Cognitive screening in Egypt: survey of opinions and best practices for detecting cognitive impairment in Egyptians

Evidence of Educational Bias in Cognitive Screening of Adults with Sickle Cell Disease: Comparison of Available Tools and Possible Strategies for Mitigation

Introduction: Alzheimer Questionnaire (AQ) and Montreal Cognitive Assessment (MoCA) are tools for assessment of cognitive impairment. MoCA is a common tool for screening of cognitive impairment but it requires trained personnel. AQ questionnaire is informant-based, simple and less time consuming with or without the involvement of trained personnel. Aim: To estimate the prevalence of cognitive impairment and to find out the accuracy of AQ compared to MoCA in Cognitive Impairment screening among elderly population in an urban area of West Bengal. Materials and Methods: The Prospective cross-sectional study was conducted in urban field practice area of All India Institute of Hygiene and Public Health, Kolkata among 140 randomly selected elderly population from June to September 2019. Accuracy of AQ with MoCA tool as gold standard in screening cognitive impairment was analysed by Cohen’s Kappa, Receiver Operating Characteristics (ROC) Curve, Spearman rho Coefficient along with sensitivity, specificity, predictive values and likelihood ratio was obtained. Results: Prevalence of cognitive impairment using MoCA and AQ was 40% (95% CI=31.8-48.6) and 36.4% (95% CI=28.5-45.0), respectively. AQ and MoCA showed good agreement (Cohen’s kappa, κ=0.834; 95% CI=0.739-0.928). The AQ and MoCA showed a strong negative correlation (spearman’s Rho=-0.709; 95%CI=0.764-0.884, p-value <0.001). Considering MoCA as gold standard, AQ showed sensitivity of 85.7% (95% CI=74.2-92.6), specificity of 96.4% (95% CI=89.9-98.7) for cognitive impairment screening and the Positive predictive value of this tool was 94.1% (95% CI=84.0-97.9%). The Youden index of 0.821 showed highest sum of sensitivity and specificity of AQ tool at 4.5 score to anticipate cognitive impairment. Conclusion: AQ is equally effective as MoCA to screen cognitive impairment among elderly at the community level. AQ can be used even by grass root level health workers without involvement of trained personnel. So, community level screening of elderly for cognitive dysfunction can be made even in resource poor settings. Early identification and referral of elderly with cognitive dysfunction will help them in better living.

Measuring cognitive impairment in young adults with polysubstance use disorder with MoCA or BRIEF-A – The significance of psychiatric symptoms

Detection of cognitive impairment in patients with brain metastases is important for both patient management and clinical trials. The most commonly used cognitive screen, the Mini Mental State Examination (MMSE), though convenient, is not sensitive in these patients. More sensitive tools are less convenient and, therefore, uncommonly used. Therefore, a practical and sensitive tool is needed. The Montreal Cognitive Assessment (MoCA) is a good candidate, shown to be sensitive in detecting mild cognitive impairment in the pre-dementia setting. This study is the first to explore the MoCA in cancer patients and is aimed at determining the feasibility of administering the MoCA in brain tumor patients. The secondary objective is to explore the relationship between MoCA and MMSE scores. Forty patients with brain metastases being treated with whole brain radiotherapy were prospectively accrued from January to May 2007. All patients were administered both the MoCA and MMSE. The MoCA was completed in 10 min in 88% of patients. 92% of all the patients found the MoCA to be only mildly or not at all inconvenient. Eighty percent of the patients were deemed cognitively impaired by the MoCA compared with 30% by the MMSE (p < 0.0001). Of the 28 patients with a normal MMSE, 71% had cognitive impairment according to the MoCA. Overall, 50% of the patients had an abnormal MoCA, yet normal MMSE. The MoCA was well tolerated and provided additional information over the MMSE, justifying further validation studies of the MoCA in brain tumor patients.

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. 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. 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. 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. 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.

Mild Cognitive Impairment: A Tricky but Relevant Diagnosis

SS3.03: Cognitive screening for dementia: crossing four essential borders

BackgroundGiven the high prevalence of cognitive impairment in Parkinson’s disease (PD), cognitive screening is important in clinical practice. The Montreal Cognitive Assessment (MoCA) is a frequently used screening test in PD to detect mild cognitive impairment (PD-MCI) and Parkinson’s disease dementia (PD-D). However, the proportion in which the subtests are represented in the MoCA total score does not seem reasonable. We present the development and preliminary evaluation of an empirically based alternative scoring system of the MoCA which aims at increasing the overall diagnostic accuracy.MethodsIn study 1, the MoCA was administered to 40 patients with PD without cognitive impairment (PD-N), PD-MCI, or PD-D, as defined by a comprehensive neuropsychological test battery. The new MoCA scoring algorithm was developed by defining Areas under the Curve (AUC) for MoCA subtests in a Receiver Operating Characteristic (ROC) and by weighting the subtests according to their sensitivities and specificities. In study 2, an independent sample of 24 PD patients (PD-N, PD-MCI, or PD-D) was tested with the MoCA. In both studies, diagnostic accuracy of the original and the new scoring procedure was calculated.ResultsDiagnostic accuracy increased with the new MoCA scoring algorithm. In study 1, the sensitivity to detect cognitive impairment increased from 62.5% to 92%, while specificity decreased only slightly from 77.7% to 73%; in study 2, sensitivity increased from 68.8% to 81.3%, while specificity stayed stable at 75%.ConclusionThis pilot study demonstrates that the sensitivity of the MoCA can be enhanced substantially by an empirically based weighting procedure and that the proposed scoring algorithm may serve the MoCA’s actual purpose as a screening tool in the detection of cognitive dysfunction in PD patients better than the original scoring of the MoCA. Further research with larger sample sizes is necessary to establish efficacy of the alternate scoring system.

e13000 Background: Brief cognitive screening measures are often selected by clinicians and researchers for brain tumor patients, primarily because of their ease of use. Currently, the Mini Mental State Examination (MMSE) is the most commonly chosen, despite a reported low sensitivity. The primary objective of this study was to compare the sensitivity of the MMSE with the Montreal Cognitive Assessment (MoCA). Methods: 44 patients with brain tumors were prospectively accrued and administered the MMSE and MoCA by blinded investigators, 75% of who completed a 4-hour “gold standard” neuropsychological assessment (NPA). Quality of life and community integration were measured with the Functional Assessment of Cancer Therapy-Brain (FACT-Br) and Community Integration Questionnaire (CIQ), respectively. McNemar's test was used to compare sensitivity and specificity at pre-defined cutoff scores and receiver operating characteristic curve analyses were used to examine outcomes across all cutoffs. Correlations were assessed with Spearman's rank correlation coefficient. Results: 55% of patients met criteria for the DSM-IV diagnosis of Cognitive Disorder NOS on the NPA. Using pre-defined cutoffs, the MoCA was significantly more sensitive than the MMSE (55.5% versus 16.6%; p = 0.016), although specificity of the MoCA was poor (60.0%). MMSE scores below 27 were 100% specific; however, this applied to only three subjects. Furthermore, 39% of cognitively impaired subjects scored perfectly on MMSE. A MoCA cutoff of 22 had 28% sensitivity and 93% specificity, and a cutoff of 28 had 94% sensitivity and 20% specificity. The MoCA was correlated with both the FACT-Br (r = 0.319, p = 0.04) and CIQ (r = 0.427, p = 0.005), while MMSE scores did not correlate with either (p &gt; 0.2). Conclusions: The MoCA is more sensitive than the MMSE, though at no cutoff is it both sensitive and specific. Despite its limitations, the MoCA may offer cost saving in the oncology clinic as a cognitive screen: individuals with MoCA scores a) below 22 are likely cognitively impaired, b) above 27 are likely cognitively normal, and c) 22–27 would likely benefit most from NPA. Furthermore, the MoCA is better able to detect cognitive impairment that is related to functional limitations and quality of life. [Table: see text]

The Montreal Cognitive Assessment (MoCA) is a cognitive screening tool used by practitioners worldwide. The efficacy of the MoCA for screening frontotemporal dementia (FTD) and related disorders is unknown. The objectives were: (1) to determine whether the MoCA detects cognitive impairment (CI) in FTD subjects; (2) to determine whether Alzheimer disease (AD) and FTD subtypes and related disorders can be parsed using the MoCA; and (3) describe longitudinal MoCA performance by subtype. We extracted demographic and testing data from a database of patients referred to a cognitive neurology clinic who met criteria for probable AD or FTD (N=192). Logistic regression was used to determine whether dementia subtypes were associated with overall scores, subscores, or combinations of subscores on the MoCA. Initial MoCA results demonstrated CI in the majority of FTD subjects (87%). FTD subjects (N=94) performed better than AD subjects (N=98) on the MoCA (mean scores: 18.1 vs. 16.3; P=0.02). Subscores parsed many, but not all subtypes. FTD subjects had a larger decline on the MoCA within 13 to 36 months than AD subjects (P=0.02). The results indicate that the MoCA is a useful tool to identify and track progression of CI in FTD. Further, the data informs future research on scoring models for the MoCA to enhance cognitive screening and detection of FTD patients.

BackgroundImplementation of a standardized cognitive assessment strategy after aneurysmal subarachnoid hemorrhage (aSAH) has not been reported in the literature, despite frequency of post-aSAH cognitive impairment and recommendations to perform cognitive...

Objective: Hypertension is a risk factor for cognitive impairment. According to the 2018 ESH/ESC guidelines for hypertension management, cognitive screening tests should be included in the assessment of older hypertensive adults. Numerous screening tests are available, but their diagnostic accuracy in hypertensive people has been scarcely investigated. The present study aimed at analyzing and comparing the diagnostic accuracy of the MiniCog, the Montreal Cognitive Assessment (MoCA), the Mini Mental State Examination (MMSE) and the Clock Drawing Test (CDT) in older hypertensive patients. Design and method: The study was carried out in the Referral Centre for Hypertension in Elderly of Careggi Hospital, Florence, Italy, between February 2017 and May 2019. Subjects aged 65 or older without a prior diagnosis of cognitive impairment were enrolled. Participants underwent a cognitive screening using the MMSE, the MoCa, the Mini-Cog and the CDT, followed by a complete neuropsychological evaluation. Depressive symptoms and functional status were assessed with the Geriatric Depression Scale and the Basic and Instrumental Activities of Daily Life, respectively. Sensitivity and specificity were assessed for each tests and their combinations, using the ROC curves for the MMSE and the MoCA. Results: Among 94 participants undergoing a complete cognitive evaluation, 35 (37.2%) had mild cognitive impairment or dementia. Seven patients (7.44%) had a multi-domain cognitive impairment. According to the ROC curves, the best detection of cognitive impairment could be achieved with a cut-off score of 24 for the MoCA (AUC 0.746) and 27.5 for the MMSE (AUC 0.689). The MoCA had the highest diagnostic accuracy, providing a sensitivity of 80% and a specificity of 59%. A cognitive screening including both the Mini-Cog and the MMSE provided a higher sensitivity (74%) and specificity (51%) than the MMSE alone (sensitivity and specificity of 69% and 52%, respectively). Conclusions: In conclusion, we observed a high prevalence of cognitive impairment (37.2%) among older hypertensive outpatients with no prior diagnosis of dementia. The MoCA with a cut-off of 24 seems to have a good diagnostic accuracy in this population and could be included in the assessment of hypertension-related organ damage, to screen for cognitive impairment.

SAT0386 What is the Best Screening Test to Identify Lupus Patients with Cognitive Impairment in an Ambulatory Setting?

Brief cognitive screening instruments are used to identify patients presenting with cognitive symptoms that warrant further assessment. This study aimed to evaluate the reliability and validity of the Persian version of the Quick Mild Cognitive Impairment (Qmci-Pr) among middle-aged and older Iranian adults. Consecutive patients aged ≥55 years and caregivers attending with them as normal controls (NCs) were recruited from geriatric outpatient clinics and a hospital in Tehran, Iran. All patients completed the Qmci-Pr before completing an independent detailed neuropsychological assessment and staging using the Clinical Dementia Rating (CDR) Scale. NCs underwent the same assessment. In all, 92 participants with a median age of 70 years (±13) were available. Of these, 20 participants were NCs, 24 had subjective memory complaints (SMC), 24 had mild cognitive impairment (MCI), and 24 had Alzheimer’s disease (AD). The Qmci-Pr had good accuracy in differentiating SMC and NC from MCI (area under the curve (AUC): 0.80 (0.69–0.91)) and in identifying cognitive impairment (MCI and mild AD) (AUC: 0.87 (0.80–0.95)) with a sensitivity of 88% and specificity of 80%, at an optimal cut-off of <53/100. The Qmci-Pr is an accurate short cognitive screening impairment for separating NC and patients with SMC from MCI and identifying cognitive impairment. Further research with larger samples and comparison with other widely used instruments such as the Montreal Cognitive Assessment is needed. Given its established brevity, the Qmci-Pr is a useful screen for Iranian adults across the spectrum of cognitive decline.

Impact of Neurocognitive Dysfunction in a Veteran Population Undergoing First Outpatient Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma