Development and validation of an eye-tracking-based cognitive impairment screening system for older adults in China: a cross-sectional study.

BackgroundThe Montreal Cognitive Assessment (MoCA) was developed to enable earlier detection of mild cognitive impairment (MCI) relative to familiar multi-domain tests like the Mini-Mental State Exam (MMSE). Clinicians need to better understand the relationship between MoCA and MMSE scores.MethodsFor this cross-sectional study, we analyzed 219 healthy control (HC), 299 MCI, and 100 Alzheimer’s disease (AD) dementia cases from the Alzheimer’s Disease Neuroimaging Initiative (ADNI)-GO/2 database to evaluate MMSE and MoCA score distributions and select MoCA values to capture early and late MCI cases. Stepwise variable selection in logistic regression evaluated relative value of four test domains for separating MCI from HC. Functional Activities Questionnaire (FAQ) was evaluated as a strategy to separate dementia from MCI. Equi-percentile equating produced a translation grid for MoCA against MMSE scores. Receiver Operating Characteristic (ROC) analyses evaluated lower cutoff scores for capturing the most MCI cases.ResultsMost dementia cases scored abnormally, while MCI and HC score distributions overlapped on each test. Most MCI cases scored ≥17 on MoCA (96.3 %) and ≥24 on MMSE (98.3 %). The ceiling effect (28–30 points) for MCI and HC was less using MoCA (18.1 %) versus MMSE (71.4 %). MoCA and MMSE scores correlated most for dementia (r = 0.86; versus MCI r = 0.60; HC r = 0.43). Equi-percentile equating showed a MoCA score of 18 was equivalent to MMSE of 24. ROC analysis found MoCA ≥ 17 as the cutoff between MCI and dementia that emphasized high sensitivity (92.3 %) to capture MCI cases. The core and orientation domains in both tests best distinguished HC from MCI groups, whereas comprehension/executive function and attention/calculation were not helpful. Mean FAQ scores were significantly higher and a greater proportion had abnormal FAQ scores in dementia than MCI and HC.ConclusionsMoCA and MMSE were more similar for dementia cases, but MoCA distributes MCI cases across a broader score range with less ceiling effect. A cutoff of ≥17 on the MoCA may help capture early and late MCI cases; depending on the level of sensitivity desired, ≥18 or 19 could be used. Functional assessment can help exclude dementia cases. MoCA scores are translatable to the MMSE to facilitate comparison.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0103-3) contains supplementary material, which is available to authorized users.

Background and Purpose: Physical therapists use balance tests to assess postural control and fall risk, and cognitive tests to screen for cognitive impairment. Evidence shows that declines in balance accompany cognitive decline; it may be possible to detect both balance and cognitive impairment using only balance tests. This study has 2 aims: (1) to investigate the relationship between balance tests and the Mini-Mental State Examination (MMSE); (2) to determine whether balance test scores can accurately discriminate between older adults with and without mild cognitive impairment (MCI). Methods: Independently ambulatory older adults who walked without an assistive device (N = 128; 57 females and 71 males; mean age: 76.69 [6.26] years) residing in nursing homes were included in this cross-sectional study. The 4-Square Step Test (FSST), Timed Up-and-Go Test (TUG), Single Leg Stance Test (SLS), and Functional Reach Test were used to assess balance. The MMSE was used to evaluate cognitive function. This study employed a machine learning (ML) approach, which is a type of artificial intelligence that enables computers to learn from data and make predictions without being explicitly programmed. The ML approach was used to discriminate cognitive decline as defined by MMSE, utilizing demographics, clinical features, and balance test scores to classify older adults into normal cognition versus a combined group of participants with mild and severe cognitive impairment. Results and Discussion: A negative correlation between FSST and MMSE scores was found (r: –0.43; P < .001). The cutoff score of FSST between older adults with normal cognition (MMSE ≥24; n = 92) and older adults with mild or severe cognitive impairment (MMSE <24; n = 36) was defined as 14.56 seconds. Using this cutoff score, the FSST demonstrated an area under the curve of 0.71 (95% CI: 0.61-0.82, P: 196 < .001) resulting in a sensitivity of 0.77 and a specificity of 0.56, with a positive likelihood ratio of 1.75, and negative likelihood ratio of 0.41. This study yielded promising results, with 1 ML model achieving an accuracy of 92% in MMSE-based cognitive impairment classification. Older adults with MCI required more time to complete the FSST compared to those with normal cognitive function. Artificial neural architectures based on MMSE data outperformed other ML algorithms in using FSST scores to classify cognitive impairment. Conclusion: Cognitive impairments in older adults can be predicted using the FSST. Additionally, it has been shown that various ML models have the potential to effectively analyze these outcomes.

Studies have shown that both inter-arm blood pressure difference (IABPD) and cognitive impairment are associated with vascular events. However, the relationship between IABPD and cognitive impairment among elderly individuals in rural China remains unclear. This study aims to investigate the association between IABPD and cognitive impairment in rural older adults in Guizhou, southwestern China. The study data were obtained from the Cohort Study of the Health Status of Guizhou Rural Older Adults in China (SHGROC). A multi-stage cluster sampling method was employed to select 1,088 rural elderly individuals aged ≥ 60 years from Guizhou Province for questionnaire surveys, physical examinations, and biological sample collection. Cognitive function of participants was assessed using the Mini-Mental State Examination (MMSE). Bilateral blood pressure was measured simultaneously using an automated device, and the IABPD was calculated. Multivariable linear and logistic regression models were used to examine the relationship between IABPD and cognitive impairment. The overall prevalence of cognitive impairment in the study sample was 27.85%, and it was more common among participants with an IABPD ≥ 10 mmHg (P < 0.05). Multivariable regression analysis revealed that an inter-arm systolic blood pressure difference (IASBPD) ≥ 10 mmHg was independently associated with lower MMSE scores (β = -1.113; 95% CI: -2.120, -0.106; P = 0.030) and a higher risk of cognitive impairment (OR = 1.902; 95% CI: 1.189, 3.040; P = 0.007). Additionally, a dose-response relationship was observed between IASBPD and the risk of cognitive impairment, with a linear positive correlation. Further subgroup analysis indicated that the relationship between IASBPD and cognitive impairment was modified by sex, smoking, and regular exercise (P for interaction < 0.05). IASBPD ≥ 10 mmHg is associated with an increased risk of cognitive impairment in rural Chinese older adults. This suggested that IASBPD may provide a reference for early identification of individuals at risk of cognitive impairment.

Hypertension is a major risk factor for dementia. Yet, the most suitable cognitive screening test for hypertensive patients has yet to be identified. This study investigated cognitive impairment in hypertensive older adults and compared the discriminative ability of the most widely used cognitive screening tests. The study involved hypertensive patients aged 65+ without prior diagnosis of cognitive impairment, from the Hypertension Clinic of Careggi Hospital, Florence, Italy. Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), MiniCog and Clock Drawing Test (CDT) were administered, using a comprehensive neuropsychological assessment as gold standard. The ROC curve analysis and the paired chi-square test were used to compare the discriminative ability, sensitivity and specificity for cognitive impairment of the different screening instruments. Cognitive impairment was diagnosed in 37% of 94 participants (mean age 76, 55% female), mainly involving attention and executive functions. The MoCA (AUC = 0.746), the MMSE (AUC = 0.689) and the MiniCog (AUC = 0.684) showed similar ability in detecting cognitive impairment, while the CDT had a poorer discriminative capacity (AUC = 0.535). The sensitivity of MoCA (80%) and of MMSE/MiniCog combination (74%) was higher in comparison with MiniCog alone (49%, p = 0.007 and 0.004, respectively), while MiniCog achieved the highest specificity (88%, p < 0.001 vs all). Cognitive impairment was detected in more than one-third of hypertensive older adults without prior diagnosis of dementia. MoCA, MMSE and MiniCog showed similar discriminative ability for cognitive impairment, with MoCa and MMSE showing greater sensitivity and MiniCog the highest specificity.

Background and objectiveThere has been a growing interest in using computerized cognitive assessment to detect age-related cognitive disorders. We have developed a tablet-based cancellation test (e-CT), previously shown as a reliable measure of executive functions and free of effect of familiarity with computer-based devices in healthy older adults. This study aimed to investigate the influence of demographics and current daily use of computer-based devices in older adults with Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD). We further studied the ability of the e-CT to discriminate MCI and AD patients from older adults with normal cognition (NC).MethodsThe e-CT was administered to 325 older adults (NC = 112, MCI = 129, AD = 84). Subjects also performed the K-T test, a paper-and-pencil cancellation test from which the e-CT was developed. Multiple linear regression analyses were conducted to assess the contribution of demographics and current daily use of computer-based devices on the e-CT in patient groups. The Receiver Operating Characteristic (ROC) curves and the Area Under the Curve (AUC) were established to compare the efficacy of the e-CT and the K-T test to classify subjects into diagnostic groups.ResultsIn the MCI group, age (B = -0.37, p<0.001) and current daily use of computer-based devices (B = 5.85, p<0.001) were associated with the number of correct cancellations of the e-CT. In the AD group, only current daily use of a computer-based device was a significant contributor (B = 6.28, p<0.001). The e-CT (AUC = 0.811; 95% confidence interval [CI]: 0.756–0.867) and the K-T (AUC = 0.837; CI: 0.787–0.887) showed good and comparable diagnostic accuracy to discriminate between MCI and NC subjects. To discriminate between NC and AD, both tests showed high diagnostic accuracy, with the AUC values of 0.923 (CI: 0.876–0.971) and 0.929 (95%CI: 0.886–0.972) for the e-CT and the K-T, respectively.ConclusionThe e-CT presents satisfying discriminative validity and is a promising tool for detection of early cognitive impairment in older adults.

Emerging evidence suggests that impairments in language processing serve as early indicators of mild cognitive impairment (MCI) in older adults. This study examines the diagnostic utility of two easily administered language comprehension and retention tests in differentiating healthy older adults from those clinically diagnosed with MCI. A total of 32 individuals diagnosed with MCI and 43 cognitively healthy elderly participated in five assessments: story-retelling, nonsense phrase repetition, the Montreal Cognitive Assessment (MoCA), Instrumental Activities of Daily Living (IADLs), and the Geriatric Depression Scale (GDS). The first two assessments were designed to evaluate linguistic performance, whereas the remaining three were employed to assess overall cognitive function. Each test was administered individually, with sufficient time allocated for completion. Statistical analyses revealed significant differences between the two groups, as indicated by the odds ratio, underscoring the ability of these assessments to distinguish individuals with MCI from healthy controls. Among the cognitive tests, the story-retelling task demonstrated the highest area under the ROC curve (AUC), affirming its strong diagnostic accuracy. With an optimal immediate story-retelling cut-off score of 12.5, the test yielded high sensitivity (92%) and specificity (76.7%), reinforcing its reliability in detecting MCI. These findings highlight the effectiveness of narrative recall tasks in identifying early cognitive decline and their potential clinical application in screening protocols. Linguistic changes precede cognitive deterioration, making language-based assessments vital for early MCI detection. This study confirms that story-retelling tasks effectively differentiate individuals with MCI from healthy controls by evaluating verbal memory, organisational coherence, and recall. Given the subtle nature of these linguistic shifts, standardised language tests with normative benchmarks should be incorporated into screening protocols. Speech-language pathologists play a crucial role in detecting early cognitive decline, highlighting the importance of language-based assessments in MCI diagnosis.

Association of the combination of social isolation and living alone with cognitive impairment in community-dwelling older adults: The IRIDE Cohort Study

Background Cognitive impairment and dementia are estimated to affect 1 in 5 adults over 80 years (TILDA 2023) which impacts on participation in complex activities eg. Drving, managing finances, complex decision making. The importance of addressing these issues is to the fore with the enactment of the Assisted Decision Making Act. This review aims to provide local context to design and implementation of assessment and intervention processes for Subjective Cognitive Impairment (SCI), Mild Cognitive Impairment (MCI) and dementia in older adults attending the Integrated Day Hospital (IDH). Methods A retrospective analysis of health care records was undertaken on patients attending the IDH from January to May 2023. Inclusion criteria were adults over 70 years, recent history of falls or deterioration in functional or cognitive status. Evidence regarding SCI was gathered via patients’ response to specific question on comprehensive geriatric assessment. Evidence of MCI and dementia was gathered via cognitive screening scores. Results Preliminary results indicate a cohort of 150 patients. Preliminary analysis of cognitive screening scores reflect prevalence of MCI at 16% and dementia at 36% of older adults attending the IDH. Family-carer reported impairment is more likely to correlate to an impaired range score on testing, in comparison with self-reported impairment. 50% of older adults report SCI, with 70% of family carers reporting SCI in the same cohort. There is a prevalence of cognitive impairment in older adults presenting for falls and frailty. Final findings will be available for the purpose of this poster presentation. Conclusion Cognitive impairment in older adults is evidenced across a range of presentations including falls and frailty. This review highlights the need to explore the holistic needs of older adults to identify presence of SCI, MCI and dementia. Subsequently there is a need to provide person centred, co-ordinated and integrated interventions tailored to the needs of the older adults.

ObjectiveSocial support shows a protective effect against cognitive impairment in older adults. However, the longitudinal relationship between the distinct sources of social support and the incidence of cognitive impairment remains unclear. This study aims to investigate the association between different sources of social support and the incidence of cognitive impairment among older adults in China.MethodWe used longitudinal data (2005–2014) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS, 2005–2014, mean follow-up years 5.32 ± 2.64). In total, 5897 participants (aged 81.7 ± 9.7 years, range 65–112 years, 49.0% male) were enrolled. Cognitive impairment was measured by the Mini-Mental State Examination (MMSE). Social support included support from family and friends (marital status; contacts with family and friends; children's visits; siblings' visits, sick care; money received from and money given to children) and the availability of support from social community (social service and social security). We calculated subdistribution hazard ratios (SHR) of cognitive impairment by establishing Cox regression models, adjusting for residence, gender, age, education, participation in physical exercise, activities of daily living, smoking, drinking, negative psychological well-being, baseline cognitive function, occupation, leisure activities, and diseases.ResultsDuring a 9-year follow-up, 1047 participants developed cognitive impairment. Participants who were married had a 16.0% lower risk of developing cognitive impairment compared to the widowed older adults after controlling for all covariates, but the protective effect of being married was no longer significant (p = 0.067) when additional adjustment was made for all types of social support. Children's visits were significantly associated with the risk of cognitive impairment after controlling for all types of social support and covariate variables (SHR = 0.808, 95% confidence interval, 0.669–0.975, p = 0.026).ConclusionChildren's visits were consistently associated with a lower incidence of cognitive impairment in Chinese older adults.

A network analysis of depressive symptoms and cognitive performance in older adults with multimorbidity: A nationwide population-based study.

Objective To compare the accuracy,sensitivity,specificity of the Mini-Mental State Examination (MMSE) and Montreal cognitive assessment (MoCA) in screening of mild cognitive impairment(MCI) and dementia in community survey. Methods This study was conducted among residents aged 65 years and above in the urban and rural areas selected by stratified sampling from 6 urban and 2 rural communities.The 2 111 cases who finished the Neuropsychological tests included MMSE,MoCA,and Clinical Dementia Rating scale(CDR) were divided into groups normal control,MCI,and dementia.The accuracy,sensitivity and specificity was compared by the area under the curve (AUC) of receiver-operating characteristic curve.The clinical diagnoses of MCI was made according to Petersen′s criteria. Results The areas under curve were between 0.72 to 0.99 for MMSE and MoCA on discriminated MCI or dementia (Z=2.75，P 0.05). In MCI survey,the cutoff values and sensitivity/specificity of MMSE vs.MoCA in education levels of illiterate,primary,secondary and above were 21(84%/64%) vs.15(88%/54%),26(91%/70%) vs.20(94%/68%),27(93%/86%) vs.23(93%/80%) respectively;but in dementia survey,the cutoff values and sensitivity/specificity of MMSE vs. MoCA in education levels of illiterate,primary,secondary and above were 16(98%/85%) vs.11(98%/70%),20(100%/94%) vs.14(100%/87%),22(100%/98%) vs.16(100%/95%) respectively. Conclusions MMSE and MoCA are good cognitive assessment tools in the survey of MCI or dementia with high accuracy,sensitivity and specificity.But the cutoff value is different according to one′s education level.MoCA may be more suitable for MCI survey but MMSE for dementia. Key words: Cognition disorders; Dementia; Mini-Mental State Examination; Montreal cognitive assessment

Previous studies have found substantial heterogeneity in the effects of physical activity (PA) of different intensities on cognitive function. This study aimed to explore the association between PA levels and cognitive impairment and clarify the dose-response relationship among older adults in China. This was a cross-sectional study, using data from the 2018 China Health and Retirement Longitudinal Study (CHARLS). We explored the association between PA levels and cognitive impairment using logistic regression, subgroup analysis, and restrictive cubic spline (RCS) analysis. Among the 3354 older participants, those who performed moderate intensity PA (MPA) showed a significant association with decreased odds ratio (OR) of cognitive impairment after adjusting for all confounding factors (OR = 0.58, 95% CI: 0.43 ~ 0.80). Subgroup analysis demonstrated consistent effects across all subgroups (P > 0.05). The results of the RCS analysis revealed a non-linear "J"-shaped dose-response relationship between PA levels and cognitive impairment (P nonlinear < 0.05), with the lowest OR at around 1600 MET-min/wk. MPA has greater benefits for cognitive function compared to light intensity PA, whereas vigorous intensity PA does not appear to offer additional protective benefits. PA is a dose-dependent factor associated with cognitive impairment in Chinese older adults, and approximately 1,600 MET-min/wk represents the optimal PA level for minimizing the risk of cognitive impairment. These findings can help offer more scientific PA recommendations to reduce or delay the development of cognitive impairment in older adults.

Introduction: The Montreal Cognitive Assessment (MoCA) is a cognitive screening test widely used in clinical practice and suited for the detection of Mild Cognitive Impairment (MCI). The aims were to evaluate the psychometric properties of the Persian MoCA as a screening test for mild cognitive dysfunction in Iranian older adults and to assess its accuracy as a screening test for MCI and mild Alzheimer disease (AD). Method: One hundred twenty elderly with a mean age of 73.52 ± 7.46 years participated in this study. Twenty-one subjects had mild AD (MMSE score ≤21), 40 had MCI, and 59 were cognitively healthy controls. All the participants were administered the Mini-Mental State Examination (MMSE) to evaluate their general cognitive status. Also, a battery of comprehensive neuropsychological assessments was administered. Results: The mean score on the Persian version of the MoCA and the MMSE were 19.32 and 25.62 for MCI and 13.71 and 22.14 for AD patients, respectively. Using an optimal cutoff score of 22 the MoCA test detected 86% of MCI subjects, whereas the MMSE with a cutoff score of 26 detected 72% of MCI subjects. In AD patients with a cutoff score of 20, the MoCA had a sensitivity of 94% whereas the MMSE detected 61%. The specificity of the MoCA was 70% and 90% for MCI and AD, respectively. Discussion: The results of this study show that the Persian version of the MoCA is a reliable screening tool for detection of MCI and early stage AD. The MoCA is more sensitive than the MMSE in screening for cognitive impairment, proving it to be superior to MMSE in detecting MCI and mild AD.

Early detection of cognitive impairment is essential for timely intervention. Currently, most widely used cognitive screening tests are influenced by language and cultural differences; therefore, there is a need for the development of a language-neutral, visual-based cognitive assessment tool. The Visual Cognitive Assessment Test (VCAT), a 30-point test that assesses memory, executive function, visuospatial function, attention, and language, has demonstrated its utility in a multilingual population. In this study, we evaluated the reliability, validity, and diagnostic performance of the VCAT for screening early cognitive impairment in Chongqing, China METHODS: A total of 134 individuals (49 healthy controls (HCs), 52 with mild cognitive impairment (MCI), and 33 with mild dementia) completed the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), VCAT, and domain-specific neuropsychological assessments. The diagnostic performances of MMSE, MoCA, and VCAT were evaluated using the area under the curve (AUC), sensitivity, and specificity. Construct validity of the VCAT was assessed with well-established domain-specific cognitive assessments. Reliability was measured using Cronbach's alpha. The VCAT and its subdomains demonstrated both good construct validity and internal consistency (α=0.577). The performance of VCAT was comparable to that of MoCA and MMSE in differentiating mild dementia from nondemented groups (AUC: 0.940vs. 0.902 and 0.977, respectively; p=.098 and .053) and in distinguishing cognitive impairment (CI) from HC (AUC: 0.929vs. 0.899 and 0.891, respectively; p=.239 and .161), adjusted for education level. The optimal score range for VCAT in determining dementia, MCI, and HC was 0-14, 15-19, and 20-30, respectively. The VCAT proves to be a reliable screening test for early cognitive impairment within our cohort. Being both language and cultural neutral, the VCAT has the potential to be utilized among a wider population within China.

REVIEW QUESTION / OBJECTIVE The objective of this review is to identify the effectiveness of combined cognitive and physical interventions on the risk of falls in cognitively impaired older adults. INCLUSION CRITERIA Types of participants Older persons who are 65 years or older will be included. Studies where the majority of participants have been indicated through mean ages and standard deviations will also be eligible for inclusion. Participants who have been diagnosed or identified as having a cognitive impairment will be included in this review. The participants will be characterized as having a cognitive impairment through: 1. Diagnosis of a dementia or cognitive impairment or other condition which directly results in reduced cognition. 2. Reduced Mini Mental State Examination or other such global assessment of cognition, e.g. through the Montreal Cognitive Assessment. Participants will not be limited by dementia diagnosis (i.e. Alzheimer's disease, vascular, mild cognitive impairment), but their cognitive impairment must be acquired and progressive in nature. Studies with a population of older adults with an increased risk of falls will be considered but will only be included if more than 75% of the total sample has reduced cognition identified in the criteria above. Types of intervention(s)/phenomena of interest This review will consider publications that describe multifactorial or multiple interventions where a physical and cognitive element has been noted by the authors or reviewers. It is the aim of this review to capture studies which have a combined physical and cognitive element in the intervention; however studies which TRUNCATED AT 250 WORDS