Relationship of the Japanese Old Stories Cognitive Scale With the Revised Hasegawa Cognitive Scale and Mini-Mental State Examination

The Revised Hasegawa Dementia Scale (HDS-R) is the most widely used instrument to screen for dementia in Japan and is similar to the Mini-Mental State Examination (MMSE). The development of a quicker and simpler screening tool, the Japanese Old Stories Cognitive Scale (JOSS), was previously reported. A total of 953 new outpatients from 8 memory clinics in Japan completed the JOSS, HDS-R, and MMSE at first visit. We investigated the relationship of JOSS score with both the total and individual domain scores on the HDS-R and MMSE. We found a significant relation between JOSS score and total HDS-R and MMSE scores. In addition, JOSS score was significantly related to scores on 8 of the 9 HDS-R domains and 7 of the 11 MMSE domains. We obtained regression lines for JOSS score versus HDS-R and MMSE scores. JOSS score could be useful for predicting HDS-R and MMSE scores and thus in estimating cognitive functioning.

Examining the validity of the Mini-Mental State Examination (MMSE) and its domains using network analysis

BACKGROUND

The Mini-Mental State Examination (MMSE) is the most widely used standardised screener for impairments across a range of cognitive domains. However, the degree to which its domains (orientation, registration, attention, recall, language, and visuospatial) capture cognitive functioning measured using standardised neuropsychological tests is unclear.

METHOD

A longitudinal research design with four biannual assessments over a 6-year period was used with an initial sample of 1037 older adults (aged above 70 years). Participants completed MMSE and neuropsychological tests at each assessment. Network analysis was utilised to investigate unique associations among the MMSE and its domains and neuropsychological test performance at each time point.

RESULTS

The total MMSE and two of its domains, language and recall, were associated with neuropsychological memory performance. The MMSE orientation, registration and visuospatial domains did not have any unique associations with neuropsychological performance. No stable internal interconnections between MMSE domains were found over time. The association of total MMSE as well as its recall domain with neuropsychological memory performance remained very similar over the 6-year period.

CONCLUSIONS

The present study adds evidence to the validity of the MMSE and supports the clinical usage of the MMSE, whereby the total score is used for screening patients with or without cognitive impairments, with repeated administration to monitor cognitive changes over time, to inform intervention. However, the tool is not able to diagnose the cases for changes in specific cognitive domains and as such, should not replace a complete neuropsychological assessment.

The diagnostic value of cognitive assessment indicators for mild cognitive impairment (MCI)

OBJECTIVE

This study aims to evaluate and analyze the standard diagnostic methods for mild cognitive impairment (MCI).

METHODS

This study used a prospective case-control study to examine baseline data and diagnostic indicators in a population of elderly with MCI. Based on different cognitive abilities, this study divided MCI and healthy control groups. The diagnostic indicators included CDT, MOCA, MMSE, PSQI, MBI, DST, HAMD, AD-related blood markers, and olfactory testing. The diagnostic value of each indicator was done using the ROC curve.

RESULTS

This study included 240 adult participants, 135 in the health group and 105 in the MCI group. A comparison of baseline data revealed statistically significant differences between the two groups regarding age, blood glucose, MMSE, CTD, MOCA, ability to perform daily living, AD-related blood indices and olfactory tests (all p < 0.05). Logistic regression analysis statistically showed that age, MOCA, and CDT were independent diagnostic factors for MCI (all p < 0.05). Combining these three indicators has the best diagnostic specificity (92.54%). AD-related blood and olfactory tests indices had only moderate diagnostic values (AUC: 0.7-0.8).

CONCLUSION

Age, MOCA, and CDT are good indicators for diagnosing early-stage MCI. AD-related blood indices and olfactory tests can serve as valuable adjuncts in diagnosing MCI.

Digital Clock and Recall is superior to the Mini-Mental State Examination for the detection of mild cognitive impairment and mild dementia

BACKGROUND

Disease-modifying treatments for Alzheimer's disease highlight the need for early detection of cognitive decline. However, at present, most primary care providers do not perform routine cognitive testing, in part due to a lack of access to practical cognitive assessments, as well as time and resources to administer and interpret the tests. Brief and sensitive digital cognitive assessments, such as the Digital Clock and Recall (DCR™), have the potential to address this need. Here, we examine the advantages of DCR over the Mini-Mental State Examination (MMSE) in detecting mild cognitive impairment (MCI) and mild dementia.

METHODS

We studied 706 participants from the multisite Bio-Hermes study (age mean ± SD = 71.5 ± 6.7; 58.9% female; years of education mean ± SD = 15.4 ± 2.7; primary language English), classified as cognitively unimpaired (CU; n = 360), mild cognitive impairment (MCI; n = 234), or probable mild Alzheimer's dementia (pAD; n = 111) based on a review of medical history with selected cognitive and imaging tests. We evaluated cognitive classifications (MCI and early dementia) based on the DCR and the MMSE against cohorts based on the results of the Rey Auditory Verbal Learning Test (RAVLT), the Trail Making Test-Part B (TMT-B), and the Functional Activities Questionnaire (FAQ). We also compared the influence of demographic variables such as race (White vs. Non-White), ethnicity (Hispanic vs. Non-Hispanic), and level of education (≥ 15 years vs. < 15 years) on the DCR and MMSE scores.

RESULTS

The DCR was superior on average to the MMSE in classifying mild cognitive impairment and early dementia, AUC = 0.70 for the DCR vs. 0.63 for the MMSE. DCR administration was also significantly faster (completed in less than 3 min regardless of cognitive status and age). Among 104 individuals who were labeled as "cognitively unimpaired" by the MMSE (score ≥ 28) but actually had verbal memory impairment as confirmed by the RAVLT, the DCR identified 84 (80.7%) as impaired. Moreover, the DCR score was significantly less biased by ethnicity than the MMSE, with no significant difference in the DCR score between Hispanic and non-Hispanic individuals.

CONCLUSIONS

DCR outperforms the MMSE in detecting and classifying cognitive impairment-in a fraction of the time-while being not influenced by a patient's ethnicity. The results support the utility of DCR as a sensitive and efficient cognitive assessment in primary care settings.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT04733989.

Associations between cognitive test scores and pain tolerance: The Tromsø study

OBJECTIVES

Previous studies have suggested that experimental pain sensitivity is associated with cognitive function. The aim of this study is to assess this relationship in a large population-based sample.

METHODS

We included 5,753 participants (aged 40-84 years) from the seventh wave of the population-based Tromsø Study who had been examined with cognitive tests and experimental pain assessments, and for whom information on covariates were available. Cox regression models were fitted using standardized scores on cognitive tests (12-word immediate recall test, digit symbol coding test, and Mini-Mental State Examination [MMS-E]) as the independent variable and cold pressor or cuff pressure pain tolerance as the dependent variables. Statistical adjustment was made for putative confounders, namely, age, sex, education, smoking, exercise, systolic blood pressure, body mass index, symptoms indicating anxiety or depression, analgesic use, and chronic pain.

RESULTS

In multivariate analysis, cold pressor tolerance time was significantly associated with test scores on the 12-word immediate recall test (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.90-0.97, p < 0.001), the digit symbol coding test (HR 0.94, 95% CI 0.89-0.98, p = 0.004), and the MMS-E (HR 0.93, 95% CI 0.90-0.96 p < 0.001). Tolerance to cuff pressure algometry was significantly associated with 12-word immediate recall (HR 0.94-0.97, p < 0.001) and Digit Symbol Coding test scores (HR 0.93, 95% CI 0.89-0.96, p < 0.001) while there was no significant association with Mini Mental State Examination test score (HR 0.98, 95% CI 0.95-1.00, p = 0.082).

CONCLUSION

Lower pain tolerance was associated with poorer performance on cognitive tests.

Cognitive symptoms progress with limbic-predominant age-related TDP-43 encephalopathy stage and co-occurrence with Alzheimer disease

Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) is a neuropathologic entity characterized by transactive response DNA-binding protein of 43-kDa (TDP-43)-immunoreactive inclusions that originate in the amygdala and then progress to the hippocampi and middle frontal gyrus. LATE-NC may mimic Alzheimer disease clinically and often co-occurs with Alzheimer disease neuropathologic change (ADNC). This report focuses on the cognitive effects of isolated and concomitant LATE-NC and ADNC. Cognitive/neuropsychological, neuropathologic, genetic, and demographic variables were analyzed in 28 control, 31 isolated LATE-NC, 244 isolated ADNC, and 172 concurrent LATE-NC/ADNC subjects from the National Alzheimer's Coordinating Center. Cases with LATE-NC and ADNC were significantly older than controls; cases with ADNC had a significantly higher proportion of cases with at least one APOE ε4 allele. Both LATE-NC and ADNC exhibited deleterious effects on overall cognition proportional to their neuropathological stages; concurrent LATE-NC/ADNC exhibited the worst overall cognitive effect. Multivariate logistic regression analysis determined an independent risk of cognitive impairment for progressive LATE-NC stages (OR 1.66; p = 0.0256) and ADNC levels (OR 3.41; p < 0.0001). These data add to the existing knowledge on the clinical consequences of LATE-NC pathology and the growing literature on the effects of multiple concurrent neurodegenerative pathologies.

Association of time-varying sleep duration and cognitive function with mortality in the elderly: a 12-year community-based cohort study

BACKGROUND

Sleeping problems and cognitive impairment are common in elders. Baseline sleep duration and cognitive status are predictors of mortality. But few studies have explored whether longitudinal changes in sleep duration and cognitive function are related to mortality in older adults. The present study investigated the time-varying relationships of sleep duration and cognitive function with subsequent mortality among community-dwelling elders by using 12 years of repeated-measure data.

METHODS

Taichung Community Health Study for Elders (TCHS-E) is a retrospective, population-based cohort that started in 2009 (wave 1) with a total of 912 elders aged 65 years or above. Follow up was conducted in 2010 (wave 2), 2018 (wave 3), and 2020 (wave 4). Sleep duration and Mini-Mental State Examination (MMSE) forms were executed at baseline and three visits during follow-up. Time-varying Cox proportional hazards regression estimated adjusted hazard ratios (HRs) of mortality with 95% confidence intervals (CIs).

RESULTS

During about 12 years (9,396 person-years) follow-up, 329 deaths from all causes were documented, including 102 deaths due to expanded cardiovascular disease (CVD). In the multivariable-adjusted, time-varying Cox proportional hazard model, the adjusted HR values of all-cause mortality were 1.47 (1.02-2.12) for sleep duration > 9 h/day (vs. 7 h/day) and 1.81 (1.26-2.59) for MMSE < 27 (vs. 30). The adjusted HR values of the expanded CVD mortality were 2.91 (1.24-6.83) for MMSE of 29; 2.69 (1.20-6.05) for MMSE of 27-28; and 4.32 (95% CI: 1.92-9.74) for MMSE < 27. The dose-dependent relationship was significant (p < 0.001). The combinations of sleep duration longer than 9 h/day and MMSE < 27 were linked with the highest risks for expanded CVD and all-cause mortality.

CONCLUSIONS

Long sleep duration and low cognitive function were jointly and independently linked with higher risk of mortality in elders residing in community.

The Association between Education and Cognitive Performance Varies at Different Levels of Cognitive Performance: A Quantile Regression Approach

INTRODUCTION

Educational differences in cognitive performance among older adults are well documented. Studies that explore this association typically estimate a single average effect of education on cognitive performance. We argue that the processes that contribute to the association between education and cognitive performance are unlikely to have equal effects at all levels of cognitive performance. In this study, we employ an analytical approach that enables us to go beyond averages to examine the association between education and five measures of global and domain-specific cognitive performance across the outcome distributions.

METHODS

This cross-sectional study included 1,780 older adults aged 58-68 years from the Longitudinal Aging Study Amsterdam. Conditional quantile regression was used to examine variation across the outcome distribution. Cognitive outcomes included Mini-Mental State Examination (MMSE) score, crystallized intelligence, information processing speed, episodic memory, and a composite score of global cognitive performance.

RESULTS

The results showed that the associations between education and different cognitive measures varied across the outcome distributions. Specifically, we found that education had a stronger association with crystallized intelligence, MMSE, and a composite cognitive performance measure in the lower tail of performance distributions. The associations between education and information processing speed and episodic memory were uniform across the outcome distributions.

CONCLUSION

Larger associations between education and some domains of cognitive performance in the lower tail of the performance distributions imply that inequalities are primarily generated among individuals with lower performance rather than among average and high performers. Additionally, the varying associations across some of the outcome distributions indicate that estimating a single average effect through standard regression methods may overlook variations in cognitive performance between educational groups. Future studies should consider heterogeneity across the outcome distribution.

"Try to Build This Bunny as Fast as Possible without Using Red or Pink Bricks": How Simple Assembly Tasks Might Aid in Detecting People with Mild Cognitive Impairment and Dementia

(1) Background: Dementia and mild cognitive impairment (MCI) are still underdiagnosed in the general population. Impaired odor identification has been identified as an early marker of MCI and dementia. We aim to investigate whether short tasks, in which simple forms must be assembled from single building blocks based on a template or while considering specific re-strictions, could increase the diagnostic quality of established cognitive screening tests in detecting MCI or dementia. (2) Methods: A brief assembly test, where participants had to assemble simple animal shapes from Lego® Duplo® building blocks, the Frontal Assessment Battery, and the Mini-Mental State Exam (MMSE) were administered to a consecutive series of 197 patients (89 with mild dementia, 62 with mild cognitive impairment, and 46 without cognitive impairment) referred for neuropsychological testing. (3) Results: Both participants with dementia and with MCI performed badly in the assembly tasks. The assembly tasks and the Frontal Assessment Battery were substantially correlated. Complementing MMSE scores with the assembly tasks improved the diagnostic accuracy of individuals with dementia and MCI. (4) Conclusions: People with suspected dementia or MCI may already benefit from simple assembly tasks. Although these tests require little additional time, they can notably increase sensitivity for dementia or MCI.

The impact of music listening intervention on Asia elderly with dementia: a systematic review

From an initial pool of 2303 studies, ten eligible and potential studies were selected through rigor inclusion and exclusion criteria for this systematic review to examine music therapy's effect on dementia. The review included 967 participants, with the majority being female. A significant number of studies were conducted in Taiwan. Although several cognitive ability assessment methods were employed in the selected studies, the Mini-Mental State Examination (MMSE) was the most commonly used tool for evaluating the effects of music therapy on dementia. Overall, the current review demonstrates that music therapy can be a valuable strategy for treating patients with dementia, with its outcomes including improved cognitive function and potentially slowing the progression of the disease's severity. Therefore, this study can significantly contribute to future studies and practices aimed at using music therapy to treat dementia.

Association between neighborhood availability of physical activity facilities and cognitive performance in older adults

The existing evidence on the contextual influence of the availability of local facilities for physical activity on the cognitive health of elderly residents is sparse. This study examined the association between neighborhood physical activity facilities and cognitive health in older individuals. A cohort study of community-dwelling older adults was performed using baseline data and follow-up data from the Taiwan Biobank. Cognitive health was measured in 32,396 individuals aged 60-70 years using the Mini-Mental State Examination (MMSE) with follow-up information on 8025 participants. The district was used as the proxy for local neighborhood. To determine neighborhood physical activity facilities, school campuses, parks, activity centers, gyms, swimming pools, and stadiums were included. Multilevel linear regression models were applied to examine the associations of neighborhood physical activity facilities with baseline MMSE and MMSE decline during follow-up, with adjustment for individual factors and neighborhood socioeconomic characteristics. Multilevel analyses revealed that there was a neighborhood-level effect on cognitive health among older adults. After adjusting for compositional and neighborhood socioeconomic characteristics, baseline MMSE was higher in individuals living in the middle- (beta = 0.12, p-value = 0.140) and high-density facility (beta = 0.22, p-value = 0.025) groups than in the low-density group (p-value for trend-test = 0.031). MMSE decline during follow-up was slower in the middle- (beta = 0.15, p-value = 0.114) and high-density facility (beta = 0.27, p-value = 0.052) groups than in the low-density group (p-value for trend-test = 0.032). Greater neighborhood availability of physical activity facilities was associated with better cognitive health among older residents. These findings have implications for designing communities and developing strategies to support cognitive health of an aging population.

Dual-task multicomponent exercise-cognitive intervention improved cognitive function and functional fitness in older adults

BACKGROUND

Maintaining cognitive and physical function is essential to healthy aging.

AIM

This study aims to investigate the effect of an exercise-cognitive dual-task program in Chinese language on cognitive function and functional fitness in older adults.

METHODS

Seventy adults aged 60-84 years were conveniently assigned to one of the three groups: exercise-cognitive dual-task (EC) group (n = 28), exercise group (n = 22), and control group (n = 20). The EC group received a 90-min class including multicomponent exercise-cognitive dual-task twice a week. The exercise group received a 90-min class including multicomponent exercise twice a week. The control group maintained their regular level of physical activity and general lifestyle. Cognitive functions and functional fitness were measured before and after the 12-week intervention.

RESULTS

The participants in the EC and exercise group significantly improved scores in Taiwanese Frontal Assessment Battery, the Chang Gung University Orthographical Fluency Test, and the Mini-Mental State Examination; however, those in the control group did not. The participants in the EC and exercise group showed significant increases in almost all functional fitness tests. The participants in the EC group showed significantly higher improvements in Chang Gung University Orthographical Fluency Test score and aerobic endurance than the exercise group and in Chang Gung University Orthographical Fluency Test score and lower body strength than the control group. In addition, the changes in Taiwanese Frontal Assessment Battery and Mini-Mental State Examination scores were significantly correlated with the changes in functional fitness.

CONCLUSION

The dual-task intervention resulted in greater improvements in verbal fluency, endurance, and muscular strength than exercise alone and control.

Fluctuations in Cognitive Test Scores and Loss to Follow-Up in Community-Dwelling Older Adults: The IRIDE Cohort Study

INTRODUCTION

We examined the relationship between previous fluctuations in Mini-Mental State Examination (MMSE) scores, future changes in MMSE scores, and attrition from follow-up surveys, which helps in a more comprehensive interpretation of repeatedly collected MMSE scores.

METHODS

This 4-year longitudinal study included 2,073 community-dwelling older adults aged ≥65 years in Japan. The MMSE was administered at baseline (T0), 2 years (T1), and 4 years (T2) follow-up. We performed multinomial logistic regression analysis with the dependent variable, indicating the change in MMSE score from T1 to T2 (categorized as increase, no change [reference category], and decrease) and attrition at T2. The independent variables included the change in MMSE scores from T0 to T1 and MMSE scores at T0 and T1.

RESULTS

The mean MMSE score was 29 across the three time points. A one-point decrease in MMSE score from T0 to T1 was associated with 79% (95% confidence interval: 1.62, 1.97) higher odds of an increase in MMSE score from T1 to T2 and 28% (1.17, 1.40) higher odds of attrition at T2. A one-point decrement in the MMSE score at T0 and T1 was also associated with an increase in the MMSE score from T1 to T2 and attrition at T2.

CONCLUSION

Focusing on cognitive fluctuation for 2 years, rather than cognitive function at a point in time, would have no remarkable advantage when focusing on future cognitive function and attrition. Our results emphasize the need for further studies to identify factors that distinguish between those who continue to attend follow-up surveys and show improvements in cognitive test scores and those who drop out.

"Mmm, Smells like Coffee!": How a Brief Odor Identification Test Could Help to Identify People with Mild Cognitive Impairment and Dementia

(1) Background: Dementia and mild cognitive impairment (MCI) are still underdiagnosed in the general population. Impaired odor identification has been identified as an early marker of MCI and dementia. We aimed to compare the additional diagnostic value of two odor identification tests to a cognitive screening test in detecting MCI or dementia. (2) Methods: The Sniffin' Sticks odor identification test (SS-OIT), a brief odor identification test (B-OIT) requiring the identification of coffee scent, and the Mini-Mental State Exam (MMSE) were administered to a consecutive series of 174 patients (93 with dementia, 42 with mild cognitive impairment, and 39 without cognitive impairment) referred for neuropsychological testing. (3) Results: Both participants with dementia and with MCI exhibited impairments in odor identification. The SS-OIT and the B-OIT were substantially correlated. Complementing MMSE scores with the SS-OIT or the B-OIT similarly improved the diagnostic accuracy of individuals with dementia and MCI. (4) Conclusions: People with suspected dementia or MCI may already benefit from brief odor identification tests. Although these tests require little additional time, they can notably increase sensitivity for dementia or MCI.

Sleep profile in a population of community-dwelling nonagenarians: data from the Mugello study

BACKGROUND

Very few studies have investigated sleep characteristics in the oldest-old individuals (aged ≥85 years) and data collected often rely on self-reported information. This study had three aims: (i) to objectively assess, using a wearable device, the sleep characteristics of a large community of oldest-old subjects; (ii) to assess differences in sleep parameters between self-reported 'good sleepers' and 'bad sleepers'; (iii) to assess whether there was a relationship between sleep parameters and cognitive status in this community-dwelling population.

METHODS

There were 178 subjects (74.2% women, median age 92 years) included in the 'Mugello study', who wore an armband 24 h/day for at least two consecutive nights to estimate sleep parameters. The perceived sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), the cognitive status through the Mini-Mental State Examination. Continuous variables were compared between men/women, and good/bad sleepers with the independent t-test or Mann-Whitney U-test, according to data distribution. Chi-square test was used for categorical/dichotomous variables. An ordinal logistic regression model was used to study the possible association between sleep parameters and cognitive function.

RESULTS

Participants spent in bed nearly 9 h, with a total sleep time of 7 h, a sleep onset latency of 17 min, and a sleep efficiency of 83%. Sleep onset latency was significantly associated with different cognitive levels when age and education level were considered. No significant difference in sleep parameters estimated using the SenseWear armband were found between poor (n = 136, 76.4%) and good sleepers (n = 42, 23.6%), identified according to the PSQI.

CONCLUSIONS

In this study, actigraphic measurements revealed that subjects with a cognitive decline were more prone to increased sleep onset latency. Sleep quality assessed using the PSQI was not coherent with actigraphic measurements in this sample, supporting the need for objective measures when investigating sleep quality in the oldest-old population.

A simple method to evaluate the pentagon copy test of the Mini-Mental State Examination for the differentiation of dementia with Lewy bodies

There are many commonalities between the clinical symptoms of dementia with Lewy bodies (DLB) and those of Alzheimer's disease (AD). The accurate differentiation of these two diseases is an important neuropsychological issue. The Mini-Mental State Examination (MMSE) is often used as a screening test for dementing disorders. We created evaluation items for the pentagon copy test of MMSE and developed a simple, highly accurate evaluation method for differentiating DLB in combination with conventional evaluation items such as the Qualitative Scoring MMSE Pentagon Test (QSPT). Subjects were divided into three groups: DLB (n = 119), AD (n = 50), and Normal (n = 26). The severities of DLB and AD ranged from mild cognitive impairment (MCI) to mild dementia. We compared the results of the pentagon copy test. We found that the rates of patients with abnormalities in "motor incoordination" and "gestalt destruction" were higher in the DLB group than the AD group. Furthermore, receiver operating characteristic curve analysis suggested the differentiation of DLB with high accuracy (sensitivity: 0.70, specificity: 0.78) using the criterion of patients meeting one of the following three characteristics: "the number of angles on QSPT: scores other than 4," "major tremor (Parkinsonism-related tremor) is present," and "gestalt destruction (distortion in overall coherence) is present." This evaluation method may be clinically useful for evaluating MCI to mild DLB patients because the burden on patients is low.

Normative Scores on the Norwegian Version of the Mini-Mental State Examination

BACKGROUND

The Mini-Mental State Examination (MMSE), a simple test for measuring global cognitive function, is frequently used to evaluate cognition in older adults. To decide whether a score on the test indicates a significant deviation from the mean score, normative scores should be defined. Moreover, because the test may vary depending on its translation and cultural differences, normative scores should be established for national versions of the MMSE.

OBJECTIVE

We aimed to examine normative scores for the third Norwegian version of the MMSE.

METHODS

We used data from two sources: the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) and the Trøndelag Health Study (HUNT). After persons with dementia, mild cognitive impairment, and disorders that may cause cognitive impairment were excluded, the sample contained 1,050 cognitively healthy persons, 860 from NorCog, and 190 from HUNT, whose data we subjected to regression analyses.

RESULTS

The normative MMSE score varied from 25 to 29, depending on years of education and age. More years of education and younger age were associated with higher MMSE scores, and years of education was the strongest predictor.

CONCLUSION

Mean normative MMSE scores depend on test takers' years of education and age, with level of education being the strongest predictor.

Effects of multimodal cognitive exercise program on cognitive function, bone density, blood lipid, fitness, and depression in old women with mild cognitive impairment

The purpose of this study is to verify the effects of participation in 12-week multimodal cognitive exercise program on cognitive function, bone mineral density, blood lipids, senior functional fitness, and depression of the old women with mild cognitive impairment and osteopenia. As a result, the exercise group showed significant effects in cognitive function, depression, bone mineral density, blood lipid, lower extremity flexibility, upper extremity flexibility, dynamic balance, and body endurance. Such results prove that multimodal cognitive exercise program is an effective interventional exercise program for improving cognitive function in the old women with mild cognitive impairment.

Effects of intensive vs. standard blood pressure control on cognitive function: Post-hoc analysis of the STEP randomized controlled trial

Background

The STEP (Strategy of Blood Pressure Intervention in the older Hypertensive Patients) trial showed that intensive systolic blood pressure (SBP) control resulted in a lower incidence of cardiovascular events than standard treatment. This study analyzed the effects of intensive SBP lowering on cognitive function.

Methods

STEP was a multicenter, randomized controlled trial of hypertensive patients aged 60-80 years. Participants were randomly assigned (1:1) to SBP goals of 110-130 mmHg (intensive treatment) or 130-150 mmHg (standard treatment). Each individual was asked to complete a cognitive function test (Mini-Mental State Examination; MMSE) at baseline and during follow-up. The primary outcome for this study was the annual change in MMSE score. Subjects with a score less than education-specific cutoff point were categorized as cognitive decline.

Results

The analysis enrolled 6,501 participants (3,270 participants in the intensive-treatment and 3,231 participants in the standard-treatment groups). Median follow-up was 3.34 years. There was a minor change in MMSE score, with an annual change of -0.001 [95% confidence interval [CI] -0.020, 0.018] and 0.030 (95% CI 0.011, 0.049) in the intensive- and standard-treatment groups, respectively (p = 0.052). Cognitive decline occurred in 46/3,270 patients (1.4%) in the intensive-treatment group and 42/3,231 (1.3%) in the standard-treatment group (hazard ratio 0.005, 95% CI 0.654, 1.543, p = 0.983).

Conclusions

Compared with standard treatment, intensive SBP treatment did not result in a significant change in cognitive function test score. The impact of intensive blood pressure lowering was not evident using this global cognitive function test.

Trial registration

ClinicalTrials.gov. Unique identifier: NCT03015311.

Effectiveness of a self-reporting yes/no survey for dementia screening-trial in Fukui, Japan

Background: Early intervention for dementia patients is extremely important for the prevention of dementia. However, so far, it is not clear as to what kind of screening will be useful for the early detection of dementia. Objective: We aimed to investigate the relationship between the results of a short self-reporting yes/no survey selected in Kihon Checklist, developed by the Japanese Ministry of Health, Labor and Welfare to identify older adults who are at risk of requiring support/care, and other original items developed by Dementia Prevention Team, Fukui, Japan, and Mini-Mental State Examination (MMSE) scores, and determine the diagnostic efficacy of the self-reporting yes/no survey. Methods: Self-reporting yes/no surveys were conducted for 87,687 individuals aged ≥65 years, living in Fukui, Japan, and did not have Long-Term Care Insurance, Japan. According to the survey results, selected individuals were advised to visit a local hospital to be assessed with MMSE. Results: Individuals who could not make a call by looking up phone numbers and manage their own deposits and savings at the bank or automatic teller machine (ATM) had an increased risk of low MMSE score (≤23; odds ratio: 2.74 [1.89-3.97]; 95% confidence interval: 2.12 [1.46-3.07]). Conclusions: Self-reporting yes/no survey could effectively screen for dementia. Not being able to make a call by looking up phone numbers and not being able to manage their own deposits and savings at the bank or ATM are signs of dementia.

Urinary Amino Acid-Conjugated Acrolein and Taurine as New Biomarkers for Detection of Dementia

BACKGROUND

Dementia, including Alzheimer's disease (AD), is one of the serious diseases at advanced age, and its early detection is important for maintaining quality of life (QOL).

OBJECTIVE

In this study, we sought novel biomarkers for dementia in urine.

METHODS

Samples of urine were collected from 57 control subjects without dementia, 62 mild cognitive impairment (MCI) patients, and 42 AD patients. Mini-Mental State Examination (MMSE) was evaluated when subjects were examined by medical doctors. Urinary amino acid (lysine)-conjugated acrolein (AC-Acro) was measured using N ɛ-(3-formyl-3, 4-dehydropiperidine) lysine (FDP-Lys) ELISA kit, and taurine content was measured using a taurine assay kit. Values were normalized by creatinine content which was measured with the colorimetric assay kit.

RESULTS

We found that urinary amino acid (lysine)-conjugated acrolein (AC-Acro) and taurine negatively correlated with MMSE score and are significantly lower in dementia patients compared to the normal subjects. When AC-Acro and taurine were evaluated together with age using an artificial neural network model, median relative risk values for subjects with AD, subjects with mild cognitive impairment, and control subjects were 0.96, 0.53, and 0.06, respectively.

CONCLUSION

Since urine is relatively easy to collect, our findings provide a novel biomarker for dementia without invasiveness.

Cognitive and Neuropsychological Profiles in Alzheimer's Disease and Primary Age-Related Tauopathy and the Influence of Comorbid Neuropathologies

BACKGROUND

Alzheimer's disease neuropathologic change (ADNC) is defined by the progression of both hyperphosphorylated-tau (p-tau) and amyloid-β (Aβ) and is the most common underlying cause of dementia worldwide. Primary age-related tauopathy (PART), an Aβ-negative tauopathy largely confined to the medial temporal lobe, is increasingly being recognized as an entity separate from ADNC with diverging clinical, genetic, neuroanatomic, and radiologic profiles.

OBJECTIVE

The specific clinical correlates of PART are largely unknown; we aimed to identify cognitive and neuropsychological differences between PART, ADNC, and subjects with no tauopathy (NT).

METHODS

We compared 2,884 subjects with autopsy-confirmed intermediate-high stage ADNC to 208 subjects with definite PART (Braak stage I-IV, Thal phase 0, CERAD NP score "absent") and 178 NT subjects from the National Alzheimer's Coordinating Center dataset.

RESULTS

PART subjects were older than either ADNC or NT patients. The ADNC cohort had more frequent neuropathological comorbidities as well as APOE ɛ4 alleles than the PART or NT cohort, and less frequent APOE ɛ2 alleles than either group. Clinically, ADNC patients performed significantly worse than NT or PART subjects across cognitive measures, but PART subjects had selective deficits in measures of processing speed, executive function, and visuospatial function, although additional cognitive measures were further impaired in the presence of neuropathologic comorbidities. In isolated cases of PART with Braak stage III-IV, there are additional deficits in measures of language.

CONCLUSION

Overall, these findings demonstrate underlying cognitive features specifically associated with PART, and reinforce the concept that PART is a distinct entity from ADNC.

Effect modification by aging on the associations of nicotine exposure with cognitive impairment among Chinese elderly

Active and passive exposure to tobacco smoke may increase risk of cognitive decline. However, effects of enhanced the aging process on the association of urinary nicotine metabolites with cognitive impairment remain unclear. In this study, 6657 Chinese older adults completed the physical examinations and cognitive tests. We measured urinary nicotine metabolite levels, mitochondrial DNA copy number (mtDNA-CN), and relative telomere length (RTL) and analyzed effects of urinary nicotine metabolites and their interaction with mtDNA-CN or RTL on cognitive impairment by generalized linear models and qg-computation, respectively. Each 1-unit increase in urinary 3-OHCot, 3-OHCotGluc, CotGluc, or NicGluc levels corresponded to a 1.05-, 1.09-, 1.04-, and 0.90-fold increased risk of cognitive impairment. Each 1-quantile increment in the mixture level of 8 nicotine metabolites corresponded to an increment of 1.40- and 1.34-fold risk of cognitive impairment in individuals with longer RTL or low mtDNA-CN. Urinary 3-OHCotGluc and RTL or mtDNA-CN exhibited an additive effect on cognitive impairment in addition to the mixture of 8 nicotine metabolites and mtDNA-CN. The findings suggested that aging process may increase the risk of tobacco-related cognitive impairment.

Serotonin Receptor Gene Polymorphisms Are Associated with Cerebrospinal Fluid, Genetic, and Neuropsychological Biomarkers of Alzheimer's Disease

A decrease in serotonergic transmission throughout the brain is among the earliest pathological changes in Alzheimer's disease (AD). Serotonergic receptors are also affected in AD. Polymorphisms in genes of serotonin (5HT) receptors have been mostly associated with behavioral and psychological symptoms of dementia (BPSD). In this study, we examined if AD patients carrying different genotypes in 5HTR1B rs13212041, 5HTR2A rs6313 (T102C), 5HTR2C rs3813929 (-759C/T), and 5HTR6 rs1805054 (C267T) polymorphisms have a higher risk of faster disease progression (assessed by neuropsychological testing), are more prone to develop AD-related pathology (reflected by levels of cerebrospinal fluid [CSF] AD biomarkers), or have an association with an apolipoprotein E (APOE) haplotype. This study included 115 patients with AD, 53 patients with mild cognitive impairment (MCI), and 2701 healthy controls. AD biomarkers were determined in the CSF of AD and MCI patients using enzyme-linked immunosorbent assays (ELISA), while polymorphisms were determined using either TaqMan SNP Genotyping Assays or Illumina genotyping platforms. We detected a significant decrease in the CSF amyloid β_1-42 (Aβ_1-42) and an increase in p-tau₁₈₁/Aβ_1-42 ratio in carriers of the T allele in the 5HTR2C rs3813929 (-759C/T) polymorphism. A significantly higher number of APOE ε4 allele carriers was observed among individuals carrying a TT genotype within the 5HTR2A T102C polymorphism, a C allele within the 5HTR1B rs13212041 polymorphism, and a T allele within the 5HTR6 rs1805054 (C267T) polymorphism. Additionally, individuals carrying the C allele within the 5HTR1B rs13212041 polymorphism were significantly more represented among AD patients and had poorer performances on the Rey-Osterrieth test. Carriers of the T allele within the 5HTR6 rs1805054 had poorer performances on the MMSE and ADAS-Cog. As all four analyzed polymorphisms of serotonin receptor genes showed an association with either genetic, CSF, or neuropsychological biomarkers of AD, they deserve further investigation as potential early genetic biomarkers of AD.

Modeling of correlated cognitive function and functional disability outcomes with bounded and missing data in a longitudinal aging study

Longitudinal studies of correlated cognitive and disability outcomes among older adults are characterized by missing data due to death or loss to follow-up from deteriorating health conditions. The Mini-Mental State Examination (MMSE) score for assessing cognitive function ranges from a minimum of 0 (floor) to a maximum of 30 (ceiling). To study the risk factors of cognitive function and functional disability, we propose a shared parameter model to handle missingness, correlation between outcomes, and the floor and ceiling effects of the MMSE measurements. The shared random effects in the proposed model handle missingness (either missing at random or missing not at random) and correlation between these outcomes, while the Tobit distribution handles the floor and ceiling effects of the MMSE measurements. We used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and a simulation study. By ignoring the MMSE floor and ceiling effects in the analyses of the CLHLS, the association of systolic blood pressure with cognitive function was not significant and the association of age with cognitive function was lower by 16.6% (from -6.237 to -5.201). By ignoring the MMSE floor and ceiling effects in the simulation study, the relative bias in the estimated association of female gender with cognitive function was 43 times higher (from -0.01 to -0.44). The estimated associations obtained with data missing at random were smaller than those with data missing not at random, demonstrating how the missing data mechanism affects the analytic results. Our work underscores the importance of proper model specification in longitudinal analysis of correlated outcomes subject to missingness and bounded values.

A Mini-Mental State Examination Formula May Help to Distinguish Alzheimer's Disease from Dementia with Lewy Bodies

Background:

Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB) differ in their memory, attention, and visuoconstructional characteristics. The subscales of the well-known Mini-Mental State Examination (MMSE) provide an opportunity to assess these characteristics. Previous research has shown that analysis of the MMSE subscale performance of AD and DLB patients helps to differentiate them.

Objective:

Study the MMSE scores of AD and DLB patients to see if the ability of previously reported analyses to differentiate them could be improved. Include other dementia patients for perspective.

Methods:

We studied the MMSEs of all patients seen in our clinics during an 18-month period. Different equations were studied, derived from the subscales of Memory (M, 3 points maximum), Attention (A, 5 points maximum), and Pentagon-copying (P, 1 point maximum).

Results:

We obtained 400 MMSEs, 136 from AD patients and 24 from DLB patients, scoring range 1–30. The equation P minus M provided the best discrimination between AD and DLB. Using a P-M score = 1 to identify AD, the positive predictive value was 0.97, negative predictive value 0.22, specificity 0.92, and sensitivity 0.43. As a secondary finding, the P-M = 1 equation was also helpful to differentiate AD from Parkinson’s disease dementia.

Conclusion:

Considering AD versus DLB in our clinic population, a demented patient who was unable to recall the three memory words on the MMSE but able to copy the intersecting pentagons had a 97% likelihood of having AD. Additional work is needed to improve the sensitivity of the P-M = 1 equation.

Diagnostic Accuracy of the Swedish Version of the Rowland Universal Dementia Assessment Scale (RUDAS-S) for Multicultural Cognitive Screening in Swedish Memory Clinics

Background:

The number of people with a migration background and dementia is increasing in Europe. All patients with suspected dementia have the right to an appropriate cognitive assessment and correct diagnosis for optimal treatment and support. Rowland Universal Dementia Assessment Scale (RUDAS) cognitive screening instrument is less affected by language, culture, and educational background, and adapted for use in multicultural populations.

Objective:

To compare the diagnostic accuracy of RUDAS-S to the Swedish version of Mini-Mental State Examination (MMSE-SR) for detecting dementia in a multicultural group of outpatients in Swedish memory clinics.

Methods:

We tested 123 outpatients (36 nonnative Swedish), in 4 memory clinics in Southern Sweden with RUDAS-S to supplement the usual cognitive assessment.

Results:

RUDAS-S had moderate to good diagnostic performance for detecting dementia in a multicultural population in Sweden, with an area under the receiver operating characteristic curve (AUC) of 0.81. At a cutoff score <25 its sensitivity was 0.92, specificity 0.60, and accuracy 76%. The AUC for the MMSE-SR was 0.79. At a cutoff score <23 its sensitivity was 0.65, specificity 0.81, and accuracy 73%.

Conclusion:

RUDAS-S is at least as accurate as MMSE-SR for detecting dementia in memory clinics in Sweden and can be used for all patients undergoing a cognitive assessment, irrespective of their cultural, language, and educational background. However, there is a need for other cross-cultural cognitive tests to complement RUDAS-S to extend cognitive examination.

Neuropsychiatric Inventory Questionnaire Associated with Cognitive Function, Age, and Duration of Education in Patients with Alzheimer's Disease

INTRODUCTION

Alzheimer's disease (AD) is the most common cognitive disease, and behavioral and psychological symptoms of dementia (BPSD) can place a heavy burden on families. The presence of these symptoms related to AD is commonly assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q). This study sought to clarify the relationship between scores on the 12-domain NPI-Q and individual factors in patients with AD.

METHODS

Participants were 218 new outpatients with AD at five memory clinics. Cognitive function was assessed using the Revised Hasegawa Dementia Scale (HDS-R) and Mini-Mental State Examination (MMSE). We examined which individual factors were associated with the total NPI-Q score and the number of domains. We also examined which domains were associated with the factors identified.

RESULTS

A higher total NPI score was significantly associated with lower scores on both cognitive assessments and a longer duration of education. Exhibiting symptoms on a greater number of domains was significantly associated with lower scores on both cognitive assessments, longer duration of education, and advanced age. The nighttime disturbances domain was significantly associated with lower scores on both cognitive assessments and advanced age. The delusions domain was significantly associated with lower education.

CONCLUSIONS

BPSD may appear more easily with reduced quality of life and ongoing dissatisfaction. Effective individualized services are important for patients with AD, and therefore, we should account for age, cognitive function, and duration of education in the services provided.

Trajectories of MMSE and MoCA scores across the healthy adult lifespan in the Italian population

Background

This study compares the performance at the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) across the healthy adult lifespan in an Italian population sample.

Methods

The MMSE and MoCA were administered to 407 Italian healthy native-speakers (165 males; age range 20–93 years; education range 4–25 years). A generalized Negative Binomial mixed model was run to profile MMSE and MoCA scores across 8 different age classes (≤ 30; 31–40; 41–50; 51–60; 61–70; 71–80; 81–85; ≥ 86) net of education and sex.

Results

MMSE and MoCA total scores declined with age (p < 0.001), with the MoCA proving to be “more difficult” than the MMSE (p < 0.001). The Age*Test interaction (p < 0.001) indicates that the MoCA proved to profile a sufficiently linear involutional trend in cognition with advancing age and to be able to detect poorer cognitive performances in individuals aged ≥ 71 years. By contrast, MMSE scores failed in capturing the expected age-related trajectory, reaching a plateau in the aforementioned age classes.

Discussion

The MoCA seems to be more sensitive than the MMSE in detecting age-related physiological decline of cognitive functioning across the healthy adult lifespan. The MoCA might be therefore more useful than the MMSE as a test for general cognitive screening aims.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-022-02174-0.

Hippocampal calcification and its effects on cognitive function and symptoms in dementia

BACKGROUND

Hippocampal calcification (HC), highly prevalent in older people, has not attracted attention until recently. Despite its potential effects on cognition and behaviour, and its possible impact on the diagnosis and severity of dementia, it has not been investigated. This study aimed to evaluate the prevalence of HC and its influence on cognition and behavioural symptoms in patients with dementia.

METHODS

Data from consecutive patients who visited a medical centre for dementia, for the first time between April 2016 and September 2018, were extracted and analysed. These data included the patients' demographics, the presence of HC and hippocampal thickness as measured on computed tomography, the diagnosis of dementia and its type, cognitive function measured using the Mini-Mental State Examination and the Clock Drawing Test, and the chief complaints or symptoms prompting the visit.

RESULTS

A high incidence of HC (85/267 patients) was observed. There was no significant difference in the ages of patients with and without HC. Patients with HC had higher cognitive function than those without HC at their first visit. This result was contrary to our expectations as it was not explained by the chief complaints recorded at the first visit.

CONCLUSIONS

Our study showed a high prevalence of HC in older patients with dementia. Patients with HC had better cognitive function than did those without HC during their first hospital visit. This study suggests that HC may not affect the cognitive functions related to dementia. However, further research is needed to evaluate the long-term consequences of dementia with HC.

Clinical Staging of Alzheimer's Disease: Concordance of Subjective and Objective Assessments in the Veteran's Affairs Healthcare System

INTRODUCTION

Uncertainty surrounding the accurate assessment of the early-stage Alzheimer's disease (AD) may cause delayed care and inappropriate patient access to new AD therapies.

METHODS

To analyze clinical assessments of patients with AD in the Veteran's Affairs (VA) Healthcare System and evaluate concordance between subjective and objective assessments, we processed clinical notes extracted by text integration utilities between April 1, 2008 and October 14, 2021. Veterans who had mild, moderate, or severe AD with clinical notes documenting both clinician's judgement of AD severity and objective test scores from the Mini-Mental State Examination or the Montreal Cognitive Assessment were included. Using clinician-defined severity cohorts, we determined concordance between the clinician's (subjective) assessments and the test-derived (objective) assessments of AD severity. Concordance was assessed over time and by selected symptoms and comorbidities, as well as healthcare system factors.

RESULTS

A total of 8888 notes were initially extracted; the final analysis sample included 7514 notes corresponding to 4469 unique patients (mean [standard deviation] age of 78 [9] years; 96.5% male; 77.8% White). Subjective and objective assessments were concordant in approximately half (53%) of overall notes. In the mild Alzheimer's cohort, patients were assessed to have more severe disease by objective test scores in 40% of notes. Concordance varied about 21-73%, 47-58%, and 40-64% across symptoms/comorbidities, clinician types, and Veteran's Integrated Service Networks, respectively. The proportion of concordant notes was higher in visits to dementia (61%) instead of non-dementia clinics (53%).

CONCLUSIONS

We found higher concordance between clinician's assessment and test-based assessment of Alzheimer's disease severity in dementia specialty clinics. Discordance is especially high for the subjectively assessed mild AD cohort where objective assessments showed a higher severity level in 40% of notes. These data indicate a critical need for improved understanding of clinical assessments and decision-making to identify appropriate patients for anti-amyloid therapy.

Estimating the longitudinal trajectory of cognitive function measurement using short-term data with different disease stages: Application in Alzheimer's disease

Alzheimer's disease (AD) is a chronic neurodegenerative disease characterized by a gradual decline in cognitive function over a few decades. The Mini-Mental State Examination (MMSE) is a widely used measure for evaluating global cognitive functioning. Characterizing the longitudinal trajectory of the MMSE in the population of interest is important to detect AD onset for preventive intervention. In this study, we formulate a new class of longitudinal trajectory modeling for MMSE from short-term individual data based on an ordinary differential equation. The proposed method models the relationship between individual decline speed of MMSE and the average MMSE using the fractional polynomial function model and subsequently estimates the longitudinal trajectory of MMSE by solving the ordinary differential equation for the estimated model. The appropriate model for trajectory estimation is selected based on the proposed criterion for quantifying the goodness of trajectory fit. The accuracy of the trajectory estimation of the proposed method was demonstrated via simulation studies. The proposed method was successfully applied to MMSE data from the Japanese Alzheimer's Disease Neuroimaging Initiative study.

Italian telephone-based Mini-Mental State Examination (Itel-MMSE): item-level psychometric properties

Background

The Italian telephone-based Mini-Mental State Examination (Itel-MMSE), despite being psychometrically sound, has shown relevant ceiling effects, which may negatively impact the interpretation of its scores. In address to overcome such an issue, this study aimed at providing item-level insights on the Itel-MMSE through Item Response Theory (IRT) analyses.

Methods

Five-hundred and sixty-seven healthy Italian adults (227 males, 340 females; mean age: 51 ± 17 years, range 18–96; mean education: 13.31 ± 4.3 years). A two-parameter logistic IRT model was implemented to assess item discrimination and difficulty of the Itel-MMSE. Construct unidimensionality, statistical independence of items, and model and item fit were tested. Informativity levels were also assessed graphically.

Results

With respect to the Itel-MMSE total score, ceiling effects were found in 92.7% of participants. Unidimensionality was violated; both model and item fit were poor; a few items showed statistical dependence. Both the whole test and its items proved to be scarcely informative, especially for medium-to-high levels of ability, except for attention and spatial orientation subtests, which consistently yielded the highest discriminative capability.

Discussion

The Itel-MMSE appears to be most informative in low-performing healthy individuals. However, the present findings should not lead practitioners to aprioristically equate ceiling effects/low informativity to clinical uselessness. Items assessing attention and, to a lesser extent, spatial orientation appear to be the most informative.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-02041-4.

Metabolic Syndrome and High-Obesity-Related Indices Are Associated with Poor Cognitive Function in a Large Taiwanese Population Study Older than 60 Years

Metabolic syndrome (MetS) is prevalent in Taiwan; however, the association between MetS and cognitive function is unclear. The aim of this study was to explore the associations between MetS, its components, and obesity-related indices with cognitive function in a large Taiwanese cohort. We enrolled a total of 28,486 participants who completed the Mini-Mental State Examination (MMSE) questionnaire, which was used to evaluate cognitive function. MetS was defined according to the NCEP-ATP III guidelines and modified criteria for Asians. Ten obesity-related indices were also evaluated: body mass index (BMI), abdominal volume index (AVI), body adiposity index (BAI), waist−hip ratio (WHR), a body shape index (ABSI), lipid accumulation product, waist-to-height ratio (WHtR), conicity index (CI), body roundness index (BRI), and triglyceride glucose index. The prevalence of MetS and its components (except for hypertriglyceridemia) and the number of MetS components increased while the cognitive impairment worsened (from MMSE ≥ 24, 18−23 to 0−17). In addition, increases in all obesity-related index values were associated with a decline in cognitive function (from MMSE ≥ 24, 18−23 to 0−17, ANOVA p < 0.001). Multivariable analysis showed that MetS (p = 0.002), abdominal obesity (p < 0.001), low high-density lipoprotein cholesterol (p = 0.004), and hyperglycemia (p = 0.012) were significantly associated with a low MMSE score. Further, participants with high BMI (p = 0.001), WHR (p < 0.001), WHtR (p < 0.001), BRI (p < 0.001), CI (p < 0.001), BAI (p < 0.001), AVI (p < 0.001), and ABSI (p < 0.001) values were significantly associated with a low MMSE score. Our results show that MetS and its components (except for hypertriglyceridemia and high blood pressure) may lead to cognitive impairment, and that high values of obesity-related indices were associated with poor cognitive function.

Evaluation of the Accuracy of Cognitive Screening Tests in Detecting Dementia Associated with Alzheimer's Disease: A Hierarchical Bayesian Latent Class Meta-Analysis

BACKGROUND

Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) are neuropsychological tests commonly used by physicians for screening cognitive dysfunction of Alzheimer's disease (AD). Due to different imperfect reference standards, the performance of MoCA and MMSE do not reach consensus. It is necessary to evaluate the consistence and differentiation of MoCA and MMSE in the absence of a gold standard for AD.

OBJECTIVE

We aimed to assess the accuracy of MoCA and MMSE in screening AD without a gold standard reference test.

METHODS

Studies were identified from PubMed, Web of Science, CNKI, Chinese Wanfang Database, China Science and Technology Journal Database, and Cochrane Library. Our search was limited to studies published in English and Chinese before August 2021. A hierarchical Bayesian latent class model was performed in meta-analysis when the gold standard was absent.

RESULTS

A total of 67 studies comprising 5,554 individuals evaluated for MoCA and 76,862 for MMSE were included in this meta-analysis. The pooled sensitivity was 0.934 (95% CI 0.906 to 0.954) for MoCA and 0.883 (95% CI 0.859 to 0.903) for MMSE, while the pooled specificity was 0.899 (95% CI 0.859 to 0.928) for MoCA and 0.903 (95% CI 0.879 to 0.923) for MMSE. MoCA was useful to rule out dementia associated with AD with lower negative likelihood ratio (LR-) (0.074, 95% CI 0.051 to 0.108). MoCA showed better performance with higher diagnostic odds ratio (DOR) (124.903, 95% CI 67.459 to 231.260).

CONCLUSION

MoCA had better performance than MMSE in screening dementia associated with AD from patients with mild cognitive impairment or healthy controls.

Different MMSE domains are associated to cognitive decline and education

The Mini-Mental State Examination (MMSE) is a long-established test to screen for dementia, estimate the severity and monitor the progression of cognitive impairment. The MMSE total score is dependent upon demographic factors, particularly education, but little is known about how education influences the 6 distinct MMSE cognitive domains. The present study aims to understand how the performances in the MMSE cognitive domains reflect clinical diagnosis and educational level. The study recruited 1043 participants, comprising 388 healthy controls, 360 patients with Mild Cognitive Impairment (MCI) and 295 patients with dementia. The association of the MMSE cognitive domains scores with clinical diagnosis (healthy, MCI, dementia) and educational level (primary education, middle school, high school and university/college) was analyzed with a multivariate ordinal regression model. The scores in all MMSE domains were generally higher in healthy controls as compared to patients with MCI, and higher in these as compared to patients with dementia. The MMSE domain Constructional ability was associated to the education level, the domains Orientation, Recall and Language were associated to diagnosis, Attention and calculation was associated to both education level and diagnosis, and Registration was not associated to either education or diagnosis. In conclusion, impairment in specific MMSE domains pinpoints cognitive decline, probably indicating brain areas affected by neurodegeneration, and impairment in others reflects lower education levels and the lack of acquisition of relevant schooling abilities.

Is There an Association between Norton Scale and Cognitive Impairment in Hip Fractured Elderly Patients?

INTRODUCTION

Geriatric assessment as an integrative part of assessment is a composite of a large number of scales. Sometimes it is difficult to transfer all of them. The Norton Scale Score (NSS) assesses the degree of risk to develop bedsores. In previous studies, a correlation between Norton Scale and function was found. A correlation between Norton Scale and cognitive assessments was not evaluated yet. The aim of this study was to determine if there is an association between Norton Scale Score and cognitive impairment. This association can further facilitate geriatric assessment in frail older patients, especially in older patients with communicative difficulties.

METHODS

We have performed an observational cohort study which included hip fractured older patients consecutively admitted to the rehabilitation ward of the Shmuel Harofe Geriatric Medical Center. The collected data included demographic data and data on chronic illnesses. Results of cognitive status assessment (Mini-Mental State Examination - MMSE) and Norton Scale assessment were received from the computerized patients' charts. We evaluated the association between these 2 scales.

RESULTS

The study included 224 consecutive hip fracture patients with a mean age of 81.78 ± 7.19 years. Norton scores at admission, age, education, and previous stroke emerged as the only statistically significant parameters differing between those with cognitive decline and those without it. After adjusting for confounding variables, lower Norton scores at admission (OR 1.303, CI: 1.097-1.548, p = 0.003) were associated with an increased risk finding for cognitive impairment.

CONCLUSION

Our findings suggest that there is an association between Norton Scale Scores and cognitive impairment. Norton score parameters, under certain circumstances, such as speech and other communication difficulties, can be used as a proxy measure for MMSE to indicate cognitive impairment. These findings can be even more helpful in the present time of "COVID-19," when we have to evaluate older patients with facial masks and other defensive suits.

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 association between plasma soluble triggering receptor expressed on myeloid cells 2 and cognitive impairment after acute ischemic stroke

BACKGROUND

Previous researches have suggested that soluble triggering receptor expressed on myeloid cells 2 (sTREM2) plays a pivotal role in central nervous system pathologies and the development of neurodegenerative disorders. This study aimed to prospectively investigate the association between plasma sTREM2 levels and post-stroke cognitive impairment (PSCI).

METHODS

A sample of 599 consecutive acute ischemic stroke patients with sTREM2 measurements from the China Antihypertensive Trial in Acute Ischemic Stroke were eventually included in this analysis. Cognitive impairment was defined as a score of <25 for Mini-Mental State Examination, measured at 3-month follow up. Binary logistic regression was used to estimate the odds ratios (ORs) of plasma sTREM2 levels on the risk of PSCI.

RESULTS

Of the 599 participants (mean age, 60.0 ± 10.4 years; male, 70.5%), 228 (38.1%) patients were diagnosed as PSCI. The risk of PSCI elevated significantly with higher plasma sTREM2 levels (p for trend <0.01). After adjusting for several confounding factors, the ORs for the highest quartile of sTREM2 compared with the lowest quartile was 2.06 (95% confidence interval, 1.20-3.53) for PSCI. Moreover, the addition of sTREM2 to the conventional model with established risk factors significantly improved risk discrimination (C-statistics increased from 0.668 to 0.691, p = 0.02) and reclassification (net reclassification improvement: 32.2%, p < 0.001; integrated discrimination improvement: 1.3%, p = 0.01) for PSCI.

LIMITATIONS

Results might be subject to selective bias and potential confounding.

CONCLUSIONS

The present study demonstrated that elevated level of plasma sTREM2 may be associated with PSCI, and sTREM2 has potential value in predicting PSCI.

Discrimination of the Cognitive Function of Community Subjects Using the Arterial Pulse Spectrum and Machine-Learning Analysis

Early identification of cognitive impairment would allow affected patients to receive care at earlier stage. Changes in the arterial stiffness have been identified as a prominent pathological feature of dementia. This study aimed to verify if applying machine-learning analysis to spectral indices of the arterial pulse waveform can be used to discriminate different cognitive conditions of community subjects. 3-min Radial arterial blood pressure waveform (BPW) signals were measured noninvasively in 123 subjects. Eight machine-learning algorithms were used to evaluate the following 4 pulse indices for 10 harmonics (total 40 BPW spectral indices): amplitude proportion and its coefficient of variation; phase angle and its standard deviation. Significant differences were noted in the spectral pulse indices between Alzheimer’s-disease patients and control subjects. Using them as training data (AUC = 70.32% by threefold cross-validation), a significant correlation (R² = 0.36) was found between the prediction probability of the test data (comprising community subjects at two sites) and the Mini-Mental-State-Examination score. This finding illustrates possible physiological connection between arterial pulse transmission and cognitive function. The present findings from pulse-wave and machine-learning analyses may be useful for discriminating cognitive condition, and hence in the development of a user-friendly, noninvasive, and rapid method for the early screening of dementia.

Validation of a modified Chinese version of Mini-Addenbrooke's Cognitive Examination for detecting mild cognitive impairment

BACKGROUND

For detecting mild cognitive impairment (MCI), brief cognitive screening tools are increasingly required for the advantage of time saving and no need for special equipment or trained raters. We aimed to develop a modified Chinese version of Mini-Addenbrooke's Cognitive Examination (C-MACE) and further evaluate its validation in detecting MCI.

METHODS

A total of 716 individuals aged from 50 to 90 years old were recruited, including 431 cognitively normal controls (NC) and 285 individuals with MCI. The effect size of Cramer's V was used to explore which items in the Chinese version of Addenbrooke's Cognitive Examination-III (ACE-III-CV) best associated with MCI and to form the C-MACE. Receiver operating characteristic (ROC) analyses were carried out to explore the ability of C-MACE, ACE-III-CV, Chinese version of Montreal Cognitive Assessment-Basic (MoCA-BC), and Mini-Mental State Examination (MMSE) in discriminating MCI from NC.

RESULTS

Five items with greatest effect sizes of Cramer's V were selected from ACE-III-CV to form the C-MACE: Memory Immediate Recall, Memory Delayed Recall, Memory Recognition, Verbal Fluency Animal and Language Naming. With a total score of 38, the C-MACE had a satisfactory classification accuracy in detecting MCI (area under the ROC curve, AUC = 0.892), superior to MMSE (AUC = 0.782) and comparable to ACE-III-CV (AUC = 0.901) and MoCA-BC (AUC = 0.916). In the subgroup of Age > 70 years, Education ≤ 12 years, the C-MACE got a highest classification accuracy (AUC = 0.958) for detecting MCI.

CONCLUSION

In the Chinese-speaking population, C-MACE derived from ACE-III-CV may identify MCI with a good classification accuracy, especially in aged people with low education.

Spanish-language screening scales: A critical review

INTRODUCTION

Dementia is a chronic, degenerative disease with a strong impact on families and health systems. The instruments currently in use for measuring cognitive impairment have different psychometric characteristics in terms of application time, cut-off point, reliability, and validity. The objective of this review is to describe the characteristics of the validated, Spanish-language versions of the Mini-Cog, Clock-Drawing Test, and Mini-Mental State Examination scales for cognitive impairment screening.

DEVELOPMENT

We performed a three-stage literature search of articles published on Medline since 1953. We selected articles on validated, Spanish-language versions of the scales that included data on reliability, validity, sensitivity, and specificity.

CONCLUSIONS

The 3 screening tools assessed in this article provide support for primary care professionals. Timely identification of mild cognitive impairment and dementia is crucial for the prognosis of these patients.

Assessment of structural brain changes in patients with type 2 diabetes mellitus using the MRI-based brain atrophy and lesion index

Patients with type 2 diabetes mellitus (T2DM) often have cognitive impairment and structural brain abnormalities. The magnetic resonance imaging (MRI)-based brain atrophy and lesion index can be used to evaluate common brain changes and their correlation with cognitive function, and can therefore also be used to reflect whole-brain structural changes related to T2DM. A total of 136 participants (64 men and 72 women, aged 55–86 years) were recruited for our study between January 2014 and December 2016. All participants underwent MRI and Mini-Mental State Examination assessment (including 42 healthy control, 38 T2DM without cognitive impairment, 26 with cognitive impairment but without T2DM, and 30 T2DM with cognitive impairment participants). The total and sub-category brain atrophy and lesion index scores in patients with T2DM with cognitive impairment were higher than those in healthy controls. Differences in the brain atrophy and lesion index of gray matter lesions and subcortical dilated perivascular spaces were found between non-T2DM patients with cognitive impairment and patients with T2DM and cognitive impairment. After adjusting for age, the brain atrophy and lesion index retained its capacity to identify patients with T2DM with cognitive impairment. These findings suggest that the brain atrophy and lesion index, based on T1-weighted and T2-weighted imaging, is of clinical value for identifying patients with T2DM and cognitive impairment. Gray matter lesions and subcortical dilated perivascular spaces may be potential diagnostic markers of T2DM that is complicated by cognitive impairment. This study was approved by the Medical Ethics Committee of University of South China (approval No. USC20131109003) on November 9, 2013, and was retrospectively registered with the Chinese Clinical Trial Registry (registration No. ChiCTR1900024150) on June 27, 2019.

Serum Levels of α-Klotho Are Correlated with Cerebrospinal Fluid Levels and Predict Measures of Cognitive Function

BACKGROUND

α-klotho might play a role in neurodegenerative diseases.

OBJECTIVE

To determine levels of α-klotho and apoE in serum and cerebrospinal fluid (CSF) samples and their relationship with the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR).

METHODS

All subjects were between age 39 to 83+ (n = 94). CDR and MMSE were administered to all participants. CSF was collected in the early afternoon by lumbar puncture.

RESULTS

Serum and CSF levels of α-klotho are positively correlated and both predict scores on the MMSE and CDR, regardless of sex or apoE4 status.

CONCLUSION

Our results demonstrate that α-klotho may be an important biomarker of cognitive health and neurodegeneration, and that relatively non-invasive sampling of α-klotho from serum is likely highly reflective of CSF levels.

The Effects of Social Activities and Living Arrangements on Cognitive Functions in Middle-aged and Elderly Adults: A Panel Study Using the 2006-2018 Korean Longitudinal Study of Aging

OBJECTIVES

Previous studies have shown that participation in social activities (SA) can prevent cognitive decline (CD) and that living arrangements (LA) can affect cognitive function. This study aimed to evaluate the effects of SA and LA on CD, as well as their interactions, using longitudinal data.

METHODS

Data were used from the 2006-2018 Korean Longitudinal Study for Aging, which followed 10 254 adults older than 45 years over a 12-year period. CD was defined as a ≥4-point score decrease in the Mini-Mental Status Exam over 2 years. We developed an extended Cox proportional hazards model for time-dependent covariates to estimate the hazard ratio (HR) of CD in 4 groups: (1) socially active and living with others, (2) socially active and living alone, (3) socially inactive and living with others (SILO), and (4) socially inactive and living alone (SILA). The model was stratified by gender and adjusted for important confounders.

RESULTS

The HR of CD was significantly higher in the SILO group in men (HR,1.36; 95% confidence interval [CI], 1.08 to 1.78) and in the SILA group in women (HR, 1.72; 95% CI, 1.08 to 2.75). However, the interaction term for gender was not significant.

CONCLUSIONS

Among socially inactive elderly adults, the HR of CD was elevated in men who lived with others and in women who lived alone, although the interaction term for gender was not significant. Socially inactive men who live with others and socially inactive women who live alone are particularly encouraged to participate in SA to prevent CD.

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.

Tap Test Can Predict Cognitive Improvement in Patients With iNPH-Results From the Multicenter Prospective Studies SINPHONI-1 and -2

Background: We analyzed the predictive value of the tap test (TT) on the outcome of cerebrospinal fluid (CSF) shunting in patients with idiopathic normal pressure hydrocephalus (iNPH) and cognitive impairment up to 12 months postoperatively. Methods: We analyzed the data of two prospective multicenter studies on ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS) use in iNPH patients. We selected patients with Mini-Mental State Examination (MMSE) scores ≤ 26 points as study subjects. We used a multivariate logistic regression model to obtain the optimal threshold of MMSE scores after TT to predict the score improvement at 12 months following shunting and that helped to control for confounding factors such as age and MMSE scores before TT. We used logistic regression models to identify variables with age-adjusted odds ratio (A-OR) and multivariate-adjusted OR (M-OR). Results: For an improvement of ≥3 points in the MMSE score cutoff 7 days following TT in VPS and LPS cohort studies, the MMSE scores improved by 6 points after 12 months. The VPS cohort had sensitivity, specificity, and area under the curve (AUC) of 69.2, 73.7, and 0.771%, respectively; however, for the LPS cohort, they were 86.2, 90.9, and 0.906%, respectively. For MMSE scores that improved by ≥3 points in patients after the TT, the possibility of an improvement by 6 points at 12 months following CSF shunt had A-OR 7.77 and M-OR 6.3 times for the VPS, and A-OR 62.3 and M-OR 59.6 times for the LPS cohort. Conclusion: CSF shunting contributes to improved cognitive function in iNPH patients. Furthermore, MMSE score evaluation at the TT can sensitively predict improvement in postoperative MMSE scores following LPS intervention. Clinical Trial Registration: SINPHONI-1 (ClinicalTrials.gov, no. NCT00221091), first posted: September 22, 2005. SINPHONI-2 [University Hospital Medical Information Network (UMIN) Clinical Trials no. UMIN000002730], the posted: February 1, 2010.

Sex Differences on Montreal Cognitive Assessment and Mini-Mental State Examination Scores and the Value of Self-Report of Memory Problems among Community Dwelling People 70 Years and above: The HUNT Study

INTRODUCTION

The aims were to examine if the total and item scores on the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) and self-reported memory problems differed between older women and men, and if self-reported memory problems were associated with scores on the 2 tests.

METHODS

We included 309 home-dwelling people aged 70 years and older, 155 women, mean age 75.6 (SD 4.1) years, and 154 men, mean age 76.0 (SD 4.6) years. They were examined with MoCA and MMSE, and they answered 2 questions: "have you experienced any memory problems" and "have you experienced significant memory problems the last 5 years?"

RESULTS

The participants scored significantly higher on the MMSE (women 28.0 [1.8], men 28.4 [1.4]) than on MoCA (women 24.6 [3.3], men 24.3 [3.1]). Spearman's rho was 0.36 between the tests. Women scored significantly higher than men on delayed recall of MoCA (3.0 [1.6] vs. 2.4 [1.6]), whereas men scored significantly higher on visuoconstruction (3.8 [1.2] vs. 3.5 [1.0]) and serial subtraction on MoCA (2.7 [0.6] vs. 2.5 [0.8]) and serial sevens on MMSE (4.5 [0.8] vs. 4.1 [1.1]). Multivariate linear regression analyses revealed that female sex, younger age, and higher education were associated with a higher score on MoCA, whereas age and education were associated with a higher score on MMSE. About half of the participants (no sex difference) had experienced significant memory problems the last 5 years, and they had significantly lower scores on both tests.

CONCLUSIONS

The MoCA score was associated with sex, age, and education, whereas sex did not influence the MMSE score. The question "have you experienced significant memory problems the last 5 years?" may be useful to evaluate older people's cognition.

Screening for cognitive sequelae of SARS-CoV-2 infection: a comparison between the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA)

Background

Due to SARS-CoV-2-related encephalopathic features, COVID-19 patients may show cognitive sequelae that negatively affect functional outcomes. However, although cognitive screening has been recommended in recovered individuals, little is known about which instruments are suitable to this scope by also accounting for clinical status. This study thus aimed at comparatively assessing the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) in detecting cognitive deficits in post-COVID-19 patients premorbidly/contextually being or not at risk for cognitive deficits (RCD + ; RCD-).

Methods

Data from N = 100 COVID-19-recovered individuals having been administered both the MMSE and the MoCA were retrospectively analyzed separately for each group. RCD ± classification was performed by taking into consideration both previous and disease-related conditions. Equivalent scores (ESs) were adopted to examine classification performances of the two screeners.

Results

The two groups were comparable as for most background and cognitive measures. MMSE or MoCA adjusted scores were mostly unrelated to disease-related features. The two screeners yielded similar estimates of below-cut-off performances—RCD + : MMSE: 20%, MoCA: 23.6%; RCD-: MMSE: 2.2%, MoCA: 4.4%. However, agreement rates dropped when also addressing borderline, “low-end” normal, and normal ability categories—with the MoCA attributing lower levels than the MMSE (RCD + : Cohen’s k = .47; RCD-: Cohen’s k = .17).

Discussion

Although both the MMSE and the MoCA proved to be equally able to detect severe cognitive sequelae of SARS-CoV-2 infection in both RCD + and RCD- patients, the MoCA appeared to be able to reveal sub-clinical defects and more sharply discriminate between different levels of ability.