Chapter

Montreal Cognitive Assessment (MoCA): Concept and Clinical Review

January 2013

DOI:10.1007/978-1-4471-2452-8_6

In book: Cognitive Screening Instruments (pp.111-151)

Authors:

Parunyou Julayanont

Texas Tech University Health Sciences Center

Natalie A. Phillips

Concordia University Montreal

Howard Chertkow

McGill University

Ziad Nasreddine

Université de Sherbrooke

The Montreal Cognitive Assessment (MoCA) is a cognitive screening instrument developed to detect mild cognitive impairment (MCI). It is a simple 10 minute paper and pencil test that assesses multiple cognitive domains including memory, language, executive functions, visuospatial skills, calculation, abstraction, attention, concentration, and orientation. Its validity has been established to detect mild cognitive impairment in patients with Alzheimer’s disease and other pathologies in cognitively impaired subjects who scored in the normal range on the MMSE. MoCA’s sensitivity and specificity to detect subjects with MCI due to Alzheimer’s disease and distinguish them from healthy controls are excellent. MoCA is also sensitive to detect cognitive impairment in cerebrovascular disease and Parkinson’s disease, Huntington’s disease, brain tumors, systemic lupus erythematosus, substance use disorders, idiopathic rapid eye movement sleep behaviour disorder, obstructive sleep apnoea, risk of falling, rehabilitation outcome, and epilepsy. There are several features in MoCA’s design that likely explain its superior sensitivity for detecting MCI. The MoCA’s memory testing involves more words, fewer learning trials, and a longer delay before recall than the MMSE. Executive functions, higher-level language abilities, and complex visuospatial processing can also be mildly impaired in MCI participants of various etiologies and are assessed by the MoCA with more numerous and demanding tasks than the MMSE. MoCA was developed in a memory clinic setting and normed in a highly educated population. Norms in lesser educated, community based, multi-cultural samples will hopefully be available to help first line healthcare providers better assess subjects presenting with cognitive complaints. The MoCA is freely accessible for clinical and educational purposes (www. mocatest. org), and is available in 36 languages and dialects.

Validity and diagnostics of the Italian version of the Montreal Cognitive Assessment (MoCA) in non-demented Parkinson’s disease patients

Article

Full-text available

Jul 2023
AGING CLIN EXP RES

Background This study aimed at: (1) assessing, in an Italian cohort of non-demented Parkinson’s disease (PD) patients, the construct validity of the Montreal Cognitive Assessment (MoCA) against both first- and second-level cognitive measures; (2) delivering an exhaustive and updated evaluation of its diagnostic properties. Methods A retrospective cohort of N = 237 non-demented PD patients having been administered the MoCA was addressed, of whom N = 169 further underwent the Mini-Mental State Examination (MMSE) and N = 68 the Parkinson’s Disease Cognitive Rating Scale (PD-CRS). A subsample (N = 60) also underwent a second-level cognitive battery encompassing measures of attention/executive functioning, language, memory, praxis and visuo-spatial abilities. Construct validity was assessed against both the PD-CRS and the second-level cognitive battery. Diagnostics were tested via receiver-operating characteristics analyses against a below-cut-off MMSE score. Results The MoCA was associated with both PD-CRS scores (p < .001) and the vast majority of second-level cognitive measures (ps < .003). Both raw and adjusted MoCA scores proved to be highly accurate to the aim of identifying patients with MMSE-confirmed cognitive dysfunctions. A MoCA score adjusted for age and education according to the most recent normative dataset and < 19.015 is herewith suggested as indexing cognitive impairment in this population (AUC = .92; sensitivity = .92; specificity = .80). Discussion The Italian MoCA is a valid and diagnostically sound screener for global cognitive inefficiency in non-demented PD patients. Further studies are nevertheless needed that confirm its diagnostic values against a measure other than the MMSE.

Using shoe-mounted inertial sensors and stepping exergames to assess the motor- cognitive status of older adults: A correlational study

Article

Full-text available

Mar 2023

Objective Stepping exergames designed to stimulate physical and cognitive skills can provide important information concerning individuals’ performance. In this study, we investigated the potential of stepping and gameplay metrics to assess the motor-cognitive status of older adults. Methods Stepping and gameplay metrics were recorded in a longitudinal study involving 13 older adults with mobility limitations. Game parameters included games’ scores and reaction times. Stepping parameters included length, height, speed, and duration, measured by inertial sensors placed on the shoes while interacting with the exergames. Parameters measured on the first gameplay were correlated against standard cognitive and mobility assessments, including the Montreal Cognitive Assessment (MoCA), gait speed, and the Short Physical Performance Battery. Based on MoCA scores, patients were then stratified into two groups: cognitively impaired and healthy controls. The differences between the two groups were visually inspected, considering their within-game progression over the training period. Results Stepping and gameplay metrics had moderate-to-strong correlations with cognitive and mobility performance indicators: faster, longer, and higher steps were associated with better mobility scores; better cognitive games’ scores and reaction times, and longer and faster steps were associated with better cognitive performance. The preliminary visual analysis revealed that the group with cognitive impairment required more time to advance to the next difficulty level, also presenting slower reaction times and stepping speeds when compared to the healthy control group. Conclusion Stepping exergames may be useful for assessing the cognitive and motor status of older adults, potentially allowing assessments to be more frequent, affordable, and enjoyable. Further research is required to confirm results in the long term using a larger and more diverse sample.

Incidence and predictors of post-stroke cognitive impairment among patients admitted with first stroke at tertiary hospitals in Dodoma, Tanzania: A prospective cohort study

Article

Full-text available

Apr 2024
PLOS ONE

Introduction Stroke survivors develop cognitive impairment, which significantly impacts their quality of life, their families, and the community as a whole but not given attention. This study aims to determine the incidence and predictors of post-stroke cognitive impairment (PSCI) among adult stroke patients admitted to a tertiary hospital in Dodoma, Tanzania. Methodology A prospective cohort study was conducted at tertiary hospitals in the Dodoma region, central Tanzania. A sample size of 158 participants with the first stroke confirmed by CT/MRI brain aged ≥ 18 years met the criteria. At baseline, social-demographic, cardiovascular risks and stroke characteristics were acquired, and then at 30 days, participants were evaluated for cognitive functioning using Montreal Cognitive Assessment (MoCA). Key confounders for cognitive impairment, such as depression and apathy, were evaluated using the Personal Health Questionnaire (PHQ-9) and Apathy Evaluation Scale (AES), respectively. Descriptive statistics were used to summarise data; continuous data were reported as Mean (SD) or Median (IQR), and categorical data were summarised using proportions and frequencies. Univariate and multivariable logistic regression analysis was used to determine predictors of PSCI. Results The median age of the 158 participants was 58.7 years; 57.6% of them were female, and 80.4% of them met the required criteria for post-stroke cognitive impairment. After multivariable logistic regression, left hemisphere stroke (AOR: 5.798, CI: 1.030–32.623, p = 0.046), a unit cm³ increase in infarct volume (AOR: 1.064, 95% CI: 1.018–1.113, p = 0.007), and apathy symptoms (AOR: 12.259, CI: 1.112–89.173, p = 0.041) had a significant association with PSCI. Conclusion The study revealed a significant prevalence of PSCI; early intervention targeting stroke survivors at risk may improve their outcomes. Future research in the field will serve to dictate policies and initiatives.

The Association between Intracranial Calcifications and Symptoms in Patients with Primary Familial Brain Calcification

Article

Full-text available

Jan 2024

(1) Background: Primary Familial Brain Calcification (PFBC) is a neurodegenerative disease characterized by bilateral calcifications of the basal ganglia and other intracranial areas. Many patients experience symptoms of motor dysfunction and cognitive disorders. The aim of this study was to investigate the association between the amount and location of intracranial calcifications with these symptoms. (2) Methods: Patients with suspected PFBC referred to our outpatient clinic underwent a clinical work-up. Intracranial calcifications were visualized on Computed Tomography (CT), and a Total Calcification Score (TCS) was constructed. Logistic and linear regression models were performed. (3) Results: Fifty patients with PFBC were included in this study (median age 64.0 years, 50% women). Of the forty-one symptomatic patients (82.0%), 78.8% showed motor dysfunction, and 70.7% showed cognitive disorders. In multivariate analysis, the TCS was associated with bradykinesia/hypokinesia (OR 1.07, 95%-CI 1.02–1.12, p < 0.01), gait ataxia (OR 1.06, 95%-CI 1.00–1.12, p = 0.04), increased fall risk (OR 1.04, 95%-CI 1.00–1.08, p = 0.03), and attention/processing speed disorders (OR 1.06, 95%-CI 1.01–1.12, p = 0.02). Calcifications of the lentiform nucleus and subcortical white matter were associated with motor and cognitive disorders. (4) Conclusions: cognitive and motor symptoms are common among patients with PFBC, and there is an association between intracranial calcifications and these symptoms.

Risk factors for cognitive dysfunction amongst patients with cardiovascular diseases

Article

Full-text available

Sep 2024

Background The impact of cardiovascular diseases on cognition raises important research questions. The study aimed to investigate the relationship between demographic data, cardiovascular diseases, kidney disease and depressive symptoms on cognition. Methods A cross-sectional study of patients with cardiovascular diseases was performed. The Montreal Cognitive Assessment (MoCA) was applied for cognitive evaluation. Based on MoCA three groups were defined: preserved cognition, mild, and advanced cognitive dysfunction (CD). Data were analyzed using Cronbach alpha (Cα) and McDonald’s ω (Mω) for internal consistency. The Chi-square test, Cramer’s V test, and correlation analyses were also applied. Results Of 628 patients, 55.2% had mild CD, and the mean age was 67.95 (SD 9.53) years. Cα and Mω were 0.7, indicating good internal consistency. We found a moderate positive correlation between depression and the severity of CD (r = 0.25, p = 0.0001). A weak association between CD and female gender (p = 0.016), atrial fibrillation (p = 0.03), stroke (p = 0.009), and a moderate association for age group (p < 0.0001), education level (p < 0.0001), smoking (p < 0.0001), and renal dysfunction (p < 0.0001) was found. Age ≥ 70 years, eGFR 30–59 mL/min/1.73m² significantly increased the likelihood for mild and advanced CD, while smoking and > 9 classes decreased it. Female gender, history of atrial fibrillation, and stroke significantly increased the likelihood of advanced CD. Conclusion Mild CD was the most common in patients with cardiovascular diseases. Older age, lower education, being a non-smoker, and renal dysfunction were risk factors for both mild and advanced CD. Female gender, previous diagnosis of atrial fibrillation, and stroke are risk factors for advanced CD.

Investigating the Prevalence and Determinants of Mild Cognitive Impairment in the Elderly Population at Primary Care Facilities

Article

Aug 2024

Aim: To investigate the prevalence and determine profile of patients with mild cognitive impairment (MCI) among older adults attended at the first level of care and the possible factors associated with MCI. Study Design: Observational, cross-sectional and analytical study. Methodology: The study was conducted with Mexican patients attending the outpatient consultation of the Gerontology Speciality at the Family Medicine Clinic “División del Norte” (an Ambulatory Care Medical Unit), in Mexico City. Data was collected through a protective design using the Montreal Cognitive Assessment test and a structured survey on sociodemographic factors. A descriptive statistical analysis and univariate and multivariate logistic regression models were performed. Results: The median age was 72 years old (IQR=66-78 years). The youngest participant was 60 years old and the oldest was 93 years old (range=33 years). The elderly population with MCI are female, septuagenarian, with a basic level of education. The prevalence of MCI was 28%, and 18% for dementia. The factors that increase the risk of MCI are: age (OR=1.072, 95% CI 1.034-1.111), hypertriglyceridemia (OR=13.709, 95%CI 1.267-148.294), peptic ulcer disease (OR=5.92, 95%CI 1.009-34.719), glaucoma (OR=4.048, 95%CI 1.051-15.596), chronic obstructive pulmonary disease (OR=5.616, 95%CI 1.024-30.802), and asthma (OR=12.323, 95%CI 1.128-134.578). The high educational level was associated as a protective factor (OR=0.336, 95%CI 0.189-0.596). Conclusion: Prevention programmes are necessary to avoid MCI, along with interventions to improve patients' quality of life, and the promotion of educational and engaging activities to support cognitive health in elderly people.

The Risk of Atrial Fibrillation and Previous Ischemic Stroke in Cognitive Decline

Article

Full-text available

Jul 2024

Objectives: Our study investigated the inverse relationship between cognitive decline (CD) and the presence of documented atrial fibrillation (AFib), ischemic stroke, heart failure, lower extremity peripheral artery disease, and diabetes mellitus. Methods: We conducted a retrospective cross-sectional study between December 2016 and November 2019. A total of 469 patients were enrolled who underwent cognitive evaluation with three cognitive tests (Montreal Cognitive Assessment—MOCA, Mini-Mental State Examination—MMSE, and General Practitioner Assessment of Cognition—GPCOG). We used the standard cut-off values, and the optimal thresholds were obtained from the receiver operating characteristic curves. Results: The standard cut-off level of the MOCA (<26 points) was associated with the presence of AFib (OR: 1.83, 95% CI: 1.11–3.01) and the optimal cut-off level with <23 points with ischemic stroke (OR: 2.64, 95% CI: 1.47–4.74; p = 0.0011). The optimal cut-off value of the MMSE (<28 points) was associated with the presence of ischemic stroke (OR: 3.07, 95% CI: 1.56–6.07; p = 0.0012), AFib (OR: 1.65, 95% CI: 1.05–2.60; p = 0.0287), and peripheral artery disease (OR: 2.72, 95% CI: 1.38–5.36; p = 0.0039). GPCOG < 8 points were associated with ischemic stroke (OR: 2.18, 95% CI: 1.14–4.14; p = 0.0176) and heart failure (OR: 1.49, 95% CI: 1.01–2.21; p = 0.0430). Conclusions: Our research highlighted the broader utility of cognitive assessment. The MOCA and MMSE scores proved to be associated with documented AFib. Higher cognitive test results than the standard threshold for CD of the MMSE, GPCOG, and lower MOCA scores represented risk factors for the presence of previous ischemic stroke.

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

Article

Full-text available

Jul 2024

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

Computer-aided diagnosis of Alzheimer’s disease and neurocognitive disorders with multimodal Bi-Vision Transformer (BiViT)

Article

Full-text available

Jul 2024
PATTERN ANAL APPL

Cognitive disorders affect various cognitive functions that can have a substantial impact on individual’s daily life. Alzheimer’s disease (AD) is one of such well-known cognitive disorders. Early detection and treatment of cognitive diseases using artificial intelligence can help contain them. However, the complex spatial relationships and long-range dependencies found in medical imaging data present challenges in achieving the objective. Moreover, for a few years, the application of transformers in imaging has emerged as a promising area of research. A reason can be transformer’s impressive capabilities of tackling spatial relationships and long-range dependency challenges in two ways, i.e., (1) using their self-attention mechanism to generate comprehensive features, and (2) capture complex patterns by incorporating global context and long-range dependencies. In this work, a Bi-Vision Transformer (BiViT) architecture is proposed for classifying different stages of AD, and multiple types of cognitive disorders from 2-dimensional MRI imaging data. More specifically, the transformer is composed of two novel modules, namely Mutual Latent Fusion (MLF) and Parallel Coupled Encoding Strategy (PCES), for effective feature learning. Two different datasets have been used to evaluate the performance of proposed BiViT-based architecture. The first dataset contain several classes such as mild or moderate demented stages of the AD. The other dataset is composed of samples from patients with AD and different cognitive disorders such as mild, early, or moderate impairments. For comprehensive comparison, a multiple transfer learning algorithm and a deep autoencoder have been each trained on both datasets. The results show that the proposed BiViT-based model achieves an accuracy of 96.38% on the AD dataset. However, when applied to cognitive disease data, the accuracy slightly decreases below 96% which can be resulted due to smaller amount of data and imbalance in data distribution. Nevertheless, given the results, it can be hypothesized that the proposed algorithm can perform better if the imbalanced distribution and limited availability problems in data can be addressed. Graphical abstract

Remote versus face-to-face fall risk assessment in home dwelling older adults: a reliability study

Article

Full-text available

Jun 2024
Physiother Theor Pract

Background: Falls are a leading cause of severe injury and death in older adults. Remote screening of fall risk may prevent falls and hence, advance health and wellness of older adults. While remote health care is becoming a common practice, we question if remote evaluation of fall risk is as reliable as face-to-face (FTF). Objective: To assess the inter-tester reliability of synchronized remote and FTF fall risk assessment. Methods: This inter-format, inter-rater reliability study included 48 home dwelling older adults aged 65 and over. Five valid functional and balance tests were conducted: 30 Second Sit-to-Stand (STS), MiniBESTest, Timed up and go (TUG), 4-Meter Walk (4MWT), and Berg Balance Scale (BBS). Instructions were provided via videoconferencing, and two physiotherapists scored performance simultaneously, one remotely, and one in the room. Inter-rater reliability between remote and FTF scores was analyzed using intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM), minimal detectable change (MDC95) and Bland and Altman analysis. Results: Excellent ICCs were found for STS, MiniBESTest, TUG, and BBS (0.90-0.99), and moderate for 4MWT (0.74). SEM and MDC95 values were STS (0.37,1.03 repetitions), MiniBESTest (1.43,3.97 scores), TUG (1.22,3.37 seconds), 4MWT (0.17,0.47 m/second), and BBS (1.79,4.95 scores). The Bland and Altman analysis showed excellent agreement between remote and FTF assessments of the STS. All other tests showed low to moderate agreement. Mean difference ± SD and 95%LOA were as follows: STS (-0.11 ± 0.52), (-1.13,0.91) repetitions, MiniBESTest (0.45 ± 1.98), (-3.43,4.32) scores, TUG (-0.35 ± 1.54), (-3.37,2.67) seconds, 4MWT (-0.08 ± 0.22), (-0.35,0.51) meter/second, and BBS (0.04 ± 2.53), (-4.93,5.01) scores. Conclusions: The findings support the responsible integration of remote fall risk assessment in clinical practice, enabling large-scale screenings and referrals for early intervention to promote healthy aging and fall prevention.

Usefulness of cognitive assessment in the prediction of documented atrial fibrillation and ischaemic stroke: a cross-sectional study

Conference Paper

Jun 2024

Background/Introduction Atrial fibrillation (AF) is sometimes detected when thromboembolic events occur, commonly ischaemic stroke (IS). In patients with AF, the prevalence of cognitive dysfunction (CD) is higher, independently from IS. Purpose Evaluating the usefulness of cognitive evaluation and the CHA2DS2-VASc score for the prediction of documented AF and IS. Methods In this cross-sectional retrospective study, we included 469 patients with cardiovascular diseases. Between December 2016 and November 2019, all patients completed two cognitive tests during hospitalization. The Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE) were used. The associations between cognitive test scores (standard and optimal cut-off values) and AF/IS were analyzed by logistic regression. We determined the area under the curve (AUC) of CD tests and optimal cut-off values using the receiver operating characteristic curves and the maximum Youden index. Results We found a significant association between the standard MoCA cut-off value for CD (<26 points) and the presence of documented AF (OR: 1.83, 95% CI: 1.11-3.01, p= 0.0174) and IS (OR: 2.09, 95% CI: 1.04-4.22, p= 0.0379). The standard MMSE score of <24 points was a risk factor for the presence of a previous IS (OR: 2.43, 95% CI: 1.3-4.53, p= 0.0051). For the prediction of documented AF, the optimal cut-off score was <26 for MoCA and <28 points for MMSE. For MoCA, the optimal cut-off was <23 points in the prediction of IS and <28 points for MMSE. The determined CHA2DS2-VASc cut-off score for AF was >3 points and for IS >5 points. The receiver operating characteristic curve analyses showed non-inferiority between CD tests and CHA2DS2-VASc score in anticipating documented episodes of AF and were superior to CHA2DS2-VASc score in the prediction of a previous IS (MoCA: AUC dif: 0.128; p= 0.0110, MMSE: AUC dif: 0.130, p= 0.0084). Conclusions In this study, we demonstrated that the MoCA and MMSE tests can detect the presence of documented AF and IS. Risk factors for AF were MoCA <26 points and MMSE <28 points while for IS MoCA <23 points and MMSE <28 points. In patients who present cognitive impairment AF screening may be appropriate.

Validity of the MoCA as a cognitive screening tool in epilepsy: Are there implications for global care and research?

Article

Full-text available

Jun 2024

Objective This study evaluated the diagnostic performance of a widely available cognitive screener, the Montreal cognitive assessment (MoCA), to detect cognitive impairment in older patients (age ≥ 55) with epilepsy residing in the US, using the International Classification of Cognitive Disorders in Epilepsy (IC‐CoDE) as the gold standard. Methods Fifty older adults with focal epilepsy completed the MoCA and neuropsychological measures of memory, language, executive function, and processing speed/attention. The IC‐CoDE taxonomy divided participants into IC‐CoDE Impaired and Intact groups. Sensitivity and specificity across several MoCA cutoffs were examined. Spearman correlations examined relationships between the MoCA total score and clinical and demographic variables and MoCA domain scores and individual neuropsychological tests. Results IC‐CoDE impaired patients demonstrated significantly lower scores on the MoCA total, visuospatial/executive, naming, language, delayed recall, and orientation domain scores (Cohen's d range: 0.336–2.77). The recommended MoCA cutoff score < 26 had an overall accuracy of 72%, 88.2% sensitivity, and 63.6% specificity. A MoCA cutoff score < 24 yielded optimal sensitivity (70.6%) and specificity (78.8%), with overall accuracy of 76%. Higher MoCA total scores were associated with greater years of education (p = 0.016) and fewer antiseizure medications (p = 0.049). The MoCA memory domain was associated with several standardized measures of memory, MoCA language domain with category fluency, and MoCA abstraction domain with letter fluency. Significance This study provides initial validation of the MoCA as a useful screening tool for older adults with epilepsy that can be used to identify patients who may benefit from comprehensive neuropsychological testing. Further, we demonstrate that a lower cutoff (i.e., <24) better captures cognitive impairment in older adults with epilepsy than the generally recommended cutoff and provides evidence for construct overlap between MoCA domains and standard neuropsychological tests. Critically, similar efforts in other regions of the world are needed. Plain Language Summary The Montreal cognitive assessment (MoCA) can be a helpful tool to screen for cognitive impairment in older adults with epilepsy. We recommend that adults 55 or older with epilepsy who score less than 24 on the MoCA are referred to a neuropsychologist for a comprehensive evaluation to assess any changes in cognitive abilities and mood.

Regarding: “Comparison of a single session of tDCS on cerebellum vs. motor cortex in stroke patients: a randomized sham-controlled trial”

Article

Full-text available

Apr 2024

Akiyoshi Matsugi

The possible role of oxidative stress marker glutathione in the assessment of cognitive impairment in multiple sclerosis

Article

Full-text available

Apr 2024

Oxidative stress markers have a distinct role in the process of demyelination in multiple sclerosis. This study investigated the potential correlation of markers of oxidative stress (glutathione [GSH], catalase) with the number of demyelinating lesions and the degree of disability, cognitive deficit, and depression in patients with relapsing-remitting multiple sclerosis (RRMS). Sixty subjects meeting the criteria for RRMS (19 men and 41 women), and 66 healthy controls (24 men, 42 women) were included. In this study, GSH significantly negatively correlated with the degree of cognitive impairment. This is the first study of subjects with RRMS that performed the mentioned research of serum GSH levels on the degree of cognitive damage examined by the Montreal Scale of Cognitive Assessment (MoCA) test. The development of cognitive changes, verified by the MoCA test, was statistically significantly influenced by the positive number of magnetic resonance lesions, degree of depression, expanded disability status scale (EDSS), age, and GSH values. Based on these results, it can be concluded that it is necessary to monitor cognitive status early in RRMS patients, especially in those with a larger number of demyelinating lesions and a higher EDSS level and in older subjects. Also, the serum level of GSH is a potential biomarker of disease progression, which could be used more widely in RRMS.

Cognitive impairment as a predictor of long-term psychological distress in patients with polysubstance use disorders: a prospective longitudinal cohort study

Article

Full-text available

Feb 2024
BMC PSYCHIATRY

Background The association between polysubstance use disorder (pSUD), mental illness, and cognitive impairments is well established and linked to negative outcomes in substance use disorder treatment. However, it remains unclear whether cognitive impairment predicts long-term psychological distress among treatment seeking patients with pSUD. This study aimed to investigate the associations and predictive ability of cognitive impairment on psychological distress one and 5 years after treatment initiation. Methods N = 164 treatment seeking patients with pSUD were sampled at treatment initiation. We examined associations between cognitive impairment according to Montreal Cognitive Assessment® (MoCA®), Wechsler Abbreviated Scale of Intelligence (WASI), and Behaviour Rating Inventory of Executive Function - Adult version (BRIEF-A) administered at treatment initiation and psychological distress defined by the Symptom Check List-90-Revised (SCL-90-R) at treatment initiation, one and five years later. We ran hierarchical logistic regressions to assess the predictive ability of the respective cognitive instruments administered at treatment initiation on psychological distress measured one and five years later including psychological distress at treatment initiation and substance intake at the time-points of the measurements as covariates. Results The main results was that MoCA® and BRIEF-A predicted psychological distress at years one and five, but BRIEF-A lost predictive power when accounting for psychological distress at treatment initiation. WASI predicted psychological distress at year five, but not at year one. Conclusions Results from MoCA® and WASI was found to be less sensitive to the effect of psychological distress than BRIEF-A. Cognitive impairment at treatment initiation may hold predictive value on later psychological distress, yet its clinical utility is uncertain.

Glucose Metabolism and Cognitive Decline in Progressive Supranuclear Palsy and Corticobasal Syndrome: A Preliminary Study

Article

Full-text available

Jan 2024

Multiple studies have analyzed the possible correlations between diabetes and Alzheimer’s disease. Less is known about the context of cognitive deterioration among patients with atypical Parkinsonian syndromes and glucose metabolism impairment. The aim of this study was to evaluate the association between the impaired glucose metabolism and cognitive decline among patients with progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). The study included 22 patients with PSP and CBS with disease durations varying from 3 to 6 years. The levels of glycated hemoglobin (HbA1C), fasting blood glucose, fasting C-peptide and the presence of microalbuminuria were evaluated, and oral glucose tolerance tests (OGTT) were performed. Based on the OGTT results, the glycemic variability, mean glycemia, glycemia standard deviation (SD) and coefficient of variation (%CV) were calculated. All patients underwent a three-Tesla brain magnetic resonance (MRI) examination and neuropsychological cognitive assessment with the use of standardized scales: Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB). A statistical analysis revealed that poor control of glycemia with high glycemic variability and increased atrophy of the medial temporal lobe among patients with PSP and CBS correlated with worse cognitive performance independent of age or sex, even among patients who did not fulfill the criteria for diabetes. The study results indicate the importance of glucose metabolism control and optimal treatment in the context of cognition maintenance among patients with PSP and CBS. Due to the relatively small number of analyzed patients, the issue requires further assessment. To the best of our knowledge, this is the first study discussing the role of glycemic variability in atypical Parkinsonian syndromes.

Relationship between Cognitive Function and the Upper Limb Function in Multiple sclerotic Patients

Article

Full-text available

Sep 2023

Key Words: Multiple Sclerosis, Upper limb function, Cognitive function.

Improvements in Montreal Cognitive Assessment scores after neurobehavioral therapy in adults with functional (nonepileptic) seizures and traumatic brain injury

Article

Aug 2023
J PSYCHIATR RES

Cognitive functioning impacts clinical symptoms, treatment response, and quality of life in adults with functional/nonepileptic seizures (FS/NES), but no study to date examines effects of behavioral FS/NES treatment on cognition in these patients. We hypothesized that there would be a reduction in cognitive symptoms in participants with FS/NES and traumatic brain injury (TBI) following neurobehavioral therapy (NBT). We also hypothesized that select seizure-related, medication, subjective cognitive, and mental health symptoms would be negatively correlated with improvements in cognitive performance after NBT. Participants were 37 adults with TBI + FS/NES and 35 adults with TBI only, recruited from medical centers in the northeastern or southeastern U.S. TBI + FS/NES participants completed a 12 session NBT intervention, and TBI without seizures participants were not treated. All participants completed pre-post assessments of cognition (Montreal Cognitive Assessment [MoCA]) and baseline sociodemographic factors and mental health symptoms. Pre-post MoCA scores increased significantly in TBI + FS/NES participants (28/37 [75.7%] improved) but not in TBI comparisons (10/35 [28.6%] improved). Language, memory, and visuospatial/executive functions, but not attention, improved over time in the TBI + FS/NES group. Gains in cognition were concentrated in those TBI + FS/NES participants with likely baseline cognitive impairments (MoCA total score <26), and 9/17 of these participants moved from the “impaired” range at baseline (<26) to the “intact” range at endpoint (≥26). Lastly, participants taking fewer medications and reporting lower subjective cognitive difficulties at baseline showed larger pre-post MoCA total score improvements. Overall, results from this study suggest the potential for positive change in cognition in FS/NES and co occurring TBI using evidence-based psychotherapy.

Ecological validity of the Montreal Cognitive Assessment (MoCA) in non-demented Parkinson's disease patients

Article

Full-text available

Jul 2023
NEURODEGENER DIS

Background: The ecological validity of performance-based cognitive screeners needs to be tested in order for them to be fully recommended for use within clinical practice and research. Objectives: To examine, within an Italian cohort of non-demented PD patients, the ecological validity of the Montreal Cognitive Assessment (MoCA), by assessing its association with 1) functional independence (FI), 2) quality of life (QoL) and 3) behavioural-psychological (BP) outcomes. Methods: Seventy-four non-demented PD patients were administered the MoCA and underwent motor-functional - i.e., Unified Parkinson's Disease Rating Scale (UPDRS) , Modified Hoehn-Yahr Scale (HY) and Schwab and England Scale (SES) -, behavioural and psychological - i.e., State- and Trait-Anxiety Inventory-Form Y (STAI-Y1/-Y2), Beck Depression Inventory (BDI) and Dimensional Apathy Scale (DAS) - and QoL evaluations - i.e., MOS 36-Item Short Form Health Survey (SF-36). Associations of interest against FI, QoL and BP outcomes were tested via Bonferroni-corrected Pearson's/Spearman's correlations whilst covarying for demographics, disease duration as well as UPDRS-III, UPDRS-IV and HY scores. Intake of psychotropic drugs was also covaried when assessing the association between the MoCA and BP/QoL measures. Results: MoCA scores were significantly associated with the SES (rs(73)=.34; p=.005) and the DAS-Executive (r(67)=-.47; p<.001), whilst not to other FI/BP outcomes and to QoL measures. Conclusions: The MoCA is a valid estimate of daily-life functional autonomy in non-demented PD patients, also reflecting apathetic features of a dysexecutive nature.

AI and Non AI Assessments for Dementia

Preprint

Full-text available

Jun 2023

Current progress in the artificial intelligence domain has led to the development of various types of AI-powered dementia assessments, which can be employed to identify patients at the early stage of dementia. It can revolutionize the dementia care settings. It is essential that the medical community be aware of various AI assessments and choose them considering their degrees of validity, efficiency, practicality, reliability, and accuracy concerning the early identification of patients with dementia (PwD). On the other hand, AI developers should be informed about various non-AI assessments as well as recently developed AI assessments. Thus, this paper, which can be readable by both clinicians and AI engineers, fills the gap in the literature in explaining the existing solutions for the recognition of dementia to clinicians, as well as the techniques used and the most widespread dementia datasets to AI engineers. It follows a review of papers on AI and non-AI assessments for dementia to provide valuable information about various dementia assessments for both the AI and medical communities. The discussion and conclusion highlight the most prominent research directions and the maturity of existing solutions.

Correlates of the Post-Stroke cognitive impairment among patients with first-ever stroke admitted at tertiary hospitals in Dodoma, Tanzania: a prospective longitudinal study

Preprint

Jun 2023

Introduction Stroke patients develop cognitive impairment that, significantly impacting their quality of life, their families, and the community as a whole, but they are not given attention. This study aims to determine the prevalence and predictors of post-stroke cognitive impairment (PSCI) among adult stroke patients admitted to a tertiary hospital in Dodoma, Tanzania. Methodology A prospective longitudinal study was conducted at tertiary hospitals in the Dodoma region, central Tanzania. A sample size of 158 participants with the first stroke confirmed by CT/MRI brain aged ≥ 18 years met the criteria. At baseline, social-demographic, cardiovascular risks and stroke characteristics were acquired and then at 30 days, participants were evaluated for depression and apathy.. Descriptive statistics were summarised as continuous data reported as Mean (SD) or Median (IQR), and categorical data were summarised using proportions and frequencies. Univariate and multivariable logistic regression analysis were computed to determine predictors of PSCI Results Of 158 participants, the mean age was 58.7 years, 57.6% were female, and 80.4% of participants met the criteria for post-stroke cognitive impairment. After multivariable logistic regression, left hemisphere stroke (AOR: 5.798, CI: 1.030 – 32.623, p = 0.046), a unit cm ³ increase in infarct volume (AOR: 1.064, 95% CI: 1.018 – 1.113, p = 0.007), and apathy symptoms (AOR: 12.259, CI: 1.112 – 89.173, p = 0.041) had a significant association with PSCI. Conclusion The study showed a high prevalence of PSCI; profiling at-risk stroke survivors in a timely intervention may improve their prognosis. Future studies in the area would inform future interventions and policies.

Clinimetrics of the Italian version of the Montreal Cognitive Assessment (MoCA) in adult-onset idiopathic focal dystonia

Article

Full-text available

Jun 2023
J NEURAL TRANSM

This study aimed at assessing the clinimetrics of the Montreal Cognitive Assessment (MoCA) in an Italian cohort of patients with adult-onset idiopathic focal dystonia (AOIFD). N = 86 AOIFD patients and N = 92 healthy controls (HCs) were administered the MoCA. Patients further underwent the Trail-Making Test (TMT) and Babcock Memory Test (BMT), being also screened via the Beck Depression Inventory-II (BDI-II) and the Dimensional Apathy Scale (DAS). Factorial structure and internal consistency were assessed. Construct validity was tested against TMT, BMT, BDI-II and DAS scores, whilst diagnostics against the co-occurrence of a defective performance on at least one TMT measure and on the BMT. Case–control discrimination was examined. The association between MoCA scores and motor-functional measures was explored. The MoCA was underpinned by a mono-component structure and acceptably reliable at an internal level. It converged towards TMT and BMT scores, as well as with the DAS, whilst diverging from the BDI-II. Its adjusted scores accurately detected cognitive impairment (AUC = .86) at a cut-off of < 17.212. The MoCA discriminated patients from HCs (p < .001). Finally, it was unrelated to disease duration and severity, as well as to motor phenotypes. The Italian MoCA is a valid, diagnostically sound and feasible cognitive screener in AOIFD patients.

Methods of cognitive status research in patients with glioblastoma

Article

Full-text available

Jun 2022

Introduction: Glioblastoma is a high-grade, aggressive central nervous system tumor with predominantly astrocytic differentiation, characterized by fast invasive growth into the surrounding brain parenchyma and aggressive clinical course. The short life expectancy of patients diagnosed with glioblastoma necessitates the need to maximize their quality of remaining life. One of the most common reasons for quality of life impairment in these patients is the cognitive deficit accompanying the disease. There is a lack of a unified and standardized method for the assessment of cognitive functions in these patients, which meets all the necessary criteria to be convenient and usable in the wide clinical practice. Aim: The aim of the present study is to compare the Montreal cognitive assessment (MoCA) brief screening test with an extended neuropsychological examination to determine its applicability in patients diagnosed with glioblastoma. Material and methods: The study includes 27 patients undergoing neurosurgical intervention for histologically proven IDH-wildtype glioblastoma in the Department of Neurosurgery, “St. Marina” University Hospital – a tertiary healthcare center, for the period January 2019 to December 2022. Preoperatively, patients were examined with the short MoCA screening test and an extended neuropsychological examination including the following subtests: Issac set test, Trail making test A and B, Luria test, Raven‘s color matrices, Stroop test and Bender test. Results: Of all the patients studied, those with a MoCA score below 26 points present at least one negative test of the extended neuropsychological examination. MoCA patients with scores of 26 or more do not demonstrate cognitive impairment in the extended neuropsychological impairment. Conclusion: The obtained results support the claim that the MoCA short screening test is applicable for preoperative diagnosis of cognitive disorders in patients with glioblastoma. Due to the study‘s small sample size, further research is needed to definitively prove this claim.

Cognitive Measurement in Vascular Dementia Patients with Prefrontal Cortex Activation Analysis

Article

Full-text available

Dec 2022

Stroke is one of the world‘s second leading causes of death,with a prevalence of 10.9% in 2018. In Indonesia, strokes have increased over the last five years. Epidemiology suggests that small strokes in the prefrontal cortex (PFC) can cause cognitive impairment, leading to vascular dementia. The prefrontal cortex is a structure in the brain that is located in the frontal lobe. Accurate detection or diagnosis becomes important for therapeutic management because, it is difficult to identify at an early stage. Therefore, in this study, an analysis of differences in brain activation in healthy elderly (non-stroke) and post-stroke patients with vascular dementia was conducted when performing memory recall work. This study involved seven elderly non-stroke and seven stroke patients with vascular dementia. Brain activity was recorded using a 19-channel clinical electroencephalogram (EEG). The study compared prefrontal cortex activity during an attention test. Standardized lowresolution brain electromagnetic tomography (sLORETA) was used to analyze active brain areas. Then the analysis of differences in prefrontal cortex activity between non-stroke patients and those with vascular dementia used a paired T-test. The results of the paired T-test (with p

VALIDATION OF THE BRAZILIAN ALTERNATIVE VERSION OF THE MONTREAL ASSESSMENT (MOCA): PILOT STUDY

Article

Nov 2022

The Montreal Cognitive Assessment (MoCA) is a screening tool designed to detect mild cognitive impairment (MCI). The current version used in Brazil, MoCA-BR, did not have a reliable cross-cultural adaptation to Brazilian Portuguese and has structural aws that might lead to a higher rate of false-positives. In previous stages of this study, the Alternative Version of the MoCA-BR was developed, with changes in the sections: Memory and Delayed Recall, Language and Naming. to verify the inuence of cross-cultural Objectives: adaptation on the performance of cognitive tools, and the applicability and internal accuracy of the Alternative Version of the MoCA-BR. a pilot, prospective, monocentric, longitudinal, Methods: and analytical study. Both versions of the test were applied in a randomized and cognitively healthy population, between 18 and 60 years, within a medium interval of 54,56 days (median = 32 days) between the questionnaires. out of 104 part Results: icipants, 70 were included (64.3% female, 40.2 years). The alternative version was superior in the naming domain (p < 0.001), and in the adapted sentence within the language domain (p = 0.003). There were no signicant differences within the delayed recall domain. The alternative version showed good internal consistency, with a Cronbach's alpha coefcient of 0.75. The cut-off point suggested by the study is 27 points, with sensitivity and specicity of 91.3% and 79.2%, respectively. Cultural factors affect the accuracy of cognitive tests, and Conclusions: adaptation is essential for their use in different countries.

Diagnostics and clinical usability of the Montreal Cognitive Assessment (MoCA) in amyotrophic lateral sclerosis

Article

Full-text available

Sep 2022

Background The present study aimed at (1) assessing the diagnostic properties of the Montreal Cognitive Assessment (MoCA) in non-demented ALS patients and at (2) exploring the MoCA administrability according to motor-functional status. Materials N = 348 patients were administered the MoCA and Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Administrability rates and prevalence of defective MoCA scores were compared across King’s and Milano-Torino clinical stages. Regression models were run to test whether the non-administrability of the MoCA and a defective score on it were predicted, net of the ECAS-Total, by disease duration, ALS Functional Rating Scale-Revised (ALSFRS-R) and progression rate, computed as (48: ALSFRS-R)/disease duration. Intrinsic and post-test diagnostics were tested against a below-cut-off ECAS-total score. Results The 79.9% of patients successfully underwent the MoCA, whose administrability rates decreased with advanced clinical stages, at variance with its defective score prevalence. The probability of the FAB not being administrable was predicted only by lower ALSFRS-R-bulbar and-upper-limb scores; no motor features, but the ECAS-Total, predicted a defective MoCA performance. The MoCA showed high accuracy (AUC = 0.82) and good intrinsic and post-test properties—being slightly more specific than sensitive. Discussion In non-demented ALS patients, the MoCA is featured by optimal diagnostics as a screener for cognitive impairment, especially for ruling-out its occurrence, as long as patients are in the early stages of the disease and have sufficiently spared bulbar and upper-limb functions.

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

Article

Full-text available

Sep 2022
BMC MED INFORM DECIS

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.

Prevalence of depression and suicidal ideation in trauma patients in western Rajasthan

Article

Full-text available

Aug 2022

Depression is a common psychiatric disorder in trauma patients. Early detection of depression in a traumatized patients can help alleviate long-term symptoms and adverse effects associated with depression. This study aimed to determine the prevalence of depression and suicidal ideation in trauma patients after one month of injury. Hospital-based cross-sectional study was carried out among 120 individuals with a history of trauma from March 2020 to May 2020. Purposive sampling was used to recruit participants over a specified period. The Beck's Depression Inventory-II (BDI-II) was used to measure depression intensity and suicidal ideation. The statistical analysis was carried out using SPSS version 20. The study included a total of 120 participants. The prevalence of depression was 30% in study participants. In our study, 8 (44.44%) of 18 participants over the age of 60, 30 (36.59%) of 82 male participants, 9 (64.29%) of 14 separated or divorced participants, 17 (45.95%) of 37 illiterate participants, 25 (43.86%) of 57 participants from low socioeconomic backgrounds, and 23 (42.59%) of 54 participants from rural backgrounds had more depression. Twenty (46.51%) out of 43 polytrauma participants, 5 (45.45%) out of 11 participants injured due to violence, 31 (33.70%) out of 92 participants who had a history of more than 48 hrs hospitalization, and 17 (48.57%) out of 35 participants had a history of ICU admission had more depression. Twenty-one participants (58.33%) of the 36 who suffered from depression had suicidal thoughts or intentions. Suicidal ideation and depression were more common in traumatic patients. Physicians' treatment should not be limited to early physical rehabilitation. They must also prioritise early mental rehabilitation in order to avoid long-term issues with mental and physical disabilities.

Development and evaluation of serious games for diagnosis and cognitive improvement of patients with mild cognitive impairment: A study protocol

Article

Full-text available

Aug 2022

Introduction Early diagnosis of cognitive impairment and improving cognitive function of patients with mild cognitive impairment (MCI) are of particular importance for preventing Alzheimer's disease (AD). Health-oriented serious games (SGs) could be innovative tools for evaluating and improving cognitive status. In this study, a SG will be developed to evaluate and improve cognitive status of patients with MCI based on different cognitive aspects of mini-mental state examination (MMSE) and Addenbrooke's cognitive examination-revised version (ACE-R). Furthermore, the SG will be validated and assessed in diagnosing and improving the cognitive status of patients with MCI. Material and methods This qualitative and quantitative study includes four steps. In the first step, the literature is reviewed systematically. In the second step, game stories and scenarios are designed for the proposed game series based on the results of step 1 in collaboration with the clinical experts. Then, a game will be designed for the different cognitive aspects of MMSE and ACE-R. The third step includes the technical design and development of the game and usability evaluation. 60 participants in two healthy or patient (who are at the MCI stage) groups will be selected using convenience and purposive sampling methods based on inclusion and exclusion criteria. In the fourth step, evaluation of the serious game for patients with MCI is performed. We will conduct correlation analysis to evaluate the degree of coordination between the game and the cognitive test results. Moreover, we will evaluate the effect of the game on improving cognitive status through a before-after study. Results The correlation between the game and MMSE/ACE-R results will be calculated. Furthermore, the MMSE/ACE-R mean difference before and after playing the game will be examined. The results of machine learning algorithms and indicators such as sensitivity and specificity to evaluate the effectiveness of the game in disease diagnosis will also be reported. Conclusion Medical staff who intend to use SGs for diagnosing MCI can choose the game based on the results of correlation between different games and aspects of psychological tests. Moreover, examining the impact of each game on the cognitive status could help therapists choose games that could improve the cognitive status of people with MCI. The results could also be useful for technical designers who intend to design suitable games for the patients with MCI.

Structural disconnectome mapping of cognitive function in poststroke patients

Article

Full-text available

Jul 2022

Background and purpose: Sequalae following stroke represents a significant challenge in current rehabilitation. The location and size of focal lesions are only moderately predictive of the diverse cognitive outcome after stroke. One explanation building on recent work on brain networks proposes that the cognitive consequences of focal lesions are caused by damages to anatomically distributed brain networks supporting cognition rather than specific lesion locations. Methods: To investigate the association between poststroke structural disconnectivity and cognitive performance, we estimated individual level whole-brain disconnectivity probability maps based on lesion maps from 102 stroke patients using normative data from healthy controls. Cognitive performance was assessed in the whole sample using Montreal Cognitive Assessment, and a more comprehensive computerized test protocol was performed on a subset (n = 82). Results: Multivariate analysis using Partial Least Squares on the disconnectome maps revealed that higher disconnectivity in right insular and frontal operculum, superior temporal gyrus and putamen was associated with poorer MoCA performance, indicating that lesions in regions connected with these brain regions are more likely to cause cognitive impairment. Furthermore, our results indicated that disconnectivity within these clusters was associated with poorer performance across multiple cognitive domains. Conclusions: These findings demonstrate that the extent and distribution of structural disconnectivity following stroke are sensitive to cognitive deficits and may provide important clinical information predicting poststroke cognitive sequalae.

Speech Pathology and Occupational Therapy Students’ Perceptions and Experiences of an Interprofessional Simulation

Article

Full-text available

Oct 2024

Clinical placements and interprofessional practice for healthcare students are often met with anxiety, unpreparedness and a lack of confidence. Whilst interprofessional simulations may address these concerns, there are gaps in the literature. This study aimed to: (i) investigate the impact of interprofessional simulations on students’ perceived confidence, anxiety and preparedness for placements and their attitudes toward interprofessional practice and education, and, (ii) understand students’ experiences and satisfaction with the simulation. Pre-simulation and post-simulation survey results were collected from 25 speech pathology and 25 occupational therapy graduate-entry Masters degree students from one Australian university. Quantitative data was analysed using descriptive statistics and the Wilcoxon signed-rank test while qualitative data was reviewed through content analysis. Statistically significant (p<0.05) improvements across students’ confidence, anxiety and preparedness ratings were observed. Students’ attitudes towards interprofessional practice and education revealed statistically significant positive changes on 8/10 questions and they described the simulation to be a meaningful learning experience. Results indicate that following participation in an interprofessional simulation, students’ perceptions of their confidence, anxiety and preparedness for an adult inpatient hospital placement improved. Moreover, students’ attitudes towards interprofessional practice and education were more positive and the experience was reported to be beneficial. Future studies could explore timing-related considerations and simulation anxiety itself.

Assessing Rapid Spatial Working Memory in Community-living Older Adults in a Virtual Adaptation of the Rodent Water Maze Paradigm

Article

Sep 2024
BEHAV BRAIN RES

Large-scale evidence for the validity of remote MoCA administration among people with cerebellar ataxia

Article

Sep 2024
CLIN NEUROPSYCHOL

Obstructive Sleep Apnea: Relationship Between Mild Neurocognitive Impairments and Quality of Life

Article

Full-text available

Jul 2024

Avi Choudhary

Patients with obstructive sleep apnea might have neurocognitive impairments and reduced quality of life. Considering the same, this study was conducted to identify the association between mild cognitive impairments and quality of life. This study aims to identify the association between mild neurocognitive impairment and quality of life in patients with mild, moderate, and severe Obstructive Sleep Apnea Syndrome. It was an observational study with a sample size of 75 subjects which were selected purposively from Kure Medical System. Montreal cognitive assessment and SF-36 were administered to examine the presence of mild cognitive impairments and quality of life of the subjects in all three groups. Pearson analysis was applied to explore the correlation between the MoCA score and SF-36. The findings of this analysis were suggestive of a positive but non-significant correlation between the MoCA Score and all the domains of SF-36 except mental health (p > 0.05). Mental Health was found to be negatively correlated with MoCA Score (r = − 0.0025). As per the findings of this study, the SF-36 scores were related to the MoCA Score, but the relationship was not found to be significant.

Late-Onset Epilepsy Clinic: from clinical diagnostics to biomarkers

Article

Jun 2024

Psychometric properties of the Montreal Cognitive Assessment v8.2. test: Pilot study

Article

Full-text available

Mar 2024

Objectives . The world is rapidly ageing and, with the increasing age, there is a potential increase in the number of patients with Alzheimer’s disease or dementia. This calls for a reliable screening tool that easily and rapidly could identify the symptoms of pathological cognitive decline. As currently such tools are limited in Latvia, the objective of this study was to examine the psychometric properties of the newly translated Montreal Cognitive Assessment test. Materials and Methods . Sixty-five Latvian native speakers aged 55-90 ( M = 72.11, SD = 10.26) participated in the study and were divided into three groups – with diagnosis of dementia ( n = 21), mild cognitive impairment ( n = 18) and control group ( n = 26). All participants were assessed using the Montreal Cognitive Assessment test [1], and a test-retest was conducted after 2 weeks ( n = 37). Results . Almost all mean values and inter-item correlation coefficients were acceptable (.2-.8), apart from indices in the Naming task and Verbal fluency task. The items showed very high reliability (α = .95) and the test-retest reliability showed consistent results ( r = .98). Conclusions . Overall, the results from the pilot study show acceptable psychometric properties; however, the pilot study should be continued and criterion validity should be tested.

Effects of Multicomponent Exercise on Community-Dwelling Older Adults With Mild Cognitive Impairment

Article

Jan 2024
Res Gerontol Nurs

Purpose To explore the effects of a group-based multicomponent exercise program on general cognitive functioning, depression, and social functioning in community-dwelling older adults with mild cognitive impairment (MCI) and whether the effects can be maintained. Method Fifty older adults with MCI were conveniently recruited from two communities in the study area and randomly assigned to the intervention group or control group. The intervention group received three sessions of 60-minute, multicomponent exercise per week for 3 months, plus MCI-related health education. The control group only received MCI-related health education. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Beijing Version (MoCA-BJ) were used to assess general cognitive function. The Functional Activities Questionnaire (FAQ) and Geriatric Depression Scale (GDS-30) were used to evaluate participants' social function and depression, respectively. Participants' exercise intensity was assessed using the Category Ratio Scale. Results After the 3-month intervention, there were significant improvements in general cognitive function ( p = 0.046), attention ( p = 0.009), delayed recall ( p = 0.015), and social function ( p = 0.011) in the intervention group compared with the control group. However, after 3-month postintervention follow up, no significant differences in MMSE, MoCA-BJ, GDS-30, and FAQ scores were noted between groups. Conclusion The 3-month multicomponent exercise program improved general cognitive function and social functioning in community-dwelling older adults with MCI. However, there was no evidence that these benefits lasted for another 3 months after stopping the exercise program. [ Research in Gerontological Nursing, xx (x), xx–xx.]

Cognition and saccadic eye movement performance are impaired in chronic rhinosinusitis

Article

Jan 2024

Background Patients with chronic rhinosinusitis (CRS) can experience cognitive dysfunction. The literature on this topic mostly reflects patient‐reported measurements. Our goal was to assess cognitive function in patients with CRS using objective measures, including saccadic eye movements—a behavioral response reflecting cognitive and sensory information integration that is often compromised in conditions with impaired cognition. Methods Participants (N = 24 with CRS, N = 23 non‐CRS healthy controls) enrolled from rhinology clinic underwent sinonasal evaluation, quality of life assessment (Sino‐nasal Outcome Test 22 [SNOT‐22]), and cognitive assessment with the Neuro‐QOL Cognitive Function‐Short Form, the Montreal Cognitive Assessment (MoCA), and recording of eye movements using video‐oculography. Results Participants with CRS were more likely to report cognitive dysfunction (Neuro‐QOL; 45.8% vs. 8.7%; p = 0.005) and demonstrate mild or greater cognitive impairment (MoCA; 41.7% vs. 8.7%; p = 0.005) than controls. Additionally, participants with CRS performed worse on the MoCA overall and within the executive functioning and memory domains (all p < 0.05) and on the anti‐saccade ( p = 0.014) and delay saccade ( p = 0.044) eye movement tasks. Poorer performance on the MoCA ( r = −0.422; p = 0.003) and the anti‐saccade ( r = −0.347; p = 0.017) and delay saccade ( r = −0.419; p = 0.004) eye movement tasks correlated with worse CRS severity according to SNOT‐22 scores. Conclusion This study is the first to utilize objective eye movement assessments in addition to researcher‐administered cognitive testing in patients with CRS. These patients demonstrated a high prevalence of cognitive dysfunction, most notably within executive functioning and memory domains, with the degree of dysfunction correlating with the severity of CRS.

The study of Associations between TNFα GENE G308A polymorphism and clinical-neurological, neuroimaging, hemodynamic characteristics and cognitive dysfunction in patients with post-infectious encephalopathy

Article

Full-text available

Jun 2023

Khrystyna Duve

Introduction. Infectious diseases can affect brain function and cause the development of encephalopathy, even if the pathogen does not directly affect the central nervous system. Infections caused by viruses, bacteria, or parasites can lead to a secondary inflammatory response in the brain, commonly known as neuroinflammation, through the action of inflammatory mediators that affect the brain endothelium and parenchyma, and the response of brain cells to these mediators. Neurological consequences associated with infectious diseases are poorly understood. Nowadays, there is no established strategy for the treatment or prevention of neurological damage associated with peripheral infections. Aim of study was: to establish probable associations of the G308A polymorphic variant of the TNFα gene with clinical-neurological, neuroimaging, hemodynamic characteristics and cognitive dysfunction in patients with post-infectious encephalopathy. Material and methods. 128 patients with PIE who were undergoing treatment in the neurological departments of the communal non-profit enterprise "Ternopil Regional Clinical Psychoneurological Hospital" during 2021-2022 were examined. 26 patients underwent molecular genetic analysis. The control group consisted of 12 practically healthy persons, representative in terms of age and sex. All patients met the inclusion criteria for the study. Neuroimaging was performed using multispiral computed tomography (CT) or magnetic resonance imaging (MRI). The state of cerebral blood flow was studied using transcranial duplex scanning (TCI) of intracranial vessels and extracranial brachiocephalic vessels on a Philips HDI device. Research in the cognitive sphere was carried out using the Montreal Cognitive Test (The Montreal Cognitive Assessment, MoCA). The molecular genetic study of the G308A polymorphic variant of the TNFα gene was carried out according to standard protocols developed in the molecular genetic laboratory of the state institution "Reference Center for Molecular Diagnostics of the Ministry of Health of Ukraine". The results. Analyzing the dependence of clinical-neurological syndromes, neuroimaging, hemodynamic characteristics, and cognitive dysfunction on the polymorphic variant G308A of the TNFα gene in patients with PIE, probable differences in the distribution of genotype frequencies were established only for clinical-neurological syndromes (cephalic syndrome, p=0.005 and movement disorder syndrome, p =0.038) and neuroimaging changes (gliosis phenomenon, p=0.026). Regarding the frequency distribution of alleles of the G308A polymorphic variant of the TNFα gene in patients with PIE, a probable predominance of carriers of the A allele among persons with cephalic syndrome compared to persons without cephalic syndrome was found (91.67% vs. 8.33%). Conclusions. Thus, the allelic polymorphism of the TNFα gene affects the course of PIE, which determines the expediency of further research.

Machine learning and knowledge engineering for cognitive memory assessment of age groups by anomalies in a serious game

Article

Nov 2023

Quantifying the Impact of Myopia on Visual Perception in Children Through Eye Tracking

Conference Paper

Jul 2023

SocialBit: protocol for a prospective observational study to validate a wearable social sensor for stroke survivors with diverse neurological abilities

Article

Full-text available

Aug 2023

Introduction Social isolation has been found to be a significant risk factor for health outcomes, on par with traditional risk factors. This isolation is characterised by reduced social interactions, which can be detected acoustically. To accomplish this, we created a machine learning algorithm called SocialBit. SocialBit runs on a smartwatch and detects minutes of social interaction based on vocal features from ambient audio samples without natural language processing. Methods and analysis In this study, we aim to validate the accuracy of SocialBit in stroke survivors with varying speech, cognitive and physical deficits. Training and testing on persons with diverse neurological abilities allows SocialBit to be a universally accessible social sensor. We are recruiting 200 patients and following them for up to 8 days during hospitalisation and rehabilitation, while they wear a SocialBit-equipped smartwatch and engage in naturalistic daily interactions. Human observers tally the interactions via a video livestream (ground truth) to analyse the performance of SocialBit against it. We also examine the association of social interaction time with stroke characteristics and outcomes. If successful, SocialBit would be the first social sensor available on commercial devices for persons with diverse abilities. Ethics and dissemination This study has received ethical approval from the Institutional Review Board of Mass General Brigham (Protocol #2020P003739). The results of this study will be published in a peer-reviewed journal.

Effects of Individual Cognitive Stimulation Therapy on People With Dementia: A PRISMA- Guided Systematic Review

Conference Paper

Dec 2022

Risk factors of Silent Cerebral Infarcts in Patients with Acute Coronary Syndrome Based on MRI Findings

Thesis

Jun 2022

Introduction The presence of silent brain infarcts increases the risk of subsequent stroke by two to four times in the general population, independent of cardiovascular risk factors. The presence of silent brain infarcts doubles the risk of dementia, including Alzheimer's disease. Aim Of The work the degree of existence and the risk factors associated with silent cerebral infarcts (CSI) in patient with acute coronary syndrome (ACS) younger than 55 years old. Early detection might be helpful in optimizing treatment and prevention of further complications. Patients and Methods: This study was prospective cross-sectional study included 40 patients <55 years with ACS admitted at Sohag university hospitals:-with a definite diagnosis of ACS. MRI (1.5 Tesla) were done for all patients. Single cerebral infarction or more (and or) evidence of chronic white matter ischemia CWMI were considered as abnormal MRI findings. RESULTS: Patients were divided into two groups according to MRI findings: Group 1:-eight out of 40 patients (20%) with normal MRI. Group 2:-32/40 patients (80%) with MRI findings of SCI and or chronic white matter ischemia. There was non-significant difference between two groups as regards-age, sex, and ACS presentation, but there was significant difference as regards-body mass index (BMI and family history (FH) of vascular events. Incidence of hypertension and dyslipidemia were significantly higher in abnormal MRI group. There was a non-significant difference between 2 groups as regards Montreal cognitive score (MOCA). Abnormal MRI group had significant higher TG and LDL. There was non-significant difference between 2 groups as regard echocardiographic criteria, coronary angiographic parameters and carotid Doppler findings. Conclusion: More than two-third of patients with ACS present an abnormal MRI suggestive of atherosclerosis and ischemia. Risk factors include BMI, FH, dyslipidemia and hypertension.

Risk factors of Silent Cerebral Infarcts in Patients with Acute Coronary Syndrome Based on MRI Findings

Article

Full-text available

Jun 2022

A Verbal Card Sorting Task to Measure Executive Functions

Article

Full-text available

Jun 2023
AM J SPEECH-LANG PAT

Purpose: The Wisconsin Card Sorting Test (WCST) is commonly used to measure nonverbal executive functions (EFs) in a variety of clinical populations. However, in some clinical populations (e.g., people with aphasia), deficits may be present in more linguistic (or verbal) domains and less pronounced in nonverbal domains. Thus, when determining possible deficits in these individuals, it is critical to assess both verbal and nonverbal cognitive abilities. The purpose of this study was to create a verbal card sorting task (VCST) to complement the WCST. Method: We created the VCST by modifying a computerized version of the WCST, the Berg Card Sorting Task (BCST). We then compared 35 individuals with mild traumatic brain injury (mTBI) and 33 matched controls' performance on each task. We tested the VCST in individuals with mTBI first because they demonstrate impaired EFs but unimpaired language. We therefore expected the mTBI group to perform similarly on the VCST and BCST, suggesting that the two tasks measure EFs similarly. Results: In line with our hypothesis, the mTBI group had unimpaired inhibition and sustained attention but impaired shifting on each task. Component loadings for both tasks were also similar, and participants' inhibition and shifting scores positively correlated across the two tasks. Conclusions: Together, these findings suggest that the VCST is a potentially useful tool for measuring verbal EF deficits. Our results also provide important insights into the EF impairments experienced by individuals with mTBI. Supplemental material: https://doi.org/10.23641/asha.23230475.

The feasibility of a stepping exergame prototype for older adults with major neurocognitive disorder residing in a long-term care facility: a mixed methods pilot study View supplementary material The feasibility of a stepping exergame prototype for older adults with major neurocognitive disorder residing in a long-term care facility: a mixed methods pilot study

Article

Feb 2023
DISABIL REHABIL

Purpose: To explore the feasibility of an exergame prototype in residential individuals with major neurocognitive disorder (MNCD). Materials and methods: Participants were randomly assigned to a 12-week stepping exergame training or traditional exercise (active control group). Semi-structured interviews were conducted after six and 12 weeks of exergaming. Qualitative data were thematically analysed using NVivo 12. The Short Physical Performance Battery, one minute sit-to-stand test, Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory, Cornell Scale for Depression in Dementia, and Dementia Quality of Life were assessed at baseline and post intervention using a Quade's ANCOVA. Results: Seven older adults with MNCD in the exergame and 11 in the active control group completed the study [mean age = 83.2 ± 6.5 years; 94.4% female; SPPB score = 7.3 ± 2.4]. Results indicated that the VITAAL exergame prototype was experienced as enjoyable and beneficial. The post-MMSE score was higher (η2=.02, p = 0.01, F = 8.1) following exergaming versus traditional exercise. Conclusions: The findings suggest that the exergame prototype is accepted by individuals with MNCD residing in a long-term care facility when they are able to participate and under the condition that they are extensively guided. The preliminary efficacy results revealed higher post-MMSE scores after exergaming versus traditional exercise. Future trials should confirm or refute these findings. Trial registration: The trial was registered in ClinicalTrials.gov (Identifier: NCT04436315)Implications for rehabilitationThe VITAAL exergame prototype is accepted by individuals with MNCD residing in a long-term care facility who are able to participate.Supervision of exergaming by health professionals is essential for successful implementation.The VITAAL exergame prototype might maintain cognitive levels in major neurocognitive disorder longer than walking combined with standardised squatting and stepping exercises.

Depressive Symptoms Mediate the Relationship between Sustained Food Insecurity and Cognition: A Causal Mediation Analysis

Article

Feb 2023
ANN EPIDEMIOL

Background: This study aimed to investigate the association of change in food insecurity over time with cognitive function in midlife, and whether depressive symptoms mediated that relationship. Methods: We used longitudinal data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Change in food insecurity in 2000-2005 was coded as 'persistently food-secure', 'persistently food-insecure', 'became food-insecure', and 'became food-secure'. Depressive symptoms were measured in 2010, and cognitive function was measured in 2015. Multivariable linear regression controlled for sociodemographic and cardiovascular health factors was used. We also conducted causal mediation analysis. Results: Our study population included 2,448 participants (57.23% female and 43.18% Black, mean age = 40.31 in 2000). Compared to persistent food security, persistently and became food-insecure were associated with worse cognition, particularly with processing speed (βpersistent=-0.20 standard unit, 95%CI= -0.36, -0.04; βbecame= -0.17, 95%CI=-0.31, -0.03), and these associations appeared mediated by depressive symptoms (proportion mediated = 14% for persistently food-insecure and 18% for became food-insecure). Conclusions: Persistent and transition to food insecurity were associated with worse cognition, both directly and indirectly through increasing depressive symptoms. Targeting food insecurity or depressive symptoms among persistently or became food insecure individuals may have the potential to slow premature cognitive aging.

Difference in GFAP Levels in POCD and Non-POCD Patients After on Pump CABG

Article

Full-text available

Dec 2022
Vasc Health Risk Manag

Introduction On-pump, coronary artery bypass grafting (CABG) is the most common cause of postoperative cognitive dysfunction (POCD) after cardiac surgery. Previous studies showed that the incidence of POCD after cardiac surgery was 60%, higher than non-cardiac surgery with 11.7%. Glial fibrillary acid protein (GFAP) is one of the sensitive biomarkers of brain damage. Previous studies have found that elevated GFAP serum is associated with cognitive impairment. This study aims to measure the difference in GFAP levels in POCD and non-POCD patients after CABG on-pump surgery. Methods This study is a retrospective cohort design study. The data were obtained from 56 subjects undergoing elective CABG on the pump surgery enrolled into two groups consisting of 28 POCD as a case group and 28 non-POCD as a control group. In this study, the ELISA method measured the levels of GFAP biomarkers within 24 hours after surgery. After 72 hours, the patient received a MoCA-INA examination to determine cognitive impairment. Data analysis was carried out by SPSS 23.00 software. Results The mean age of patients in both groups was 60 years and was dominated by males (>85%). POCD patients were found to have a significantly longer duration of cardiopulmonary bypass (CPB) and cross-clamp surgery than non-POCD patients (p = 0.002 and p = 0.004). Postoperative GFAP levels in POCD patients were significantly higher than in non-POCD patients (12.95 ± 7.47 vs 3.80 ± 2.77, p < 0.001). There was a significant increase in GFAP levels compared with non-POCD (8.28 ± 7.24 vs −1.5 ± 3.03, p < 0.001). The area under the curve (AUC) value of GFAP against POCD was 0.887, cut-off GFAP 4.750 with a sensitivity of 92.9% and a specificity of 71.4%. Conclusion POCD patients had higher GFAP levels than non-POCD patients. There are differences in GFAP levels in patients with POCD and non-POCD post-CABG surgery.

Effects of Personalized Cognitive Training with the Machine Learning Algorithm on Neural Efficiency in Healthy Younger Adults

Article

Full-text available

Oct 2022
Int J Environ Res Publ Health

To date, neural efficiency, an ability to economically utilize mental resources, has not been investigated after cognitive training. The purpose of this study was to provide customized cognitive training and confirm its effect on neural efficiency by investigating prefrontal cortex (PFC) activity using functional near-infrared spectroscopy (fNIRS). Before training, a prediction algorithm based on the PFC activity with logistic regression was used to predict the customized difficulty level with 86% accuracy by collecting data when subjects performed four kinds of cognitive tasks. In the next step, the intervention study was designed using one pre-posttest group. Thirteen healthy adults participated in the virtual reality (VR)-based spatial cognitive training, which was conducted four times a week for 30 min for three weeks with customized difficulty levels for each session. To measure its effect, the trail-making test (TMT) and hemodynamic responses were measured for executive function and PFC activity. During the training, VR-based spatial cognitive performance was improved, and hemodynamic values were gradually increased as the training sessions progressed. In addition, after the training, the performance on the trail-making task (TMT) demonstrated a statistically significant improvement, and there was a statistically significant decrease in the PFC activity. The improved performance on the TMT coupled with the decreased PFC activity could be regarded as training-induced neural efficiency. These results suggested that personalized cognitive training could be effective in improving executive function and neural efficiency.

Fluency and Memory Differences Between Ischemic Vascular Dementia and Alzheimer's Disease

Article

Full-text available

Nov 1997
NEUROPSYCHOLOGY

This study compared 32 patients with ischemic vascular dementia (IVD) to 32 patients with probable Alzheimer's disease (AD) on select language and verbal memory tests. The IVD and AD patients were individually matched on the basis of age, dementia severity, years of education, and gender. The IVD patients had poorer verbal fluency, but better free recall, fewer recall intrusions, and better recognition memory than the AD patients. Relationships between the neuropsychological measures and radiological indexes of cortical and subcortical pathology were also examined. A number of infarcts, white-matter lucency, and ventricular enlargement correlated with some of the neuropsychological measures; cortical atrophy correlated with most of the measures. The findings suggest that neuropsychological deficits in IVD may be related to dysfunction of frontal-subcortical circuits, although an associated degenerative cortical process may also be involved.

The validity of thai version of the montreal cognitive assessment (MoCA-T)

Technical Report

Full-text available

Jan 2009

Rational and objective: Mild Cognitive impairment(MCI) is the prodrome of dementia or incipient dementia that is challenging in clinical practice. The Montreal Cognitive Assessment ( MoCA) test has been demonstrated to be valid and reliable instrument for screening of MCI in various cross-cultural clinical samples. The objective of this study is to examine the validity and reliability of the Thai version of The MoCA test in screening for patients with amnestic MCI ( aMCI) by using Clinical Dementia Rating Scale( CDR ) as the gold standard. Method :The sample composed of 120 subjects consecutively included from the memory clinic at a university hospital, the King Chulalongkorn Memorial Hospital, in Bangkok, Thailand. 40 patients were diagnosed as aMCI with CDR stage 0.5 and 40 patients had been treated for mild Alzheimer’s disease (AD) according to NINCDS-ADRDA ,DSM IV-TR criteria and CDR stage 1 . 40 relatives of the geriatric patients visiting our memory clinic were randomly selected as normal subjects with CDR stage 0. All subjects completed the Thai Geriatric Depressive Rating Scale(TGDS). Thai version of MMSE(TMSE) , MoCA-Thai , and CDR were administered by trained psychiatrists. Written informed consents were given by the patients or authorizing caregivers. The internal consistency and criterion validity of MoCA-T was explored and compared with the CDR as the gold standard for diagnosis of MCI. Result: The internal consistency of MoCA-T was demonstrated to have the Cronbach’s alpha coefficient of 0.914. Score of MoCA and MMSE were found to be highly correlated with r = 0.900 (p<0.001). Age, year of education and depressive score were significantly correlated with MoCA score . From multiple regression analysis , The global CDR score and year of education were the significant predictors for score of MoCA. With the cut off score under 25 and 22 by adding 1 point for subjects with ≤ 6 years of education , the sensitivity and specificity were 0.8 and 0.80 for aMCI , 1.0 and 0.98 for AD. Conclusion: MoCA-T showed a lower cut off score comparing to the original version. MoCA-T is a reliable and valid screening tool for diagnosis of aMCI in Thai clinical sample.

Assessing Executive Abilities Following Acute Stroke with the Trail Making Test and Digit Span

Article

Full-text available

Jan 2011

The Trail Making Test and Digit Span are neuropsychological tests widely used to assess executive abilities following stroke. The Trails B and Digits Backward conditions of these tests are thought to be more sensitive to executive impairment related to frontal lobe dysfunction than the Trails A and Digits Forward conditions. Trails B and Digits Backward are also thought to be more sensitive to brain damage in general. Data from the Stroke and Lesion Registry maintained by the Washington University Cognitive Rehabilitation Research Group were analyzed to compare the effects of frontal versus nonfrontal strokes and to assess the effects of stroke severity. Results showed that the performance of patients with frontal and nonfrontal strokes was comparable in each condition of both the Trail Making Test and Digit Span, providing no support for the widely held belief that Trails B and Digits Backward are more sensitive to frontal lobe damage. Further, Trails A was as strongly correlated with stroke severity as Trails B, whereas Digits Backward was more strongly correlated with stroke severity than Digits Forward. Overall, the Trail Making Test and Digit Span are sensitive to brain damage but do not differentiate between patients with frontal versus nonfrontal stroke.

Power of discrimination of Montreal Cognitive Assessment (MOCA) scale in Turkish patients with mild cognitive impairement and Alzheimer's disease

Article

Full-text available

Jan 2010

Introduction: The MOCA is a screening device used to assess attention and concentration, executive functions, memory, language, visuo-spatial abilities, abstract thinking, calculation, and orientation domains. The main aim of this study is to carry out a cultural adaptation study and to evaluate the predictive validity of the MOCA in Turkish Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD) patients. Materials and Method: The study group consisted of 20 participants (10 women, 10 men) with AD, 20 participants with MCI, and 165 healthy volunteer subjects. Effects of the three variables, the group, age and education level was analyzed with 3 (AD, MCI, control) x 4 (50-59, 60-69, 70-79, 80+) x 2 (5-8 year, 9+ year) factorial ANOVA respectively. Results: According to the ANOVA results, the main effect of the group on the MOCA scores and the interaction effect of group and age on the MOCA scores were statistically significant. Conclusion: The MOCA differentiated AD group from MCI and control groups. AD groups failed the tests while MCI and control groups followed them. Our results demonstrate that the MOCA total score significantly correlates with the SMMT score.

Letter and Category Fluency in Patients With Frontal Lobe Lesions

Article

Full-text available

Apr 1998

This study examines the hypothesis that patients with frontal lobe lesions are impaired on tests of letter but not category fluency. This hypothesis was proposed by Moscovitch (1994), based on a series of cognitive studies with young. normal participants. A group of patients with lateral prefrontal lesions and age-matched controls were tested on 2 tests of verbal fluency, the FAS task and a category fluency task that used semantic categories as cues (e.g., animals). Patients with frontal lobe lesions generated fewer items than controls on both letter and category fluency. This effect did not interact with the type of fluency test, suggesting that the frontal lobes are more generally involved in verbal fluency. Moreover, this pattern of findings, along with previous results of impaired free recall and remote retrieval in this patient group, suggests that patients with frontal lobe lesions do not efficiently organize and develop retrieval strategies.

The relationship of montreal cognitive assessment scores to framingham coronary and stroke risk scores

Article

Full-text available

Jan 2011

We examined the relationship between a brief cogni-tive screening measure and Framingham Coronary and Stroke Risk scores. We administered the Mon-treal Cognitive Assessment (MoCA) to participants in the Dallas Heart Study, a community-based mul-tiethnic study investigating the development of athe-rosclerosis. The composition of the group was 50% African American, 36% Caucasian and 14% Hispan-ic. There were 765 subjects (mean age 51 years) who had both Coronary and Stroke Risk scores and an additional 144 subjects with only Coronary Risk scores available. There was a small significant inverse relationship between MoCA and Framingham Coro-nary and Stroke Risk scores. MoCA scores were in-fluenced by education, but were not influenced by age or by the presence of one or more apoE4 alleles.

Sensitivity and Specificity of the Montreal Cognitive Assessment Modified for Individuals Who Are Visually Impaired

Article

Full-text available

Jun 2010

Evaluating the cognitive status of individuals who are visually impaired is limited by the design of the test that is used. This article presents data on the sensitivity and specificity of the version of the Montreal Cognitive Assessment for people who are visually impaired. The original validation data were reanalyzed, excluding the five visual items. The results indicated that the specificity was excellent, while sensitivity was reduced; however, the recommended proportionally adjusted cutoff values showed better sensitivity.

Differentiation of Alzheimer’s, Huntington’s, and Parkinson’s Disease Patients on the Basis of Verbal Learning Characteristics

Article

Full-text available

Jan 1989

Examined the degree to which patients with dementia could be differentiated on the basis of their verbal learning characteristics. 83 patients with Parkinson's disease (PD), 22 with Huntington's disease (HD), and 22 with probable Alzheimer's disease were administered the California Verbal Learning Test. PD and HD Ss were divided into subgroups to control for the severity of overall memory impairment. Intrusions, perseverations, and rate of forgetting were the most discriminating variables. Profile differences between HD and PD were sufficiently robust to separate these 2 groups. Results do not support a simplistic cortical–subcortical dichotomy; rather, individual dementing syndromes have unique patterns of verbal learning performance that are distinct from one another. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

The Spectrum of Category Effects in Object and Action Knowledge in Dementia of the Alzheimer's Type

Article

Full-text available

Jul 2001

The validity and origin of category effects in the anomia demonstrated by individuals with dementia of the Alzheimer's type (DAT) remains controversial. Twenty DAT subjects were tested with picture naming and semantic association judgement tests. Picture and word stimuli were drawn from biological, nonbiological, and actions–verbs categories, all of equal difficulty and previously normed on elderly controls. DAT subjects made significantly more naming and semantic judgement errors in the biological category than in the nonbiological category. They were relatively more accurate in naming and making judgements for actions–verbs when presented as words or as 5-s animations. When line drawings of actions were shown for naming, performance deteriorated significantly. Converging results from these 2 tasks provide strong evidence for a semantic memory impairment preferentially affecting biological items to a greater extent than nonbiological items or action verbs in DAT. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy

Article

Full-text available

Jul 2001
MOVEMENT DISORD

Our objective was to examine whether rapid eye movement (REM) sleep behavior disorder occurs in disproportionally greater frequency in multiple system atrophy (MSA), Parkinson's disease (PD), and dementia with Lewy bodies (DLB), collectively known as the synucleinopathies, compared to other nonsynucleinopathy neurodegenerative disorders. In study 1, we reviewed the clinical records of 398 consecutive patients evaluated at Mayo Clinic Rochester for parkinsonism and/or cognitive impairment. The frequency of suspected and polysomnogram (PSG)‐confirmed REM sleep behavior disorder (RBD) among subjects with the synucleinopathies MSA, PD, or DLB was compared to the frequency among subjects with the nonsynucleinopathies Alzheimer's disease (AD), frontotemporal dementia (FTD), corticobasal degeneration (CBD), progressive supranuclear palsy (PSP), mild cognitive impairment (MCI), primary progressive aphasia (PPA), and posterior cortical atrophy (PCA). In study 2, we reviewed the clinical records of 360 consecutive patients evaluated at Mayo Clinic Jacksonville for parkinsonism and/or cognitive impairment. The frequency of probable RBD among patients with PD and DLB was compared to the frequency among patients with AD and MCI. In study 3, we reviewed the brain biopsy or postmortem autopsy diagnoses of 23 Mayo Clinic Rochester patients who had been clinically examined for possible RBD and a neurodegenerative disorder. In study 1, patients with MSA, PD, or DLB were more likely to have probable and PSG‐confirmed RBD compared to subjects with the nonsynucleinopathies (probable RBD 77/120=64% vs. 7/278=3%, p < 0.01; PSG‐confirmed RBD 47/120=39% vs. 1/278=0%, p < 0.01). In study 2, patients with PD and DLB were more likely to have probable RBD compared to those with AD and MCI (56% vs. 2%, p < 0.01). In study 3, of the 23 autopsied patients who had been questioned about possible RBD, 10 were clinically diagnosed with RBD. The neuropathologic diagnoses in these 10 included Lewy body disease in nine, and MSA in one. Of the other 13 cases, 12 did not have a history suggesting RBD, and the one case who did had normal electromyographic atonia during REM sleep on PSG and autopsy findings of PSP. Only one of these 13 had a synucleinopathy. The positive predictive values for RBD indicating a synucleinopathy for studies 1–3 were 91.7%, 94.3%, and 100.0%, respectively. Clinically suspected and PSG‐proven RBD occurs with disproportionally greater frequency in MSA, PD, and DLB compared to other neurodegenerative disorders. In the setting of degenerative dementia and/or parkinsonism, we hypothesize that RBD is a manifestation of an evolving synucleinopathy. © 2001 Movement Disorder Society.

Comparison of the Folstein Mini Mental State Examination (MMSE) to the Montreal Cognitive Assessment (MoCA) as a Cognitive Screening Tool in an Inpatient …

Article

Full-text available

Jan 2010

Identifying the presence of cognitive impairment in patients admitted for inpatient rehabilitation is important as it may impact on their ability to participate in a rehabilitation program. The Folstein Mini Mental State Examination (MMSE) has been used by clinicians as a cognitive screening tool for its convenience, even though it is not sensitive, and often fails to detect cognitive impairment. Recently, the Montreal Cognitive Assessment (MoCA) has been developed as a brief cognitive screening tool to detect mild-moderate cognitive impairment. We performed a longitudinal study to compare the utility of the MMSE and MoCA in an inpatient rehabilitation setting. A total of 50 consecutive patients were studied with an average age of 71.7 years of age. The mean test score for MMSE was 26.5 and 22.2 for the MoCA. The Pearson's correlation coefficient between the scores was 0.695 (p < 0.003). The mean performance time for the MMSE was 7.4 minutes and 14.8 minutes for the MoCA. MMSE did not perform well as a screening instrument for mild cognitive impairment as there were 43 patients who scored 24 or more on MMSE, and 25 patients (58%) scored 25 or less on MoCA, indicating the presence of cognitive impairment. Even though the MoCA takes longer to administer, the additional important information provided indicates that the MoCA should be used rather than the MMSE as a cogni-tive screening tool.

The Chinese (Cantonese) Montreal Cognitive Assessment in Patients with Subcortical Ischemic Vascular Dementia

Article

Full-text available

Sep 2011

Subcortical ischemic vascular dementia (SIVD) has been proposed as the most frequent subtype of vascular cognitive impairment. The aim of this study was to evaluate the psychometric properties of the Chinese (Cantonese) Montreal Cognitive Assessment (CC-MoCA) in patients with SIVD in the Guangdong Province of China. 71 SIVD patients and 60 matched controls were recruited for the CC-MoCA, Mini Mental State Examination and executive clock drawing tasks. Receiver-operating characteristic curve analyses were performed to determine optimal sensitivity and specificity of the CC-MoCA total score in differentiating mild vascular dementia (VaD) patients from moderate VaD patients and controls. The mean CC-MoCA scores of the controls, and mild and moderate VaD patients were 25.2 ± 3.8, 16.4 ± 3.7, and 10.0 ± 5.1, respectively. In our study, the optimal cutoff value for the CC-MoCA to be able to differentiate patients with mild VaD from controls is 21/22, and 13/14 to differentiate mild VaD from moderate VaD. The CC-MoCA is a useful cognitive screening instrument in SIVD patients.

Clustering and switching on verbal fluency: The effects of focal frontal-and temporal-lobe lesions

Article

Full-text available

Jul 1998
NEUROPSYCHOLOGIA

We examined the hypothesis that, on verbal fluency, clustering (i.e. generating words within subcategories) is related to temporal-lobe functioning, whereas switching (i.e. shifting between subcategories) is related to frontal-lobe functioning. Tests of phonemic and semantic fluency were administered to 53 patients with focal frontal-lobe lesions (FL), 23 patients with unilateral temporal-lobe lesions (TL) and 55 matched controls. Performance by FL patients was consistent with our hypothesis: in comparison to controls, patients with left-dorsolateral or superior-medial frontal lesions switched less frequently and produced normal cluster sizes on both phonemic and semantic fluency. Performance by TL patients was not consistent across fluency tasks and provided partial support for our hypothesis. On phonemic fluency, TL patients were unimpaired on both switching and clustering. On semantic fluency, TL patients were impaired on switching in comparison to controls and left TL patients produced smaller clusters than right TL patients. The best indices for discriminating the patient groups, therefore, were phonemic-fluency switching (impaired only with frontal lesions) and semantic-fluency clustering (impaired only with temporal-lobe lesions).

Sentence Repetition and Processing Resources in Alzheimer's Disease

Article

Full-text available

Dec 2000

Sentence processing in Alzheimer's disease (AD) has been found to be influenced by several grammatical and extragrammatical factors, including phrase structure and verb–argument relations, number of propositions/verbs, and processing resource capacity. This study examines the effects of these variables on sentence production in AD. Normal control and AD subjects were asked to repeat six types of sentences varying along the above dimensions of complexity. Subjects' processing resource capacity was measured using several verbal working memory tests. AD subjects' sentence-repetition performance was impaired compared to the normal control group. Significant effects were observed for branching direction of phrase struc- ture, canonicity of verb–argument relations, and serial position of errors. Sentence-repetition performance significantly correlated with working memory scores. The findings are interpreted within a resource capacity theory of sentence processing.

Category-specific neural processing for naming pictures of animals and naming pictures of tools: An ALE meta-analysis

Article

Full-text available

Jan 2010

Using activation-likelihood estimation (ALE) meta-analysis, we identified brain areas that are invoked when people name pictures of animals and pictures of tools. We found that naming animals and naming tools invoked separate distributed networks in the brain. Specifically, we found that naming animals invoked greater responses than naming tools in frontal lobe structures that are typically modulated by emotional content and task demands, and in a number of visual areas in the ventral stream. In contrast, naming tools invoked greater responses in a different set of areas in the ventral stream than those invoked by naming animals. Naming tools also invoked greater responses than naming animals in motor areas in the frontal lobe as well as in sensory areas in the parietal lobe. The only overlapping sites of activation that we found for naming these two categories of objects were in the left pars triangularis, the left inferior temporal gyrus, and the left parahippocampal gyrus. Taken together, our meta-analysis reveals that animals and tools are categorically represented in visual areas but show convergence in higher-order associative areas in the temporal and frontal lobes in regions that are typically regarded as being involved in memory and/or semantic processing. Our results also reveal that naming tools not only engages visual areas in the ventral stream but also a fronto-parietal network associated with tool use. Whether or not this network associated with tool use contributes directly to recognition will require further investigation.

Validation of the Sinhala version of the Montreal Cognitive Assessment in screening for dementia

Article

Full-text available

Dec 2011

To validate the Sinhala version of the Montreal Cognitive Assessment (MoCA) scale in screening for dementia. The MoCA translation and cultural adaptation was carried using a combined qualitative and quantitative approach. Sample size was calculated to detect a targeted sensitivity of 85% and a specificity of 85%. Sample consisted of 49 participants diagnosed with dementia of the Alzheimer's type (AD) according to DSM-IV criteria and 49 normal controls (NC) aged ≥50 years. All subjects were administered the Mini Mental State Examination (MMSE) and MoCA Sinhala version (MoCA-S). Concurrent validity was assessed using Pearson correlation coefficients between the MoCA-S scores and MMSE scores. Criterion validity was assessed using receiver operating characteristic (ROC) analysis. Mean MoCA scores between NC (26.71, SD 2.4) and AD group (16.78, SD 5.9) were significantly different (t=10.8, p<0.001). Cronbach's alpha of 0.818 indicated good internal consistency. Attention (digit span, sustained attention, and the serial 7 calculation task) had the highest discriminant ability followed by visuospatial skills (trail making, cube drawing and clock drawing). Naming had poor discriminant ability. There was a high, positive correlation between MoCA-S total scores and MMSE total scores. (r=0.907, p<0.001). The area under the ROC curve was 0.975 (95%CI 0.94-1.0) for the MoCA and 0.928 (95% CI 0.87-0.98) for MMSE. A cut-off value of 24 provided the best balance between sensitivity (98.0 7%) and specificity (79.6 %). MoCA-S is a valid and reliable instrument which can be used as a brief screening instrument for dementia in Sri Lanka.

Verbal Learning and Memory in Older Adults with Minor and Major Depression

Article

Full-text available

Dec 2011
ARCH CLIN NEUROPSYCH

Late-life minor depression (miD) is a prevalent but poorly understood illness. Verbal learning and memory profiles have commonly been used to characterize neuropsychiatric disorders. This study compared the performance of 27 older adults with miD on the California Verbal Learning Test (CVLT) with 26 age-matched individuals with Major Depressive Disorder (MDD) and 36 non-depressed controls. Results revealed that the miD group performed comparably with controls and significantly better than the MDD group on several CVLT indices. Moreover, cluster analysis revealed three distinct groups, consistent with theoretical representations of "normal," "subcortical," and "cortical" verbal learning and memory profiles. The majority of the miD group showed "normal" profiles (74%), whereas most individuals with MDD displayed "subcortical" profiles (54%). The findings suggest that depression in the elderly is a heterogeneous entity and that the CVLT may be a useful tool for characterizing learning and memory in late-onset depressive disorders.

Construct Validity of the Montreal Cognitive Assessment (MoCA)

Article

Full-text available

Nov 2011
J INT NEUROPSYCH SOC

The Montreal Cognitive Assessment (MoCA) is a brief instrument developed for the screening of milder forms of cognitive impairment. The present study aims to assess the construct related validity of the MoCA through the establishment of the factorial, convergent, and discriminant related validities, and the reliability of data. In a Portuguese sample of 830 participants, several models were tested using Confirmatory Factor Analysis. Although all tested models showed a good fit, the six-factor model based on the conceptual model proposed by the MoCA's authors showed a significantly better fit. The results allowed us to establish the factorial, convergent, and discriminant validity of this six-dimensional structure. An overall psychometric adequacy of the items, and a good reliability were also found. This study contributes to overcome an important gap in the construct related validity of this instrument. The present findings corroborate the six-dimensional structure of the MoCA and provide good evidence of the construct related validity. The MoCA has proved to be an appropriate measure for cognitive screening taking into account different cognitive domains, which will enable clinicians and researchers to use this test and its six latent dimensions to achieve a better understanding of the individuals' cognitive profile.

Cognitive Performance in Asymptomatic Patients With Advanced Carotid Disease

Article

Full-text available

Sep 2011

: In the absence of stroke or transient ischemic attack, patients with advanced carotid stenosis or occlusion (ICAs/o) are considered asymptomatic, yet they are prone to mostly subtle cognitive impairment. : The Mini-Mental State Examination (MMSE) often fails to detect mild cognitive impairment. The Montreal Cognitive Assessment (MoCA) is more sensitive in recognizing such changes. : Scores on the MoCA and MMSE were compared in 70 asymptomatic patients with ICAs/o and 70 controls matched for demographic variables and vascular risk factors. : MMSE scores fell mostly within the normal range in both patients and controls. Differences were significant for total MoCA scores (P<0.001). Patients with ICAs/o performed worse on visuospatial and executive function (P=0.018), abstraction (P<0.001), and delayed recall (P<0.001). Lower MoCA scores were associated with diabetes (odds ratio=6.41; 95% confidence interval, 1.277-32.220; P=0.024) and older age (odds ratio=0.86; 95% confidence interval, 0.780-0.956; P=0.004). Patients with diabetes performed worse on delayed recall (P<0.001), and patients with hypertension were worse on the MoCA naming subtest (P=0.04). : The MoCA successfully identified reduced cognitive status in patients with ICAs/o. The MoCA subtest scores revealed a pattern of cognitive impairment similar to that documented in other studies using more extensive neuropsychological tests. MoCA could be used as part of the clinical evaluation of patients with ICAs/o.

Normative data for the Montreal Cognitive Assessment (MoCA) in a population-based sample

Article

Full-text available

Sep 2011
NEUROLOGY

To provide normative and descriptive data for the Montreal Cognitive Assessment (MoCA) in a large, ethnically diverse sample. The MoCA was administered to 2,653 ethnically diverse subjects as part of a population-based study of cardiovascular disease (mean age 50.30 years, range 18-85; Caucasian 34%, African American 52%, Hispanic 11%, other 2%). Normative data were generated by age and education. Pearson correlations and analysis of variance were used to examine relationship to demographic variables. Frequency of missed items was also reviewed. Total scores were lower than previously published normative data (mean 23.4, SD 4.0), with 66% falling below the suggested cutoff (<26) for impairment. Most frequently missed items included the cube drawing (59%), delayed free recall (56%; <4/5 words), sentence repetition (55%), placement of clock hands (43%), abstraction items (40%), and verbal fluency (38%; <11 words in 1 minute). Normative data stratified by age and education were derived. These findings highlight the need for population-based norms for the MoCA and use of caution when applying established cut scores, particularly given the high failure rate on certain items. Demographic factors must be considered when interpreting this measure.

Assessing Executive Abilities Following Acute Stroke with the Trail Making Test and Digit Span

Article

Full-text available

Jan 2011
BEHAV NEUROL

“Subcortical” cognitive impairment in patients with systemic lupus erythematosus

Article

Nov 2000

Studies of cognitive functioning in patients with systemic lupus erythematosus (SLE) have found deficits even in patients without other evidence of neurologic involvement. The present study used scores on the 11 items of the Mini-Mental State Exam (MMSE) to classify the cognitive impairment of 93 SLE patients as suggestive of “cortical” or “subcortical” dysfunction using a validated statistical algorithm. Ninety-five percent of patients were categorized as having “subcortical” deficits, and 5% were categorized as having “cortical” deficits. When the analysis was limited to only those with total MMSE scores ≤ 24, 81% were classified as “subcortical” and 19% as “cortical.” These results suggest that SLE patients can have psychomotor and mental tracking deficits of a type seen in patients with subcortical brain disease, even in the absence of gross neurologic involvement. ( JINS , 2000, 6 , 821–825.)

Verbal fluency in Huntington's disease: A longitudinal analysis of phonemic and semantic clustering and switching

Article

Feb 2002
NEUROPSYCHOLOGIA

Two underlying components of verbal fluency tasks have been identified as clustering (the ability to generate successive words within a sub-category) and switching (the ability to shift from one sub-category to another). Selective impairment of switching ability occurs in patients with frontostriatal pathology, whilst clustering ability is compromised with temporal lobe dysfunction. Letter fluency tasks have been shown to be especially sensitive to frontostriatal deficits, whereas, category fluency tasks tend to be compromised by temporal lobe pathology. This study examined two types of verbal fluency task (letter fluency and category fluency) using two levels of analysis (phonemic and semantic) for clustering and switching measures. The performance of 21 frontostriatally compromised Huntington's disease (HD) patients was followed over an average of 3.5 annual follow-up visits. HD patients showed a significant reduction of correctly generated words over time, together with a significant increase in word repetitions. Phonemic switching decreased significantly over time for both letter and category fluency. Semantic switching, however, remained stable over time for both verbal fluency tasks. Clustering (both semantic and phonemic) likewise remained stable and did not vary longitudinally for either letter or category fluency. Hence, phonemic switching alone drove verbal fluency performance and this selective impairment can be explained by the progressive involvement of frontostriatal circuitry in the natural progression of HD.

The nature of the naming deficit in Alzheimer's and Huntington's disease

Article

Sep 1991

A comparison of naming performance, on the Boston Naming Test, of 52 patients with dementia of Alzheimer's type (DAT), 16 patients with Huntington's disease (HD) and 52 normal control subjects was performed using a comprehensive classification of error types. Spontaneous and cued naming scores were significantly impaired both in the DAT and HD groups, but performance in the DAT patients was significantly worse than that of the HD patients. Normal controls made predominantly semantic-category and circumlocutory errors. The HD group differed from normal only in the proportion of visually based errors, which was greater in the patient group. By contrast, the DAT patients made a significantly greater proportion of semantic-superordinate and semantic-associative errors. The same pattern of naming errors was found when a group of DAT and HD patients matched for overall naming ability was compared. A subgroup of 22 DAT patients was followed longitudinally over 3 y. Their deterioration in overall naming performance was accompanied by a consistent change in the profile of naming errors: the proportion of semantic-associative errors increased significantly as did the proportion of visual errors. These results are considered in the light of current cognitive models of naming. They suggest that in HD, naming deficits initially involve disruption of perceptual analysis, whereas in DAT such impairments in the early stages reflect a breakdown in semantic processes. However, as DAT progresses, perceptual problems also begin to contribute to the patients' naming difficulties. Postlexical (phonemic) processes remain relatively intact throughout in both diseases.

Mental symptoms in Parkinson's disease are important contributors to caregiver distress

Article

Oct 1999

Objective: To determine the emotional and social distress of caring for a patient with Parkinson's disease and to explore the impact of motor and mental symptoms in subjects with Parkinson's disease on their caregivers' situation. Design: Cross-sectional, population-based study using self-report questionnaires to measure caregiver distress and rating scales to assess patient symptomatology. Setting: Neurology and old age psychiatry services in Stavanger, Norway. Subjects: Caregivers of 94 home-dwelling patients with Parkinson's disease. Two control groups (patients with diabetes mellitus and healthy elderly). Outcome measures: Measures of social and emotional distress in caregivers, including the Relative Stress Scale, Beck Depression Inventory and the General Health Questionnaire. Results: Caregivers, in particular spouses, had more severe depression and a higher proportion reporting tiredness, sadness and less satisfaction with life compared with healthy elderly subjects. Using linear regression analysis, patient predictors of caregiver distress were depression, functional and cognitive impairment, agitation, aberrant motor behaviour and delusions. Conclusions: Caring for a spouse with Parkinson's disease is associated with emotional and social distress, underlining the importance of also assessing the needs of carers. Mental symptoms of parkinsonian patients were the most consistent and powerful predictors of caregiver distress, suggesting that identification and treatment of mental symptoms may reduce distress in caregivers of subjects with Parkinson's disease.

Psychological defects produced by temporal lobe resection

Article

Jan 1953

B. Milner

Proceedings, Association for Research in Nervous and Mental Disease

Article

[Cognitive impairment in patients with idiopathic normal pressure hydrocephalus]

Article

Apr 2008

Hiroaki Kazui

The major cognitive impairment in patients with idiopathic normal pressure hydrocephalus (iNPH) is frontal lobe symptoms, such as psychomotor slowing and impairment of attention, working memory, verbal fluency and executive function. Compared with Alzheimer's disease (AD), frontal lobe symptoms are disproportionately severe and the impairment of memory and orientation is disproportionately mild in patients with iNPH. Concerning memory impairment, recognition memory is relatively preserved compared with recall in iNPH. The cognitive impairment of iNPH could be classified into subcortical dementia type. However, compared with Binswanger's disease, impairment of memory and visuospatial attention in NPH may be more severe. Agraphia is also found in some iNPH patients. Thus, iNPH patients could have not only cognitive impairment of subcortical but also cortical types. After shunt operation, cognitive impairment improves but marked improvement in cognitive functions is less frequent than that of the gait disorder. The impairment of memory, working memory and visuoconstructive and psychomotor slowing appears likely to respond shunt surgery. However, in iNPH patients with impairment of memory and either of visuoconstructive or executive function, improvement of overall cognitive deficits after shunt surgery is less, suggesting that a higher degree of neural impairment may identify less reversible injury or that superimposed AD might limit the potential to show improvement. Neuroanatomical bases of cognitive impairment of iNPH are not well documented. However, damage of periventricular structures, such as corpus callosum, frontal subcortical and cortical areas, thalamus, basal ganglia and hippocampus, could be associated with cognitive impairment of iNPH.

The Montreal Cognitive Assessment (MoCA): Validation of alternate forms and new recommendations for education corrections

Article

Jul 2011

The challenge of time: Clock-drawing and cognitive function in the elderly

Article

Oct 1986
INT J GERIATR PSYCH

This study compares the ‘clock-drawing test’ to two standardized cognitive screens in an elderly population. A newly developed hierarchical classification of errors in clock-drawing correlated well with the severity of scores on both cognitive and screens and also demonstrated acceptable standards for sensitivity and specificity. Clock-drawing appears to be a practical test which can be useful for clinicians as a screen for cognitive impairment in old age and possibly as a marker of change in cognitive status.

Montreal Cognitive Assessment (MoCA): Concept and Clinical Review

Abstract

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