Can MoCA and MMSE Be Interchangeable Cognitive Screening Tools? A Systematic Review

Effects of sleep deprivation on brain atrophy in individuals with mild cognitive impairment and Alzheimer's disease

Dementia, a prevalent condition in the United States, affecting millions of individuals and their families, underscores the importance of healthy cognitive ageing, which involves maintaining cognitive function and mental wellness as individuals grow older, promoting overall well-being and quality of life. Our original research study investigates the correlation between lifestyle factors and brain atrophy in individuals with mild cognitive impairment (MCI) or Alzheimer's disease (AD), as well as healthy older adults. Conducted over six months in West Texas, the research involved 20 participants aged 62-87. Findings reveal that sleep deprivation in MCI subjects and AD patients correlate with posterior cingulate cortex, hippocampal atrophy and total brain volume, while both groups exhibit age-related hippocampal volume reduction. Notably, fruit/vegetable intake negatively correlates with certain brain regions' volume, emphasizing the importance of diet. Lack of exercise is associated with reduced brain volume and hippocampal atrophy, underlining the cognitive benefits of physical activity. The study underscores lifestyle's significant impact on cognitive health, advocating interventions to promote brain health and disease prevention, particularly in MCI/AD cases. While blood profile data showed no significant results regarding cognitive decline, the study underscores the importance of lifestyle modifications in preserving cognitive function.

The Effects of Multidisciplinary Intensive Rehabilitation on Cognitive and Executive Functions in Parkinson's Disease: A Clinical Database Analysis

Background/Objectives: This study is based on data collected from a medical health record review to assess whether multidisciplinary intensive rehabilitation treatment in Parkinson's disease (PD) patients can improve global cognitive functioning and executive functions. Methods: The data related to PD patients were extrapolated from a clinical database called "NeuroRehab". A total of 104 PD patients (51 males; 53 females) performed 6 weeks of multidisciplinary intensive rehabilitation treatment in clinical practice from January 2019 to May 2023. This training program was characterized by three daily sessions of 60 min of activities (muscle relaxation and stretching exercises, moderate physical aerobic exercise, and occupational therapy). The patients were classified and stratified according to disease severity (according to the Hoehn and Yahr scale), postural instability and gait difficulty (PIGD) or tremor-dominant (TD) subtypes, disease duration (DD), and the presence of dyskinesias. The effect of multidisciplinary intensive rehabilitation treatment on cognitive and executive functions was evaluated through the administration of cognitive tests, such as the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Frontal Assessment Battery (FAB). All the parameters were evaluated at the baseline (T0) and at the end of the rehabilitation program (T1). Results: The multidisciplinary intensive rehabilitation treatment significantly improved cognitive performance. The MMSE, MoCA, and FAB test scores after the rehabilitation program (T1) were significantly higher compared to the scores obtained at the baseline (T0). Moreover, further analyses on subgroups of the patients who scored below the cut-off in the MMSE showed that at least 50% of patients overcame the cut-off score. Interestingly, the same analyses performed for the MoCA and FAB revealed a higher rate of improvement in cognitive functions, with normal scores in both tests after 6 weeks of multidisciplinary intensive rehabilitation treatment. Conclusions: This study revealed the potential effects of a 6-week multidisciplinary rehabilitation program in improving cognitive status in a PD inpatient cohort.

Exploring functional and structural connectivity disruptions in spinocerebellar ataxia type 3: Insights from gradient analysis

AIMS

Spinocerebellar Ataxia Type 3 (SCA3) is a rare genetic ataxia that impacts the entire brain and is characterized as a neurodegenerative disorder affecting the neural network. This study explores how alterations in the functional hierarchy, connectivity, and structural changes within specific brain regions significantly contribute to the heterogeneity of symptom manifestations in patients with SCA3.

METHODS

We prospectively recruited 51 patients with SCA3 and 59 age-and sex-matched healthy controls. All participants underwent comprehensive multimodal neuroimaging and clinical assessments. In SCA3 patients, an innovative approach utilizing gradients in resting-state functional connectivity (FC) was employed to examine atypical patterns of hierarchical processing topology from sensorimotor to supramodal regions in the cerebellum and cerebrum. Coupling analyses of abnormal FC and structural connectivity among regions of interest (ROIs) in the brain were also performed to characterize connectivity alterations. Additionally, relationships between quantitative ROI values and clinical variables were explored.

RESULTS

Patients with SCA3 exhibited either compression or expansion within the primary sensorimotor-to-supramodal gradient through four distinct calculation methods, along with disruptions in FC and structural connectivity coupling. A comprehensive correlation was identified between the altered gradients and the clinical manifestations observed in patients. Notably, altered fractional anisotropy values were not significantly correlated with clinical variables.

CONCLUSION

Abnormal gradients and connectivity in the cerebellar and cerebral cortices in SCA3 patients may contribute to disrupted motor-to-supramodal functions. Moreover, these findings support the potential utility of FCG analysis as a biomarker for diagnosing SCA3 and assessing treatment efficacy.

Network meta-analysis of non-pharmacological interventions for cognitive impairment after an ischemic stroke

Objective

This study aims to evaluate the effectiveness of non-pharmacological interventions in improving cognitive function in patients with ischemic stroke through network meta-analysis.

Methods

We searched databases including the Cochrane Library, PubMed, EmBase, and Web of Science for randomized controlled trials (RCTs) on non-pharmacological treatments to improve cognitive impairment following ischemic stroke. The publication date was up to 15 March 2023. Due to the insufficiency of included studies, supplementary searches for high-quality Chinese literature were performed in databases such as CNKI, WanFang Data, and VIP Chinese Science Journals Database. Two reviewers independently went through the literature, extracted data, and assessed the risk of bias in the included studies using the risk of bias assessment tool recommended by the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. By utilizing R 4.2.3 RStudio software and the GeMTC package, a Bayesian network meta-analysis was conducted to assess the improvement in Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores under a variety of non-pharmacological interventions.

Results

A total of 22 RCTs involving 2,111 patients and 14 different non-pharmacological treatments were included. These interventions were transcranial direct current stimulation (tDCS), reminiscence therapy (RT), remote ischemic conditioning (RIC), physical fitness training (PFT), intensive patient care program (IPCP), moderate-intensity continuous training + high-intensity interval training (MICT + HIIT), medium intensity continuous training (MICT), grip training (GT), acupuncture, cognitive behavioral therapy (CBT), cognitive rehabilitation training (CRT), high pressure oxygen (HPO), moxibustion, and repetitive transcranial magnetic stimulation (rTMS). The results of the network meta-analysis indicated that rTMS had the highest likelihood of being the most effective intervention for improving MMSE and MoCA scores.

Conclusion

The evidence from this study suggests that rTMS holds promise for improving MMSE and MoCA scores in patients with cognitive impairment following ischemic stroke. However, further high-quality research is needed to confirm and validate this finding.

Guideline for the cognitive assessment and follow-up in the Guangdong-Hong Kong-Macao Greater Bay Area (2024 edition)

This practice guideline focuses on the cognitive assessment for mild cognitive impairment in the Guangdong-Hong Kong-Macao Greater Bay Area. To achieve the standardization and normalization of its clinical practice and generate individualized intervention, the National Core Cognitive Center of the Second Affiliated Hospital of Guangzhou Medical University, the Cognitive Disorders Branch of Chinese Geriatic Society, the Dementia Group of Neurology Branch of Guangdong Medical Association and specialists from Hong Kong and Macao developed guidelines based on China's actual conditions and efficiency, economic cost and accuracy. The article addresses the significance, background, and the process of the assessment and follow-up to realize the promotion and dissemination of cognitive assessment.

Neurocognitive disorder in Myotonic dystrophy type 1

Cognitive deficits and abnormal cognitive aging have been associated with Myotonic dystrophy type 1 (DM1), but the knowledge of the extent and progression of decline is limited. The aim of this study was to examine the prevalence of signs of neurocognitive disorder (mild cognitive impairment and dementia) in adult patients with DM1. A total of 128 patients with childhood, juvenile, adult, and late onset DM1 underwent a screening using the Montreal Cognitive Assessment (MoCA). Demographic and clinical information was collected. The results revealed that signs of neurocognitive disorder were relatively rare among the participants. However, 23.8 % of patients with late onset DM1 (aged over 60 years) scored below MoCA cut-off (=23), and this group also scored significantly worse compared to patients with adult onset. Age at examination were negatively correlated with MoCA scores, although it only explained a small portion of the variation in test results. Other demographic and clinical factors showed no association with MoCA scores. In conclusion, our findings indicate a low prevalence of signs of neurocognitive disorder in adult patients with DM1, suggesting that cognitive deficits rarely progress to severe disorders over time. However, the performance of patients with late onset DM1 suggests that this phenotype warrants further exploration in future studies, including longitudinal and larger sample analyses.

Individualized prediction of cognitive test scores from functional brain connectome in patients with first-episode late-life depression

BACKGROUND

In the realm of cognitive screening, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are widely utilized for detecting cognitive deficits in patients with late-life depression (LLD), However, the interindividual variability in neuroimaging biomarkers contributing to individual-specific symptom severity remains poorly understood. In this study, we used a connectome-based predictive model (CPM) approach on resting-state functional magnetic resonance imaging data from patients with LLD to establish individualized prediction models for the MoCA and the MMSE scores.

METHODS

We recruited 135 individuals diagnosed with first-episode LLD for this research. Participants underwent the MMSE and MoCA tests, along with resting-state functional magnetic resonance imaging scans. Functional connectivity matrices derived from these scans were utilized in CPM models to predict MMSE or MoCA scores. Predictive precision was assessed by correlating predicted and observed scores, with the significance of prediction performance evaluated through a permutation test.

RESULTS

The negative model of the CPM procedure demonstrated a significant capacity to predict MoCA scores (r = -0.309, p = 0.002). Similarly, the CPM procedure could predict MMSE scores (r = -0.236, p = 0.016). The predictive models for cognitive test scores in LLD primarily involved the visual network, somatomotor network, dorsal attention network, and ventral attention network.

CONCLUSIONS

Brain functional connectivity emerges as a promising predictor of personalized cognitive test scores in LLD, suggesting that functional connectomes are potential neurobiological markers for cognitive performance in patients with LLD.

Validity, feasibility, and effectiveness of a voice-recognition based digital cognitive screener for dementia and mild cognitive impairment in community-dwelling older Chinese adults: A large-scale implementation study

INTRODUCTION

We investigated the validity, feasibility, and effectiveness of a voice recognition-based digital cognitive screener (DCS), for detecting dementia and mild cognitive impairment (MCI) in a large-scale community of elderly participants.

METHODS

Eligible participants completed demographic, cognitive, functional assessments and the DCS. Neuropsychological tests were used to assess domain-specific and global cognition, while the diagnosis of MCI and dementia relied on the Clinical Dementia Rating Scale.

RESULTS

Among the 11,186 participants, the DCS showed high completion rates (97.5%) and a short administration time (5.9 min) across gender, age, and education groups. The DCS demonstrated areas under the receiver operating characteristics curve (AUCs) of 0.95 and 0.83 for dementia and MCI detection, respectively, among 328 participants in the validation phase. Furthermore, the DCS resulted in time savings of 16.2% to 36.0% compared to the Mini-Mental State Examination (MMSE) and Montral Cognitive Assessment (MoCA).

DISCUSSION

This study suggests that the DCS is an effective and efficient tool for dementia and MCI case-finding in large-scale cognitive screening.

HIGHLIGHTS

To our best knowledge, this is the first cognitive screening tool based on voice recognition and utilizing conversational AI that has been assessed in a large population of Chinese community-dwelling elderly. With the upgrading of a new multimodal understanding model, the DCS can accurately assess participants' responses, including different Chinese dialects, and provide automatic scores. The DCS not only exhibited good discriminant ability in detecting dementia and MCI cases, it also demonstrated a high completion rate and efficient administration regardless of gender, age, and education differences. The DCS is economically efficient, scalable, and had a better screening efficacy compared to the MMSE or MoCA, for wider implementation.

Association between cognitive impairment and antiseizure medication adherence among people with epilepsy in Addis Ababa, Ethiopia

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.

Facial emotion recognition in individuals with mild cognitive impairment: An exploratory study

Understanding facial emotions is fundamental to interact in social environments and modify behavior accordingly. Neurodegenerative processes can progressively transform affective responses and affect social competence. This exploratory study examined the neurocognitive correlates of face recognition, in individuals with two mild cognitive impairment (MCI) etiologies (prodromal to dementia - MCI, or consequent to Parkinson's disease - PD-MCI). Performance on the identification and memorization of neutral and emotional facial expressions was assessed in 31 individuals with MCI, 26 with PD-MCI, and 30 healthy controls (HC). Individuals with MCI exhibited selective impairment in recognizing faces expressing fear, along with difficulties in remembering both neutral and emotional faces. Conversely, individuals with PD-MCI showed no differences compared with the HC in either emotion recognition or memory. In MCI, no significant association emerged between the memory for facial expressions and cognitive difficulties. In PD-MCI, regression analyses showed significant associations with higher-level cognitive functions in the emotional memory task, suggesting the presence of compensatory mechanisms. In a subset of participants, voxel-based morphometry revealed that the performance on emotional tasks correlated with regional changes in gray matter volume. The performance in the matching of negative expressions was predicted by volumetric changes in brain areas engaged in face and emotional processing, in particular increased volume in thalamic nuclei and atrophy in the right parietal cortex. Future studies should leverage on neuroimaging data to determine whether differences in emotional recognition are mediated by pathology-specific atrophic patterns.

Does social isolation mediate the association between hearing loss and cognition in adults? A systematic review and meta-analysis of longitudinal studies

Background

There has been extensive research on the relationship between hearing and cognitive impairment in older adults but little examination of the role of mediating factors. Social isolation is a potential mediator, occurring because of hearing loss, and contributing to accelerated cognitive decline. Previous systematic reviews on this topic area have not considered the temporal nature of hearing loss and cognitive impairment exclusively or examined potential mediators within a longitudinal study design.

Methods

A systematic review was conducted. Electronic searches were performed in Web of Science, PubMed (Medline), Scopus, EMBASE, PsychInfo, and ProQuest (PsychArticles and ProQuest Dissertation and Theses) based on a search string of keywords relating to hearing loss, social isolation, and cognitive impairment/dementia in June 2023. Papers were critically appraised using the CASP checklists for cohort studies. Risk of bias in the selected studies was assessed using the Item Bank for Assessment of Risk of Bias and Precision for Observational Studies of Interventions or Exposures.

Results

Eleven of the 15 included studies provide evidence of a dose-dependent association between hearing threshold (40 dB HL or greater) and later cognitive impairment or incident dementia. Only one study included social isolation as a mediator, which was found to not be a significant contributing factor. The meta-analysis of 5 studies pooled hazard ratio for cognitive impairment due to hearing loss is 1.11 (95% CI: 1.06 to 1.15, p < 0.001). The pooled hazard ratio for incident dementia due to hearing loss was HR 1.21 (95% CI: 1.11 to 1.31, p = 0.002).

Conclusion

The analysis of included studies indicate that hearing threshold level affects later cognitive status or dementia diagnosis. There is not enough evidence to determine the role of social isolation as a mediator. Future epidemiology studies need to measure different elements of social isolation and ensure that hearing and cognition are measured at multiple time points.

Time-effectiveness of low-frequency rTMS for epilepsy and improvement in cognitive function in patients: A systematic review and meta-analysis

OBJECTIVE

Performed a systematic review and meta-analysis to evaluate the effect of low-frequency repeated transcranial magnetic stimulation (rTMS) in treating epilepsy.

METHODS

An electronic search of PubMed, EMBASE, Weipu, and Wanfang databases was conducted to select randomized controlled clinical trials (RCTs) of low-frequency rTMS for epilepsy and related diseases. Outcome measures mainly included seizure frequency, response rate, and cognitive assessment score. Odds ratio (OR), standardized mean difference (SMD), and 95% confidence interval (CI) were calculated to evaluate these effects. The heterogeneity test was measured using chi-square and I2. Possible effects of covariates were investigated using meta-regressions. The sensitivity analysis and publication bias assessment also was performed.

RESULTS

The retrieval time was from the establishment to February 2023. 18 RCTs were identified, including 1224 patients. The results showed that rTMS treatment reduced the frequency of the seizure in antiepileptics drugs (AEDs) therapy (SMD = -1.066, 95% CI [-1.618, -0.515]), especially in the first week after treatment (SMD = -1.641, 95% CI [-2.778, -0.503]), and significantly improved the effective rate (OR = 3.877, 95% CI [2.725, 5.515]) and cognitive assessment score (SMD = 1.038, 95% CI [0.745, 1.332]). The sensitivity analysis indicated that the results were stable, and Egger's tests showed no evidence of publication biases.

CONCLUSION

The current evidence suggests that low-frequency rTMS-assisted therapy significantly improves antiepileptics drugs' efficacy and improves patients' cognitive function. This additional therapeutic effect has a certain timeliness. Limited by the quantity and quality of the selected studies, further prospective studies with more participants are needed to draw broad and accurate conclusions.

Application of a cognitive program with a comprehensive strategy feedback for Korean older adults

This study assesses the effect of a cognitive program with a comprehensive strategy feedback on the cognitive function and memory self-efficacy of community-dwelling older adults and explores its applicability in Korea. The study employed a group pre-posttest design on 10 cognitively normal older participants. The four-week cognitive program involved daily completion of cognitive tasks at home using CoTras-Pro 2 and remotely provided individual non-face-to-face feedback. Additionally, biweekly face-to-face group feedback sessions were conducted with five participants. The Korean version of the Montreal Cognitive Assessment, the Korean-Color Word Stroop Test, and the Memory Self-Efficacy Questionnaire were used. Post-interviews were conducted to collect feedback. The program exerted a notable positive impact on cognitive function and memory self-efficacy. A study designed as a large-scale program conducted in collaboration with community-based public and private organizations holds the potential to be modeled for similar intervention programs involving a large number of participants.

Relationship Between Work-Related Noise Exposure and Cognitive Impairment: A Cross-Sectional Study in China

Background

Noise exposure and the risk of cognitive impairment are currently major public health issues.

Objective

This study aimed to analyze the relationship between noise exposure and early impairment of cognitive function from the perspective of occupational epidemiology and to provide evidence for the long-term prevention and treatment of dementia in the context of aging.

Methods

This study was conducted in China between May and August 2021. The independent variables were the type of hazardous factors, duration of noise exposure, perceived noise intensity, and cumulative noise exposure (CNE). The dependent variable was cognitive function, which was measured using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Multiple linear and logistic regression were used to analyze the relationship between noise exposure and cognitive function and to establish an effect curve.

Results

The detection rates of cognitive dysfunction using the MMSE and MoCA were 1.1% and 36.2%, respectively. The predicted MMSE and MoCA scores showed a downward trend within the CNE value ranging from 90-140 dB.time. Each unit increase in CNE decreased cognitive function scores by 0.025 (0.037, 0.013) and 0.020 (0.037, 0.003) points,respectively.

Conclusions

From the perspective of occupational epidemiology, these findings reveal a potential link between long-term noise exposure and early cognitive impairment.

Risk factors prediction of 6-month mortality after noncardiac surgery of older patients in China: a multicentre retrospective cohort study

BACKGROUND

Identifying the risk factors associated with perioperative mortality is crucial, particularly in older patients. Predicting 6-month mortality risk in older patients based on large datasets can assist patients and surgeons in perioperative clinical decision-making. This study aimed to develop a risk prediction model of mortality within 6 months after noncardiac surgery using the clinical data from 11 894 older patients in China.

MATERIALS AND METHODS

A multicentre, retrospective cohort study was conducted in 20 tertiary hospitals. The authors retrospectively included 11 894 patients (aged ≥65 years) who underwent noncardiac surgery between April 2020 and April 2022. The least absolute shrinkage and selection operator model based on linear regression was used to analyse and select risk factors, and various machine learning methods were used to build predictive models of 6-month mortality.

RESULTS

The authors predicted 12 preoperative risk factors associated with 6-month mortality in older patients after noncardiac surgery. Including laboratory-associated risk factors such as mononuclear cell ratio and total blood cholesterol level, etc. Also including medical history associated risk factors such as stroke, history of chronic diseases, etc. By using a random forest model, the authors constructed a predictive model with a satisfactory accuracy (area under the receiver operating characteristic curve=0.97).

CONCLUSION

The authors identified 12 preoperative risk factors associated with 6-month mortality in noncardiac surgery older patients. These preoperative risk factors may provide evidence for a comprehensive preoperative anaesthesia assessment as well as necessary information for clinical decision-making by anaesthesiologists.

Perioperative neurocognitive disorder changes in elderly diabetes patients within 30 days after surgery: a retrospective cohort study

BACKGROUND

Perioperative neurocognitive disorders (PND) are a common central nervous system complication that predominantly affects the elderly. PND after surgery includes postoperative delirium (POD), delayed neurocognitive recovery up to 30 days (DNR), and postoperative neurocognitive disorder up to 12 months. Diabetes is an important independent risk factor for PND. Over the years, few studies have assessed the incidence of PND and the difference in serum biomarkers between diabetic and non-diabetic patients. We sought to examine the difference in the incidence of PND between elderly diabetic and non-diabetic patients in China and identify the risk factors of PND in elderly diabetics.

METHODS

We conducted a secondary and exploratory data analysis from our prior studies, including patients aged 65 years or older who underwent non-cardiac elective surgery with general anesthesia. We used the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Montreal Cognitive Assessment (MoCA) to assess patient cognition.

RESULTS

A total of 236 patients were analyzed; the incidence of PND was significantly higher in diabetic than in non-diabetic patients within 30 days (59.2% vs. 36.8%) (P = 0.022). Multivariate logistic regression analysis showed that the preoperative MoCA was an independent risk factor for PND (odds ratio, 0.88 [0.8 to 0.97]; P = 0.014), and Hosmer-Lemeshow tests showed that it could predict PND in diabetic patients (P = 0.360). According to the maximum Youden index, the optimal cutoff for preoperative MoCA was 21.5 points, yielding a specificity and sensitivity of 88.0% and 55.2% for PND. The levels of glial fibrillary acidic protein (GFAP) and Tau in diabetic patients before and after surgery were significantly higher than in non-diabetic patients among cases of PND (P = 0.002 and 0.011, respectively).

CONCLUSION

The incidence of PND is higher in diabetic than in non-diabetic patients in China, and preoperative MoCA is an independent risk factor for PND in diabetics. Meanwhile, the changes in GFAP and p-Tau in diabetic patients who experienced PND were significantly higher than in non-diabetic ones.

Aerobic Training Increases Hippocampal Volume and Protects Cognitive Function for Type 2 Diabetes Patients with Normal Cognition

AIM

To evaluate the effects of aerobic training on hippocampal volume and cognitive function in patients with type 2 diabetes mellitus (T2DM) with normal cognition.

MATERIALS AND METHODS

One hundred patients with T2DM aged 60-75 years who met inclusion criteria were randomized into the aerobic training group (n=50) and control group (n=50). The aerobic training group received 1 year of aerobic training, while the control group maintained their lifestyle without additional exercise intervention. The primary outcomes were hippocampal volume measured by MRI and Mini-mental State Examination (MMSE) score or Montreal Cognitive Assessment scale (MoCA) scores.

RESULTS

Eighty-two participants completed the study (aerobic training group, n=40; control group, n=42). There was no significant difference between the two groups at baseline (P>0.05). After one year of moderate aerobic training, increase in total and right hippocampal volume in the aerobic training group were significantly higher than in the control group (P=0.027, P=0.043, respectively). In the aerobic group, total hippocampal volume significantly increased after the intervention compared with baseline (P=0.034). The between-group difference in the change of MMSE and MoCA scores was statistically significant (P=0.015, P=0.027, respectively). Logistic regression showed strong correlations between aerobic training and increase in total hippocampal volume (OR:1.091, [95%CI 0.969, 1.228], P=0.002), improvement of MMSE scores (OR:1.127, [95%CI 1.005, 1.263], P=0.041) or MoCA scores (OR:2.564, [95%CI 2.098.2.973], P=0.045).

CONCLUSIONS

One-year moderate aerobic training increased total and right hippocampal volume and protected cognitive function for T2DM patients with normal cognition. Early intervention focusing on cognition protection should be considered for T2DM patients in clinical settings.

Cross-cultural adaptation of assessments for time-related abilities of Indian older adults and evaluation of their reliability and validity

BACKGROUND

Older adults may have difficulties in daily time management due to age-related or disease-related cognitive impairment. Standardised assessments for time-related abilities are currently unavailable in India.

AIM

The study aimed to adapt the Kit for Assessing Time-processing Ability-Senior (KaTid-Senior) and Time-Self rating, Senior (Time-S Senior) for daily time management of Indian older adults, translate these into an Indian language, and evaluate the reliability and validity of the adapted assessments.

MATERIALS AND METHODS

The two Swedish-origin assessments were reviewed, adapted for linguistic and cultural relevance into English, and translated into Kannada language. Older adults (n = 128) were conveniently selected, assessed with the Montreal Cognitive Assessment, and assigned to age and gender-matched groups: cognitively-impaired and cognitively-normal. Data was then collected with the adapted assessments.

RESULTS

Both adapted assessments demonstrated acceptable reliability (internal consistency) in this sample (α =0.89 - 0.90). The cognitively-impaired group had significantly (p < 0.001) lower scores on the assessments as compared to the cognitively-normal group. There was a strong to moderate correlation between the assessments supporting their convergent validity.

CONCLUSIONS

The adapted assessments are reliable and valid in the Indian context.

SIGNIFICANCE

The study would facilitate contextually-relevant assessment and management of time-related abilities in Indian older adults.

Sociodemographic features associated with the MoCA, SPPB, and GDS scores in a community-dwelling elderly population

BACKGROUND

An accurate evaluation of cognitive function, physical health, and psychological health is fundamental for assessing health problems in the elderly population, and it is important to identify the necessity of early therapeutic intervention. The objective of this study was to evaluate the states of mental and physical functions and to investigate the relationships between sociodemographic features and these functions in a community-dwelling elderly population.

METHODS

This community-based cross-sectional study was conducted in a suburban district of Shanghai, China. A total of 1025 participants aged 60-89 years underwent investigations of demographic and lifestyle features and a multidimensional geriatric evaluation comprising the Montreal Cognitive Assessment (MoCA), Short Physical Performance Battery (SPPB), and Geriatric Depression Scale (GDS).

RESULTS

The results of the multivariate linear regression models demonstrated that the MoCA and SPPB scores decreased with advancing age (all P < 0.01). However, the GDS score did not exhibit an age-related decrease (P = 0.09). Both sex and living alone influenced the MoCA score (P < 0.01 and P = 0.04, respectively), SPPB score (P < 0.01 and P = 0.04, respectively), and GDS score (P < 0.01 and P < 0.01, respectively). A higher education level was related to better MoCA and SPPB scores (all P < 0.01). Furthermore, age and sex had interactive effects on the MoCA score (P = 0.03) and SPPB score (P < 0.01). The kernel-weighted local polynomial smoothing curves exhibited similar trends.

CONCLUSIONS

It is imperative to develop a more sensitive evaluation of physical function, and to encourage various intellectually and emotionally stimulating social activity strategies to promote healthy aging, especially in elderly women and those living alone who have a low education level.

P300 Event-Related Potential Predicts Cognitive Dysfunction in Patients with Vestibular Disorders

OBJECTIVE

Our aim was to determine the correlation between cognitive impairment and P300 event-related potential (ERP) in older adults with vertigo and imbalance, which further provides a reference for clinical diagnosis and patients' rehabilitation.

METHODS

A total of 79 older adult patients with vertigo and imbalance in our outpatient department from January 2022 to December 2022 were selected and divided into the mild group (n = 20), moderate group (n = 39), and severe group (n = 20) according to the Dizziness Handicap Inventory (DHI). The auditory P300 component of event-related potentials (ERPs), Generalized Anxiety Disorder Questionnaire-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Mini-Mental State Examination (MMSE) were used to evaluate depression, anxiety, and cognitive function in these patients, respectively.

RESULTS

The P300 latencies of the different severity groups were 292 ± 10 ms, 301 ± 8 ms, and 328 ± 5 ms, respectively, and the differences were statistically significant (p = 0.010). The P300 amplitudes of the different severity groups were 14.4 ± 2.6 μV, 3.9 ± 0.8 μV, and 5.1 ± 1.4 μV, respectively, and the differences were also statistically significant (p = 0.004). There was no statistically significant difference in the DHI evaluation or VAS visual simulation scoring between the two groups (p = 0.625, and 0.878, respectively). Compared with the short-course group, the long-course group showed prolonged P300 latency and decreased amplitude, higher scores in PHQ-9 and GAD-7, and lower scores in MMSE, and all the differences were statistically significant (p = 0.013, 0.021, 0.006, 0.004, and 0.018, respectively).

CONCLUSION

Older patients with more severe symptoms of vertigo and imbalance are at higher risk of developing abnormal cognitive function. The P300 can be used as an objective neurophysiological test for the assessment of cognitive function relevant to elderly patients with vertigo and imbalance.

Neuropsychological Assessment in Patients with Traumatic Brain Injury: A Comprehensive Review with Clinical Recommendations

Traumatic brain injury is damage to the brain occurring after birth, often resulting in the deterioration of cognitive, behavioural, and emotional functions. Neuropsychological evaluation can assist clinicians to better assess the patient's clinical condition, reach differential diagnoses, and develop interventional strategies. However, considering the multiple rating scales available, it is not easy to establish which tool is most suitable for the different brain injury conditions. The aim of this review is to investigate and describe the most used neurocognitive assessment tools in patients with traumatic brain injury to provide clinicians with clear indications on their use in clinical practice. Indeed, during the acute phase, after the head trauma, alertness and wakefulness of the patients affected by a disorder of consciousness can be assessed using different scales, such as the Coma Recovery Scale-Revised. In both postacute and chronic phases after traumatic brain injury, general cognitive assessment tools (such as the Mini Mental State Examination) or more specific cognitive tests (e.g., Wisconsin Card Sorting Test and Trail Making Test) could be administered according to the patient's functional status. In this way, clinicians may be aware of the patient's neuropsychological and cognitive level, so they can guarantee a personalized and tailored rehabilitation approach in this frail patient population.

Cognitive impairment according to Montreal Cognitive Assessment independently predicts the ability of chronic obstructive pulmonary disease patients to maintain proper inhaler technique

BACKGROUND

Maintaining correct inhaler technique is crucial in the management of chronic obstructive pulmonary disease (COPD). We aimed to investigate the inhaler technique in patients with COPD, to compare it immediately after and at 1 month after training, and to identify the predictors of incorrect inhaler use at 1 month after training.

METHODS

This prospective study was conducted at the COPD clinic of Siriraj Hospital (Bangkok, Thailand). Patients demonstrating improper inhaler use were trained face-to-face by pharmacists. Inhaler technique was re-assessed immediately after and at 1 month after training. The Montreal Cognitive Assessment (MoCA) score, pulmonary function tests, 6-min walk distance (6 MWD), modified Medical Research Council scale score, and COPD Assessment Test (CAT) score were evaluated.

RESULTS

Sixty-six patients with COPD who demonstrated at least one critical error during the use of any controller inhaler were enrolled. The mean age was 73.0 ± 9.0 years, and 75.8% patients had moderate/severe COPD. Immediately after training, all patients used dry powder inhalers correctly and 88.1% used pressurized metered-dose inhalers correctly. At 1 month, the number of patients demonstrating the correct technique decreased across all devices. Multivariable analysis revealed that MoCA score ≤ 16 was independently associated with a critical error at 1 month after training (adjusted odds ratio: 12.7, 95% confidence interval: 1.8-88.2, p = 0.010). At 1 month, CAT score (11.4 ± 8.9 vs. 8.4 ± 5.5, p = 0.018) and 6 MWD (351 ± 93 m vs. 372 ± 92 m, p = 0.009) had significantly improved in patients demonstrating the correct technique, and CAT score met the minimal clinically important difference.

CONCLUSIONS

Face-to-face training by pharmacists improved patient performance. However, the number of patients following proper technique had decreased at 1 month after training. Cognitive impairment (MoCA score ≤ 16) independently predicted the ability of COPD patients to maintain proper inhaler technique. Assessment of cognitive function combined with technical re-assessment and repeated training should improve COPD management.

Does Multicomponent Training Improve Cognitive Function in Older Adults Without Cognitive Impairment? A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVES

To carry out a systematic review and meta-analysis to verify the effects of multicomponent training on the cognitive function of older adults without cognitive impairment.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Adults aged 60 years and older.

METHODS

The searches were accomplished through MEDLINE (via PubMed), EMBASE, Cochrane Library, Web of Science, SCOPUS, LILACS, and Google Scholar databases. We performed the searches up to November 18, 2022. The study included only randomized controlled trials and older adults without any cognitive impairment (dementia, Alzheimer's, mild cognitive impairment, neurologic diseases). Risk of Bias 2 tool and PEDro scale was performed.

RESULTS

Ten randomized controlled trials were included in the systematic review, of which 6 (involving 166 participants) were compiled in the meta-analysis of random effects models. The Mini-Mental State Examination and Montreal Cognitive Assessment were used to assess global cognitive function. The Trail-Making Test (TMT) (A and B domains) was performed by 4 studies. Compared with the control group, multicomponent training increases the global cognitive function (standardized mean difference = 0.58, 95% CI: 0.34-0.81, I² = 11%; P < .001). Regarding TMT-A and TMT-B, multicomponent training decreases the time performed in the tests (TMT-A: mean difference = -6.70, 95% CI: -10.19 to -3.21; I² = 51%; P = .0002) (TMT-B: mean difference = -8.80, 95% CI: -17.59 to -0.01; I² = 69%; P = .05). The PEDro scale for the studies in our review ranged from 7 to 8 (mean = 7.4 ± 0.5), meaning good methodologic quality, and most studies were judged as at least low in terms of risk of bias.

CONCLUSION AND IMPLICATIONS

Multicomponent training improves cognitive function in older adults without cognitive impairment. Therefore, a possible protective effect of multicomponent training for cognitive function in older adults is suggested.

Modern Approaches to the Diagnosis of Cognitive Impairment and Alzheimer's Disease: A Narrative Literature Review

BACKGROUND

The aging of the worlds population leads to an increase in the prevalence of age-related diseases, including cognitive impairment. At the stage of dementia, therapeutic interventions become usually ineffective. Therefore, researchers and clinical practitioners today are looking for methods that allow for early diagnosis of cognitive impairment, including techniques that are based on the use of biological markers.

AIM

The aim of this literature review is to delve into scientific papers that are centered on modern laboratory tests for Alzheimers disease, including tests for biological markers at the early stages of cognitive impairment.

METHODS

The authors have carried out a descriptive review of scientific papers published from 2015 to 2023. Studies that are included in the PubMed and Web of Science electronic databases were analyzed. A descriptive analysis was used to summarized the gleaned information.

RESULTS

Blood and cerebrospinal fluid (CSF) biomarkers, as well as the advantages and disadvantages of their use, are reviewed. The most promising neurotrophic, neuroinflammatory, and genetic markers, including polygenic risk models, are also discussed.

CONCLUSION

The use of biomarkers in clinical practice will contribute to the early diagnosis of cognitive impairment associated with Alzheimers disease. Genetic screening tests can improve the detection threshold of preclinical abnormalities in the absence of obvious symptoms of cognitive decline. The active use of biomarkers in clinical practice, in combination with genetic screening for the early diagnosis of cognitive impairment in Alzheimers disease, can improve the timeliness and effectiveness of medical interventions.

The Impact of COVID-19 Lockdown Measures and COVID-19 Infection on Cognitive Functions: A Review in Healthy and Neurological Populations

The COVID-19 pandemic severely affected people's mental health all over the world. This review aims to present a comprehensive overview of the literature related to the effects of COVID-19 lockdown measures and COVID-19 infection on cognitive functioning in both healthy people and people with neurological conditions by considering only standardized tests. We performed a narrative review of the literature via two databases, PUBMED and SCOPUS, from December 2019 to December 2022. In total, 62 out of 1356 articles were selected and organized into three time periods: short-term (1-4 months), medium-term (5-8 months), and long-term (9-12 months), according to the time in which the tests were performed. Regardless of the time period, most studies showed a general worsening in cognitive performance in people with neurological conditions due to COVID-19 lockdown measures and in healthy individuals recovered from COVID-19 infection. Our review is the first to highlight the importance of considering standardized tests as reliable measures to quantify the presence of cognitive deficits due to COVID-19. Indeed, we believe that they provide an objective measure of the cognitive difficulties encountered in the different populations, while allowing clinicians to plan rehabilitation treatments that can be of great help to many patients who still, nowadays, experience post-COVID-19 symptoms.

Trace elements and Alzheimer dementia in population-based studies: A bibliometric and meta-analysis

Alterations in the concentrations of trace elements may play a vital role in Alzheimer dementia progression. However, previous research results are inconsistent, and there is still a lack of review on the relationship between all the studied-trace elements and AD from various perspectives of population-based studies. In this study, we systematically reviewed previous population-based studies and identified the altered trace elements in AD patients. We searched the Web of Science Core Collection, PubMed, and Scopus database, and ultimately included 73 articles. A bibliometric analysis was conducted to explore the evolution of the field from an epidemiological perspective. Bibliometric data such as trace elements, biological materials, detection methods, cognitive tests, co-occurrence and co-citation statistics are all analyzed and presented in a quantitative manner. The 73 included studies analyzed 39 trace elements in total. In a further meta-analysis, standardized mean differences (SMDs) of 13 elements were calculated to evaluate their altered in AD patients, including copper, iron, zinc, selenium, manganese, lead, aluminum, cadmium, chromium, arsenic, mercury, cobalt, and manganese. We identified four trace elements-copper (serum), iron (plasma), zinc (hair), and selenium (plasma)-altered in AD patients, with SMDs of 0.37 (95% confidence interval [CI]: 0.10, 0.65), -0.68 (95% CI: -1.34, -0.02), -0.35 (95% CI: -0.62, -0.08), and -0.61 (95% CI: -0.97, -0.25), respectively. Finally, we formed a database of various trace element levels in AD patients and healthy controls. Our study can help future researchers gain a comprehensive understanding of the advancements in the field, and our results provide comprehensive population-based data for future research.

Cognitive impairment following traumatic brain injury in Uganda: Prevalence and associated factors

BACKGROUND

As the burden of dementia continues to rise in sub-Saharan Africa, it is crucial to develop an evidence base for potentially modifiable risk factors such as Traumatic Brain Injury (TBI). Cognitive impairment may result from TBI and since it is an established prodromal form of dementia, we investigated the burden of cognitive impairment and associated factors in persons with a history of TBI in southwestern Uganda.

METHODS

This was a community-based quantitative study with a cross-sectional design among 189 persons with a history of TBI in southwestern Uganda. Data were collected by the research team in March and June 2022 and entered into Kobo Toolbox before being transferred to RStudio version 4.1.0 for cleaning and analysis. Data were analyzed at a 5% level of significance.

RESULTS

Most study participants had some form of cognitive impairment (56.1%), with 43.1% of the participants having mild cognitive impairment (MCI). Cognitive impairment was associated with older age (p-value<0.001); loss of consciousness following the TBI (p-value = 0.019) and a history of tobacco use (p-value = 0.003). As a measure of severity of the TBI, loss of consciousness (aOR = 4.09; CI = 1.57-11.76; p<0.01) and older age (aOR = 1.04; CI = 1.01-1.07; p<0.01) were identified as risk factors for cognitive impairment.

CONCLUSION

There is a high burden of cognitive impairment among individuals with a history of TBI in southwestern Uganda, and most associated risk factors are potentially modifiable. Long-term follow-up of TBI patients would enable early identification of some risks. Patients with TBI could benefit from behavioural modifications such as restriction of alcohol intake and tobacco use to slow down the progression into dementia.

[Features of neuropsychological status and results of magnetic resonance morphometry in patients with Alzheimer's disease and glaucoma]

OBJECTIVE

To identify the relationship of neuropsychological changes in patients with Alzheimer's disease (AD) and primary open-angle glaucoma (POAG) and to evaluate the results of magnetic resonance (MR)-morphometry in patients with these diseases.

MATERIAL AND METHODS

We examined 32 patients (median age 67 [61.25; 76.75] years, 78.1% women) diagnosed with AD and POAG. The patients were divided into the AD group (n=16) and the POAG group (n=16). Complaints and anamnesis were collected for all patients, neurological status and neuropsychological status were assessed. MRI of the brain, followed by morphometry, was performed.

RESULTS

Cognitive impairments (CI) were revealed in patients of both groups. The severity of CI in patients with AD was more pronounced than in patients with POAG (p<0.001). Alzheimer's type of CI was detected in both groups. MR-morphometry revealed a decrease in the volume of the left hippocampus, the volume of the right and left amygdala as well as a decrease in the thickness of the right and left entorhinal cortex in the AD group compared with the POAG group (p<0.05). A significant decrease in the thickness of the right medial orbitofrontal cortex was found in the POAG group compared with the AD group (p<0.05).

CONCLUSION

In AD and POAG, there is a similarity of the neuropsychological profile, which reflects the neurodegeneration characteristic of these diseases. MRI morphometry requires an assessment of both volumes and thickness of brain structures. A neuroimaging pattern identified in patients with POAG can be regarded as an indicator of the glaucomatous process.

Review of clinical practice guidelines relating to cognitive assessment in stroke

PURPOSE

To assess the content, quality, and supporting evidence base of clinical practice guidelines (CPGs) with reference to cognitive assessment in stroke.

MATERIALS AND METHODS

We performed a systematic review to identify eligible CPGs pertaining to cognitive assessment in adult stroke survivors. We compared content and strength of recommendations. We used the AGREE-II (appraisal of guidelines for research and evaluation) tool to appraise the quality of the guideline.

RESULTS

Eight eligible guidelines were identified and seven were rated as high quality (i.e., appropriately addressing at least four domains of the AGREE-II tool including "rigor of development"). There was heterogeneity in the recommendations offered and limited guidance on fundamental topics such as which cognitive test to use or when to perform testing. Generally, the lowest quality of evidence (expert opinion) was used to inform these recommendations.

CONCLUSIONS

Although assessment of cognition is a key aspect of stroke care, there is a lack of guidance for clinicians. The limited evidence base, in part, reflects the limited research in the area. A prescriptive approach to cognitive assessment may not be suitable, but more primary research may help inform practice.Implications for rehabilitationCognitive assessment in stroke exhibits substantial variation in practice, clinical practice guidelines rarely give prescriptive recommendations on which approach to take.Where guideline recommendations on cognitive assessment in stroke were made these were based on expert opinion.Our summary of the guideline content found certain areas of consensus, for example, routine assessment using validated tools.

The Hong Kong Grocery Shopping Dialog Task (HK-GSDT): A Quick Screening Test for Neurocognitive Disorders

The Hong Kong Grocery Shopping Dialog Task (HK-GSDT) is a short and easy-to-administer cognitive test developed for quickly screening neurocognitive disorders (NCDs). In the test, participants are instructed to do a hypothetical instrumental activity of daily living task of purchasing ingredients for a dish from a grocery store and verbally describe the specific shopping procedures. The current study aimed to validate the test with a sample of 545 Hong Kong older adults (58.8% female; aged 73.4 ± 8.37 years), including 464 adults with normal cognitive function, 39 with mild NCD, and 42 with major NCD. Demographic characteristics (i.e., sex, age, education) and clinical diagnosis of cognitive states (i.e., major NCD, mild NCD, and normal aging) were collected. Cognitive functioning was measured using the HK-GSDT and several standardized NCD-screening tests. The results showed good reliability (i.e., internal consistency) and structural validity in the HK-GSDT. It discriminated among different cognitive conditions, particularly between major NCDs and the other conditions, as effectively as did the existing standardized neurocognitive tests (e.g., Montreal Cognitive Assessment, Hong Kong List Learning Test). Moreover, the HK-GSDT explained additional variance of cognitive condition on top of those standardized neurocognitive tests. These results indicate that the HK-GSDT can be used alone, or in combination with other tests, to screen for NCDs.

The Coronavirus Footprint on Dual-Task Performance in Post-Acute Patients after Severe COVID-19: A Future Challenge for Rehabilitation

Recent studies suggest that also the non-critical form of COVID-19 infection may be associated with executive function impairments. However, it is not clear if they result from cognitive impairments or by COVID-19 infection per se. We aimed to investigate if patients in the post-acute stage of severe COVID-19 (PwCOVID), without manifest cognitive deficits, reveal impairments in performing dual-task (DT) activities compared to healthy controls (HS). We assessed balance in 31 PwCOVID vs. 30 age-matched HS by stabilometry and the Timed Up and Go (TUG) test with/without a cognitive DT. The DT cost (DTC), TUG test time and sway oscillations were recorded; correct cognitive responses (CCR) were calculated to evaluate cognitive performance. Results show a significant difference in overall DT performance between PwCOVID and HS in both stabilometry (p < 0.01) and the TUG test (p < 0.0005), although with similar DTCs. The main difference in the DTs between groups emerged in the CCR (effect size > 0.8). Substantially, PwCOVID gave priority to the motor task, leaving out the cognitive one, while HS performed both tasks simultaneously. Our findings suggest that PwCOVID, even without a manifest cognitive impairment, may present a deficit in executive function during DTs. These results encourage the use of DTs and CCR in PwCOVID.

Preoperative Intestinal Microbiome and Metabolome in Elderly Patients with Delayed Neurocognitive Recovery

BACKGROUND

Delayed neurocognitive recovery (dNCR) is a common complication of the central nervous system in elderly patients. Currently, it is not clear whether the occurrence of dNCR is associated with the intestinal microbiota and its related metabolites. This study investigated the preoperative intestinal microflora and faecal metabolites of dNCR patients.

METHODS

Twenty-two elderly urological patients were divided into a dNCR group (D group) and a non-dNCR group (ND group) according to the postoperative Mini-Mental State Examination (MMSE) score on the first and third day after surgery. A postoperative MMSE score ≤ 2 points compared with the preoperative score was considered evidence of dNCR. We used a comprehensive method that combined 16S rRNA gene sequencing and untargeted metabolomics to study the preoperative intestinal microflora and faecal metabolites of the two groups, and conducted correlation analysis between them.

RESULTS

Compared with the D group, the microbial community in the ND group was more abundant. At the family level, the ND group was significantly enriched in Lachnospiraceae, Peptostreptococcaceae and Muribaculaceae. At the genus level, the faecal microbiota of the ND group was differentially enriched in Agathobacter, Dorea, Fusicatenibacter, Coprococcus_2 and Romboutsia while that of the D group was differentially enriched in Anaerofilum. Untargeted metabolomics revealed significant differences in eight different metabolites between the two groups, including ribose, ethanol, leucine, maltose, pentadecanoic acid, malonic acid 1,3,4-dihydroxybenzoic acid and 3-hydroxypalmitic acid. In addition, differential metabolites were associated with the abundance of specific bacteria.

CONCLUSIONS

The occurrence of dNCR may be associated with the intestinal flora and its related metabolite composition of patients before surgery.

Montreal Cognitive Assessment for Evaluating Cognitive Impairment in Subarachnoid Hemorrhage: A Systematic Review

Subarachnoid hemorrhage (SAH) is a severe condition with high mortality and extensive long-term morbidity. Although research has focused mainly on physical signs and disability for decades, in recent years, it has been increasingly recognized that cognitive and psychological impairments may be present in many patients with SAH, negatively impacting their quality of life. We performed a systematic review aiming to provide a comprehensive report on the diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) test for evaluating the presence of cognitive impairment in patients with SAH. Using appropriate search terms, we searched five databases (PubMed, Scopus, PsychINFO, Web of Sciences, and Latin American and Caribbean Health Sciences Literature) up to January 2022. Two cross-sectional studies investigated the accuracy of MoCA in SAH patients in the subacute and chronic phase. We appraised the quality of the included studies using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. The MoCA test provides information about general cognitive functioning disturbances. However, a lower threshold than the original cutoff might be needed as it improves diagnostic accuracy, lowering the false positive rates. Further research is necessary for an evidence-based decision to use the MoCA in SAH patients.

The Effect of Music-Based Intervention on General Cognitive and Executive Functions, and Episodic Memory in People with Mild Cognitive Impairment and Dementia: A Systematic Review and Meta-Analysis of Recent Randomized Controlled Trials

Background: Music-based intervention has been used as first-line non-pharmacological treatment to improve cognitive function for people with mild cognitive impairment (MCI) or dementia in clinical practice. However, evidence regarding the effect of music-based intervention on general cognitive function as well as subdomains of cognitive functions in these individuals is scarce. Objective: To evaluate the efficacy of music-based interventions on a wide range of cognitive functions in people with MCI or dementia. Method: We searched the effect of various music therapies using randomized controlled trials on cognitive function using several databases. Studies based on any type of dementia or MCI were combined. The effects of music-based intervention on each cognitive function were pooled by meta-analysis. Results: A total of 19 studies involving n = 1024 participants (mean age ranged from 60 to 87 years old) were included. We found statistically significant improvements in MMSE (general cognitive function), the Frontal Assessment Battery (executive function), and the Auditory Verbal Learning Test (episodic memory). Conclusions: This study provides positive evidence to support music-based interventions for improving a wide range of cognitive functions in older adults with MCI and dementia. Therefore, we recommend increased use of music in people’s homes, day care centers and nursing homes. This study was registered with PROSPERO, number 250383.

Blood glucose mediated the effects of cognitive function impairment related to aluminum exposure in Chinese aluminum smelting workers

OBJECT

To explore the effects of occupational aluminum exposure on workers' cognitive function and blood glucose concentration, and to analyze whether blood glucose concentration can mediate the cognitive changes caused by aluminum.

METHOD

Our study recruited 375 workers from an aluminum factory in northern China. We collected the fasting elbow venous blood of the workers, measured their fasting blood glucose concentration (FBG), and used ICP-MS to determine plasma aluminum concentration (P-Al) as an indicator of internal exposure. The Montreal Cognitive Assessment (MoCA), was used to assess the cognitive function of workers. Generalized linear model was used to analyze the association of P-Al with cognitive function and blood glucose concentration, and the restricted cubic spline model was used to fit the dose-response relationship. We also conducted a mediation effect analysis.

RESULT

We observed the dose-response relationship, that is, as the P-Al increased, sum of MoCA, visuospatial/executive, naming, language, and abstraction scores decreased, and the blood glucose concentration increased. For every e-fold increase in P-Al, sum of MoCA, visuospatial/executive, naming, language, and abstraction scores decreased by 0.328 points, 0.120 points, 0.059 points, 0.060 points, and 0.083 points, respectively, and FBG rose by 0.109 mmol/L. FBG has a significant mediating effect between P-Al and sum of MoCA (P for mediator=0.042), and it could explain 10.7% of the effect of cognitive level related to P-Al.

CONCLUSION

Occupational aluminum exposure negatively affected the cognitive function of workers and positively affected FBG. FBG may partially explain the impact of occupational aluminum exposure on workers' cognitive function.

Stability of Montreal Cognitive Assessment in Individuals with Mild Cognitive Impairment: Potential Influence of Practice Effect

Background: The Montreal Cognitive Assessment (MoCA) is a standard test for screening and monitoring cognitive functions. Objective: This study explored the two-year changes in MoCA scores in older adults. Methods: Fifty-seven participants with mild cognitive impairment (MCI) and 87 participants with normal cognition completed the baseline and two-year follow-up assessments. Apart from MoCA, tests on visuospatial judgment, memory, and motor-related executive function were administered. Results: The results identified three MCI subgroups based on the differential changes in MoCA scores. They were the consistently low, consistently high, and low-to-high between-time performances. These heterogeneous test performances are on contrary to the significant deteriorations in executive function and finger dexterity across all subgroups. Repeated exposure to MoCA tests during the follow-up period was found to be a plausible indicator of the MCI subgroup categorization. Conclusion: Findings raise concerns over adopting brief clinical instrument for repeated testing, such as MoCA, for monitoring MCI conditions among older adults.

Twelve-Month Cognitive and Functional Outcomes Following Cardiac Surgery: The DEXACET Trial of Intravenous Acetaminophen Versus Placebo

Background: Delirium, an acute decline in attention and global cognitive dysfunction, occurs frequently following cardiac surgery and has been demonstrated to be significantly associated with cognitive dysfunction and reduced functional ability. In the DEXACET trial, we demonstrated a significant reduction in postoperative in-hospital delirium with intravenous (IV) acetaminophen when compared with placebo. In this analysis we examined whether this protective association also extended to 12 month cognitive and functional outcomes.

Methods: This study was a prospective, randomized, placebo-controlled, triple-blinded, factorial design trial conducted at Beth Israel Deaconess Medical Center, approved by the IRB. In this trial, 120 older cardiac surgical patients were randomly assigned to receive either intravenous (IV) acetaminophen or placebo in addition to propofol or dexmedetomidine. Those receiving IV acetaminophen displayed a significant reduction in in-hospital delirium. We collected cognitive, mood and functional outcome data using the Montreal Cognitive Assessment, telephone version (T-MoCA), Geriatric Depression Scale (GDS) and the Basic and Instrumental Activities of Daily Living (ADLs, IADLs) at 1 month and 12 months after surgery.

Results: Of the 120 enrolled patients in the primary trial, 93 (77.5%) and 83 (69.2%) patients responded to assessments at 1 month and 12 months, respectively. No statistically significant differences in median T-MoCA scores were observed between acetaminophen and placebo groups at 1 month (18.0 vs.18.0, p = 0.52) or 12 months (19.0 vs.18.0, p = 0.62) following surgery. There were similarly no differences in GDS, ADLs or IADLs between treatment groups. Losses to follow-up limited the sample sizes and 10 of the 23 (45%) original study participants who had postoperative delirium were lost to follow up.

Conclusion: Administration of intravenous acetaminophen was not associated with a difference in long term cognitive or functional status following cardiac surgery. Additional research on long-term outcomes following postoperative delirium with a larger sample size and improved cohort retention strategies will be needed to address this important area.

Cognition in prodromal Parkinson's disease

One characteristic of Parkinson's disease (PD) is a prodromal phase, lasting many years during which both pre-clinical motor and non-motor symptoms occur. Around one-fifth of patients with PD manifest mild cognitive impairment at time of clinical diagnosis. Thus, important challenges are to define the time of onset of cognitive dysfunction in the prodromal phase of PD, and to define its co-occurrence with other specific characteristics. Evidence for cognitive change in prodromal PD comes from various study designs, including both longitudinal and cross-sectional approaches with different target groups. These studies support the concept that changes in global cognitive function and alterations in executive functions occur, and that these changes may be present up to 6 years before clinical PD diagnosis. Notably, this evidence led to including global cognitive impairment as an independent prodromal marker in the recently updated research criteria of the Movement Disorder Society for prodromal PD. Knowledge in this field, however, is still at its beginning, and evidence is sparse about many aspects of this topic. Further longitudinal studies including standardized assessments of global and domain-specific cognitive functions are needed to gain further knowledge about the first appearance, the course, and the interaction of cognitive deficits with other non-motor symptoms in prodromal stage PD. Treatment approaches, including non-pharmacological interventions, in individuals with prodromal PD might help to prevent or delay cognitive dysfunction in early PD.

Equating Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores: conversion norms from a healthy Italian population sample

BACKGROUND

This study aimed to provide equating norms for the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) from a sample of healthy Italian adults.

METHODS

Four-hundred and seven Italian healthy adults (165 males, 242 females; mean age = 60.61 ± 13.74 years, range= 20-93; mean education = 12.2 ± 4.42 years, range= 4-25) were administered the MMSE and the MoCA. 'MMSE-to-MoCA' and 'MoCA-to-MMSE' conversion tables were derived via log-linear smoothing equi-percentile equating (LSEE). Equivalence between empirical and conversion-derived scores was determined with a two one-sided test (TOST) procedure.

RESULTS

Conversion-derived scores were statistically equivalent to empirical ones for both the MMSE (p = 0.948) and the MoCA (p = 0.437). The LSEE yielded impossible/unreliable conversion estimates for floor scores on both tests, whereas conversions for uppermost scores were highly consistent.

DISCUSSION

The present data will help avoid inter-rater heterogeneity in cross-sectionally and longitudinally adopting either one of the two cognitive screening tests, and to retrospective analyze data collected via either one test or the other.

The Frontal Assessment Battery (FAB) and its sub-scales: validation and updated normative data in an Italian population sample

BACKGROUND

Deficits of executive functioning (EF) are frequently found in neurological disorders. The Frontal Assessment Battery (FAB) is one of the most widespread and psychometrically robust EF screeners in clinical settings. However, in Italy, FAB norms date back to 15 years ago; moreover, its validity against "EF-loaded" global cognitive screeners (e.g., the Montreal Cognitive Assessment, MoCA) has yet to be tested. This study thus aimed at (a) providing updated normative data for the Italian FAB and (b) assessing its convergent validity with the MoCA.

METHODS

Four-hundred and seventy-five healthy Italian native speakers (306 females, 169 males; mean age: 61.08 ± 15.1; mean education: 11.67 ± 4.57) were administered by the MoCA and the FAB. FAB items were divided into three subscales: FAB-1 (linguistically mediated EF), FAB-2 (planning), and FAB-3 (inhibition). Regression-based norms were derived (equivalent scores) for all FAB measures.

RESULTS

Age and education were predictive of all FAB measures, whereas no gender differences were detected. The FAB and its sub-scales were related to MoCA measures-the strongest associations being found with MoCA total and MoCA-EF scores. FAB sub-scales were both internally related and associated with FAB total scores.

DISCUSSION

The FAB proved to have convergent validity with both global cognitive and EF measures in healthy individuals. The present study provides updated normative data for the FAB and its sub-scales in an Italian population sample, and thus supports an adaptive usage of this EF screener.

The Montreal Cognitive Assessment: Normative Data from a Large, Population-Based Sample of Cognitive Healthy Older Adults in Norway—The HUNT Study

Background: Several studies have found that normative scores on the Montreal Cognitive Assessment Scale (MoCA) vary depending on the person’s education and age. The evidence for different normative scores between sexes is poor. Objective: The main aim of the study was to determine normative scores on the MoCA for Norwegian older adults stratified by educational level, age, and sex. In addition, we aimed to explore sex differences in greater detail. Methods: From two population-based studies in Norway, we included 4,780 people age 70 years and older. People with a diagnosis of dementia or mild cognitive impairment, a history of stroke, and depression were excluded. Trained health personnel tested the participants with the MoCA. Results: The mean MoCA score varied between 22 and 27 and was highest among women 70–74 years with education >13 years and lowest among men age 85 and older with education ≤10 years. Education, age, and sex were significant predictors of MoCA scores. Conclusion: In the present study of cognitively healthy Norwegian adults 70 years and older, we found that the normative score on the MoCA varied between 22 and 27 depending on a person’s education, age, and sex. We suggest that normative scores should be determined taking these three variables into consideration.

A Scoping Review of Audiovisual Integration Methodology: Screening for Auditory and Visual Impairment in Younger and Older Adults

With the rise of the aging population, many scientists studying multisensory integration have turned toward understanding how this process may change with age. This scoping review was conducted to understand and describe the scope and rigor with which researchers studying audiovisual sensory integration screen for hearing and vision impairment. A structured search in three licensed databases (Scopus, PubMed, and PsychInfo) using the key concepts of multisensory integration, audiovisual modality, and aging revealed 2,462 articles, which were screened for inclusion by two reviewers. Articles were included if they (1) tested healthy older adults (minimum mean or median age of 60) with younger adults as a comparison (mean or median age between 18 and 35), (2) measured auditory and visual integration, (3) were written in English, and (4) reported behavioral outcomes. Articles that included the following were excluded: (1) tested taste exclusively, (2) tested olfaction exclusively, (3) tested somatosensation exclusively, (4) tested emotion perception, (5) were not written in English, (6) were clinical commentaries, editorials, interviews, letters, newspaper articles, abstracts only, or non-peer reviewed literature (e.g., theses), and (7) focused on neuroimaging without a behavioral component. Data pertaining to the details of the study (e.g., country of publication, year of publication, etc.) were extracted, however, of higher importance to our research question, data pertaining to screening measures used for hearing and vision impairment (e.g., type of test used, whether hearing- and visual-aids were worn, thresholds used, etc.) were extracted, collated, and summarized. Our search revealed that only 64% of studies screened for age-abnormal hearing impairment, 51% screened for age-abnormal vision impairment, and that consistent definitions of normal or abnormal vision and hearing were not used among the studies that screened for sensory abilities. A total of 1,624 younger adults and 4,778 older participants were included in the scoping review with males composing approximately 44% and females composing 56% of the total sample and most of the data was obtained from only four countries. We recommend that studies investigating the effects of aging on multisensory integration should screen for normal vision and hearing by using the World Health Organization's (WHO) hearing loss and visual impairment cut-off scores in order to maintain consistency among other aging researchers. As mild cognitive impairment (MCI) has been defined as a “transitional” or a “transitory” stage between normal aging and dementia and because approximately 3–5% of the aging population will develop MCI each year, it is therefore important that when researchers aim to study a healthy aging population, that they appropriately screen for MCI. One of our secondary aims was to determine how often researchers were screening for cognitive impairment and the types of tests that were used to do so. Our results revealed that only 55 out of 72 studies tested for neurological and cognitive function, and only a subset used standardized tests. Additionally, among the studies that used standardized tests, the cut-off scores used were not always adequate for screening out mild cognitive impairment. An additional secondary aim of this scoping review was to determine the feasibility of whether a meta-analysis could be conducted in the future to further quantitatively evaluate the results (i.e., are the findings obtained from studies using self-reported vision and hearing impairment screening methods significantly different from those measuring vision and hearing impairment in the lab) and to assess the scope of this problem. We found that it may not be feasible to conduct a meta-analysis with the entire dataset of this scoping review. However, a meta-analysis can be conducted if stricter parameters are used (e.g., focusing on accuracy or response time data only).

Systematic Review Registration:https://doi.org/10.17605/OSF.IO/GTUHD.

Increase of ALCAM and VCAM-1 in the plasma predicts the Alzheimer's disease

Cell adhesion molecules (CAM) are crucial in several pathological inflammation processes in Alzheimer's disease (AD). However, their potential for clinical diagnostics remains unknown. The present investigation evaluated the clinical significance of ALCAM, VCAM-1, NCAM, and ICAM-1 levels in the plasma of participants with cognitive impairment (44 patients with mild cognitive impairment, 71 patients with Alzheimer's dementia, and 18 patients with other dementia) and 28 controls with normal cognitive ability. We also detected plasma levels of multiple inflammatory factors (IFN-gamma, IL-18, IL-1beta, IL-13, IL-8, IL-7, CCL11, MCP-1, TSLP, IL-10, BDNF, IL-17, IL-5, TREM-1) using Multiplex liquid chip and plasma levels of Abeta1-42 and Abeta1-40 using liquid-phase flow cytometry (FCM). Our findings demonstrated a correlation of ALCAM and VCAM-1 with age, the severity of cognitive decline, and MTA, but no significant difference between groups for NCAM and ICAM-1. ALCAM and VCAM-1 both demonstrated a positive correlation with the degree of atrophy in the medial temporal lobe structure. Further analysis revealed no significant correlation in plasma between VCAM-1, ALCAM and Abeta1-40, Abeta1-42. Nevertheless, there was a significant correlation between VCAM-1, ALCAM and many inflammatory factors. Furthermore, the predictive value of ALCAM and VCAM-1 for AD was assessed using a multi-parameter regression model. ALCAM and VCAM-1 in combination with ApoE4, education, age, and MMSE could predict AD with high precision (AUC=0.891; AIC=146.9) without imaging diagnosis. ALCAM and VCAM-1 combination improved the predictive accuracy significantly. In a nutshell, these findings revealed ALCAM and VCAM-1 as reliable indicators of Alzheimer's disease.

Postoperative delirium and neurocognitive disorders

PURPOSE OF REVIEW

Postoperative neurocognitive disorders (NCD) are significant causes of morbidity and mortality. In this paper, we will review our understanding and potential management of postoperative NCD.

RECENT FINDINGS

Postoperative delirium, delayed neurocognitive recovery and postoperative cognitive dysfunction (POCD) are recognized as a part of the continuous spectrum of postoperative NCD. Although the pathophysiology is still poorly understood, there is renewed focus on improving neurocognitive outcomes of aging surgical population. Novel methods of neurocognitive screening are developed and research in the prevention and management of NCD has gained traction.

SUMMARY

A spectrum of NCD exists in surgical patients ranging from postoperative delirium, delayed neurocognitive recovery, and POCD. Identification of patients at-risk for developing NCD can help target appropriate perioperative intervention. Also, specialized care teams and the implementation of standardized protocols are crucial for the successful management perioperative NCD. Finally, large, randomized, multicenter studies are needed to confirm benefits of preventive and treatment strategies.

HIV-Dementia Scale as a screening tool for the detection of subcortical cognitive deficits: validation of the Italian version

Mini-Mental State Examination (MMSE) lacks of sensitivity in detecting cognitive deficits associated with subcortical damage. The HIV-Dementia Scale (HDS), a screening tool originally created for detecting cognitive impairment due to subcortical damage in HIV + patients, has proved to be useful in other neurological diseases. Until now, an Italian version of the HDS is not available. We aimed at: (1) validating the HDS Italian version (HDS-IT) in a cohort of cognitively healthy subjects (CN); (2) exploring the suitability of HDS-IT in detecting cognitive impairment due to subcortical damage (scCI). The psychometric properties of the HDS-IT were assessed in 180 CN (mean age 67.6 ± 8.3, range 41-84) with regard to item-total correlation, test-retest reliability and convergent validity with MMSE. Item-total correlations ranged 0.44-0.72. Test-retest reliability was 0.70 (p < 0.001). The HDS-IT scores were positively associated with MMSE score (rS = 0.49, p < 0.001). Then, both the HDS-IT and the MMSE were administered to 44 scCI subjects (mean age 64.9 ± 10.6, range 41-84). Mean HDS-IT total score was close to the original version and significantly lower in the scCI group compared to CN (8.6 ± 3.6 vs. 12.6 ± 2.5, p < 0.001). ROC analysis yielded an optimal cutoff value of 11, with sensitivity of 0.70 and specificity of 0.82. Patients showed poorer scores on HDS-IT compared to CN (12.6 ± 2.5 vs. 8.6 ± 3.6, p < 0.001). Our results support the use of HDS-IT as a screening tool suitable for detecting cognitive deficits with prevalent subcortical pattern, being complementary to MMSE in clinical practice.

The montreal cognitive assessment and mini-mental state examination visuoexecutive subtests in acute ischemic stroke patients and their correlations with demographic and clinical factors

Visuoexecutive impairment is common among acute ischemic stroke patients. This study aimed to examine the ability of the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) visuoexecutive subtests to detect visuoexecutive abnormality in acute ischemic stroke patients and to identify the predictors for their impairments. 336 patients who completed the MMSE and MoCA were enrolled in this study. We compared the proportion of participants with incorrect MoCA visuoexecutive tasks and MMSE pentagon copying. Multivariate logistic regression analysis was used to evaluate the associations between the visuoexecutive dysfunction and demographic and clinical characteristics in the samples. Among all the participants, the MoCA detected more visuoexecutive dysfunction than the MMSE (88.69% vs. 45.83%, respectively; p < 0.001). The predictors identified by the univariate analysis included the factors of gender, age, educational level, smoking, alcohol consumption, Oxfordshire Community Stroke Project (OCSP), previous strokes, initial NIHSS score and number of old lacunar infarctions, while from the multivariate logistic regression analysis, the factors of age, educational level, NIHSS score, previous strokes and number of old lacunar infarctions served as predictive factors for the visuoexecutive impairment in acute stroke patients. In conclusion, visuoexecutive impairment is associated with the factors of the educational level, stroke severity, stroke history and number of old lacunar infarctions. Our findings may guide the clinicians to intervene the risks for the patients at an early stage after stroke and form the basis for good rehabilitation plans.

Cognitive disorders in patients with chronic kidney disease: specificities of clinical assessment

Neurocognitive disorders are frequent among chronic kidney disease (CKD) patients. Identifying and characterizing cognitive impairment (CI) can help to assess the ability of adherence to CKD risk reduction strategy, identify potentially reversible causes of cognitive decline, modify pharmacotherapy, educate the patient and caregiver and provide appropriate patient and caregiver support. Numerous factors are associated with the development and progression of CI in CKD patients and various conditions can influence the results of cognitive assessment in these patients. Here we review clinical warning signs that should lead to cognitive screening; conditions frequent in CKD at risk to interfere with cognitive testing or performance, including specificities of cognitive assessment in dialysis patients or after kidney transplantation; and available tests for screening and observed cognitive patterns in CKD patients.

Comparison of cognitive performance between patients with Parkinson's disease and dystonia using an intraoperative recognition memory test

Neuroscientific studies on the function of the basal ganglia often examine the behavioral performance of patients with movement disorders, such as Parkinson’s disease (PD) and dystonia (DT), while simultaneously examining the underlying electrophysiological activity during deep brain stimulation surgery. Nevertheless, to date, there have been no studies comparing the cognitive performance of PD and DT patients during surgery. In this study, we assessed the memory function of PD and DT patients with the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE). We also tested their cognitive performance during the surgery using a continuous recognition memory test. The results of the MoCA and MMSE failed to reveal significant differences between the PD and DT patients. Additionally, no significant difference was detected by the intraoperative memory test between the PD and DT patients. The intraoperative memory test scores were highly correlated with the MMSE scores and MoCA scores. Our data suggest that DT patients perform similarly to PD patients in cognitive tests during surgery, and intraoperative memory tests can be used as a quick memory assessment tool during surgery.

Anatomical Brain Changes and Cognitive Abilities in Patients with Obstructive Sleep Apnea Syndrome and Nonalcoholic Fatty Liver Disease

Obstructive sleep apnea (OSA) is characterized by repetitive complete or partial collapse of the upper airway and reduction of airflow during sleep. It is associated with significantly increased daytime muscle sympathetic nerve activity thought to result from the repetitive intermittent periods of hypoxemia during sleep and brain alterations that are likely to result. Different brain regions are affected by subsequent hypoxia/anoxia. Neurodegenerative processes result in measurable atrophy of cortical gray matter in the temporal lobes and posterior cingulate cortex, as well as in subcortical structures such as the hippocampus, amygdala, and thalamus. This study involved a group of firstly diagnosed, therapy-naive, nonalcoholic fatty liver disease (NAFLD) patients, out of which 144 (96 males and 48 females), aged 34-57 (mean 47.88 ± 6.07), satisfied the recruiting criteria for the study and control groups. All the patients underwent MRI scanning, polysomnography testing, and cognitive evaluation. Cognitively, worse results were obtained in the group with OSA (p < 0.05) and NAFLD (p=0.047). A significant decrease in volumes of cortical and subcortical structures was revealed (p < 0.001). In conclusion, brain deterioration followed by cognitive impairment is, most likely, the result of intermittent hypoxia and anoxia episodes that initiate the domino process of deteriorating biochemical reactions in the brain.

A comparison of the Mini-Mental State Examination (MMSE) with the Montreal Cognitive Assessment (MoCA) for mild cognitive impairment screening in Chinese middle-aged and older population: a cross-sectional study

BACKGROUND

The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are the most commonly used scales to detect mild cognitive impairment (MCI) in population-based epidemiologic studies. However, their comparison on which is best suited to assess cognition is scarce in samples from multiple regions of China.

METHODS

We conducted a cross-sectional analysis of 4923 adults aged ≥55 years from the Community-based Cohort Study on Nervous System Diseases. Objective cognition was assessed by Chinese versions of MMSE and MoCA, and total score and subscores of cognitive domains were calculated for each. Education-specific cutoffs of total score were used to diagnose MCI. Demographic and health-related characteristics were collected by questionnaires. Correlation and agreement for MCI between MMSE and MoCA were analyzed; group differences in cognition were evaluated; and multiple logistic regression model was used to clarify risk factors for MCI.

RESULTS

The overall MCI prevalence was 28.6% for MMSE and 36.2% for MoCA. MMSE had good correlation with MoCA (Spearman correlation coefficient = 0.8374, p < 0.0001) and moderate agreement for detecting MCI with Kappa value of 0.5973 (p < 0.0001). Ceiling effect for MCI was less frequent using MoCA versus MMSE according to the distribution of total score. Percentage of relative standard deviation, the measure of inter-individual variance, for MoCA (26.9%) was greater than for MMSE (19.0%) overall (p < 0.0001). Increasing age (MMSE: OR = 2.073 for ≥75 years; MoCA: OR = 1.869 for≥75 years), female (OR = 1.280 for MMSE; OR = 1.163 for MoCA), living in county town (OR = 1.386 and 1.862 for MMSE and MoCA, respectively) or village (OR = 2.579 and 2.721 for MMSE and MoCA, respectively), smoking (OR = 1.373 and 1.288 for MMSE and MoCA, respectively), hypertension (MMSE: OR = 1.278; MoCA: OR = 1.208) and depression (MMSE: OR = 1.465; MoCA: OR = 1.350) were independently associated with greater likelihood of MCI compared to corresponding reference group in both scales (all p < 0.05).

CONCLUSIONS

MoCA is a better measure of cognitive function due to lack of ceiling effect and with good detection of cognitive heterogeneity. MCI prevalence is higher using MoCA compared to MMSE. Both tools identify concordantly modifiable factors for MCI, which provide important evidence for establishing intervention measures.