Abnormal Montreal Cognitive Assessment Scores Research Articles

Montreal Cognitive Assessment (MoCA) XpressO: Validation of a digital self-administered cognitive prescreening tool.

The need for cognitive testing is increasing with the aging population and the advent of new Alzheimer disease therapies. To respond to the increased demand, the XpressO was developed as a self-administered digital cognitive prescreening tool that will help distinguish between populations of subjective and objective cognitive impairment according to the Montreal Cognitive Assessment (MoCA). This is a prospective validation study. XpressO is composed of tasks that assess memory and executive functions. It is validated compared to the digital MoCA as a gold standard. Out of 118 participants screened from the MoCA Clinic and a family practice clinic, 88 met inclusion criteria, two participants had missing data due to incomplete tasks, 86 participants were included in the analysis; the mean age was 70.34 years. A logistic regression model was built, and its accuracy was evaluated by the sensitivity, specificity, and Area Under the Curve (AUC) of the Receiver Operating Characteristic. Analysis showed strong correlation between (1) XpressO memory tasks scores and the MoCA Memory Index Score (p-values < 0.001), and between (2) XpressO sub-test scores and MoCA total score (p-values < 0.005). The AUC for predicting MoCA performance is 0.845. To classify individuals with normal and abnormal MoCA scores, two threshold values were introduced for the total XpressO scores: sensitivity of 91% at a cutoff of 72, specificity of 90% at a cutoff of 42, and an undetermined range in between. XpressO demonstrated high AUC, high sensitivity and specificity to predict cognitive performance compared to the digital MoCA. It may provide efficient cognitive prescreening by identifying individuals who would benefit from further clinical assessments, potentially reducing waiting times and high burden on healthcare clinics.

Predicting alcohol relapse post-detoxification: The role of cognitive impairments in alcohol use disorder patients.

Studies on early abstinence suggest that cognitive function is significantly reduced in the first year of abstinence, which raises the question of whether it is relevant to early relapse in patients with substance use disorders. This study investigates the extent to which impairments in executive function and memory predict alcohol relapse in patients with alcohol use disorder (AUD). Understanding these relationships is crucial for improving therapeutic approaches to prevent relapse in patients with AUD. We selected 116 adult patients (79 male and 37 female) diagnosed with AUD based on DSM-5 criteria, all of whom were undergoing alcohol detoxification treatment. A comprehensive array of neuropsychological tests was administered to assess global cognition, memory, and executive functions. Patients' alcohol use was monitored monthly during a 6-month follow-up period. Logistic regression and Cox regression were used to explore the relationship between cognitive function and the likelihood of alcohol relapse. Impairments in global cognition, semantic and phonemic fluency, cognitive flexibility, and learning ability during detoxification were significant predictors of relapse in AUD patients, showing similar predictive values at both 3 and 6 months post-treatment. An abnormal Montreal Cognitive Assessment (MoCA) score increased the risk of relapse by 123% (HR: 2.227), and impairments in both semantic and phonemic fluency each increased the risk by 142% (HR: 2.423). Additionally, abnormal performance on the MoCA, Trail Making Test Part B (TMT-B), and California Verbal Learning Test (CVLT) was associated with a higher number of drinking days at 3 months (IRR: 3.764; IRR: 2.237; IRR: 2.738, respectively) and abnormal MoCA and TMT-B scores at 6 months (IRR: 2.451; IRR: 1.859, respectively). The MoCA test is a valuable tool for predicting relapse risk in AUD patients undergoing detoxification treatment, with similar predictive value for relapse at 3 or 6 months. Learning ability needs to be assessed and their impairments considered in the treatment of AUD patients.Future research should explore strategies for managing patients with impairments in memory and learning ability to enhance treatment effectiveness and prevent relapse.

FRAILTY AND COGNITIVE IMPAIRMENT: RESULTS FROM A DIVERSE SAMPLE OF OLDER PERSONS RECEIVING HEMODIALYSIS

Abstract Persons who are receiving hemodialysis are at high risk for frailty and cognitive impairment. However, little is known about the overlap of these conditions in a diverse older hemodialysis population. Our goal is to examine frailty and cognition in a diverse sample of older adults receiving hemodialysis. Data was collected as part of a cross-sectional observational study examining mentation, mood, and mobility. Frailty was identified using the Study of Osteoporotic Fractures Index and cognition was assessed with the Montreal Cognitive Assessment (MoCA) (cut off score ≤ 26). Blind MoCAs were administered (cut off score ≤ 22) when appropriate. 35 participants (mean age = 73.9 ± 10.7) enrolled. 60% were males and 20% were Spanish-speaking. 20% identified as Asian, 23% as Black, and 23% as Hispanic/ Latino. Of note, four blind MoCAs in Spanish were administered. 83% had abnormal MoCA scores. 86% were frail or pre-frail. The majority of the sample (69%) had concurrent cognitive impairment and frailty or pre-frailty. In this diverse sample of older adults receiving hemodialysis, we found that both frailty and cognitive impairment are extremely common, with a large portion of the sample exhibiting both. This suggests that interventions targeting cognitive impairment or frailty should account for the frequent overlap of both conditions, particularly among historically underserved populations.

B - 26 Examining Montreal Cognitive Assessment (MoCA) Performance by Primary and Testing Language.

The MoCA has been translated into almost 100 languages including a Spanish version used in multiple validation studies. Research considering primary language and language of test administration is limited. We compared MoCA scores of primary Spanish speakers tested in English (S-E) with those of primary Spanish speakers tested in Spanish (S-S). This project involved secondary analysis of deidentified National Alzheimer's Coordinating Center data. Cases with first visit MoCA data, demographics, and primary language of Spanish were included resulting in a final sample (N = 395) of S-S (n = 265) and S-E (n = 130) participants. Coarsened exact matching was used to derive a sample subset matched on age, education, and Clinical Dementia Rating global score (n = 160). Participants were compared on demographics and MoCA. In the final sample, S-S and S-E participants were not different in age, but educational level was lower in S-S (M = 10.0; SD = 5.3) than S-E (M = 14.6; SD = 3.9; p < 0.001) participants. MoCA scores were lower in S-S (M = 19.1, SD = 6.2) than S-E participants (M = 21.2, SD = 6.1; p = 0.002). A larger proportion of the S-S group (79%) had an abnormal MoCA compared to the S-E group (67%; p = 0.021). In the matched sample, MoCA scores were not significantly different between S-S (M = 21.2; SD = 4.8) and S-E (M = 21.2; SD = 5.3; p = 0.95) participants; rates of abnormal MoCA scores were not significantly different between S-S (73%) and S-E (66%; p = 0.39) participants. Relationships between primary language, test administration language, and MoCA score were reduced in groups matched on education. Future research should explore additional education and language interactions among bilingual older adults.

An Exploratory Study to Investigate the Utility of Clinical Screening for Neurodegenerative Disease in Age-Related Eye Disease Research.

Unrecognized neurodegenerative diseases (NDD) in age-related eye disease research studies have the potential to confound vision-specific quality of life and retinal optical coherence tomography (OCT) outcome measures. The aim of this exploratory study was to investigate relationships between NDD screening tools and visual outcome measures in a small cohort of controls from the Colorado Age-Related Macular Degeneration Registry (CO-AMD), to consider the utility of future studies. Twenty-nine controls from the CO-AMD were screened using the Montreal Cognitive Assessment (MoCA), a Colorado Parkinsonian Checklist, and the Lewy Body Composite Risk Score. Univariate and multivariable linear regression modeling was used to assess associations between screening tools and the National Eye Institute Visual Function Questionnaire-25 (VFQ-25) and macular OCT outcome measures, and t tests were used to evaluate outcome measure differences between those with normal vs abnormal MoCA scores. One patient withdrew. The average age was 72.8 years, and 68% were female patients. Ten participants (36%) had abnormal MoCA scores, and their VFQ-25 scores were only 1 point less and not statistically different than those with normal MoCA scores. Macular OCT volumes and thicknesses for retinal nerve fiber layer (RNFL) and retinal ganglion cell layer were consistently and moderately lower for those with abnormal MoCA scores, and a positive association between MoCA and macular RNFL volume was observed, although differences and regression were not significant. Parkinson screening tests were abnormal for only 4 participants and were not associated with OCT or VFQ-25 measures by regression modeling. Given the degree and direction of observed differences, further investigation is warranted regarding the relationship between cognitive screening tools and macular OCT measures in age-related eye disease research, but future investigations regarding the relationship between NDD screening tools and VFQ-25 seem unwarranted.

Cross-sectional assessment of mild cognitive impairment in pre-dialysis chronic kidney disease and its association with inflammation and changes seen on MRI: what the eyes cannot see.

Introduction:Mild cognitive impairment (MCI) is a prevalent and underdiagnosed condition in chronic kidney disease (CKD), that shares common pathophysiological factors such as chronic inflammation.Objective:To evaluate the association of MCI in CKD stages 1-5 using inflammatory markers and changes by magnetic resonance imaging (MRI).Patients and Methods:Cross-sectional study in adult patients with pre-dialysis CKD. MCI was assessed by the Montreal Cognitive Assessment (MoCA) and the estimated glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration equation. Sociodemographic and clinical data were collected from medical records. The cytokines IL-4, IL-6, IL-17, TNF-α and hs-CRP were determined. Brain MRI was performed in a 1.5 Tesla device, without paramagnetic contrast. A descriptive analysis followed by a comparison of abnormal versus normal MoCA scores among all studied variables. A linear regression analysis was performed using MoCA as a dependent variable, adjusted for confounding factors.Results:Of 111 invited patients, eighty completed the neuropsychological assessment and 56 underwent MRI, and were included in the study. Mean age was 56.3 ± 8.3 years and 51.8% (n = 29) had altered MoCA. When compared to the group with normal MoCA, the group with altered MoCA had higher levels of IL-6 and IL-17. There was no correlation between altered MoCA with eGFR or with MRI abnormalities.Conclusão:MCI assessed by MoCA was prevalent in patients with pre-dialysis CKD, it was associated with inflammation and showed no correlation with MRI changes.

Cross-sectional and longitudinal characterisation of cognitive function and outcomes in patients presenting to hospital with cardiovascular risk factors

Abstract Background/Introduction Cardiovascular (CV) diseases including atrial fibrillation and arteriosclerosis are associated with impaired cognitive function. Cognitive dysfunction can impact the process of shared clinical decision making, reduce adherence to polypharmacy, and decrease quality of life. The prevalence of cognitive dysfunction in contemporary patients with CV diseases and its implication on future CV events is not well known. Purpose We 1) quantified cognitive function in patients presenting to hospital with CV diseases, 2) identified clinical variables and blood biomarkers associated with cognitive dysfunction, and 3) quantified the hazard of abnormal cognitive function for predicting MACCE (major adverse CV and cerebrovascular events). Methods and results Of 1625 consecutive patients presenting acutely to a large teaching hospital with CV diseases, 614 patients (median age [Q1, Q3] 68 [58, 76] years; 66% male) who completed the Montreal Cognitive Assessment (MoCA) were analysed. The median [Q1, Q3] MoCA score was 25 points [21, 27]. 360 patients (59%) had an abnormal score (&amp;lt;26). At baseline, patients with abnormal scores were more likely to be female (odds ratio, OR [95% confidence intervals], 1.874 [1.287, 2.728]), have BMI&amp;lt;30 (OR 0.584 [0.410, 0.831]), heart failure (OR 1.492 [1.043, 2.135]), diabetes (OR 2.212 [1.529, 3.199]), chronic kidney disease (CKD-EPI&amp;lt;60 ml/min, OR 1.553 [1.021, 2.361]), and have more CV co-morbidities (OR per additional co-morbidity 1.415 [1.246, 1.605]). Amongst 12 CV biomarkers tested, elevated Bone Morphogenetic Protein 10 (OR 1.325 [1.022, 1.719]) and Growth Differentiation Factor 15 (OR 1.419 [1.054, 1.912]) increased odds of abnormal scores. Cox proportional hazards model adjusted for competing risk of non-CV death assessed the relationship between abnormal cognitive function and MACCE (stroke, TIA, myocardial infarction, hospitalisation for heart failure, CV death). Follow-up time ranged from 2.7 to 6.1 years. Patients were censored at 2.5 years for this analysis. 130 out of 614 patients experienced a MACCE (21%) and 71 had a non-CV death (12%). Patients with abnormal MoCA scores were at higher risk for MACCE (subhazard ratio, sHR [95% CI] 1.827 [1.253, 2.664]). The hazard remained significant after adjustment for age, sex, obesity, atrial fibrillation, stroke, heart failure, hypertension, coronary artery disease, diabetes, peripheral artery disease and renal dysfunction (sHR 1.367 [1.056, 2.326]; Figure). All-cause mortality was 1.785 times higher for those with abnormal MoCA scores [1.061, 3.002]. Conclusion In this study, 3 out of 5 patients with CV diseases had abnormal MoCA scores at baseline. Abnormal cognitive scores significantly predicted patients who went on to experience a MACCE within 2.5 years of follow-up. These observations call for further research and action to provide additional diagnostics, support and early intervention to address cognitive dysfunction in CV patients. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EU H2020 CATCH ME Cumulative incidence function

Heart and brain interactions in heart failure: Cognition, depression, anxiety, and related outcomes.

Cognitive impairment, anxiety and depression are common in heart failure (HF) patients and its evolution is not fully understood. To assess the cognitive status of HF patients over time, its relation to anxiety and depression, and its prognostic impact. Prospective, longitudinal, single center study including patients enrolled in a structured program for follow-up after hospital admission for HF decompensation. Cognitive function, anxiety/depression state, HF-related quality of life (QoL) were assessed before discharge and during follow-up (between 6th and 12th month) using Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS) and Kansas City Cardiomyopathy Questionnaire, respectively. HF related outcomes were all cause readmissions, HF readmissions and the composite endpoint of all-cause readmissions or death. 43 patients included (67±11.3 years, 69% male); followed-up for 8.2±2.1 months. 25.6% had an abnormal MoCA score that remained stable during follow-up (22.6±4.2 vs. 22.2±5.5; p=NS). MoCA score <22 at discharge conferred a sixfold greater risk of HF readmission [HR=6.42 (1.26-32.61); p=0.025], also predicting all-cause readmissions [HR=4.00 (1.15-13.95); p=0.03] and death or all-cause readmissions [HR=4.63 (1.37-15.67); p=0.014]. Patients with higher MoCA score showed a greater ability to deal with their disease (p=0.038). At discharge, 14% and 18.6% had an abnormal HADS score for depression and anxiety, respectively, which remained stable during follow-up and was not related to MoCA. Cognitive function, anxiety and depressive status remain stable in HF patients despite optimized HF therapy. Cognitive status shall be routinely screened to adopt attitudes that improve management as it has an impact on HF-related QoL and prognosis.

Heart and brain interactions in heart failure: Cognition, depression, anxiety, and related outcomes

BackgroundCognitive impairment, anxiety and depression are common in heart failure (HF) patients and its evolution is not fully understood. ObjectivesTo assess the cognitive status of HF patients over time, its relation to anxiety and depression, and its prognostic impact. MethodsProspective, longitudinal, single center study including patients enrolled in a structured program for follow-up after hospital admission for HF decompensation. Cognitive function, anxiety/depression state, HF-related quality of life (QoL) were assessed before discharge and during follow-up (between 6th and 12th month) using Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS) and Kansas City Cardiomyopathy Questionnaire, respectively. HF related outcomes were all cause readmissions, HF readmissions and the composite endpoint of all-cause readmissions or death. Results43 patients included (67±11.3 years, 69% male); followed-up for 8.2±2.1 months. 25.6% had an abnormal MoCA score that remained stable during follow-up (22.6±4.2 vs. 22.2±5.5; p=NS). MoCA score <22 at discharge conferred a sixfold greater risk of HF readmission [HR=6.42 (1.26-32.61); p=0.025], also predicting all-cause readmissions [HR=4.00 (1.15-13.95); p=0.03] and death or all-cause readmissions [HR=4.63 (1.37-15.67); p=0.014]. Patients with higher MoCA score showed a greater ability to deal with their disease (p=0.038). At discharge, 14% and 18.6% had an abnormal HADS score for depression and anxiety, respectively, which remained stable during follow-up and was not related to MoCA. ConclusionsCognitive function, anxiety and depressive status remain stable in HF patients despite optimized HF therapy. Cognitive status shall be routinely screened to adopt attitudes that improve management as it has an impact on HF-related QoL and prognosis.

C-33 Abnormal MoCA Scores in a Clinic-Referred Sample

Abstract Objective To examine Montreal Cognitive Assessment (MoCA) performance and frequency of low scores among veterans with primary diagnoses of cognitive disorder, psychiatric disorder, or no disorder. Method A clinic-referred sample of veterans (n = 214; Mage = 66.1, SD = 15; Medu = 13.3, SD = 2.7) diagnosed with mild cognitive impairment (MCI; n = 97), dementia (n = 47), depression (n = 18), PTSD (n = 22), or no cognitive or psychiatric disorder (n = 30) were included. All participants were administered the MoCA as part of a larger battery of tests. Analysis of covariance (ANCOVA), controlling for age and education, was conducted (Bonferroni correction applied) to compare diagnostic groups on MoCA uncorrected total score. Results Across groups, mean MoCA scores were significantly different using ANCOVA, F(4, 207) = 31.5, p &lt; .001. As expected, those with no diagnosis (M = 24.7, SD = 2.1) or psychiatric disorders (PTSD M = 24.4, SD = 4.1; Depression M = 23.9, SD = 3) scored higher than those with cognitive disorder (MCI M = 21.7, SD = 3.1; Dementia M = 17.4, SD = 4.1), p &lt; .001. While both psychiatric groups scored higher than those with dementia (p &lt; .001), the depression group did not significantly differ from those with MCI (p = .11). Examination of scores across all groups revealed a majority of participants scored below the recommended cutoff of &lt; 26. Specifically, 100% of dementia cases, 89.7% of MCI cases, 63.3% of no diagnosis cases, 50% of PTSD cases, and 72.2% of depression cases scored &lt; 26. Conclusion Abnormal MoCA scores are common, even in the absence of cognitive impairment. Individuals with PTSD or depression are likely to score below the publisher's recommend cutoff. While this may reflect cognitive symptoms of psychiatric conditions, it may also reflect normative limitations as identified in past studies.

Prognostic factors among older adults with advanced non-small cell lung cancer (NSCLC): A multisite cohort study.

11540 Background: Prognosis in NSCLC is vital for clinical decision making. With the aging US population and rapidly changing treatment landscape, we aimed to identify prognostic factors among older adults with advanced NSCLC receiving chemo-, immuno-, and/or targeted therapy. Methods: We conducted a prospective cohort study of adults age ≥65 with advanced NSCLC starting a new non-curative systemic treatment (chemo-, immuno-, and/or targeted therapy) at a Comprehensive Cancer Center, Veterans Affairs Medical Center, and safety-net hospital. Prior to treatment initiation, patients completed a geriatric assessment including cognition, function, comorbidities, mood, social support, and quality of life. Cox proportional hazards models were performed to identify prognostic factors for overall survival (OS). Results: In a sample of 51 patients, median age was 73 (range 65-94). The majority of patients had stage IVB (59%) or IVA (39%) NSCLC. Current treatment included immunotherapy (37%), targeted therapy (29%), chemoimmunotherapy (18%), and chemo (16%). Most patients had received prior NSCLC treatment (80%): chemo (51%), targeted therapy (35%), immunotherapy (22%), radiation (RT; 47%), and/or surgery (19%). At enrollment, 73% had an abnormal Montreal Cognitive Assessment score &lt; 26 (MoCA; median score 23) and 35% had an abnormal Timed Up and Go time ≥13.5 secs (TUG; median time 12.7 secs). Median OS was 12.5 months. In univariable analyses, stage IVB disease (HR 6.99, 95% CI 1.55-31.5), prior RT (HR 2.98, 95% CI 1.08-8.21), worse MoCA score (HR 1.15 per 1 point change, 95% CI 1.03-1.28), and longer TUG time (HR 1.13 per 1 sec change, 95% CI 1.05-1.23) were associated with worse OS. Of note, age, current NSCLC treatment, line of therapy, and Karnofsky Performance Status were not associated with OS. In multivariable analysis, MoCA score was the only statistically significant prognostic factor (HR 1.15, 95% CI 1.01-1.30). Conclusions: We found that abnormal pretreatment cognition is very common and an important prognostic factor among older adults with advanced NSCLC. Pretreatment screening for cognitive impairment should be considered to inform prognostication, decision making, and treatment planning.

Functional deficits and other psychiatric associations with abnormal scores on the Montreal Cognitive Assessment (MoCA) in older HIV-infected patients.

The authors assessed the association of physical function, social variables, functional status, and psychiatric co-morbidity with cognitive function among older HIV-infected adults. From 2012-2014, a cross-sectional study was conducted among HIV-infected patients ages 50 or older who underwent comprehensive clinical geriatric assessment. Two San Francisco HIV clinics. 359 HIV-infected patients age 50 years or older. Unadjusted and adjusted Poisson regression measured prevalence ratios and 95% confidence intervals for demographic, functional and psychiatric variables and their association with cognitive impairment using a Montreal Cognitive Assessment (MoCA) score < 26 as reflective of cognitive impairment. Thirty-four percent of participants had a MoCA score of < 26. In unadjusted analyses, the following variables were significantly associated with an abnormal MoCA score: born female, not identifying as homosexual, non-white race, high school or less educational attainment, annual income < $10,000, tobacco use, slower gait speed, reported problems with balance, and poor social support. In subsequent adjusted analysis, the following variables were significantly associated with an abnormal MoCA score: not identifying as homosexual, non-white race, longer 4-meter walk time, and poor social support. Psychiatric symptoms of depressive, anxiety, and post-traumatic stress disorders did not correlate with abnormal MoCA scores. Cognitive impairment remains common in older HIV-infected patients. Counter to expectations, co-morbid psychiatric symptoms were not associated with cognitive impairment, suggesting that cognitive impairment in this sample may be due to neurocognitive disorders, not due to other psychiatric illness. The other conditions associated with cognitive impairment in this sample may warrant separate clinical and social interventions to optimize patient outcomes.

The utility of the Montreal Cognitive Assessment in predicting need for fitness to drive evaluations in older adults

ObjectivesWith age, older adults (≥65 years) become increasingly vulnerable to cognitive disorders that may impair driving ability. Health practitioners are often tasked with screening older drivers and may recommend fitness to drive (FTD) evaluations for those potentially needing driving rehabilitation or cessation. Here, we examine whether the Montreal Cognitive Assessment (MoCA), which mainly tests cognitive ability, may identify older adults who might benefit from FTD testing. Methods/design264 older drivers (≥65 years), recruited from three primary care clinics, completed the MoCA and FTD evaluation. We compared literature-based MoCA cut-points (≥26 and < 26, respectively) and sensitivity analysis-determined MoCA cut-points to participant demographic and health characteristics as related to their ability to predict FTD score. ResultsMedian age was 73, 89% were White, and 54% were male. Most (83%) had abnormal (fail or conditional pass) FTD test outcomes. Overall, 57% had abnormal literature-based MoCA scores. For participants with abnormal MoCA scores (<26), increasing 4-m Gait Speed test scores (OR = 11.81) and age (OR = 1.05) increased odds of abnormal FTD test scores. For those with normal MoCA scores (26–30), self-reported excellent health status versus fair health decreased likelihood of abnormal FTD test scores (OR = 0.33) while being female increased likelihood (OR = 2.93). Sensitivity analysis determined a separate abnormal MoCA score cutoff (<28); 81% had abnormal MoCA scores and were more likely to have abnormal FTD scores with increasing age (OR = 1.07). Those with normal MoCA scores (28–30) experienced increased likelihood of abnormal FTD scores when female (OR = 4.97) and decreased likelihood when they were able to follow road signs (OR = 0.12). DiscussionMoCA may be valuable when identifying those who might benefit from FTD evaluations among those with both normal and abnormal cognitive function, especially when accounting for factors like gait speed, age, and gender. Future research should further explore these factors' roles in predicting abnormal FTD test outcomes.

Effect of small-vessel disease on cognitive trajectory after atrial fibrillation-related ischaemic stroke or \xa0TIA

Post-stroke dementia is common but has heterogenous mechanisms that are not fully understood, particularly in patients with atrial fibrillation (AF)-related ischaemic stroke or TIA. We investigated the relationship between MRI small-vessel disease markers (including a composite cerebral amyloid angiopathy, CAA, score) and cognitive trajectory over 12 months. We included patients from the CROMIS-2 AF study without pre-existing cognitive impairment and with Montreal Cognitive Assessment (MoCA) data. Cognitive impairment was defined as MoCA < 26. We defined “reverters” as patients with an “acute” MoCA (immediately after the index event) score < 26, who then improved by ≥ 2 points at 12 months. In our cohort (n = 114), 12-month MoCA improved overall relative to acute performance (mean difference 1.69 points, 95% CI 1.03–2.36, p < 0.00001). 12-month cognitive impairment was associated with increasing CAA score (per-point increase, adjusted OR 4.09, 95% CI 1.36–12.33, p = 0.012). Of those with abnormal acute MoCA score (n = 66), 59.1% (n = 39) were “reverters”. Non-reversion was associated with centrum semi-ovale perivascular spaces (per-grade increase, unadjusted OR 1.83, 95% CI 1.06–3.15, p = 0.03), cerebral microbleeds (unadjusted OR 10.86, 95% CI 1.22–96.34, p = 0.03), and (negatively) with multiple ischaemic lesions at baseline (unadjusted OR 0.11, 95% CI 0.02–0.90, p = 0.04), as well as composite small-vessel disease (per-point increase, unadjusted OR 2.91, 95% CI 1.23–6.88, p = 0.015) and CAA (per-point increase, unadjusted OR 6.71, 95% CI 2.10–21.50, p = 0.001) scores. In AF-related acute ischaemic stroke or TIA, cerebral small-vessel disease is associated both with cognitive performance at 12 months and failure to improve over this period.

High rates of undiagnosed vascular cognitive impairment among American Indian veterans.

As data on prevalence and etiology of dementia in American Indians are limited, we sought to determine rates and patterns of memory loss among American Indian veterans with vascular risk factors. Sixty consecutive outpatient American Indian veterans with a mean age of 64years (range 50-86), without prior dementia or mild cognitive impairment (MCI), and with ≥ 2 vascular risk factors were enrolled. The Montreal Cognitive Assessment (MoCA) and the Beck Depression Inventory-II were used to screen for cognitive impairment and depression. Patients with MoCA scores < 26 were referred for additional evaluation, including imaging, serology, and neuropsychological testing. Overall rates, types, and distribution of cognitive impairment were determined. Most prevalent vascular risk factors included hypertension (92%), hyperlipidemia (88%), diabetes (47%), and smoking (78%). Eight patients (13%) with severe depression were excluded, leaving 23/52 with abnormal MoCA scores (44%, 95%CI 30%-59%). Fifteen completed additional evaluation for memory loss, including four with normal MoCA scores who requested evaluation based on symptoms. Results were adjudicated as normal (4), non-amnestic MCI (4), vascular MCI (5), and vascular dementia (2). These results show that rates of undiagnosed cognitive impairment among American Indian veterans with vascular risk factors exceed rates previously published in non-American Indian cohorts. The most common etiology is vascular. Our findings support the need to improve vascular risk reduction in this understudied population.

Abstract P341: Poor Sleep Patterns Are Associated With Decreased Performance on the Montreal Cognitive Assessment in Both Younger and Older Women

Introduction: Poor cardiovascular health has been linked to an increased likelihood of cognitive impairment in older adults. Cognitive impairment has also been identified as an emerging co-morbidity of obstructive sleep apnea, a highly prevalent sleep disorder, particularly in patients with neurological conditions. Whether other aspects of sleep, including sleep duration, sleep quality, sleep onset latency, and insomnia are associated with cognition is not established. Objective: The aim of this study was to evaluate whether specific sleep patterns were associated with cognitive function in a diverse population of both younger and older, neurologically healthy women, and to determine whether this association is mediated by cardiovascular disease (CVD) risk factors. Methods: This was a baseline analysis of 392 women (59% racial/ethnic minority, mean age=39±16.53y, range 20-76y) participating in the ongoing American Heart Association Go Red for Women Strategically Focused Research Network population-based study at Columbia University Medical Center (CUMC). Cognitive function was assessed by the validated Montreal Cognitive Assessment (MoCA) screening instrument. Sleep duration, sleep quality, and time to sleep onset were assessed using the Pittsburgh Sleep Quality Index; insomnia was assessed using the Insomnia Severity Index. Blood lipids and glucose were measured in the biomarker core laboratory at CUMC. Multivariable linear regression models were used to evaluate associations between sleep, CVD risk factors, and MoCA scores, adjusted for age, race/ethnicity, education, health insurance, and tested for interactions between age and sleep. Results: The prevalence of abnormal MoCA (score &lt;26) was 38%; mean scores were lower in adults ≥55y vs. &lt;55y (p&lt;0.0001), and racial/ethnic minorities vs. whites (p&lt;0.0001). Average nightly sleep duration was 6.75±1.29 h, and 50% of women had poor sleep quality. In multivariable models testing for interactions, lower MoCA scores were associated with shorter sleep duration (p=0.007), worse quality sleep (p=0.0005), and higher insomnia level (p=0.04). In stratified analyses, associations between MoCA scores and sleep duration, sleep quality, and insomnia persisted among both younger (&lt;55y) and older (≥55y) groups. Lower MoCA scores were also associated with higher triglycerides (p=0.0001) and lower HDL-cholesterol (p=0.0006); formal tests of mediation suggested that the relation between cognition and insomnia was mediated by triglyceride level. Conclusions: Poor sleep patterns were highly prevalent and associated with lower cognitive function, even in younger women in this diverse population. Sleep patterns should be further investigated as a potential mechanism to identify individuals at risk of cognitive decline. Whether the relation is causal or mediated through traditional CVD risk factors deserves further study.

Abstract TP436: Native American Veterans With Vascular Risk Factors Have High Rates of Vascular Cognitive Impairment

Background: Rates of cardiovascular disease and stroke are elevated in Native Americans, and a greater propensity to develop vascular cognitive impairment (VCI) rather than Alzheimer-type dementia has been inferred, supporting a need for further research in VCI in this population. We determined rates and patterns of memory loss among Native American veterans with multiple vascular risk factors. Methods: Native American veterans ≥50 years old with ≥2 vascular risk factors, including smoking history, hyperlipidemia, diabetes, coronary artery disease, or peripheral arterial disease, were recruited between September 2015 and May 2016. The Montreal Cognitive Assessment (MoCA) and the Beck Depression Inventory-II were used to screen for cognitive impairment and depression. Patients with MoCA scores &lt;26 were referred for imaging studies, memory loss serology, neuropsychiatric testing and clinical assessment by a memory loss physician. Final cognitive status was assigned by blinded adjudication. Results: We recruited 60 Native Americans aged 50-86 (mean±SD: 64±7.1 years); 90% were male, 95% had at least high-school education, and 69% had some college or advanced degrees. Risk factors included hypertension (92%), hyperlipidemia (88%), diabetes (47%), and prior/current smoking (78%). Eight (13%) with severe depression were excluded, leaving 23/51 with abnormal MoCA scores (44%, 95%CI 30%-59%). All with cognitive impairment were male compared to 83% among non-impaired subjects (p=0.059). Fifteen completed additional evaluation for memory loss, including 4/15 with normal MoCA scores who requested evaluation based on symptoms. Results were adjudicated as normal (4), or as having non-amnestic MCI (4), vascular MCI (5), and vascular dementia (2). MoCA correctly identified cognitive status in 86% (Kappa 0.66, 95%CI 0.23-1.00). Conclusions: Native American veterans have high rates of vascular cognitive impairment, which exceed rates of cognitive impairment documented in previously published older non-Native American cohorts. These results highlight the need for improved vascular risk reduction among Native American veterans. Further study is needed to identify ways to improve care in this underserved and understudied population.

Differences in cognitive profiles between traumatic brain injury and stroke: A comparison of the Montreal Cognitive Assessment and Mini-Mental State Examination

PurposeTo investigate the profiles of cognitive impairment through Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) in patients with chronic traumatic brain injury (TBI) or stroke and to evaluate the sensitivity of the two scales in patients with TBI. MethodsIn this cohort study, a total of 230 patients were evaluated, including TBI group (n = 103) and stroke group (n = 127). The cognitive functions of two groups were evaluated by designated specialists using MoCA (Beijing version) and MMSE (Chinese version). ResultsCompared with the patients with stroke, the patients with TBI received significantly lower score in orientation subtest and recall subtest in both tests. MoCA abnormal rates in the TBI group and stroke group were 94.17% and 86.61% respectively, while MMSE abnormal rates were 69.90% and 57.48%, respectively. In the TBI group, 87.10% patients with normal MMSE score had abnormal MoCA score and in the stroke group, about 70.37% patients with normal MMSE score had abnormal MoCA score. The diagnostic consistency of two scales in the TBI group and the stroke group were 72% and 69%, respectively. ConclusionIn our rehabilitation center, patients with TBI may have more extensive and severe cognitive impairments than patients with stroke, prominently in orientation and recall domain. In screening post-TBI cognitive impairment, MoCA tends to be more sensitive than MMSE.

Abstract 223: Elevated Mip-1b, Peripheral Arterial Disease, and Antiplatelet Medication Use Predict Cognitive Function Among Asymptomatic Patients Referred for Carotid Doppler Evaluation

Background: Vascular cognitive impairment (VCI) includes the entire spectrum of cognitive disorders associated with cerebrovascular disease, ranging from mild cognitive impairment to vascular dementia. Our incomplete understanding of vascular and inflammatory mechanisms involved limits the ability to prevent cognitive impairment. We explored whether inflammation may be associated with cognitive function among subjects at risk for cerebrovascular disease. Methods: Sixty consecutive patients without dementia or stroke referred for carotid Doppler evaluation were screened for cognitive impairment using the Montreal Cognitive Assessment (MoCA). Serum was obtained for measurement of inflammatory markers using the Bio-Plex Pro Human Cytokine 27-plex Assay kit (Bio-Rad Laboratories). Hs-CRP was also measured. Inflammatory markers were analyzed according to quartiles of marker concentration for association with MoCA score. Backward stepwise regression was conducted to find the best combination of predictors. Markers having bivariate correlations at the 0.25 significance level were included as potential predictors. Relevant demographic and comorbid factors were also considered. Variables with p values &lt;0.05 were retained in the final model. Results: Fifty-eight percent of patients (35/60) had cognitive impairment (MoCA&lt;26, range 19-25). Stepwise multiple regression analysis revealed inverse correlations between three variables and MoCA scores: Macrophage Inflammatory Protein-1b - MIP-1b (b= -0.99, SE = 0.30, p=0.0016), use of antiplatelet medications (b= -1.96, SE = 0.93, p=0.039), and peripheral arterial disease - PAD (b= -1.53, SE = 0.73, p=0.041), overall model R2 = 0.26, F = 6.5, p=0.0007. Conclusions: Elevated MIP-1b, presence of PAD, and use of antiplatelet medications were associated with lower cognitive performance among patients at risk for cerebrovascular disease. The range of abnormal MoCA scores (19-25) and high prevalence of vascular risk factors among this group suggest that the cognitively impaired subjects have early VCI. These data suggest that MIP-1b should be further explored as a potential link to mechanisms for development of VCI.

The Montreal Cognitive Assessment: A Pilot Study of a Brief Screening Tool for Mild and Moderate Cognitive Impairment in HIV-Positive Veterans.

HIV-associated neurocognitive disorders (HANDs) are common, often go undetected, and can impact treatment outcomes. There is limited evidence on how to perform routine cognitive screening in HIV clinical settings. To address this, 44 HIV-positive males were recruited from a Veteran Affairs Infectious Disease clinic and completed the Montreal Cognitive Assessment (MoCA), International HIV Dementia Scale (IHDS), and Depression Anxiety and Stress Scale-21. In all, 50% scored below the MoCA cutoff and 36% scored below the IHDS cutoff. Current CD4 was the strongest predictor of an abnormal MoCA score (P = .007, 95% confidence interval [CI]: 0.987-0.998) and elevated depression was the second strongest predictor (P = .008, CI: 1.043-1.326). Combination antiviral therapy use and age were not significant predictors in this model. The MoCA appeared to be a reasonable screening tool to detect cognitive impairment in HIV-positive patients, and although it is not sufficient to diagnose HAND, it has the potential to provide meaningful clinical data.