Association Between Turn Impairments and Cognitive Function in Parkinson Disease

Changes in serum neuron-specific enolase (NSE) level, S100β protein concentration and inflammatory factor levels and their correlations with cognitive impairment Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores in intracranial tumor patients with cognitive impairment were explored. Seventy patients diagnosed with intracranial tumor based on clinical symptoms and computed tomography (CT) images were selected and divided into non-cognitive impairment group (MoCA score ≥26 points, n=44) and cognitive impairment group (MoCA score <26 points, n=26) in accordance with the comprehensive cognitive function evaluation scores. Next, the serum NSE level, S100β protein concentration and inflammatory factor levels were detected, and their relationships with MMSE and MoCA scores were analyzed via Pearsons correlation analysis. The MoCA and MMSE scores in non-cognitive impairment group were higher than those in cognitive impairment group (P<0.05). NSE and S100β levels were higher in non-cognitive impairment group compared with cognitive impairment group (P<0.05). In addition, the levels of interleukin-6 (IL-6), IL-8 and tumor necrosis factor-α (TNF-α) were higher in cognitive impairment group than those in non-cognitive impairment group (P<0.05). The levels of patient's serum NSE, S100β protein and inflammatory factors were negatively related to MMSE and MoCA scores (P<0.05). The changes in serum NSE, S100β protein and inflammatory factor levels in patients with cognitive impairment can reflect the severity of the disease to a certain extent and are directly related to cognitive impairment. Accurate and comprehensive assessment of cognitive function of patients and early development of effective and targeted cognitive interventions are of certain clinical practical value for the improvement of prognosis.

This study investigates the correlation between white matter structural damage and cognitive impairment in patients with Parkinson's disease (PD) and mild cognitive impairment (MCI). A total of 40 patients with PD were divided into two groups, i.e., a mild cognitive impairment (PD-MCI) and a normal cognitive (PDN) group, and 20 healthy patients were enrolled as the control group. Changes in the white matter structure of patients with PD were evaluated using diffusion tensor imaging (DTI), and cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) scale and Mini-Mental State Examination (MMSE). Finally, the correlations between the two groups were analyzed. The Unified Parkinson's Disease Rating Scale score was significantly higher in the PD-MCI than in the PDN group (P=0.008). The total MoCA and MMSE scores in the PD-MCI group were significantly lower than in the PDN and control groups (P<0.01). Patients in PDMCI group were tested by MMSE scale, and the abnormal score rate was 60.0%. Among them, 8 PD patients with normal MMSE total score were found to have mild cognitive impairment by MoCA evaluation. When compared with the PDN and control groups, the MoCA scores for visual space, which is assessed as part of the MoCA scale and generally represents bilateral parietal function; naming; memory; and attention were significantly lower in the PD-MCI group (P<0.001). When compared with the PDN group, the fractional anisotropy (FA) values for the right parietal and left occipital lobes were significantly lower in the PD-MCI group (P=0.005; P=0.018). The relationship between MoCA value and right parietal white matter and left occipital white matter was 0.555, 0.474, respectively. A Pearson's correlation test was conducted to compare the FA values and MoCA scores of the various brain areas in the PD-MCI group and revealed a significant positive correlation between the MoCA score and the white matter of the right parietal and left occipital lobes (P<0.01). Patients with PD experience early cognitive impairment, and the MoCA scale can be used for early screening. In addition, the DTI of white matter can highlight early white matter damage. In the current study, the damaged brain areas displayed by DTI were consistent with areas showing decreased MoCA scores and were positively correlated with the severity of PD.

Objective: We aimed to establish the association of decline in cognitive screening tests scores, the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE), with the decline in neuropsychological diagnostic status from 3-6 months to a year later. Method: Patients with ischemic stroke/ Transient Ischemic Attack (TIA) received the MoCA and MMSE within 14 days after stroke, then 3-6 months and 1 year later. The decline in MoCA and MMSE scores were defined by reduction of 2 points or more in total scores, while stable/improved MoCA scores referred to reduction of MoCA scores less than 2 or improved scores. The decline in neuropsychological diagnostic status was defined by category transition from no cognitive impairment to any cognitive impairment (≥1 domain), from mild cognitive impairment (impairment in 1-2 domains) to moderate cognitive impairment (impairment &gt;2 domains) and dementia (i.e., functional loss associated with cognitive impairment, DSM-IV criteria), as well as from moderate cognitive impairment to dementia. Results: At baseline, most patients were Chinese (70.3%) and males (69.8%) with age of 59.8 ± 11.6 years and education of 7.7 ± 4.3 years. 327 out of 400 stroke/TIA patients completed neuropsychological assessments at 3-6 months and 275 completed at 1 year after their index cerebrovascular events. Of these, 31 (11.3%) had decline in neuropsychological diagnostic status. Logistic regression was used to model the association between probability of decline in neuropsychological diagnostic status and the decline in MMSE or MoCA scores. There were not significant associations between the decline of neuropsychological diagnostic status and the decline in MMSE scores. Controlling baseline MoCA scores and the change scores of MoCA from baseline to 3-6 months, patients with decline in MoCA scores (reduction of 2 points or more) were associated with higher risks of decline in neuropsychological diagnostic status, relative to those with stable/ improved MoCA scores (odd ratio=3.21, p=0.004). Conclusion: The decline in MoCA scores are associated with a higher risks for decline in neuropsychological diagnostic status from 3-6 months to 1 year, therefore may be used to detect post-stroke cognitive decline.

To examine Montreal Cognitive Assessment (MoCA) performance in patients with Parkinson's disease (PD) with "normal" global cognition according to Mini-Mental State Examination (MMSE) score. A cross-sectional comparison of the MoCA and the MMSE. Two movement disorders centers at the University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center. A convenience sample of 131 patients with idiopathic PD who were screened for cognitive and psychiatric complications. Subjects were administered the MoCA and MMSE, and only subjects defined as having a normal age- and education-adjusted MMSE score were included in the analyses (N=100). As previously recommended in patients without PD, a MoCA score less than 26 was used to indicate the presence of at least mild cognitive impairment (MCI). Mean MMSE and MoCA scores+/-standard deviation were 28.8+/-1.1 and 24.9+/-3.1, respectively. More than half (52.0%) of subjects with normal MMSE scores had cognitive impairment according to their MoCA score. Impairments were seen in numerous cognitive domains, including memory, visuospatial and executive abilities, attention, and language. Predictors of cognitive impairment on the MoCA using univariate analyses were male sex, older age, lower educational level, and greater disease severity; older age was the only predictor in a multivariate model. Approximately half of patients with PD with a normal MMSE score have cognitive impairment based on the recommended MoCA cutoff score. These results suggest that MCI is common in PD and that the MoCA is a more sensitive instrument than the MMSE for its detection.

Objective — to analyze the results of screening for post‑stroke cognitive impairment (PCI) in patients with cerebral stroke (CS) admitted to the Stroke Center (SC) in different disease phases, and to determine independent predictors of the PCI persistence at discharge.&#x0D; Methods and subjects. 399 patients were enrolled, including 242 (60.7 %) men and 157 (39.3 %) women with the median age was 66.2 years (IQR 58.5 — 76.3). IS was diagnosed in 331 (82.9 %), and ICH in 68 (17.1 %) patients. Among patients with IS, 137 (41.4 %) had an atherothrombotic subtype, 152 (46.0 %) had a cardioembolic subtype, 21 (6.3 %) had a lacunar subtype, another 21 (6.3 %) had another or unknown cause of stroke. Patients were screened for PCI using the Mini‑Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) on admission and at discharge. Participants with MMSE score of 0 — 24 or a MoCA score of 0 — 25 were considered having PCI. Upon admission, all patients were assessed using the National Institutes of Health Stroke Scale (NIHSS), Bartel Index, and Modified Rankine Scale (mRS). The method of constructing and analyzing logistic regression models was used to determine independent predictors of the preservation of PCI at discharge. The analysis was carried out using the MedCalc v. 19.1.&#x0D; Results. The baseline NIHSS score ranged from 0 to 39 (median 11, IQR 6 — 18). The majority (64.2 %) of the subjects were hospitalized within the first 30 days from the CS onset. The MMSE score on admission ranged from 0 to 30 (median 20, IQR 2 — 27), and in 179 (44.9 %) of the patients the initial score was 0 to 17 (severe PCI), whereas in 61 (15 3 %) of the participants it was 18 to 24 (moderately severe PCI) and only 159 (39.8 %) persons scored 25 to 30 (no PCI). The baseline MoCA score ranged from 0 to 30 (median 15, IQR 1 — 24), and 356 (89.2 %) patients were shown to have PCI (score 0 to 25). According to screening with MMSE at discharge, 125 (31.4 %) patients had severe PCI, and 67 (16.8 %) had moderately severe PCI. The MoCA assessment before discharge indicated PCI in 324 (81.2 %) patients. According to both MMSE and MoCA, the rate of PCI on admission was significantly higher than at discharge (p &lt; 0.001). Among the 240 patients who had PCI according to MMSE score, 239 (99.6 %) had PCI according to the MoCA score. However, among 159 patients who screened negative for PCI with MMSE at admission, 117 (73.6 %) screened positive with MoCA. Screening results using both MMSE and MoCA were not significantly associated with affected hemisphere. ICH was associated with lower (p &lt; 0.0001) MMSE and MoCA scores compared with IS. Predictors of PCI according to MMSE score at discharge were a longer time interval from CS onset to SC admission, and a lower baseline MMSE score. However, with MoCA, the predictors were AT subtype IS, lesions in the distribution of the right or both middle cerebral arteries, older patient age, and a lower baseline MoCA score.&#x0D; Conclusions. In patients with MI, a high rate of PCI was documented on admission, but was significantly lower at discharge. In patients with established PCI, according to MMSE score, the use of MoCA for screening seems useless, however, screening with MoCA identified PCI in 3/4 in patients with a normal MMSE score. The independent predictors of scores on these two scales, indicating PCI, were significantly different, so they should not be considered interchangeable.

The impact of Parkinson’s disease (PD) dementia is substantial and has major functional and socioeconomic consequences. Early prediction of future cognitive impairment would help target future interventions. The Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), and fluency tests were administered to 486 patients with PD within 3.5 years of diagnosis, and the results were compared with those from 141 controls correcting for age, sex, and educational years. Eighteen-month longitudinal assessments were performed in 155 patients with PD. The proportion of patients classified with normal cognition, mild cognitive impairment (MCI), and dementia varied considerably, depending on the MoCA and MMSE thresholds used. With the MoCA total score at screening threshold, 47.7%, 40.5%, and 11.7% of patients with PD were classified with normal cognition, MCI, and dementia, respectively; by comparison, 78.7% and 21.3% of controls had normal cognition and MCI, respectively. Cognitive impairment was predicted by lower education, increased age, male sex, and quantitative motor and non-motor (smell, depression, and anxiety) measures. Longitudinal data from 155 patients with PD over 18 months showed significant reductions in MoCA scores, but not in MMSE scores, with 21.3% of patients moving from normal cognition to MCI and 4.5% moving from MCI to dementia, although 13.5% moved from MCI to normal; however, none of the patients with dementia changed their classification. The MoCA may be more sensitive than the MMSE in detecting early baseline and longitudinal cognitive impairment in PD, because it identified 25.8% of those who experienced significant cognitive decline over 18 months. Cognitive decline was associated with worse motor and non-motor features, suggesting that this reflects a faster progressive phenotype.

To study and compare the features of cognitive functioning in patients with very late-manifesting schizophreniform psychosis (VLMSP) depending on the clinical variants of the disease. The study included 61 patients (58 females, 3 males) aged 63 to 78 years. All patients met the ICD-10 criteria for psychosis and had no signs of dementia. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) score and the Mini-Mental State Examination (MMSE). Statistical analysis was performed using non-parametric methods. Patients with severe polymorphic psychotic symptoms had the most pronounced cognitive deficit (MMSE on Day 0 was 22.5 [20; 26] points, MoCA on Day 0 was 16 [12; 19] points, p<0.05), which partially improved after treatment, but remained below the reference values (MMSE on Day 28 was 24.5 [22; 26] points, MoCA on Day 28 was 18.5 [17; 22] points). In patients with paranoid symptoms, cognitive impairment was less pronounced (MMSE on Day 0 was 26 [24; 28] points, MoCA on Day 0 was 0 [17; 24.5] points) and stable (MMSE on Day 28 was 27 [25.5; 29.5] points, MoCA on Day 28 was 21 [17; 25] points). In the group where affective-delusional symptoms prevailed, the cognitive deficit was minimal (MMSE on Day 0 was 27.5 [27; 28.5] points, MoCA on Day 0 was 24 [23; 26.5] points) and completely reduced after treatment (MMSE on Day 28 was 29 [28; 30] points, MoCA on Day 28 was 26 [25; 28] points). The study showed significant differences in cognitive status in patients with VLMSP depending on the clinical variant of the disease. The results emphasize the need for an individualized approach to diagnosing and treating VLMSP and the importance of monitoring cognitive functions for early detection of neurodegenerative processes.

To identify the features of the cognitive status in patients with cardiac surgery profile with senile asthenia syndrome (SAS) and preasthenia. A study included 272 patients admitted for coronary artery bypass grafting (CABG). Screening for preasthenia and SAS in patients before surgery was performed using the Brief Battery of Physical Functioning Tests. SAS and preasthenia were detected in 15% of patients (n=41). Seventy-five patients were selected in the comparison group without asthenia. Assessment of the state of cognitive functions was carried out using screening neuropsychological scales - the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The median of the MMSE score (27 [26; 28] and 28 [27; 29], p=0.04), and the MoCA score (23 [19; 25] and 25 [23; 27], p=0.0085) was significantly lower in patients with asthenia and pre-asthenia compared to patients without asthenia. According to the MoCA, about 60% of patients in the pre-asthenia-asthenia group had severe cognitive impairment, while in the group without asthenia, more than 30% of cases had normal cognitive functions (p=0.003). Significant intergroup differences were found in MoCA subtests, reflecting visuospatial skills, abstraction, verbal fluency and working memory (p=0.01-0.04). Regression analysis showed that age and physical functioning index (severity of asthenia) most significantly contributed to the basic cognitive status assessed by MoCA. Features of the cognitive status in patients of cardiac surgery with the SAS and preasthenia are impairments of visuospatial thinking, verbal fluency, abstract thinking and working memory. The MoCA was shown to be informative in determining the basic cognitive status of cardiac surgical patients. At the same time, the greatest contribution to the basic cognitive status is made by age and the indicator of physical functioning, which characterizes the degree of asthenia.

ABSTRACTMini Mental State Examination (MMSE) has been used as a tool to detect cognitive impairment in patients treated with antiepileptic drugs, however fail to detect mild cognitive impairment in these patients. Studies report Montreal Cognitive Assessment (MOCA) is more sensitive than MMSE in detecting cognitive status in patients with stroke, parkinsonism, cardiovascular disease and epilepsy. Homocysteine has been implicated in the modulation of cognitive impairment in epilepsy but could not be established clearly as most studies followed MMSE. To investigate the relationship between homocysteine and cognitive status the present study employed MOCA in comparison with MMSE in epilepsy population with phenytoin monotherapy. Our findings suggest MOCA is more sensitive than MMSE in demonstrating the relationship between homocysteine and cognitive impairment in epilepsy.

Abnormal MoCA and normal range MMSE scores in Parkinson disease without dementia: cognitive and neurochemical correlates.

Objective To analyze the characteristics of cognitive function impairment in PD patients without dementia and their influencing factors, and provide evidence for early recognition and treatment of cognitive deficits in PD patients. Methods Fifty-six PD patients without dementia,admitted to our hospital from January 2010 to October 2011 were assessed with mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) for cognitive function. Logistic stepwise regression was employed to analyze the influencing factors of cognitive function impairment.Results Using MMSE scores as the standard for recognition, PD patients with mild cognitive impairment (MCI) accounted for 7.14％ (6/56); however,using MoCA scores,they accounted for 71.43％(40/56). Both of the MMSE and MoCA scores were positively correlative with the education degree of the patients (r=0.483,P=-0.007; r=0.503,P=0.000).In the cognitive domain of MMSE,the scores of visuospatial function,and abilities of delayed recall,calculation,attention and repetition had significant decrement; and MMSE indicated that abilities of delayed recall, immediate memory, calculation and attention,and visuospatial function were main cognitive disturbances of PD.In the cognitive domain of MoCA,the scores of visuospatial and executive functions,and abilities of delayed recall,abstraction and repetition had significant decrement; MoCA indicated that visuospatial and executive functions,abilities of delayed recall,denomination,attention,abstraction and repetition were main cognitive disturbances of PD. Logistic regression analysis showed that education degree and clinical types were the main influencing factors of cognitive function impairment in PD patients. Conclusion Cognitive impairment is very common in patients with PD,and the main cognitive deficits involve visuospatial and executive functions,abilities of delayed recall,calculation,attention,abstraction and repetition; education degree and clinical types are the influencing factors of cognitive impairment of PD. Key words: Parkinson'sdisease; Cognitivefunctionimpairment; Montrealcognitive assessment

Background: Cognitive impairment is very common in Parkinson's disease (PD) and constitutes the most debilitating complication of this disease. However, to date, few studies have investigated a genome-wide association in the development of cognitive impairment of PD. We aimed to identify the genetic loci associated with cognitive impairment in patients with sporadic PD by ethnicity-specific genotyping.Materials and methods: We recruited 1,070 patients with PD and performed a genome-wide association study using the Korean Chip, a microarray chip containing 827,400 single-nucleotide polymorphisms (SNPs) optimized for the Korean population. Multiple logistic regression models adjusting for age, sex, years of education, and disease duration were used to compare between patients with and without cognitive impairment, which was defined using the Mini-Mental Status Examination (MMSE) score (MMSE score ≥ 26 vs. < 26) or the Montreal Cognitive Assessment (MoCA) score (MoCA score ≥24 vs. < 24).Results: RYR2 SNP rs10495397 was most significantly associated with cognitive impairment based on the MMSE scores (OR = 3.21; 95% CI = 1.96–5.25, P = 3.36 × 10−6) and CASC17 showed the strongest association with cognitive impairment based on the MoCA scores. However, none of the SNPs were statistically significant after Bonferroni correction.Conclusion: RYR2 may play a role in cognitive impairment in PD by the pathogenic mechanism of neuroinflammation. However, more studies are needed to replicate and validate the results of our functional study.

Cognitive impairment (CI) is common in Parkinson's disease (PD) and an important cause of disability. Screening facilitates early detection of CI and has implications for management. Preclinical disability is when patients have functional limitations but maintain independence through compensatory measures. The objective of this study was to investigate the relationship between scores on the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) with levels of PD severity and disability. PD patients (n = 2,234) in a large observational study were stratified by disease severity, based on Total Unified Parkinson's Disease Rating Scale (Total UPDRS) and Hoehn and Yahr (HY) stage. Using MMSE (n = 1,184) or MoCA (n = 1,050) and basic (ADL) and instrumental activities of daily living (IADL) scales for disability, linear regression analysis examined associations between cognitive status and disability. Cognition and disability were highly correlated, with the strongest correlation between IADL and MoCA. Only 16.0% of mean MMSE scores were below threshold for CI (28) and only in advanced PD (Total UPDRS 60+, HY≥3). MoCA scores fell below CI threshold (26) in 66.2% of the sample and earlier in disease (Total UPDRS 30+, HY≥2), corresponding with impairments in ADLs. In a large clinical dataset, a small fraction of MMSE scores fell below cutoff for CI, reinforcing that MMSE is an insensitive screening tool in PD. MoCA scores indicated CI earlier in disease and coincided with disability. This study shows that MoCA, but not MMSE is sensitive to the emergence of early cognitive impairment in PD and correlates with the concomitant onset of disability.

Cohort studies on the risk of cognitive impairment in the older population of S. Korea based on glycosylated hemoglobin (HbA1c) levels are exceedingly rare. This study aimed to analyze the association between HbA1c levels and cognitive impairment in older Korean adults without dementia. We conducted a cross-sectional study using data from a community-based Ansan cohort (2009-2010), which was part of the Korea Genome Epidemiology Study. The study included 853 cohort participants aged ≥59 years living in Ansan city. Cognitive function was evaluated using the Korean version of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). The MMSE and MoCA scores were categorized into normal cognition (≥24 and ≥ 23, respectively) and cognitive impairment (≤23 and ≤ 22, respectively). Multiple logistic regression analysis was used to estimate the association between HbA1c levels and cognitive impairment, with adjustments for covariates. The mean age of the participants was 66 years, and 433 (50.8%) were female. Cognitive impairment was observed in 12.5 and 44.3% of participants, based on the MMSE and MoCA, respectively. Regarding the MMSE scores, HbA1c level was a risk factor for cognitive impairment in women. Compared to normal HbA1c (≤5.6%) levels, adjusted odds ratios of MMSE decline for HbA1c 5.7-6.4% and HbA1c ≥6.5% were high: 2.16 (95% confidence interval [CI] 1.04-4.49) and 2.96 (95% CI, 1.04-8.39), respectively. By improving glycemic control, the risk of cognitive impairment in the older population can be reduced. Further research on the role of sex differences in cognitive impairment is needed.

Cognitive decline in elderly patients with type 2 diabetes is associated with glycated albumin, ratio of Glycated Albumin to glycated hemoglobin, and concentrations of inflammatory and oxidative stress markers