guide to appropriate norms when working with a Mandarin-speaking patient and to guide future endeavors in test validation and development in areas where studies to date fall short. METHOD We conducted a systematic review utilizing the PsycInfo, PubMed, and China Knowledge Resource Integrated databases as well as additional literature search through citations. We performed evaluations of the existing norms based on their test selection, cognitive domains covered, sample size, language, regions of participant recruitment, stratification by age/gender/education levels, and reporting of other psychometric properties. We focused on articles that included performance-based tests for adults but excluded those with purely clinical norms or from commercial publishers. RESULTS We reviewed 1155 articles found through literature search and identified 43 articles reporting normative data for this population that met our inclusion criteria. Sixty-five distinctive tests and 127 versions were covered. The results are presented within two detailed tables organized by articles and tests, respectively. CONCLUSIONS We discussed the strengths and limitations of these normative reports. Practitioners are recommended to utilize normative data that most closely approximate a test-taker's cultural and demographic backgrounds. Limitations of the current review are also discussed.
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Sex related differences in nonmotor symptoms of patients with idiopathic blepharospasm. Sci Rep 2021; 11:17856. [PMID: 34497334 PMCID: PMC8426378 DOI: 10.1038/s41598-021-97289-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/18/2021] [Indexed: 02/05/2023] Open
Abstract
Idiopathic blepharospasm shows a female predominance in prevalence, whether there are sex-related differences in distributions of nonmotor symptoms (NMSs) and predictors of quality of life are unknown. Four hundred and twenty-five patients with idiopathic blepharospasm were consecutively recruited, and underwent assessments including dystonia severity, mood disturbances, sleep disturbances, cognition, ocular symptoms, and quality of life. Frequencies and distributions of NMSs, and predictors of quality of life in female and male patients were investigated. NMSs existed in majority of male (94.0%) and female (95.8%) patients. The frequencies of depression, cognition dysfunction, and poor sleep quality were higher in female patients, while the frequency of excessive daytime sleepiness was higher in male patients. More female (79.5%) patients had multiple NMS domains affected than male (70.1%) patients (p = 0.040). Quality of life was associated with depression, anxiety and motor severity for female patients (adjusted R2 = 0.367, p < 0.001), while associated with depression, excessive daytime sleepiness and motor severity for male patients (adjusted R2 = 0.430, p < 0.001). The highly prevalent coexistence of multiple NMSs found in patients with blepharospasm support that blepharospasm is a network disorder. The sex-related differences in the pattern of NMSs and predictors of quality of life may aid the development of tailored management of blepharospasm.
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Liu J, Yang W, Luo H, Ma Y, Zhao H, Dan X. Brain-derived neurotrophic factor Val66Met polymorphism is associated with mild cognitive impairment in elderly patients with type 2 diabetes: a case-controlled study. Aging Clin Exp Res 2021; 33:1659-1666. [PMID: 32892314 DOI: 10.1007/s40520-020-01687-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/17/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is reported to be associated with cognitive dysfunction, an important comorbidity factor in patients with type 2 diabetes mellitus (T2DM), especially in elderly populations, however, the underlying pathophysiological mechanisms are unclear. AIM This study was performed to investigate the association between BDNF Val66Met polymorphism and mild cognitive impairment (MCI) in elderly patients with T2DM. METHODS In total, 105 MCI and 105 normal cognition controls of T2DM patients were enrolled; all of the patients underwent neuropsychological assessments. BDNF Val66Met polymorphism was genotyped via TaqMan SNP genotyping assay. Data from clinical and laboratory-based examinations were collected. RESULTS The frequency of the BDNF Met allele was significantly higher in the MCI group than in the controls. Multiple regression analysis indicated an association of the Met allele with MCI in patients with T2DM (OR = 2.54; 95% CI 1.33-4.84; p = 0.005). Stratified by educational level, the BDNF Met allele was significantly associated with MCI in elderly T2DM patients (OR = 3.29; 95% CI 1.26-8.57; p = 0.015) among the group of low educational levels (< 12 years); however, the association was insignificant among those with higher educational levels. DISCUSSION BDNF Met allele carriers showed a higher frequency of MCI than Val/Val homozygotes in elderly T2DM patients. However, this association was only significant in patients with low education levels. CONCLUSION BDNF Val66Met polymorphism may have a potential role in MCI in elderly T2DM patients, especially those with low educational levels.
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Affiliation(s)
- Jia Liu
- Department of Geriatric Medicine, Xuanwu Hospital, The Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Wei Yang
- Department of Geriatric Medicine, Xuanwu Hospital, The Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.
| | - Hongyu Luo
- Department of Geriatric Medicine, Xuanwu Hospital, The Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Yixin Ma
- Department of Geriatric Medicine, Xuanwu Hospital, The Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Huan Zhao
- Department of Geriatric Medicine, Xuanwu Hospital, The Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xiaojuan Dan
- Department of Neurology, Xuanwu Hospital, The Capital Medical University, Beijing, China
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Rashedi V, Foroughan M, Chehrehnegar N. Psychometric Properties of the Persian Montreal Cognitive Assessment in Mild Cognitive Impairment and Alzheimer Disease. Dement Geriatr Cogn Dis Extra 2021; 11:51-57. [PMID: 33976692 PMCID: PMC8077519 DOI: 10.1159/000514673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction The Montreal Cognitive Assessment (MoCA) is a cognitive screening test widely used in clinical practice and suited for the detection of Mild Cognitive Impairment (MCI). The aims were to evaluate the psychometric properties of the Persian MoCA as a screening test for mild cognitive dysfunction in Iranian older adults and to assess its accuracy as a screening test for MCI and mild Alzheimer disease (AD). Method One hundred twenty elderly with a mean age of 73.52 ± 7.46 years participated in this study. Twenty-one subjects had mild AD (MMSE score ≤21), 40 had MCI, and 59 were cognitively healthy controls. All the participants were administered the Mini-Mental State Examination (MMSE) to evaluate their general cognitive status. Also, a battery of comprehensive neuropsychological assessments was administered. Results The mean score on the Persian version of the MoCA and the MMSE were 19.32 and 25.62 for MCI and 13.71 and 22.14 for AD patients, respectively. Using an optimal cutoff score of 22 the MoCA test detected 86% of MCI subjects, whereas the MMSE with a cutoff score of 26 detected 72% of MCI subjects. In AD patients with a cutoff score of 20, the MoCA had a sensitivity of 94% whereas the MMSE detected 61%. The specificity of the MoCA was 70% and 90% for MCI and AD, respectively. Discussion The results of this study show that the Persian version of the MoCA is a reliable screening tool for detection of MCI and early stage AD. The MoCA is more sensitive than the MMSE in screening for cognitive impairment, proving it to be superior to MMSE in detecting MCI and mild AD.
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Affiliation(s)
- Vahid Rashedi
- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.,Iranian Research Center on Aging, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahshid Foroughan
- Iranian Research Center on Aging, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Negin Chehrehnegar
- Linnaeus Centre HEAD, Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
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Freud T, Vostrikov A, Dwolatzky T, Punchik B, Press Y. 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. Front Med (Lausanne) 2020; 7:447. [PMID: 32903556 PMCID: PMC7438442 DOI: 10.3389/fmed.2020.00447] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 07/06/2020] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Tamar Freud
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Anna Vostrikov
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Tzvi Dwolatzky
- Geriatric Unit, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Boris Punchik
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.,Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Yan Press
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.,Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Be'er Sheva, Israel.,Department of Geriatrics, Soroka Medical Center, Be'er Sheva, Israel
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Cognitive impairment and associated risk factors in older adult hemodialysis patients: a cross-sectional survey. Sci Rep 2020; 10:12542. [PMID: 32719428 PMCID: PMC7385128 DOI: 10.1038/s41598-020-69482-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 07/13/2020] [Indexed: 11/08/2022] Open
Abstract
The clinical epidemiological features of cognitive impairment in Chinese older adult patients undergoing hemodialysis are not clear, we aimed to identify the extent and patterns of cognitive impairment among those patients. We conducted a cross-sectional study of 613 hemodialysis patients aged 50 to 80 from 11 centers in Beijing. A neuropsychological battery of 11 tests covering domains of attention/processing speed, executive function, memory, language, and visuospatial function was applied, patients were classified as none, mild, or major cognitive impairment according to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders criteria for cognitive impairment. Compared with Chinese population norms, 37.2% of the participants had mild cognitive impairment, 43.7% had major cognitive impairment. Memory and language were the most severe impaired domains in the mild cognitive impairment group, attention and visuospatial function domains were the most serious impaired domains in the major cognitive impairment group. Concomitant impairment across multiple cognitive domains was common. Factors associated with major cognitive impairment included age, education level, history of stroke and hypertension, dialysis vintage, and single-pool Kt/V. There is a high frequency of cognitive impairment in Chinese older adult hemodialysis patients, with varying severity and concomitant impairment across multiple domains.
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11
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Xiyang YB, Liu R, Wang XY, Li S, Zhao Y, Lu BT, Xiao ZC, Zhang LF, Wang TH, Zhang J. COX5A Plays a Vital Role in Memory Impairment Associated With Brain Aging via the BDNF/ERK1/2 Signaling Pathway. Front Aging Neurosci 2020; 12:215. [PMID: 32754029 PMCID: PMC7365906 DOI: 10.3389/fnagi.2020.00215] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/18/2020] [Indexed: 12/22/2022] Open
Abstract
Cytochrome c oxidase subunit Va (COX5A) is involved in maintaining normal mitochondrial function. However, little is known on the role of COX5A in the development and progress of Alzheimer’s disease (Martinez-Losa et al., 2018). In this study, we established and characterized the genomic profiles of genes expressed in the hippocampus of Senescence-Accelerated Mouse-prone 8 (SAMP8) mice, and revealed differential expression of COX5A among 12-month-aged SAMP8 mice and 2-month-aged SAMP8 mice. Newly established transgenic mice with systemic COX5A overexpression (51% increase) resulted in the improvement of spatial recognition memory and hippocampal synaptic plasticity, recovery of hippocampal CA1 dendrites, and activation of the BDNF/ERK1/2 signaling pathway in vivo. Moreover, mice with both COX5A overexpression and BDNF knockdown showed a poor recovery in spatial recognition memory as well as a decrease in spine density and branching of dendrites in CA1, when compared to mice that only overexpressed COX5A. In vitro studies supported that COX5A affected neuronal growth via BDNF. In summary, this study was the first to show that COX5A in the hippocampus plays a vital role in aging-related cognitive deterioration via BDNF/ERK1/2 regulation, and suggested that COX5A may be a potential target for anti-senescence drugs.
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Affiliation(s)
- Yan-Bin Xiyang
- Institute of Neuroscience, Basic Medical College, Kunming Medical University, Kunming, China
| | - Ruan Liu
- Institute of Neuroscience, Basic Medical College, Kunming Medical University, Kunming, China
| | - Xu-Yang Wang
- Department of Neurosurgery, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China
| | - Shan Li
- Institute of Neuroscience, Basic Medical College, Kunming Medical University, Kunming, China
| | - Ya Zhao
- Institute of Neuroscience, Basic Medical College, Kunming Medical University, Kunming, China
| | - Bing-Tuan Lu
- Institute of Neuroscience, Basic Medical College, Kunming Medical University, Kunming, China
| | - Zhi-Cheng Xiao
- Monash Immunology and Stem Cell Laboratories (MISCL), Monash University, Clayton, VIC, Australia
| | - Lian-Feng Zhang
- Key Laboratory of Human Diseases Comparative Medicine, Ministry of Health, Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences (CAMS) and Comparative Medicine Centre, Peking Union Medical College (PUMC), Beijing, China
| | - Ting-Hua Wang
- Institute of Neuroscience, Basic Medical College, Kunming Medical University, Kunming, China
| | - Jie Zhang
- Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, Department of Medical Genetics, The First People's Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
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Pinto TCC, Machado L, Costa MLG, Santos MSP, Bulgacov TM, Rolim APP, Silva GA, Rodrigues-Júnior AL, Sougey EB, Ximenes RCC. Accuracy and Psychometric Properties of the Brazilian Version of the Montreal Cognitive Assessment as a Brief Screening Tool for Mild Cognitive Impairment and Alzheimer's Disease in the Initial Stages in the Elderly. Dement Geriatr Cogn Disord 2020; 47:366-374. [PMID: 31466064 DOI: 10.1159/000501308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the applicability and the psychometric properties of Montreal Cognitive Assessment Brazilian Version (MoCA-BR) in the elderly, as well as comparing its accuracy as a tracking test for mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) with the accuracy of Mini-Mental State Examination (MMSE). METHOD A transversal study was performed in 4 reference medical centers that care for the elderly. In all, 229 elderly participated in the study. To select the sample, the clinical history of the elderly, Pfeffer Functional Activities Questionnaire, and neuropsychological battery, apart from MMSE and MoCA-BR cognitive tests, were selected. The elderly were classified into control, MCI, and mild AD groups. RESULTS There was a significant statistical difference between the MoCA-BR scores of the elderly and the control group, MCI, and mild AD (p < 0.001). The Cronbach alpha for MoCA-BR was 0.77, indicating a good internal consistency. The test-retest reliability was elevated, with intraclass correlation coefficient (ICC) 0.91. The inter-examiner reliability was excellent (ICC 0.96). The area under curve of the receiver operating characteristics curve was 0.95, when evaluating the ability of MoCA-BR to discriminate between the elderly with cognitive impairment and cognitively healthy elderly. CONCLUSIONS The results of the study show that the Brazilian version of MoCA is a reliable cognitive tracking tool and is accurate for the detection of MCI and early stage AD, with good applicability on the elderly with education equal to or more than 4 years and adequate to discriminate between cognitively healthy elderly, and those with MCI and mild, proving to be superior to MMSE in tracking MCI and similar to this test when tracking mild AD.
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Affiliation(s)
- Tiago Coimbra Costa Pinto
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil, .,University Hospital Doctor Washington Antônio de Barros of Universidade Federal do Vale do São Francisco, Petrolina, Brazil, .,Faculdade de Medicina da Estácio de Juazeiro, Juazeiro, Brazil,
| | - Leonardo Machado
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Maria Lúcia G Costa
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil.,Post-Graduate Program in Gerontology at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Marilia S P Santos
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Tatiana M Bulgacov
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Ana Paula P Rolim
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Gabriela A Silva
- Post-Graduate Program in Nutrition Clinical at the Universidade de Pernambuco, Recife, Brazil
| | - Antônio L Rodrigues-Júnior
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil.,Busca Vida Clinical Gerontology, Recife, Brazil
| | - Everton B Sougey
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
| | - Rosana C C Ximenes
- Post-Graduate Program in Neuropsychiatry and Behavioural Science at the Universidade Federal de Pernambuco, Recife, Brazil
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Van Mieghem NM, van Gils L, Ahmad H, van Kesteren F, van der Werf HW, Brueren G, Storm M, Lenzen M, Daemen J, van den Heuvel AFM, Tonino P, Baan J, Koudstaal PJ, Schipper MEI, van der Lugt A, de Jaegere PPT. Filter-based cerebral embolic protection with transcatheter aortic valve implantation: the randomised MISTRAL-C trial. EUROINTERVENTION 2017; 12:499-507. [PMID: 27436602 DOI: 10.4244/eijv12i4a84] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Our aim was to determine whether use of the filter-based Sentinel™ Cerebral Protection System (CPS) during transcatheter aortic valve implantation (TAVI) can affect the early incidence of new brain lesions, as assessed by diffusion-weighted magnetic resonance imaging (DW-MRI), and neurocognitive performance. METHODS AND RESULTS From January 2013 to July 2015, 65 patients were randomised 1:1 to transfemoral TAVI with or without the Sentinel CPS. Patients underwent DW-MRI and extensive neurological examination, including neurocognitive testing one day before and five to seven days after TAVI. Follow-up DW-MRI and neurocognitive testing was completed in 57% and 80%, respectively. New brain lesions were found in 78% of patients with follow-up MRI. Patients with the Sentinel CPS had numerically fewer new lesions and a smaller total lesion volume (95 mm3 [IQR 10-257] vs. 197 mm3 [95-525]). Overall, 27% of Sentinel CPS patients and 13% of control patients had no new lesions. Ten or more new brain lesions were found only in the control cohort (in 20% vs. 0% in the Sentinel CPS cohort, p=0.03). Neurocognitive deterioration was present in 4% of patients with Sentinel CPS vs. 27% of patients without (p=0.017). The filters captured debris in all patients with Sentinel CPS protection. CONCLUSIONS Filter-based embolic protection captures debris en route to the brain in all patients undergoing TAVI. This study suggests that its use can lead to fewer and overall smaller new brain lesions, as assessed by MRI, and preservation of neurocognitive performance early after TAVI. CLINICAL TRIAL REGISTRATION Dutch trial register-ID: NTR4236. URL http://www.trialregister.nl/trialreg/admin/rctsearch.asp?Term=mistral.
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Ciobica A, Padurariu M, Ciobica A, Timofte D, Stefanescu C, Nasreddine Z. General issues encountered while diagnosing mild cognitive impairment in Romanian patients. Int J Geriatr Psychiatry 2017; 32:116-117. [PMID: 27925375 DOI: 10.1002/gps.4531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/22/2016] [Accepted: 05/27/2016] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Alin Ciobica
- Alexandru Ioan Cuza University, Iasi, Romania.,Center of Biomedical Research, Romanian Academy, Iasi, Romania
| | - Daniel Timofte
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
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Ozer S, Young J, Champ C, Burke M. A systematic review of the diagnostic test accuracy of brief cognitive tests to detect amnestic mild cognitive impairment. Int J Geriatr Psychiatry 2016; 31:1139-1150. [PMID: 26891238 DOI: 10.1002/gps.4444] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 12/21/2015] [Accepted: 01/20/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE People with amnestic mild cognitive impairment (aMCI) are at an increased risk of developing dementia. Efficient ways of identifying this 'at risk' population are required for larger-scale research studies. This systematic review describes the diagnostic accuracy of brief cognitive tests for detecting aMCI. METHODS Fifteen databases were searched from 1999 to July 2013 to identify papers for inclusion. Prospective studies assessing the diagnostic test accuracy of simple and brief cognitive tests for identifying people with aMCI against a reference standard (Petersen criteria) were included. Sensitivity, specificity, positive and negative predictive values and likelihood ratios were calculated. Predictive validity and test-retest reliability were also extracted, when provided. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. RESULTS Thirty-nine studies assessing 42 index tests were included. The Montreal Cognitive Assessment was the most comprehensively assessed test with evidence of high sensitivity for aMCI and good test-retest reliability, but low specificity was reported by the only study judged to be at low risk of bias. Other brief cognitive tests that include an assessment of word recall and multi-task tests that assess several cognitive domains were also found to exhibit high sensitivities and reasonable specificities. However, the confidence of the findings was affected by overall low quality of the contributing studies. CONCLUSION Several brief cognitive tests have shown promising diagnostic test accuracy results for identifying aMCI. However, concerns over the quality of the constituent studies and lack of evidence on the predictive validity of these tests mean that new validation studies are warranted. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Seline Ozer
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire, UK. .,School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
| | - John Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire, UK
| | - Claire Champ
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Melanie Burke
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Lim PA, McLean AM, Kilpatrick C, DeForge D, Iverson GL, Silverberg ND. Temporal stability and responsiveness of the Montreal Cognitive Assessment following acquired brain injury. Brain Inj 2015; 30:29-35. [DOI: 10.3109/02699052.2015.1079732] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Apolipoprotein ε4 is associated with lower brain volume in cognitively normal Chinese but not white older adults. PLoS One 2015; 10:e0118338. [PMID: 25738563 PMCID: PMC4349764 DOI: 10.1371/journal.pone.0118338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 01/14/2015] [Indexed: 12/12/2022] Open
Abstract
Studying ethnically diverse groups is important for furthering our understanding of biological mechanisms of disease that may vary across human populations. The ε4 allele of apolipoprotein E (APOE ε4) is a well-established risk factor for Alzheimer's disease (AD), and may confer anatomic and functional effects years before clinical signs of cognitive decline are observed. The allele frequency of APOE ε4 varies both across and within populations, and the size of the effect it confers for dementia risk may be affected by other factors. Our objective was to investigate the role APOE ε4 plays in moderating brain volume in cognitively normal Chinese older adults, compared to older white Americans. We hypothesized that carrying APOE ε4 would be associated with reduced brain volume and that the magnitude of this effect would be different between ethnic groups. We performed whole brain analysis of structural MRIs from Chinese living in America (n = 41) and Shanghai (n = 30) and compared them to white Americans (n = 71). We found a significant interaction effect of carrying APOE ε4 and being Chinese. The APOE ε4xChinese interaction was associated with lower volume in bilateral cuneus and left middle frontal gyrus (Puncorrected<0.001), with suggestive findings in right entorhinal cortex and left hippocampus (Puncorrected<0.01), all regions that are associated with neurodegeneration in AD. After correction for multiple testing, the left cuneus remained significantly associated with the interaction effect (PFWE = 0.05). Our study suggests there is a differential effect of APOE ε4 on brain volume in Chinese versus white cognitively normal elderly adults. This represents a novel finding that, if verified in larger studies, has implications for how biological, environmental and/or lifestyle factors may modify APOE ε4 effects on the brain in diverse populations.
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Lim ML, Gomez R, Koopman C. A review of amnestic MCI screening in east/southeast Asian older adults with low education: implications for early informant-clinician collaboration. Int J Geriatr Psychiatry 2015; 30:144-55. [PMID: 25384754 DOI: 10.1002/gps.4225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study is to review the recent literature on established cognitive tests and appropriate screening methods for amnestic mild cognitive impairment (MCI) in East/Southeast Asian older adults with a focus on those with low education. DESIGN Peer-reviewed empirical studies conducted in Asia (China, Hong Kong, Japan, Korea, Singapore, and Taiwan) were identified using databases in psychology and medicine with combinations of the search terms "mild cognitive impairment," "dementia," "screening," "literacy," "illiteracy," "low education," "informant," "family," "cognitive test," "memory complaints," "activities of daily living," and "clinical dementia rating," limiting articles to those published in English since 1 January 2002. Of note, is that the term "amnestic mild cognitive impairment" was not used for searching the articles because the related cognitive impairment were often categorized non-specifically as MCI, but participants included those with amnestic cognitive challenges. Hence, the general term "MCI" has been used often throughout the text. RESULTS Twelve studies that examined MCI screens were identified. An integrative approach using a combination of cognitive test and informant-based measure may be more sensitive or accurate than using any single screening method alone. CONCLUSION MCI misdiagnosis may be prevalent, highlighting the need for early collaborative work between informants and clinicians to improve the accuracy of this diagnosis in older Asian adults with low education. Findings were suggestive, although restricted in generalizability even within similar cultural groups or neighboring regions. Clinical application is limited, but some findings provide guidance for future research.
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Affiliation(s)
- Magdalene L Lim
- University of Rochester Medical Center, Rochester, New York, USA
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Fang R, Wang G, Huang Y, Zhuang JP, Tang HD, Wang Y, Deng YL, Xu W, Chen SD, Ren RJ. Validation of the Chinese version of Addenbrooke's cognitive examination-revised for screening mild Alzheimer's disease and mild cognitive impairment. Dement Geriatr Cogn Disord 2014; 37:223-31. [PMID: 24193223 DOI: 10.1159/000353541] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS As a suitable test to screen for Alzheimer's disease (AD) or mild cognitive impairment (MCI), studies to validate the Chinese version of Addenbrooke's Cognitive Examination-Revised (ACE-R) are rare. METHODS A total of 151 subjects were recruited and the neuropsychological assessments were employed. One-way analysis of variance and Bonferroni correction were used to compare scores of different psychometric scales. Intraclass correlation coefficient (ICC) and Cronbach's coefficient α were used to evaluate the reliability of psychometric scales. The validity of ACE-R to screen for mild AD and amnestic subtype of MCI (a-MCI) was assessed by receiver operating characteristic (ROC) curves. RESULTS The Chinese ACE-R had good reliability (inter-rater ICC = 0.994; test-retest ICC = 0.967) as well as reliable internal consistency (Cronbach's coefficient α = 0.859). With its cutoff of 67/68, the sensitivity (0.920) and specificity (0.857) were lower than for the Mini-Mental State Examination (MMSE) cutoff (sensitivity 1.000 and specificity 0.937) to screen for mild AD. However, the sensitivity of ACE-R to screen for a-MCI was superior to the MMSE with a cutoff of 85/86. The specificity of ACE-R was lower than that of the MMSE to screen for a-MCI. The area under the ROC curve of ACE-R was much larger than that of the MMSE (0.836 and 0.751) for detecting a-MCI rather than mild AD. CONCLUSION The Chinese ACE-R is a reliable assessment tool for cognitive impairment. It is more sensitive and accurate in screening for a-MCI rather than for AD compared to the MMSE.
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Affiliation(s)
- Rong Fang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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Yu K, Zhang S, Wang Q, Wang X, Qin Y, Wang J, Li C, Wu Y, Wang W, Lin H. Development of a computerized tool for the chinese version of the montreal cognitive assessment for screening mild cognitive impairment. Int Psychogeriatr 2014; 27:1-7. [PMID: 25362894 DOI: 10.1017/s1041610214002269] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Background: The Montreal Cognitive Assessment (MoCA) is used for screening mild cognitive impairment (MCI), and the Beijing version (MoCA-BJ) is widely used in China. We aimed to develop a computerized tool for MoCA-BJ (MoCA-CC). Methods: MoCA-CC used person-machine interaction instead of patient-to-physician interaction; other aspects such as the scoring system did not differ from the original test. MoCA-CC, MoCA-BJ and routine neuropsychological tests were administered to 181 elderly participants (MCI = 96, normal controls [NC] = 85). Results: A total of 176 (97.24%) participants were evaluated successfully by MoCA-CC. Cronbach's α for MoCA-CC was 0.72. The test-retest reliability (retesting after six weeks) was good (intraclass correlation coefficient = 0.82; P < 0.001). Significant differences were observed in total scores (t = 9.38, P < 0.001) and individual item scores (t = 2.18-8.62, P < 0.05) between the NC and MCI groups, except for the score for "Naming" (t = 0.24, P = 0.81). The MoCA-CC total scores were highly correlated with the MoCA-BJ total scores (r = 0.93, P < 0.001) in the MCI participants. The area under receiver-operator curve for the prediction of MCI was 0.97 (95% confidence interval = 0.95-1.00). At the optimal cut-off score of 25/26, MoCA-CC demonstrated 95.8% sensitivity and 87.1% specificity. Conclusion: The MoCA-CC tool developed here has several advantages over the paper-pencil method and is reliable for screening MCI in elderly Chinese individuals, especially in the primary clinical setting. It needs to be validated in other diverse and larger populations.
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Affiliation(s)
- Ke Yu
- Department of Neurology,Chengdu Military General Hospital,No270,Rongdu Avenue,Jinniu District,Chengdu 610083,Sichuan,China
| | - Shangang Zhang
- Department of Rehabilitation,Wuhan General Hospital of Guangzhou Military Command,Wuhan 430070,Hubei,China
| | - Qingsong Wang
- Department of Neurology,Chengdu Military General Hospital,No270,Rongdu Avenue,Jinniu District,Chengdu 610083,Sichuan,China
| | - Xiaofei Wang
- Computer Networking Center,Chengdu Military General Hospital,Chengdu 610083,Sichuan,China
| | - Yang Qin
- Department of Geriatrics,Chengdu Military General Hospital,Chengdu 610083,Sichuan,China
| | - Jian Wang
- Department of Neurology,Chengdu Military General Hospital,No270,Rongdu Avenue,Jinniu District,Chengdu 610083,Sichuan,China
| | - Congyang Li
- Department of Psychiatry,Chengdu Military General Hospital,Chengdu 610083,Sichuan,China
| | - Yuxian Wu
- Department of Neurology,Chengdu Military General Hospital,No270,Rongdu Avenue,Jinniu District,Chengdu 610083,Sichuan,China
| | - Weiwen Wang
- Department of Neurology,Chengdu Military General Hospital,No270,Rongdu Avenue,Jinniu District,Chengdu 610083,Sichuan,China
| | - Hang Lin
- Department of Neurology,Chengdu Military General Hospital,No270,Rongdu Avenue,Jinniu District,Chengdu 610083,Sichuan,China
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Lifshitz M, Dwolatzky T, Press Y. Validation of the Hebrew version of the MoCA test as a screening instrument for the early detection of mild cognitive impairment in elderly individuals. J Geriatr Psychiatry Neurol 2012; 25:155-61. [PMID: 23124009 DOI: 10.1177/0891988712457047] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The English version of the Montreal Cognitive Assessment (MoCA) test has been shown to be reliable in screening for mild cognitive impairment (MCI). However, the sensitivity and specificity of the Hebrew version of this instrument are yet to be determined. METHODS The study population consisted of 2 groups of older individuals, 74 patients diagnosed with MCI and 80 patients who were cognitively asymptomatic. Cognitive evaluation included the Mini-Mental State Examination (MMSE), Mindstreams computerized cognitive assessment, and the MoCA test. RESULTS The Hebrew version of MoCA distinguished between cognitively asymptomatic older individuals and those with MCI, with a sensitivity of 94.6% and a specificity of 76.3%, using a cutoff of 26/30 points. CONCLUSIONS The Hebrew version of the MoCA test is effective for identifying MCI in older patients. As a screening instrument for MCI, its higher sensitivity makes it preferable o the MMSE, which is used extensively in the clinical setting.
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Freitas S, Simões MR, Alves L, Duro D, Santana I. Montreal Cognitive Assessment (MoCA): validation study for frontotemporal dementia. J Geriatr Psychiatry Neurol 2012; 25:146-54. [PMID: 22859702 DOI: 10.1177/0891988712455235] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Montreal Cognitive Assessment (MoCA) is a brief instrument developed for the screening of milder forms of cognitive impairment, having surpassed the well-known limitations of the Mini-Mental State Examination (MMSE). The aim of the present study was to validate the MoCA as a cognitive screening test for behavioral-variant frontotemporal dementia (bv-FTD) by examining its psychometric properties and diagnostic accuracy. Three matched subgroups of participants were considered: bv-FTD (n = 50), Alzheimer disease (n = 50), and a control group of healthy adults (n = 50). Compared with the MMSE, the MoCA demonstrated consistently superior psychometric properties and discriminant capacity, providing comprehensive information about the patients' cognitive profiles. The diagnostic accuracy of MoCA for bv-FTD was extremely high (area under the curve AUC [MoCA] = 0.934, 95% confidence interval [CI] = 0.866-.974; AUC [MMSE] = 0.772, 95% CI = 0.677-0.850). With a cutoff below 17 points, the MoCA results for sensitivity, specificity, positive predictive value, negative predictive value, and classification accuracy were significantly superior to those of the MMSE. The MoCA is a sensitive and accurate instrument for screening the patients with bv-FTD and represents a better option than the MMSE.
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Affiliation(s)
- Sandra Freitas
- Faculty of Psychology and Educational Sciences, University of Coimbra, 3001-802 Coimbra, Portugal.
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Chen RH, Jiang XZ, Zhao XH, Qin YL, Gu Z, Gu PL, Zhou B, Zhu ZH, Xu LY, Zou YF. Risk factors of mild cognitive impairment in middle aged patients with type 2 diabetes: a cross-section study. ANNALES D'ENDOCRINOLOGIE 2012; 73:208-12. [PMID: 22704263 DOI: 10.1016/j.ando.2012.04.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 04/07/2012] [Indexed: 11/25/2022]
Abstract
UNLABELLED The aim of this study was to evaluate the risk factors of mild cognitive impairment (MCI) in middle-aged patients with type 2 diabetes (T2DM). METHODS Montreal Cognitive Assessment (MoCA) was applied as cognition assessment implement. One hundred and fifty-seven middle-aged type 2 diabetic patients were enrolled in this cross-section study (age 40~69, mean age 55 ± 7). There were 93 patients with MCI (MoCA score<26) in MCI group and 64 with normal cognitive function (MoCA score ≥ 26) in control group. Information of history of disease, family history, data of BMI, WHR, HbA1c, FINS, C-Peptide (C-P), SBP, DBP, blood lipid (TG, TC, LDL-C, HDL-C and carotid ultrasound (carotid IMT, carotid resistance index [RI]) was collected. RESULTS There were significant differences in the rate of patients with hypertension ([40.63 vs. 58.06%], P=0.026), duration of diabetes mellitus ([3.09 ± 4.04 y vs. 4.80 ± 4.94 y], P=0.024), C-P ([2.79 ± 1.09 ng/ml vs. 2.26 ± 1.00 ng/ml], P=0.008), Max C-IMT ([0.81 ± 0.15 mm vs. 0.91 ± 0.15 mm], P<0.001), Min C-RI (0.71 ± 0.06 vs. 0.68 ± 0.06, P<0.05), and no significant differences in the duration of hypertension and hyperlipidemia, BMI, WHR, HbA1c, SBP, DBP and blood lipid between control group and MCI group. MoCA scores were positively correlated with C-P (r=0.252, P=0.005), and negatively correlated with the history of hypertension (r=-0.244, P=0.002), duration of DM (r=-0.161, P=0.044), Max C-IMT (r=-0.253, P=0.005) and Min C-RI (r=-0.183, P=0.023). Multiple regression analysis showed that history of hypertension (Beta=-0.267, P=0.002), C-P (Beta=0.281, P=0.001) and Min C-RI (Beta=-0.221, P=0.011) were significantly independent determinants for the MoCA scores. CONCLUSIONS The longer duration of diabetes, history of hypertension, lower serum C-P levels, thickened C-IMT and higher C-RI could be risk factors of MCI in type 2 diabetic patients. This finding could have an important impact on the management of cognitive decline in diabetic patients.
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Affiliation(s)
- Rui-Hua Chen
- Department of Endocrinology, Pudong New Area People's Hospital, Chuan Huan Nan Road No. 490, Shanghai, China
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Zhao SJ, Guo CN, Wang MQ, Chen WJ, Zhao YB. Serum levels of inflammation factors and cognitive performance in amnestic mild cognitive impairment: a Chinese clinical study. Cytokine 2011; 57:221-5. [PMID: 22154514 DOI: 10.1016/j.cyto.2011.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 10/10/2011] [Accepted: 11/04/2011] [Indexed: 10/14/2022]
Abstract
Early diagnosis of Alzheimer's disease (AD) is important for initiating timely therapy to block or slow the rate of disease progression. This study was designed to investigate the potential of inflammation-related biomarkers in peripheral blood to accurately reflect AD onset and progression. Individuals (n=150) with amnestic mild cognitive impairment (aMCI) were divided into two subgroups (low- and high-risk) based on APOEε4 allele carrier status, and administered a battery of neuropsychological tests and tested for serum levels of IL-6, IL-10, TNF-α, and IFN-γ by using specific enzyme-linked immunosorbent assays. Results were compared with those from age-matched healthy controls (n=150). The levels of IL-6 were significantly higher in the aMCI group than in controls (P<0.01). When the aMCI group was stratified by APOEε4 status, significant differences were found between the low- and high-risk groups and controls in the levels of IL-6 and IFN-γ (P<0.01 and P=0.041, respectively). Moreover, the IL-6 level in the low-risk aMCI group was higher than that in the high-risk aMCI group (P=0.028). A weak but significant negative correlation was found between IL-6 and cognitive performance. Taken together, these findings indicate that IL-6, while not useful alone, has potential in combination with other biomarkers to support early diagnosis of aMCI due to its association with the progression of cognitive impairment.
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Affiliation(s)
- Sheng-Jie Zhao
- Department of Neurology, Shanghai Jiaotong University Affiliated First People's Hospital, Shanghai 200080, China
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