Microstructural damage of normal-appearing white matter in subcortical ischemic vascular dementia is associated with Montreal Cognitive Assessment scores

Clinical characteristics of cerebral vascular dementia and early diagnostic value of cranial nuclear magnetic resonance

Objective

This study aimed to observe the diagnostic value of cranial magnetic resonance imaging (MRI) in patients with vascular dementia induced by ischemic stroke.

Methods

The experiment was designed according to the randomized control principle. Two hundred and eighty patients with ischemic stroke who were admitted to Gucheng County Hospital between June 2019 and June 2021 were selected as research subjects. Patients without vascular dementia after stroke were included in the control group, and patients with vascular dementia after stroke were included in the observation group. The cranial MRI was performed in both groups.

Result

Proportions of patients with large and moderate infarct lesions in brain tissues were significantly higher in the observation group than the control group. The data variation of relevant MRI detection indicators of the observation group was more obvious than that of the control group (P<0.05). The mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) scores of the observation group were lower than those of the control group (P<0.05), but the HIS score was higher (P>0.05). Patients with changes in brain morphology were more in the observation group than the control group (P<0.05).

Conclusion

Patients with vascular dementia induced by ischemic stroke are characterized by cortical atrophy, widening of the cerebral sulcus, large infarct lesion area and sparse cerebral white matter. Cranial MRI can effectively identify these features. The application of cranial MRI has some clinical values for early treatment and prognostic assessment.

Sex differences in mild vascular cognitive impairment: A multimodal transcranial magnetic stimulation study

BACKGROUND

Sex differences in vascular cognitive impairment (VCI) at risk for future dementia are still debatable. Transcranial magnetic stimulation (TMS) is used to evaluate cortical excitability and the underlying transmission pathways, although a direct comparison between males and females with mild VCI is lacking.

METHODS

Sixty patients (33 females) underwent clinical, psychopathological, functional, and TMS assessment. Measures of interest consisted of: resting motor threshold, latency of motor evoked potentials (MEPs), contralateral silent period, amplitude ratio, central motor conduction time (CMCT), including the F wave technique (CMCT-F), short-interval intracortical inhibition (SICI), intracortical facilitation, and short-latency afferent inhibition, at different interstimulus intervals (ISIs).

RESULTS

Males and females were comparable for age, education, vascular burden, and neuropsychiatric symptoms. Males scored worse at global cognitive tests, executive functioning, and independence scales. MEP latency was significantly longer in males, from both sides, as well CMCT and CMCT-F from the left hemisphere; a lower SICI at ISI of 3 ms from the right hemisphere was also found. After correction for demographic and anthropometric features, the effect of sex remained statistically significant for MEP latency, bilaterally, and for CMCT-F and SICI. The presence of diabetes, MEP latency bilaterally, and both CMCT and CMCT-F from the right hemisphere inversely correlated with executive functioning, whereas TMS did not correlate with vascular burden.

CONCLUSIONS

We confirm the worse cognitive profile and functional status of males with mild VCI compared to females and first highlight sex-specific changes in intracortical and cortico-spinal excitability to multimodal TMS in this population. This points to some TMS measures as potential markers of cognitive impairment, as well as targets for new drugs and neuromodulation therapies.

Contrast agent-free state-of-the-art magnetic resonance imaging on cerebral small vessel disease - Part 2: Diffusion tensor imaging and functional magnetic resonance imaging

Cerebral small vessel disease (cSVD) has been widely studied using conventional magnetic resonance imaging (MRI) methods, although the association between MRI findings and clinical features of cSVD is not always concordant. We assessed the additional contribution of contrast agent-free, state-of-the-art MRI techniques, particularly diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI), to understand brain damage and structural and functional connectivity impairment related to cSVD. We performed a review following the PICOS worksheet and Search Strategy, including 152 original papers in English, published from 2000 to 2022. For each MRI method, we extracted information about their contributions regarding the origins, pathology, markers, and clinical outcomes in cSVD. In general, DTI studies have shown that changes in mean, radial, and axial diffusivity measures are related to the presence of cSVD. In addition to the classical deficit in executive functions and processing speed, fMRI studies indicate connectivity dysfunctions in other domains, such as sensorimotor, memory, and attention. Neuroimaging metrics have been correlated with the diagnosis, prognosis, and rehabilitation of patients with cSVD. In short, the application of contrast agent-free, state-of-the-art MRI techniques has provided a complete picture of cSVD markers and tools to explore questions that have not yet been clarified about this clinical condition. Longitudinal studies are desirable to look for causal relationships between image biomarkers and clinical outcomes.

Montreal Cognitive Assessment of cognitive dysfunction after basal ganglia stroke

Objective

The Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive dysfunction after basal ganglia stroke, and factors affecting total MoCA score were examined.

Methods

Data were retrospectively analyzed for 30 patients with basal ganglia intracerebral hemorrhage or basal ganglia cerebral infarction, who were admitted to The Second Affiliated Hospital of Fujian Traditional Medical University (Fujian, China) from January 2017 to March 2020. Cognitive impairment was assessed using the MoCA, and potential correlations were explored between clinicodemographic characteristics (sex, age, stroke location and etiology) and MoCA dimensions or total MoCA score.

Results

Univariate linear regression showed that the total MoCA score was significantly associated with sex, age, executive function, naming, attention, abstract generalization ability, memory ability, and visuospatial orientation. However, multivariate linear regression identified only executive function, naming, attention, memory ability, and visuospatial orientation as significantly associated with the total MoCA score.

Conclusions

We showed that the MoCA test can be used for patients with basal ganglia stroke. The total MoCA score of basal ganglia stroke was significantly associated with impairments in executive function, naming, attention, memory ability, and visuospatial orientation.

Brain Age Difference at Baseline Predicts Clinical Dementia Rating Change in Approximately Two Years

BACKGROUND

The Clinical Dementia Rating (CDR) has been widely used to assess dementia severity, but it is limited in predicting dementia progression, thus unable to advise preventive measures to those who are at high risk.

OBJECTIVE

Predicted age difference (PAD) was proposed to predict CDR change.

METHODS

All diffusion magnetic resonance imaging and CDR scores were obtained from the OASIS-3 databank. A brain age model was trained by a machine learning algorithm using the imaging data of 258 cognitively healthy adults. Two diffusion indices, i.e., mean diffusivity and fractional anisotropy, over the whole brain white matter were extracted to serve as the features for model training. The validated brain age model was applied to a longitudinal cohort of 217 participants who had CDR = 0 (CDR0), 0.5 (CDR0.5), and 1 (CDR1) at baseline. Participants were grouped according to different baseline CDR and their subsequent CDR in approximately 2 years of follow-up. PAD was compared between different groups with multiple comparison correction.

RESULTS

PADs were significantly different among participants with different baseline CDRs. PAD in participants with relatively stable CDR0.5 was significantly smaller than PAD in participants who had CDR0.5 at baseline but converted to CDR1 in the follow-up. Similarly, participants with relatively stable CDR0 had significantly smaller PAD than those who were CDR0 at baseline but converted to CDR0.5 in the follow-up.

CONCLUSION

Our results imply that PAD might be a potential imaging biomarker for predicting CDR outcomes in patients with CDR0 or CDR0.5.

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

BACKGROUND

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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