Safety and feasibility of optimized transcranial direct current stimulation in patients with mild cognitive impairment due to Alzheimer's disease: a multicenter study protocol for a randomized controlled trial

Introduction

Transcranial direct current stimulation (tDCS) may effectively preserve and improve cognitive function in patients with mild cognitive impairment (MCI). Research has shown that Individual brain characteristics can influence the effects of tDCS. Computer three-dimensional brain modeling based on magnetic resonance imaging (MRI) has been suggested as an alternative for determining the most accurate tDCS electrode position based on the patients' individual brain characteristics to enhance tDCS effects. Therefore, this study aims to determine the feasibility and safety of applying tDCS treatment using optimized and personalized tDCS electrode positions in patients with Alzheimer's disease (AD)-induced MCI using computer modeling and compare the results with those of a sham group to improve cognitive function.

Method

A prospective active-sham group feasibility study was set to recruit 40 participants, who will be randomized into Optimized-tDCS and Sham-tDCS groups. The parameters for tDCS will be 2 mA (disk electrodes R = 1.5 cm) for 30 min during two sets of 15 sessions (2 weeks of resting period in between), using two electrodes in pairs. Using computer modeling, the tDCS electrode positions of each participant will be personalized. Outcome measurements are going to be obtained at three points: baseline, first post-test, and second post-test. The AD assessment scale-cognitive subscale (ADAS-Cog) and the Korean version of Mini-Mental State Examination (K-MMSE), together with other secondary outcomes and safety tests will be used.

Discussion

For the present study, we hypothesize that compared to a sham group, the optimized personalized tDCS application would be effective in improving the cognitive function of patients with AD-induced MCI and the participants would tolerate the tDCS intervention without any significant adverse effects.Clinical trial registration: https://cris.nih.go.kr, identifier [KCT0008918].

Comparing Montreal Cognitive Assessment Performance in Parkinson's Disease Patients: Age- and Education-Adjusted Cutoffs vs. Machine Learning

OBJECTIVE

The Montreal Cognitive Assessment (MoCA) is recommended for general cognitive evaluation in Parkinson's disease (PD) patients. However, age- and education-adjusted cutoffs specifically for PD have not been developed or systematically validated across PD cohorts with diverse education levels.

METHODS

In this retrospective analysis, we utilized data from 1,293 Korean patients with PD whose cognitive diagnoses were determined through comprehensive neuropsychological assessments. Age- and education-adjusted cutoffs were formulated based on 1,202 patients with PD. To identify the optimal machine learning model, clinical parameters and MoCA domain scores from 416 patients with PD were used. Comparative analyses between machine learning.

METHODS

and different cutoff criteria were conducted on an additional 91 consecutive patients with PD.

RESULTS

The cutoffs for cognitive impairment decrease with increasing age within the same education level. Similarly, lower education levels within the same age group correspond to lower cutoffs. For individuals aged 60-80 years, cutoffs were set as follows: 25 or 24 years for those with more than 12 years of education, 23 or 22 years for 10-12 years, and 21 or 20 years for 7-9 years. Comparisons between age- and education-adjusted cutoffs and the machine learning method showed comparable accuracies. The cutoff method resulted in a higher sensitivity (0.8627), whereas machine learning yielded higher specificity (0.8250).

CONCLUSION

Both the age- and education-adjusted cutoff.

METHODS

and machine learning.

METHODS

demonstrated high effectiveness in detecting cognitive impairment in PD patients. This study highlights the necessity of tailored cutoffs and suggests the potential of machine learning to improve cognitive assessment in PD patients.

The Effects of Music-Based Auditory Training on Hearing-Impaired Older Adults With Mild Cognitive Impairment

OBJECTIVES

The present study aimed to determine the effect of music-based auditory training on older adults with hearing loss and decreased cognitive ability, which are common conditions in the older population.

METHODS

In total, 20 older adults diagnosed with both mild-to-moderately severe hearing loss and mild cognitive impairment (MCI) participated. Half of this group were randomly assigned to the auditory training group (ATG), and the other half were designated as the control group (CG). For the ATG, a 40-minute training session (10 minutes for singing a song, 15 minutes for playing instruments, and 15 minutes for playing games with music discrimination) was conducted twice a week for 8 weeks (for a total of 16 sessions). To confirm the training effects, all participants were given tests pre- and post-training, and then a follow-up test was administered 2 weeks after the training, using various auditory and cognitive tests and a self-reporting questionnaire.

RESULTS

The ATG demonstrated significant improvement in all auditory test scores compared to the CG. Additionally, there was a notable enhancement in cognitive test scores post-training, except for the digit span tests. However, there was no statistically significant difference in the questionnaire scores between the two groups, although the ATG did score higher post-training.

CONCLUSION

The music-based auditory training resulted in a significant improvement in auditory function and a partial enhancement in cognitive ability among elderly patients with hearing loss and MCI. We anticipate that this music-based approach will be adopted for auditory training in clinical settings due to its engaging and easy-to-follow nature.

The Korean Version of the Oxford Cognitive Screen (K-OCS) Normative Study

OBJECTIVE

To generate a Korean version of the Oxford Cognitive Screen (K-OCS) and obtain cutoff scores that determine the impairment of each subdomain. Post-stroke cognitive impairment (PSCI) negatively impacts the rehabilitation process and independence in daily life. Its obscure manifestations require effective screening for appropriate rehabilitation. However, in most rehabilitation clinics, psychological evaluation tools for Alzheimer's dementia have been used without such considerations. The OCS is a screening assessment tool for PSCI and vascular dementia that can evaluate the cognitive domains most often affected by stroke, including language, attention, memory, praxis, and numerical cognition. It comprises 10 subtasks and enables quick and effective cognitive evaluation.

METHODS

The K-OCS, which considers Korea's unique cultural and linguistic characteristics, was developed with the approval and cooperation of the original author. Enrollment of participants without disabilities was announced at Duksung Women's University, Yongin Sevrance Hospital, CHA Bundang Medical Center. The study was conducted between September 2020 and March 2022 on 97 male and female participants aged ≥30 years.

RESULTS

All the 97 participants completed the task. In this study, the 5th percentile score was presumed to be the cutoff value for each score, and the values are provided here. The cutoff score for each OCS subtask was similar to that of the original British version.

CONCLUSION

We suggest the usability of the K-OCS as a screening tool for PSCI by providing the cutoff value of each subtask.

Preoperative mild cognitive impairment as a risk factor of postoperative cognitive dysfunction in elderly patients undergoing spine surgery

Introduction

Any persistent degree of cognitive impairment in older adults is a concern as it can progress to dementia. This study aimed to determine the incidence and risk factors for early postoperative cognitive dysfunction (POCD) in elderly patients undergoing spine surgery.

Methods

Patients were enrolled from a previous prospective observational study after screening for normal cognitive function using the Mini Mental State Examination (MMSE). Cognitive function was evaluated before surgery and at 1 week, month, and year post-surgery using MMSE and Montreal Cognitive Assessment scores (MoCA). Mild cognitive impairment (MCI) was determined using the MoCA scores adjusted for age. POCD was defined as a drop of three or more points on the MMSE 1 week post-surgery. Multivariate logistic analysis was performed to identify POCD risk factors.

Results

A total of 427 patients were included. Eighty-five (20%) had pre-existing MCI. The MCI group showed lower MoCA scores at each time point (baseline, 1 week after surgery, 1 month after surgery, 1 year after surgery) compared to the non-MCI group. Those in the MCI group had a higher rate of admission to intensive care unit after surgery, postoperative delirium, and POCD 1 week post-surgery, than those in the non-MCI group (16.5% vs. 6.7%, p = 0.008; 27.1% vs. 15.8%, p = 0.024; and 18.8% vs. 8.2%, p < 0.001, respectively). Among them, 10.3% were assessed for POCD on postoperative day 7 and self-reported poor social roles and physical functioning 1 week postoperatively.

Conclusion

Preoperative MCI was seen in ~20% of surgical patients aged >70 years. POCD was seen in ~20% of patients with pre-existing MCI, and ~ 10% of those without. Benzodiazepine use, significant comorbidities, pre-existing MCI, and depressive tendencies were risk factors for POCD.

Validation of the Short Form of Korean-Everyday Cognition (K-ECog)

BACKGROUND

Evaluating the activities of daily living (ADL) is an important factor for diagnosing dementia. The Everyday Cognition (ECog) scale was developed to measure ADL changes that were correlated with specific neuropsychological impairments. A short form of the ECog (ECog-12) was also developed, consisting of 12 items, two from each of the six cognitive domains of the ECog. The Korean full version of ECog (K-ECog) has recently been standardized, but the need for a shortened version has been raised in clinical practice. The purpose of this study was to develop a Korean version of ECog-12 (K-ECog-12) and to verify its reliability and validity by comparing those to the full version of K-ECog.

METHODS

The participants were 267 cognitively normal older adults (CN), 183 patients with mild cognitive impairment (MCI), and 89 patients with dementia. The Korean-Mini Mental State Examination (K-MMSE), Korean-Montreal Cognitive Assessment (K-MoCA), and Short form of Geriatric Depression Scale (SGDS) were administered to all participants. The K-ECog and Korean-Instrumental Activities of Daily Living (K-IADL) were rated by the informants of patients.

RESULTS

K-ECog-12 was newly constructed by replacing one item for the visuospatial function in the original ECog-12 with another one through an item response theory analysis on Korean data. The internal consistencies (Cronbach's α) of K-ECog-12 and K-ECog were 0.95 and 0.99, respectively. The test-retest reliabilities (Pearson's r) were 0.67 for K-ECog-12 and 0.73 for K-ECog. The K-ECog-12 was significantly correlated with K-ECog as well as K-IADL, K-MMSE, and K-MoCA. The K-ECog-12 scores differed significantly between the CN, MCI, and dementia groups, as did the K-ECog scores. Receiver operating characteristic curve analyses showed that K-ECog-12, like K-ECog, could differentiate MCI and dementia patients from CN as well.

CONCLUSION

The K-ECog-12 is as reliable and valid as the K-ECog in assessing ADL. Therefore, K-ECog-12 can be used as an alternative to the K-ECog in clinical and community settings in Korea.

High ApoB/ApoA-I Ratio Predicts Post-Stroke Cognitive Impairment in Acute Ischemic Stroke Patients with Large Artery Atherosclerosis

BACKGROUND

We aimed to investigate the association between the ApoB/ApoA-I ratio and post-stroke cognitive impairment (PSCI) in patients with acute stroke of large artery atherosclerosis etiology.

METHODS

Prospective stroke registry data were used to consecutively enroll patients with acute ischemic stroke due to large artery atherosclerosis. Cognitive function assessments were conducted 3 to 6 months after stroke. PSCI was defined as a z-score of less than -2 standard deviations from age, sex, and education-adjusted means in at least one cognitive domain. The ApoB/ApoA-I ratio was calculated, and patients were categorized into five groups according to quintiles of the ratio. Logistic regression analyses were performed to assess the association between quintiles of the ApoB/ApoA-I ratio and PSCI.

RESULTS

A total of 263 patients were included, with a mean age of 65.9 ± 11.6 years. The median NIHSS score and ApoB/ApoA-I ratio upon admission were 2 (IQR, 1-5) and 0.81 (IQR, 0.76-0.88), respectively. PSCI was observed in 91 (34.6%) patients. The highest quintile (Q5) of the ApoB/ApoA-I ratio was a significant predictor of PSCI compared to the lowest quintile (Q1) (adjusted OR, 3.16; 95% CI, 1.19-8.41; p-value = 0.021) after adjusting for relevant confounders. Patients in the Q5 group exhibited significantly worse performance in the frontal domain.

CONCLUSIONS

The ApoB/ApoA-I ratio in the acute stage of stroke independently predicted the development of PSCI at 3-6 months after stroke due to large artery atherosclerosis. Further, a high ApoB/ApoA-I ratio was specifically associated with frontal domain dysfunction.

Effect of Individual Virtual Reality Cognitive Training Programs on Cognitive Function and Depression in Middle-Aged Women: Randomized Controlled Trial

BACKGROUND

Given the increasing incidence of early-onset Alzheimer disease, strategies for early diagnosis and swift treatment interventions are crucial for mitigating cognitive problems in women and middle-aged individuals who face a high risk of cognitive impairment.

OBJECTIVE

This study aimed to assess the effectiveness of individual cognitive training programs based on virtual reality (VR), a nonpharmacological intervention, on cognitive function and depression in middle-aged women at risk of cognitive impairment. It used VR technology, which has recently been recognized as a promising tool.

METHODS

We administered a VR-based cognitive training program for 30 minutes daily, twice a week, for 12 weeks (24 sessions). This study included middle-aged women residing in older adults' welfare facilities in G-gu, Busan, from May to August 2021. A total of 60 participants were randomly divided into the training (n=30) and control (n=30) groups. Cognitive and depressive functions were assessed using the Korean versions of the Montreal Cognitive Assessment (K-MoCA), Digit Span Test (DST), Korean-Color Word Stroop Test (K-CWST), and Short Form of the Geriatric Depression Scale (SGDS-K) before the intervention. The training group underwent a VR-based cognitive training program, whereas the control group was educated to maintain regular daily activities. The same assessments were performed 12 weeks after treatment.

RESULTS

A comparison of the mean scores before and after K-MoCA in the training group revealed a significant increase from 24.87 (SD 2.62) to 27.50 (SD 1.70; P<.01), indicating substantial cognitive improvement. Similarly, the mean DST forward scores increased significantly from 6.97 (SD 1.10) to 7.90 (SD 1.18; P<.01), suggesting enhanced short-term auditory memory and attention. The mean DST backward scores also showed a significant improvement from 4.10 (SD 0.71) to 4.77 (SD 1.2; P=.01). Notably, the mean SGDS-K scores decreased significantly from 3.97 (SD 2.51) to 2.13 (SD 1.87; P<.01), indicating a reduction in depression within the training group.

CONCLUSIONS

The VR-based cognitive training programs significantly enhanced cognitive function and reduced depression in middle-aged women. Consequently, these programs are considered beneficial nonpharmacological cognitive training interventions for middle-aged women at high risk of cognitive impairment.

TRIAL REGISTRATION

UMIN Clinical Trials Registry UMIN000049752; https://tinyurl.com/z5du989z.

Machine learning-based prediction of post-stroke cognitive status using electroencephalography-derived brain network attributes

Objectives

More than half of patients with acute ischemic stroke develop post-stroke cognitive impairment (PSCI), a significant barrier to future neurological recovery. Thus, predicting cognitive trajectories post-AIS is crucial. Our primary objective is to determine whether brain network properties from electroencephalography (EEG) can predict post-stroke cognitive function using machine learning approach.

Methods

We enrolled consecutive stroke patients who underwent both EEG during the acute stroke phase and cognitive assessments 3 months post-stroke. We preprocessed acute stroke EEG data to eliminate low-quality epochs, then performed independent component analysis and quantified network characteristics using iSyncBrain®. Cognitive function was evaluated using the Montreal cognitive assessment (MoCA). We initially categorized participants based on the lateralization of their lesions and then developed machine learning models to predict cognitive status in the left and right hemisphere lesion groups.

Results

Eighty-seven patients were included, and the accuracy of lesion laterality prediction using EEG attributes was 97.0%. In the left hemispheric lesion group, the network attributes of the theta band were significantly correlated with MoCA scores, and higher global efficiency, clustering coefficient, and lower characteristic path length were associated with higher MoCA scores. Most features related to cognitive scores were selected from the frontal lobe. The predictive powers (R-squared) were 0.76 and 0.65 for the left and right stroke groups, respectively.

Conclusion

Estimating EEG-based network properties in the acute phase of ischemic stroke through a machine learning model has a potential to predict cognitive outcomes after ischemic stroke.

Assessment of Risk Factors for Postoperative Delirium in Older Adults Who Underwent Spinal Surgery and Identifying Associated Biomarkers Using Exosomal Protein

PURPOSE

With an increase in the aging population, the number of patients with degenerative spinal diseases undergoing surgery has risen, as has the incidence of postoperative delirium. This study aimed to investigate the risk factors affecting postoperative delirium in older adults who had undergone spine surgery and to identify the associated biomarkers.

METHODS

This study is a prospective study. Data of 100 patients aged ≥ 70 years who underwent spinal surgery were analyzed. Demographic data, medical history, clinical characteristics, cognitive function, depression symptoms, functional status, frailty, and nutritional status were investigated to identify the risk factors for delirium. The Confusion Assessment Method, Delirium Rating Scale-R-98, and Nursing Delirium Scale were also used for diagnosing delirium. To discover the biomarkers, urine extracellular vesicles (EVs) were analyzed for tau, ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), neurofilament light, and glial fibrillary acidic protein using digital immunoassay technology.

RESULTS

Nine patients were excluded, and data obtained from the remaining 91 were analyzed. Among them, 18 (19.8%) developed delirium. Differences were observed between participants with and without delirium in the contexts of a history of mental disorder and use of benzodiazepines (p = .005 and p = .026, respectively). Tau and UCH-L1-concentrations of urine EVs-were comparatively higher in participants with severe delirium than that in participants without delirium (p = .002 and p = .001, respectively).

CONCLUSION

These findings can assist clinicians in accurately identifying the risk factors before surgery, classifying high-risk patients, and predicting and detecting delirium in older patients. Moreover, urine EV analysis revealed that postoperative delirium following spinal surgery is most likely associated with brain damage.

Effect of Education on Discriminability of Montreal Cognitive Assessment Compared to Mini-Mental State Examination

Background and Purpose

The Montreal Cognitive Assessment (MoCA) has been known as a screening test for detecting mild cognitive impairment (MCI) better than Mini-Mental State Examination (MMSE). However, in previous domestic studies, no significant difference was found in the discriminability between MoCA and MMSE. Researchers have suggested that this might be because older Koreans are less educated than older Westerners. This study was conducted to examine the effect of education on the discriminability of MoCA compared to the MMSE.

Methods

Participants were 123 cognitively normal elderly, 118 with vascular MCI, 108 with amnestic MCI, 121 with vascular dementia, and 113 with dementia of the Alzheimer's type. The Korean-MoCA (K-MoCA) and Korean-MMSE (K-MMSE) were administered. Multiple regression analyses and receiver operating characteristic (ROC) curve analyses were performed.

Results

In all participants, education significantly affected both K-MoCA and K-MMSE scores along with age. The effect of education was re-examined by subgroup analysis after dividing subjects according to the level of education. Effect of education on K-MoCA and K-MMSE was only shown in the group with <9 years of education. ROC curve analyses revealed that the discriminability of K-MoCA to differentiate between vascular MCI and normal elderly was significantly higher than that of K-MMSE. When re-examining subgroups divided by education level, however, this higher discriminability of K-MoCA disappeared in the group with <9 years of education.

Conclusions

These results indicate no difference in discriminating cognitive deficits between K-MoCA and K-MMSE in Korean elderly with <9 years of education.

Physical and cognitive function to explain the quality of life among older adults with cognitive impairment: exploring cognitive function as a mediator

BACKGROUND

Physical and cognitive function are both indicators of aging, characterized by a loss of adaptive response to life challenges and functional limitations, subsequently affecting their quality of life. This study aimed to identify the direct effect of physical function and the indirect effect of cognitive function on the quality of life in older adults with mild cognitive impairment.

METHODS

The study participants were 79 older adults recruited from community centers in four urban districts of Korea. All participants completed a self-reported questionnaire for demographic characteristics and outcome variables. Outcome measures included physical function (grip strength, balance, and mobility), cognitive function, and mental and physical components of quality of life (QOL). Statistical analyses were conducted using hierarchical multiple linear regression and the PROCESS macro for mediation analysis.

RESULTS

The mean age of participants was 77.46 years old with an elementary or lower education level (53.2%). The mean score of cognitive function was 16.39 (SD = 6.5). Physical function (grip strength, balance, mobility) and cognitive function explained 25% of the variance in physical (p = 0.004) and 29% in mental (p < 0.001) components of QOL after controlling for age, sex, and education level. Mobility was associated with both physical (β=-0.27, p = 0.024) and mental (β=-0.36, p = 0.002) components of QOL. The cognitive function partially mediated the relationship between balance and the physical component of QOL; the proportion of mediation was 55%.

CONCLUSION

In conclusion, physical and cognitive function were significant predictors of QOL in older adults with cognitive impairment. Specifically, balance has significant indirect effects on the physical component of QOL through cognitive function as a mediator. Health-promoting strategies could be more effective when focusing on the direct effect of physical function as well as the mediating effect of cognitive function to promote the quality of life in this population.

Effects of Home Based Serious Game Training (Brain Talk™) in the Elderly With Mild Cognitive Impairment: Randomized, a Single-Blind, Controlled Trial

Mild cognitive impairment (MCI) increases with aging society. Serious games may be effective in improving cognitive function in patients with MCI; however, research on their effects remains insufficient. This study aimed to confirm the efficacy and safety of cognitive rehabilitation training using a serious game (Brain Talk™) for the elderly with MCI. Twenty-four elderly individuals with MCI were randomized into study and control groups. The study group received 12 training sessions (30 min/session, 3 times/week), whereas the control group did not receive training. Blinded evaluations were conducted before and after the training and four weeks after the training. The primary outcome measures were the Korean Mini-Mental State Examination (K-MMSE) and K-MoCA (Korean Montreal Cognitive Assessment). Secondary outcome measures were the Semantic Verbal Fluency Task (SVFT), Trail-Making Test-B, and 2-back test. In the study group, the K-MMSE, K-MoCA, and SVFT scores after finishing the training and 4 weeks after training showed a significant increase; however, there was no significant change in the control group. No significant differences were observed between the two groups. Cognitive function significantly improved in the study group after training. Home-based serious games are considered helpful in improving cognitive function.

A case study on the application evaluation of integrative medical service model for the improvement of quality of life for dementia patients and caregivers

BACKGROUND

Since 4 major diseases and geriatric diseases require consistent management, individuals with any of these diseases cannot live alone and need caregivers' assistance. Given these characteristics, an integrative medical service model for 4 major diseases and geriatric diseases was developed in Korea, currently. Dementia, one of the typical geriatric diseases, requires caregivers' assistance from the beginning because of its enormous burden. Thus, it is necessary to provide an integrative medical service that can improve the quality of life (QoL) for both patients and caregivers. Therefore, this study aims to collect various feedback by applying an integrative medical service, which was developed to improve the QoL in patients with dementia and their caregivers, to a single case, and to modify and improve the integrative medical service model based on the results.

METHOD/DESIGN

The integrative medical service program, which was developed to improve the QoL in patients with dementia and their caregivers in Korea, will be used for a patient-caregiver pair. This is an observational study with quantitative and qualitative feedback from various viewpoints. The program will be conducted in 8 sessions (twice a week, within 120 minutes). The patient will receive both Western and Korean medicine, and an integrative service will be provided to improve cognitive rehabilitation and QoL. Feedback collected at each session will be reflected on the program of the subsequent session.

RESULTS

This study will then modify and improve the program with feedback and provide integrative medical services to a patient with dementia and caregiver.

DISCUSSION

Patients with dementia need a program that would help them maintain cognitive function, and caregivers need a program that would improve their QoL by reducing the caregiving burden. This study is unique because the developed program is performed after modification based on feedback from the previous session. Accordingly, the patient and caregiver can check which program is the most satisfactory and helpful in improving their QoL. We expect that this study can modify the integrative medical service model to the optimized patient-based model. This study can also be used as basic data for a clinical pathway development study that applies the modified model to medical institutes.

Changes in sensory, postural stability and gait functions depending on cognitive decline, and possible markers for detection of cognitive status

Background

Numerous people never receive a formal dementia diagnosis. This issue can be addressed by early detection systems that utilize alternative forms of classification, such as gait, balance, and sensory function parameters. In the present study, said functions were compared between older adults with healthy cognition, older adults with low executive function, and older adults with cognitive impairment, to determine which parameters can be used to distinguish these groups.

Results

A group of cognitively healthy older men was found to have a significantly greater gait cadence than both the low executive function group (113.1 ± 6.8 vs. 108.0 ± 6.3 steps/min, p = 0.032) and the cognitively impaired group (113.1 ± 6.8 vs. 107.1 ± 7.4 steps/min, p = 0.009). The group with low executive function was found to have more gait stability than the impaired cognition group, represented by the single limb support phase (39.7 ± 1.2 vs. 38.6 ± 1.3%, p = 0.027). Additionally, the healthy cognition group had significantly greater overall postural stability than the impaired cognition group (0.6 ± 0.1 vs. 1.1 ± 0.1, p = 0.003), and the low executive function group had significantly greater mediolateral postural stability than the impaired cognition group (0.2 ± 0.1 vs. 0.6 ± 0.6, p = 0.012). The low executive function group had fewer mistakes on the sentence recognition test than the cognitively impaired (2.2 ± 3.6 vs. 5.9 ± 6.4, p = 0.005). There were no significant differences in visual capacity, however, the low executive function group displayed an overall greatest ability.

Conclusions

Older adults with low executive function showcased a lower walking pace, but their postural stability and sensory functions did not differ from those of the older adults with healthy cognition. The variables concluded as good cognitive status markers were (1) gait cadence for dividing cognitively healthy from the rest and (2) single limb support portion, mediolateral stability index, and the number of mistakes on the sentence recognition test for discerning between the low executive function and cognitive impairment groups.

Post-intensive care syndrome and health-related quality of life in long-term survivors of intensive care unit

OBJECTIVE

The objective of this study was to provide preliminary data for improving the health-related quality of life of long-term intensive care unit survivors by identifying the relationship between health-related quality of life and post-intensive care syndrome.

METHODS

Using a descriptive correlation research design, data from patients who visited the outpatient department for continuous treatment after discharge from the intensive care unit were analysed. Post-intensive care syndrome was measured by physical, cognitive, and mental problems. Data were collected from 1st August to 31st December, 2019, and 121 intensive care unit survivors participated in the study.

RESULTS

Health-related quality of life showed a negative correlation with physical, mental, and cognitive problems. The factors associated with health-related quality of life were physical and mental problems, education level, sedatives and neuromuscular relaxants, and marital status.

CONCLUSIONS

To improve the health-related quality of life of intensive care unit survivors, post-intensive care syndrome prevention is important, and a systematic strategy is required through a long-term longitudinal trace study. In addition, intensive care unit nurses and other healthcare professionals need to provide early interventions to reduce post-intensive care syndrome.

Correlations between COMT polymorphism and brain structure and cognition in elderly subjects: An observational study

The catechol-O-methyltransferase (COMT) gene has been noted to play an important role in individual variations in the aging process. We investigated whether COMT polymorphism could influence cognition related to white matter networks. More specifically, we examined whether methionine (Met) allele loading is associated with better individual cognitive performance. Thirty-four healthy elderly participants were recruited; each participant's COMT genotype was determined, and Korean version of Montreal Cognitive Assessment scores and a diffusion tensor image were obtained for all participants. The Met carrier group showed significantly lower mean diffusivity, axial diffusivity, and radial diffusivity values for the right hippocampus, thalamus, uncinate fasciculus, and left caudate nucleus than the valine homozygote group. The Met carrier group also scored higher for executive function and attention on the Korean version of Montreal Cognitive Assessment. Based on these results, we can assume that the COMT Met allele has a protective effect on cognitive decline contributing to individual differences in cognitive function in late life period.

Comparison of Montreal Cognitive Assessment in Korean Version for Predicting Mild Cognitive Assessment in 65-Year and Over Individuals

Objectives

The purpose of this study was to compare the validity and reliability of the two Korean versions of the MoCA for individuals aged ≥65 years.

Methods

A total of 185 participants aged ≥65 years were included in this cross-sectional study. This study investigated the reliability of the two Korean versions of the MoCA (the MoCA-K and MoCA-K2) by having each participant complete both assessments twice and comparing them to their Korean version of the Mini-Mental State Exam (MMSE-K) scores. The participants either completed the tests in order A (MoCA-K2 before MoCA-K) then B (MoCA-K before MoCA-K2) or vice versa. The tests were then completed in the opposite order. This study conducted all experiments at 3-day intervals.

Results

Of the 185 total participants analyzed, 95 indicated cognitive impairment, while 90 had normal in MoCA-K scores; 50 demonstrated cognitive impairment, while 135 had normal in MMSE-K scores; and 101 and 84 participants showed cognitive impairment and normal in MoCA-K2 scores, respectively. Cronbach's α values were 0.929 for the MoCA-K, 0.774 for the MMSE-K, and 0.919 for the MoCA-K2. The mean scores were 22.37, 25.29, and 21.96 points for the MoCA-K, MMSE-K, and MoCA-K2, respectively. The sensitivity and the specificity of the MoCA-K were 77.0% and 78.0%, respectively, while those of the MoCA-K2 were 68.9% and 80.0%, respectively.

Conclusions

These results suggest that both the MoCA-K and MoCA-K2 are suitable and reliable evaluation tools for MCI screening; however, the MoCA-K had better overall sensitivity and specificity.

A combination of multiple autoantibodies is associated with the risk of Alzheimer’s disease and cognitive impairment

Autoantibodies are self-antigen reactive antibodies that play diverse roles in the normal immune system, tissue homeostasis, and autoimmune and neurodegenerative diseases. Anti-neuronal autoantibodies have been detected in neurodegenerative disease serum, with unclear significance. To identify diagnostic biomarkers of Alzheimer’s disease (AD), we analyzed serum autoantibody profiles of the HuProt proteome microarray using the discovery set of cognitively normal control (NC, n = 5) and AD (n = 5) subjects. Approximately 1.5-fold higher numbers of autoantibodies were detected in the AD group (98.0 ± 39.9/person) than the NC group (66.0 ± 39.6/person). Of the autoantigen candidates detected in the HuProt microarray, five autoantigens were finally selected for the ELISA-based validation experiment using the validation set including age- and gender-matched normal (NC, n = 44), mild cognitive impairment (MCI, n = 44) and AD (n = 44) subjects. The serum levels of four autoantibodies including anti-ATCAY, HIST1H3F, NME7 and PAIP2 IgG were significantly different among NC, MCI and/or AD groups. Specifically, the anti-ATCAY autoantibody level was significantly higher in the AD (p = 0.003) and MCI (p = 0.015) groups compared to the NC group. The anti-ATCAY autoantibody level was also significantly correlated with neuropsychological scores of MMSE (rs = − 0.229, p = 0.012), K-MoCA (rs = − 0.270, p = 0.003), and CDR scores (rs = 0.218, p = 0.016). In addition, a single or combined occurrence frequency of anti-ATCAY and anti-PAIP2 autoantibodies was significantly associated with the risk of MCI and AD. This study indicates that anti-ATCAY and anti-PAIP2 autoantibodies could be a potential diagnostic biomarker of AD.

Reliability and Validity of the Subjective Cognitive Complaints Questionnaire for Parkinson’s Disease (SCCQ-PD)

Background and Purpose

Subjective cognitive complaints (SCCs) are gaining attention as a self-perceived symptom for cognitive impairment in patients with Parkinson’s disease (PD), but there are few suitable tools for assessing SCCs in PD. This study aimed to develop and validate a questionnaire for assessing SCCs in PD, called the Subjective Cognitive Complaints Questionnaire for Parkinson’s Disease (SCCQ-PD).

Methods

The SCCQ-PD consists of 12 yes/no questions on subjective cognitive function, and the questionnaire was completed by patients with PD (score-P) and their caregivers (score-C). The cognitive function of patients was examined using comprehensive neuropsychological tests.

Results

This study included 73 patients (38 cognitively normal, 25 with mild cognitive impairment [MCI], and 10 demented) and their caregivers. Score-P and score-C had excellent reliability (Kuder-Richardson formula 20 coefficients of 0.893 and 0.931, respectively), and the scores exhibited a strong intercorrelation. Both score-P and score-C were negatively correlated with cognitive performance, and both were excellent in discriminating demented patients from those with normal cognition or MCI (areas under the receiver operating characteristic curve of 0.83 and 0.88, respectively).

Conclusions

The SCCQ-PD is a reliable tool for assessing SCCs in patients with PD. SCCs measured using the SCCQ-PD are correlated with objective cognitive decline and useful for discriminating demented patients from nondemented patients.

Validation of Four Methods for Converting Scores on the Montreal Cognitive Assessment to Scores on the Mini-Mental State Examination-2

Background and Purpose

There are many methods for converting scores from the Montreal Cognitive Assessment (MoCA) to those on the Mini-Mental State Examination (MMSE). In this study we aimed to validate 4 methods that convert the full score range (0–30 points) of the MoCA to an equivalent range for the MMSE.

Methods

We examined the medical records of 506 subjects who completed the MoCA and MMSE-second edition (MMSE-2) on the same day. For the validation index, we calculated mean, median, and root-mean-squared error (RMSE) of the difference between true and equivalent MMSE-2 scores. We also calculated intraclass correlation coefficients (ICCs), the Bland-Altman plot, and the generalizability coefficient between true and equivalent MMSE-2 scores for reliability. We compared the ICCs according to age, sex, education, MMSE, and cognitive-status subgroups. For accuracy, we evaluated a ±2 point difference between the true and equivalent MMSE-2 scores.

Results

The 4 conversion methods had a mean of −0.79 to −0.05, a median of −1 to 0, and an RMSE of 2.61–2.94 between true and equivalent MMSE-2 scores. All conversion methods had excellent reliability, with an ICC greater than 0.75 between true and equivalent MMSE-2 scores. These results were almost maintained in the subgroup analyses. These conversion methods provided more than 65% accuracy within ±2 points of the true MMSE-2 scores.

Conclusions

We suggest that these 4 conversion methods are applicable for converting MoCA scores to MMSE-2 scores. They will greatly enhance the usefulness of existing cognitive data in clinical and research settings.

Measurement of Subjective Cognitive Decline (SCD) Using Korean-Everyday Cognition (K-ECog) as a Screening Tool: a Feasibility Study

Background and Purpose

Everyday Cognition (ECog) has been widely used to differentiate individuals with mild cognitive impairment (MCI) and dementia from normal elderly individuals. It has also been used to assess subjective cognitive decline (SCD). This study investigated the feasibility of using ECog as a screening measure for SCD in community-dwelling elderly individuals.

Methods

The participants included 84 older adults with and 93 without SCD living in the community. These 2 groups were classified based on their response (“yes” or “no”) to the question “Do you perceive memory or cognitive difficulties?” All participants were evaluated using the Korean-Mini Mental State Examination (K-MMSE), Short form of the Geriatric Depression Scale (SGDS), and the Korean version of Everyday Cognition (K-ECog).

Results

The scores of all participants were within the normal range on the K-MMSE and SGDS. The total K-MMSE score did not differ significantly between the 2 groups after controlling for age, education, and depression. The scores of SCD group were significantly higher than those of the non-SCD group for memory, language, and executive function: planning domains, as well as K-ECog total score. Receiver operating characteristic curve analysis revealed that the K-ECog total score was effective in moderately differentiating between subjects with and without SCD (area under the curve: 0.73).

Conclusions

ECog is a feasible and useful screening measure for SCD in older adults living in the community, and can be used to assess the full spectrum of cognitive and functional deficits, ranging from SCD to MCI and dementia.

Plasma neurofilament light chain level and orthostatic hypotension in early Parkinson's disease

To delineate the impact of non-motor markers (REM sleep behavior disorder (RBD), orthostatic hypotension (OH), cardiac sympathetic denervation, hyposmia) on neuronal injury in early-stage Parkinson's disease (PD), we measured the plasma neurofilament light chain (NFL) level of PD patients and evaluated its relationship with these markers. The study population comprised a cohort of 77 patients with PD and 54 controls. OH was assessed using 5-min head-up tilt-table test. Other clinical parameters such as RBD, Unified Parkinson's Disease Rating Scale (UPDRS), cognition, Cross-Cultural Smell Identification Test (CCSIT), white matter hyperintensity (WMH), cardiac metaiodobenzylguanidine (MIBG) and striatal dopamine transporter (DAT) uptake were assessed. Plasma NFL levels were measured using Simoa platform. During mean 24.8 months of follow-up, 70 patients remained PD, 5 patients converted to Parkinson-plus syndrome (P + converter), and 2 were lost to follow-up. NFL level did not differ between PD and control groups (age-adjusted means 10.40 pg/mL vs 9.51 pg/mL, p = 0.151), but PD patients with OH (median 15.31 pg/mL) had higher levels compared with those without OH (median 9.2 pg/mL, p = 0.008), as well as the control group (median 9.7 pg/mL, p = 0.002). P + converter group had the highest plasma NFL level (38.17 pg/mL, p < 0.001). In a multiple regression analysis, OH, age, and disease duration independently correlated with plasma NFL level. This finding adds biomarker-based evidence for poor clinical outcomes associated with OH in patients with PD.

Validity of the Montreal Cognitive Assessment (MoCA) Index Scores: a Comparison with the Cognitive Domain Scores of the Seoul Neuropsychological Screening Battery (SNSB)

Background and Purpose

A new approach was proposed to score the Montreal Cognitive Assessment (MoCA) index scores for 6 cognitive domains: orientation (OIS), attention (AIS), language (LIS), visuospatial function (VIS), memory (MIS), and executive function (EIS). This study investigated whether the MoCA index scores represent the functions of each cognitive domain by examining the correlations with the corresponding cognitive domain scores derived from conventional neuropsychological tests included in the Seoul Neuropsychological Screening Battery, 2nd Edition (SNSB-II).

Methods

The participants were 104 amnestic mild cognitive impairment (aMCI), 74 vascular mild cognitive impairment (VaMCI), 73 dementia of the Alzheimer's type (DAT), and 41 vascular dementia (VaD) patients. All participants were administered the Korean-MoCA and SNSB-II.

Results

Like the MoCA total score, the MoCA-OIS, MoCA-VIS, and MoCA-MIS showed differences between aMCI and AD groups and between VaMCI and VaD groups. The MoCA-AIS, MoCA-LIS, and MoCA-EIS showed significant differences between VaMCI and VaD groups, but no difference between aMCI and DAT groups. In the aMCI and VaMCI groups, all index scores of the MoCA showed significant correlations with the corresponding cognitive domain scores of the SNSB-II. Except for MoCA-MIS, the MoCA-AIS, MoCA-LIS, MoCA-VIS, and MoCA-EIS also showed significant correlations with the corresponding domain scores of the SNSB-II in the DAT and VaD groups.

Conclusions

These results indicate that all MoCA index scores, except for MoCA-MIS, which does not reflect the severity of memory impairment in dementia patients, provide highly valid information on the function of each cognitive domain in patients with mild cognitive impairment and dementia.

Converting from the Montreal Cognitive Assessment to the Mini-Mental State Examination-2

OBJECTIVE

The Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination-2 (MMSE-2) are useful psychometric tests for cognitive screening. Many clinicians want to predict the MMSE-2 score based on the MoCA score. To facilitate the transition from the MoCA to the MMSE-2, this study developed a conversion method.

METHODS

This study retrospectively examined the relationship between the MoCA and MMSE-2. Overall, 303 participants were evaluated. We produced a conversion table using the equipercentile equating method with log-linear smoothing. Then, we evaluated the reliability and accuracy of this algorithm to convert the MoCA to the MMSE-2.

RESULTS

MoCA scores were converted to MMSE-2 scores according to a conversion table that achieved a reliability of 0.961 (intraclass correlation). The accuracy of this algorithm was 84.5% within 3 points difference from the raw score.

CONCLUSIONS

This study reports a reliable and easy conversion algorithm for transforming MoCA scores into converted MMSE-2 scores. This method will greatly enhance the utility of existing cognitive data in clinical and research settings.

The Effects of Lifestyle Interventions on the Health-Promoting Behavior, Type D Personality, Cognitive Function and Body Composition of Low-Income Middle-Aged Korean Women

Low-income middle-aged women (LMW) who are vulnerable have various physical and psychosocial problems. They need lifestyle interventions to actively cope with these risk factors. This study used a randomized control group pretest-posttest design. LMW aged from 40 to 60 years were recruited and randomly assigned to an experimental group (n = 31) and a control group (n = 32). The lifestyle interventions for this study, which were implemented for eight weeks, included nutritional management, physical activity, stress management and cognitive function improvement based on King’s goal attainment theory. The measured outcomes were health-promoting behaviors, Type D personality, cognitive function and body composition. The experimental group scored significantly higher than the control group for health-promoting behaviors (effect size (ES) = 0.68~1.27, p < 0.001~0.014) and cognitive function (ES = 0.79~1.31, p < 0.001~0.005). The negative affectivity (ES = 0.70, p = 0.012) and the prevalence of a Type D personality (x² = 4.39, p = 0.047) and the systolic blood pressure (ES = 0.65, p = 0.019) decreased significantly in the experimental group compared with the control group. Lifestyle interventions for LMW were effective in improving health-promoting behavior, Type D personality traits and cognitive function.

Increased Carotid Intima-Media Thickness was not Associated With Cognitive Dysfunction After Off-Pump Coronary Surgery in Older Adult Patients Without Carotid Stenosis

Increased carotid intima-media thickness (C-IMT), a marker of atherosclerosis, is known to be associated with cerebrovascular and cortical abnormalities and cognitive impairment. This prospective observational study investigated the association between increased C-IMT and postoperative cognitive dysfunction (POCD) in older adult patients undergoing off-pump coronary artery bypass surgery. A total of 201 patients (57 females, 144 males; >60 years) were classified into increased (n = 105) or normal (n = 96) C-IMT groups by a cut-off value of 0.9 mm (bilateral C-IMT mean). Cognitive function was serially assessed with the Korean Mini-Mental State Examination, and Korean Montreal Cognitive Assessment scores preoperatively and at 7 days and 3 months postoperatively. POCD was defined as the deterioration of 1 standard deviation in at least one of the postoperative tests compared with their corresponding baseline scores. Independent risk factors for POCD were evaluated using multivariable analysis. Overall, POCD occurred in 46 patients (23%) over the 3 months. The incidences of POCD at 7 days and 3 months after surgery were similar, and there was no difference in both Korean Mini-Mental State Examination and Korean Montreal Cognitive Assessment test scores before and after surgery between groups. Chronic obstructive lung disease and intraoperative hyperglycemia episodes (>180 mg/dL), but not increased C-IMT, were independent risk factors for POCD. Unlike in nonsurgical cohorts, increased C-IMT was not significantly associated with the occurrence of POCD in older adult patients undergoing off-pump coronary artery bypass surgery.

Mild cognitive impairment, dementia, and cognitive dysfunction screening using machine learning

Objective

To develop a machine learning algorithm to identify cognitive dysfunction based on neuropsychological screening test results.

Methods

This retrospective study included 955 participants: 341 participants with dementia (dementia), 333 participants with mild cognitive impairment (MCI), and 341 participants who were cognitively healthy. All participants underwent evaluations including the Mini-Mental State Examination and the Montreal Cognitive Assessment. Each participant’s caregiver or informant was surveyed using the Korean Dementia Screening Questionnaire at the same visit. Different machine learning algorithms were applied, and their overall accuracies, Cohen’s kappa, receiver operating characteristic curves, and areas under the curve (AUCs) were calculated.

Results

The overall screening accuracies for MCI, dementia, and cognitive dysfunction (MCI or dementia) using a machine learning algorithm were approximately 67.8% to 93.5%, 96.8% to 99.9%, and 75.8% to 99.9%, respectively. Their kappa statistics ranged from 0.351 to 1.000. The AUCs of the machine learning models were statistically superior to those of the competing screening model.

Conclusion

This study suggests that a machine learning algorithm can be used as a supportive tool in the screening of MCI, dementia, and cognitive dysfunction.

Korean Traditional Medicine in Treating Patients with Mild Cognitive Impairment: A Multicenter Prospective Observational Case Series

In Korea, patients with mild cognitive impairment can choose to receive treatment of Korean medicine, and Korean medicine hospitals provide specialized medical care for the prevention and management of cognitive disorders. The aim of the study is to explore the role of Korean medicine therapy for patients with mild cognitive impairment in a real clinical setting. Fifteen patients with amnestic mild cognitive impairment were enrolled in this prospective observational study in three Korean medicine hospitals. Korean medicine treatments were delivered by experienced professionals and not restricted to standardized treatment. Outcome measures were prospectively planned to examine the Korean-Montreal Cognitive Assessment (K-MoCA), Korean-Mini Mental State Examination (K-MMSE), and other detailed neuropsychological assessment at the baseline and after 12 and 24 weeks of treatment. Korean medicine treatment for MCI treatment in the real-world clinical setting included herbal medicine and acupuncture. The most frequently used herbs in herbal decoctions were Acori Graminei Rhizoma, Polygalae Radix, and Poria Sclerotium Cum Pini Radix. The herbal medicine formulae used in this study were classified into three categories: tonifying Qi (33.3%), tonifying kidney (46.7%), and calming liver (20%) formulae. In the cognitive ability assessment, the K-MoCA score significantly improved after treatment (mean difference 2.6; 95% CI: 1.3 to 3.9, p=0.001). The K-MMSE score slightly increased after treatment; however, the improvement was not statistically significant (mean difference 0.8; 95% CI: −0.5 to 2.0, p=0.195). In detailed neuropsychological assessment, the cognitive domains of executive functions and memory after the treatment were distinctively improved. In this prospective observational case series, we could see the real clinical environments of treating patients with mild cognitive impairment in Korean medicine hospitals. Patients treated with Korean medicine showed improved results in the neuropsychological assessment after 12 and 24 weeks.

The factors associated with subjective cognitive decline and cognitive function among older adults

AIMS

To explore the risk factors for subjective cognitive decline and cognitive function among older adults in South Korea.

DESIGN

This study employed a descriptive cross-sectional design.

METHODS

A convenience sample of 182 patients was recruited from a senior welfare center in Seoul. The mean age of the participants was 78.4 years (SD 5.91). Among them, 64.3% were women. The data were collected by a trained research assistant using structured questionnaires from September 2016-February 2017. Demographic characteristics, comorbidities, depression, physical and cognitive activity levels, instrumental activities of daily living, subjective cognitive decline, and cognitive function were assessed. Student's t tests, chi-square tests, and hierarchical multiple regression analyses were used for statistical analyses.

RESULTS

The findings revealed that 37.4% of the participants were not cognitively intact. Depression, perceived health status, and cognitive function were significantly associated with subjective cognitive decline (F = 7.10, p < .001, adjusted R²  = 25.3). Age, educational level, perceived health status, and subjective cognitive decline were significantly related to cognitive function (F = 20.98, p < .001, adjusted R²  = 47.0). After controlling for these variables, cognitive activity was significantly and independently related to cognitive function.

CONCLUSION

The results suggest that for the maintenance of cognitive function, cognitive activity should be encouraged. In addition, older adults who complain of subjective cognitive decline and have risk factors such as depression need therapeutic interventions to prevent actual decrease of cognitive function.

IMPACT

The present findings advance prior knowledge by considering variables such as physical and cognitive activity levels to provide novel evidence that can be used to develop interventions for community-dwelling older adults. Thus, to be effective, nursing interventions must seek to improve cognitive function through intellectual stimulation.

Effects of a Multicomponent Cognitive Stimulation Program on Cognitive Function Improvement Among Elderly Women

PURPOSE

This study was conducted to identify the effect of a multicomponent cognitive stimulation program (MCSP) on the improvement of older people's cognitive abilities. It also aimed to determine whether the effectiveness of the MCSP is related to age.

METHODS

A one-group pretest-posttest design was used. The program was conducted once a week for 10 weeks. The Korean-Montreal Cognitive Assessment (K-MoCA) was used to measure cognitive functions before and after the MCSP. Participants included 37 people aged over 65 years with normal cognitive functions and living in I city. A paired t-test was used to compare K-MoCA scores before and after the MCSP, and a two-way analysis of variance was performed to confirm whether there is an interaction between the MCSP and age.

RESULTS

It was found that the MCSP had a significant effect on improving cognitive functions (t = -5.15, p < .001). Regarding the subdomains, visuospatial/executive ability, recall, naming, and language ability showed significant effects; however, abstractive ability-which was not a focus of the program-showed no significant effect. There were differences in visuospatial/executive functions, language skills, and memory between the 65-79 years age group and the aged over 80 group. Further, regarding the relationship between the MCSP and age, it was found that their interaction was significant only with regard to visuospatial/executive ability.

CONCLUSION

The MCSP helps to improve the cognitive functions of the elderly; however, its effect differs between the young-old group and the old-old group. Therefore, age should be considered when developing MCSPs.

Validation of the Korean-Everyday Cognition (K-ECog)

BACKGROUND

In the early diagnosis of dementia, an important factor is the evaluation of activities of daily living. The Everyday Cognition (ECog) scale was developed to measure functional changes that are the everyday correlates of specific neuropsychological impairments. This study aimed to examine the validity of the Korean version of Everyday Cognition (K-ECog).

METHODS

The participants were 268 cognitively normal older adults (NA), 151 amnestic mild cognitive impairment (aMCI), and 77 dementia of the Alzheimer's type (DAT). The Korean-Mini Mental State Examination (K-MMSE), Korean-Montreal Cognitive Assessment (K-MoCA), and Short form of the Geriatric Depression Scale (SGDS) were administered to all the participants. The K-ECog and Korean-Instrumental Activities of Daily Living (K-IADL) were rated by their informants.

RESULTS

Internal consistency (Cronbach's α) of K-ECog global function was 0.93, and its test-retest reliability (Pearson's r) was 0.73. K-ECog was significantly correlated with K-IADL (0.66), K-MMSE (-0.38), and K-MoCA (-0.26). Confirmatory factor analysis of K-ECog yielded seven factor model that the original ECog proposed. K-ECog global score and six domain scores were significantly different across the NA, aMCI, and DAT groups. Receiver operating characteristic curve analyses showed that K-ECog effectively differentiated aMCI and DAT patients from NA, suggesting that K-ECog is as sensitive for detecting functional impairments as K-IADL. The proposed optimal cut-off score to differentiate aMCI from NA was 1.41.

CONCLUSION

K-ECog is proven reliable and valid for clinical use. K-ECog can be used to distinguish very early stages of impaired ADL and cognitive impairment in the community.

Comparison of the montreal cognitive assessment and the mini-mental state examination as screening tests in hemodialysis patients without symptoms

Cognitive impairment in end-stage renal disease patients is associated with an increased risk of mortality. We examined the cognitive function in hemodialysis (HD) patients and compared the Korean versions of the Montreal Cognitive Assessment (K-MoCA) and of the Mini-Mental State Examination (K-MMSE) to identify the better cognitive screening instrument in these patients. Thirty patients undergoing hemodialysis and 30 matched reference group of apparently healthy control were included. All subjects underwent the K-MoCA, K-MMSE and a neuropsychological test battery to measure attention, visuospatial function, language, memory and executive function. All cognitive data were converted to z-scores with appropriate age and education level prior to group comparisons. Cognitive performance 1.0 SD below the mean was defined as modest cognitve impairment while 1.5 below the mean was defined as severe cognitive impairment. Modest cognitive impairment in memory plus other cognitive domains was detected in 27 patients (90%) while severe cognitive impairment in memory plus other cognitive domains was detected in 23 (77%) patients. Total scores in the K-MoCA were significantly lower in HD patients than in the reference group. However, no significant group difference was found in the K-MMSE. The K-MMSE ROC AUC (95% confidence interval) was 0.72 (0.59–0.85) and K-MoCA ROC AUC was 0.77 (0.65–0.89). Cognitive impairment is common but under-diagnosed in this population. The K-MoCA seems to be more sensitive than the K-MMSE in HD patients.

Correlation Between Montreal Cognitive Assessment and Functional Outcome in Subacute Stroke Patients With Cognitive Dysfunction

Objective

To investigate the correlation between the Montreal Cognitive Assessment (MoCA) and functional outcome among subacute stroke patients with cognitive dysfunction.

Methods

Records of 61 inpatients were reviewed. Patients were divided into two groups based on their initial MoCA score. MoCA score of 11 was set as the differentiating criterion. We compared the improvements in Modified Barthel Index (MBI) from initial assessment to discharge between the two groups.

Results

There were no significant differences between the two groups in relation to age, duration from onset to admission, hospitalization period, or years of education. In a comparison of the results of Mini-Mental Status Examinations (MMSE) administered at admission and again at discharge, there was significantly more improvement in MMSE scores in the group with low MoCA scores than in the group with high MoCA scores. However, the group with high MoCA scores also showed high MBI scores at discharge and exhibited greater MBI improvement.

Conclusion

Higher initial MoCA scores (which reflect preservation of executive function) indicate better functional outcome in the subacute stroke phase.

Loneliness in Elderly Patients with Mild Cognitive Impairment: A Pilot Study

Background and Purpose

Loneliness is a significant concern among the elderly, particularly in societies with rapidly growing aging populations. While loneliness may influence neuropsychological function, the exact nature of the association between loneliness and neuropsychological function is poorly understood.

Methods

We evaluated 50 elderly patients with mild cognitive impairment (MCI) and 33 without cognitive dysfunction with respect to demographics, clinical characteristics, cognitive and functional performance, depression scale, and loneliness scale. The associations between loneliness and neuropsychological assessments were evaluated.

Results

Although loneliness was not associated with cognitive or functional performance, it was correlated with depression in elderly patients. For elderly patients with MCI, depressive symptoms were reported more frequently in individuals with a high degree of loneliness (p<0.05).

Conclusions

Neither cognitive performance nor functional performance is associated with loneliness; however, loneliness is associated with depressive symptoms in elderly patients with MCI.

Subjective Cognitive Complaints and Objective Cognitive Impairment in Parkinson's Disease

Background and Purpose

Subjective cognitive complaints (SCCs) are very common in patients with Parkinson's disease (PD). However, the relationship between SCCs and objective cognitive impairment is still unclear. This study aimed to determine whether SCCs are correlated with objective cognitive performance in patients with PD.

Methods

Totals of 148 cognitively normal patients, 71 patients with mild cognitive impairment (MCI), and 31 demented patients were recruited consecutively from a movement-disorders clinic. Their SCCs and cognitive performances were evaluated using the Cognitive Complaints Interview (CCI) and a comprehensive neuropsychological battery.

Results

The CCI score increased with age, duration of PD, and depression score, and was inversely correlated with cognitive performance. The association between CCI score and performance remained significant after adjustment for the depression score, age, and duration of PD. The CCI score could be used to discriminate patients with dementia from cognitively normal and MCI patients [area under the receiver operating characteristics curve (AUC) of 0.80], but not patients with MCI or dementia from cognitively normal patients (AUC of 0.67).

Conclusions

SCCs as measured by the CCI are strongly correlated with objective cognitive performance in patients with PD. The CCI can also be used to screen for dementia in patients with PD.

The feasibility study of Computer Cognitive Senior Assessment System-Screen (CoSAS-S) in critically ill patients with sepsis

PURPOSE

Early cognitive assessment in the intensive care unit (ICU) is essential to monitor cognitive dysfunction after critical illness. We have implemented a Computer Cognitive Senior Assessment System-Screen (CoSAS-S) which is a brief, objective, and tablet-based cognitive screening test as a mobile platform to detect any cognitive problems in ICUs. This study aimed to evaluate the feasibility and initial validation of a tablet-based CoSAS-S in critically ill patients with sepsis.

MATERIALS AND METHODS

Thirty-six eligible patients completed CoSAS-S, Mini-Mental State Examination-Korean Version (MMSE-K) and Korean Version of Montreal Cognitive Assessment (K-MoCA) for validity testing at the ICU.

RESULTS

Eighty-eight percent of programmed assessments were completed by the sample. Spearman correlations of the CoSAS-S with MMSE-K (rho=0.613-0.874, p<0.00) and K-MoCA scores (rho=0.666-0.897, p<0.001) were moderate to high. Intra-class correlation coefficient (ICC) of total CoSAS-S score between two raters was 0.93 (p<0.001; 95% CI=0.82-0.97), suggesting the inter-rater reliability of CoSAS-S was excellent.

CONCLUSIONS

Support was found for the feasibility and validity of CoSAS-S. The application of CoSAS-S could identify the cognitive functioning of the patients. Utility of CoSAS-S in other clinical populations should be tested.

The MMSE and MoCA for Screening Cognitive Impairment in Less Educated Patients with Parkinson's Disease

Objective

To explore whether the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) can be used to screen for dementia or mild cognitive impairment (MCI) in less educated patients with Parkinson’s disease (PD).

Methods

We reviewed the medical records of PD patients who had taken the Korean MMSE (K-MMSE), Korean MoCA (K-MoCA), and comprehensive neuropsychological tests. Predictive values of the K-MMSE and K-MoCA for dementia or MCI were analyzed in groups divided by educational level.

Results

The discriminative powers of the K-MMSE and K-MoCA were excellent [area under the curve (AUC) 0.86–0.97] for detecting dementia but not for detecting MCI (AUC 0.64–0.85). The optimal screening cutoff values of both tests increased with educational level for dementia (K-MMSE < 15 for illiterate, < 20 for 0.5–3 years of education, < 23 for 4–6 years, < 25 for 7–9 years, and < 26 for 10 years or more; K-MoCA < 7 for illiterate, < 13 for 0.5–3 years, < 16 for 4–6 years, < 19 for 7–9 years, < 20 for 10 years or more) and MCI (K-MMSE < 19 for illiterate, < 26 for 0.5–3 years, < 27 for 4–6 years, < 28 for 7–9 years, and < 29 for 10 years or more; K-MoCA < 13 for illiterate, < 21 for 0.5–3 years, < 23 for 4–6 years, < 25 for 7–9 years, < 26 for 10 years or more).

Conclusion

Both MMSE and MoCA can be used to screen for dementia in patients with PD, regardless of educational level; however, neither test is sufficient to discriminate MCI from normal cognition without additional information.

Design and Rationale for a Cognitive Outcome Substudy in Ischemic Stroke Patients with High Risk of Cerebral Hemorrhage

GOAL

Cognitive impairment and dementia are common disabilities after stroke and are associated with increased risks of mortality and recurrent stroke. The prevention of dementia and preserving cognitive function are also important in stroke patients, but its strategy is not established yet. This PICASSO-COG (PreventIon of CArdiovascular events in iSchemic Stroke patients with high risk of cerebral hemOrrhage for reducing COGnitive decline) substudy aims to assess the effects of cilostazol and/or probucol on cognitive function.

MATERIALS AND METHODS

The substudy aims to assess the reduction in cognitive decline of patients treated with cilostazol and/or probucol in the PICASSO trial. Patients will be assessed using the Korean version of mini-mental state examination and Montreal Cognitive Assessment at 4, 7, 10, 13, 25, 37, and 49 months after randomization. The primary outcome is the change in mini-mental status examination score, compared between treatment groups, with a modified intention-to-treat population using a restricted maximum likelihood-based mixed effects model repeat measurement. This will allow a within-subject correlation due to repeated cognitive tests as well as a different number of measurements among subjects at baseline and each follow-up period.

CONCLUSION

PICASSO-COG is a novel study for assessing the effect on cognitive function of different antiplatelet regimens and the addition of a nonstatin lipid-lowering agent to the current standard statin therapy in patients who have a recent ischemic lesion and prior intracerebral macro- or microbleeds.