Assessment Of Cognitive Status Research Articles

Exploring the cognitive assessment potential of MRI-based volumetric hippocampal segmentation in Parkinson's disease.

To investigate the potential of magnetic resonance imaging (MRI)-based total and segmental hippocampus volume analysis in the assessment of cognitive status in Parkinson's disease (PD). We divided participants into three groups Group A-Parkinson patients (Pp) with normal cognitive status (n=25), Group B-Pp with dementia (n=17), and Group C-healthy controls (n=37). Three-dimensional T1W Fast Spoiled Gradient Recalled Echo images were used for Volbrain hippocampus subfield segmentation. We used the "Winterburn" protocol, which divides the hippocampus into five segments, Cornu Ammonis (CA),CA2/CA3, CA4/dentate gyrus, stratum radiatum, lacunosum, and moleculare, and subiculum. A total of 79 participants were included in the study, consisting of 42 individuals with PD (64.2% male) and 37 healthy controls (54.1% male). The mean age of PD was 60.9±10.7 years and the mean age of control group was 59.27±12.3 years. Significant differences were found in total hippocampal volumes between Group A and B (p=.047. Statistically significant group differences were found in total, right, and left CA1 volumes (analysis of variance [ANOVA]: F(2,76)=8.098, p=.001; F(2,76)=7.628, p=.001; F(2,76)=5.084, p=.008, respectively), as well as in total subiculum volumes (ANOVA: F(2,76)=4.368, p=.016). Post hoc tests showed that total subiculum volume was significantly lower in individuals with normal cognitive status (0.474±0.116cm3) compared to healthy controls (0.578±0.151cm3, p=.013). Volumetric hippocampal MRI can be used to assess the cognitive status of Pp. Longitudinal studies that evaluate Pp who progress from normal cognition to dementia are required to establish a causal relationship.

Harnessing the Power of Voice: A Deep Neural Network Model for Alzheimer's Disease Detection.

Voice, reflecting cerebral functions, holds potential for analyzing and understanding brain function, especially in the context of cognitive impairment (CI) and Alzheimer's disease (AD). This study used voice data to distinguish between normal cognition and CI or Alzheimer's disease dementia (ADD). This study enrolled 3 groups of subjects: 1) 52 subjects with subjective cognitive decline; 2) 110 subjects with mild CI; and 3) 59 subjects with ADD. Voice features were extracted using Mel-frequency cepstral coefficients and Chroma. A deep neural network (DNN) model showed promising performance, with an accuracy of roughly 81% in 10 trials in predicting ADD, which increased to an average value of about 82.0%±1.6% when evaluated against unseen test dataset. Although results did not demonstrate the level of accuracy necessary for a definitive clinical tool, they provided a compelling proof-of-concept for the potential use of voice data in cognitive status assessment. DNN algorithms using voice offer a promising approach to early detection of AD. They could improve the accuracy and accessibility of diagnosis, ultimately leading to better outcomes for patients.

COGNITIVE IMPAIRMENT, FALLS, AND DEMENTIA: NOVEL APPROACHES FOR EARLIER DETECTION AND MORE EFFECTIVE INTERVENTION

Abstract This symposium will discuss novel digital approaches for the remote assessment of cognitive status and detection of fall risk in older adults. We will then describe several emerging digital exercise, ballroom dancing, and other non-invasive intervention strategies targeted for vulnerable older populations at increased risk for falling, or developing cognitive impairment and dementia. Collectively, we posit that these innovative detection and intervention strategies hold significant potential as more effective and scalable approaches for identifying cognitive impairment, preventing falls, and mitigating cognitive decline in high-risk older adults. In presentation 1, Roque et al. examines the utility of ecological momentary cognitive assessment and its potential as a digital biomarker of cognitive impairment in community-dwelling older adults. In presentation 2, Mahoney et al. discusses the development and clinical potential of a novel digital health app, CatchU®, that remotely captures visual-somatosensory integration performance to detect fall propensity in older adults. In presentation 3, Bajdek et al. describes the feasibility of a 12-week digitally delivered home-based fall prevention exercise program for older adults with elevated fall risk. In presentation 4, Blumen et al. report preliminary efficacy and mechanistic findings from a randomized trial of social ballroom dancing in older adults at increased risk for dementia. In presentation 5, Reid et al. describes the feasibility of a real-world community-level physical activity intervention for older adults with motoric cognitive risk syndrome. The discussant, Dr. Verghese, will integrate the key findings from these studies, discuss their theoretical and methodological contributions, and consider future research directions.

THE RELATIONSHIP BETWEEN HURRICANE STRESSORS AND COGNITION IN PUERTO RICAN OLDER ADULTS

Abstract Acute and chronic stress exposure negatively impact cognition in older adults. There is little research on this relationship within the context of an acute disaster. This presentation explores the relationship between perceived stress, hurricane stressors, subjective cognition, and cognition in Puerto Rican older adults post-Hurricane Maria. 613 Puerto Rican older adults completed Wave 3 measures for the longitudinal PREHCO study. Perceived stress was measured via a 4-item version of the Perceived Stress Scale. Hurricane stressors were classified as three factors: Home Damage, Family/Friends Network, and Work/Health. Subjective cognition was measured by asking the participant to rate their memory based on a 5-point Likert scale. Cognition was measured via the Telephone Interview for Cognitive Status assessment and the Minimental Cabán. Analyses included two multiple linear regressions with cognitive status and cognitive functioning as the outcomes, respectively, while controlling for age, depressive symptoms, education, gender, and race. There was a significant relationship between higher concern for others post-hurricane and worse generalized cognitive functioning (p<0.05, t=-2.04). Higher levels of cognitive status were significantly associated with better perceptions of memory function (p= 0.015, t=-2.43). Yet higher levels of perceived stress were significantly associated with worse perceptions of memory function (p<0.001, t=7.037). Older adult Puerto Ricans presented with worse cognitive functioning when they were worried about their loved ones’ well-being. Even those who maintained an intact cognitive status believed their memory was worse when they were experiencing more stress. This highlights the importance of differentiating the impact of stress on cognitive ability from subjective cognition.

Trajectory of depressive symptoms prior to dementia diagnosis

AbstractBackgroundDepression has been repeatedly linked to increased risk for dementia. While there is some research to suggest that an individual’s trajectory of depression symptoms over time may inform dementia risk above and beyond depression symptoms at a single time point, this has yet to be demonstrated in a dataset specifically designed to capture longitudinal brain aging and dementia outcomes.MethodA cohort study of 4,171 community‐dwelling older adults (65+ years) who were enrolled in the Adult Changes in Thought (ACT) study. Participants were initially non‐demented at baseline, and underwent biannual assessment of cognitive status (Cognitive Abilities Screening Instrument, diagnostic consensus) and self‐reported depression symptoms (via 20‐item Centers for Epidemiological Studies‐Depression [CESD]) for up to 24 years. We used Item Response Theory (CESD‐IRT) scores to address limited sensitivity to lower depressive symptom level in the general population and nonlinear measurement properties of the CESD. Diagnosis of dementia was made at consensus meeting based on history and clinical examination.ResultSample characteristics are summarized in Table 1. Linear mixed effects modeling, adjusted for covariates (age, sex, education, race), revealed that there was greater increase of depressive symptoms prior to diagnosis of dementia compared to those who did not receive diagnosis of dementia at end of study (p<.0001). This finding was consistent when depression symptom trajectories were estimated using CESD‐20 raw vs. CES‐IRT scores (Fig. 1 & 2, respectively). The difference in depression symptom trajectories by dementia outcome did not differ as a function of sex. Significant differences (p<0.001) in mean depression symptom total scores were observed by dementia outcome as early as 10 years prior to diagnosis/censoring for both the CESD‐20 raw score (1.0 ± 0.2) and the CESD‐IRT scores (0.16 ± 0.03).ConclusionThe pattern of increasing depression symptoms many years prior to dementia diagnosis reinforces the notion that the association between depressive symptoms and dementia in older adults may be primarily due to a shared common cause, or that depressive symptoms represent an early sign of dementia in the preclinical phase. Changes in specific depressive symptoms prior to dementia diagnosis will also be examined.

11 NASA-TLX Workload Profile of the Trail Making Test

Objective:Workload is a useful construct in human factors and neuroergonomics research that describes “the perceived relationship between the amount of mental [and physical] processing capability or resources and the amount required by the task”. We apply this concept to neuropsychology and assess several dimensions of workload as it relates to performance on the Trail Making Test.Participants and Methods:Twenty college students completed the Trail Making Test (TMT). After completion of each Part A and B, workload was assessed with the NASA-Task Load Index (NASA-TLX), a popular self-report measure of workload including subscales: Mental Demand, Physical Demand, Temporal Demand, Performance, Effort, and Frustration, with an overall average total score as well.Results:Completion time differed of course between Parts A and B (p < .001). Of more interest, overall workload differed between TMT A (M = 20.33, SD = 13.32) and TMT B (M = 35.79, SD = 17.37) (p < .001, h2 = .68). The greatest subscale differences were with Mental Demand (p < .001, h2 = .68) and Effort (p < .001, h2 = .59), but Physical Demand also showed a difference (p < .007, h2 = .33). Temporal Demand showed the smallest and nonsignificant difference (p = .081, h2 = .152).Conclusions:Based on previous research in our lab, most results were expected and understandable. As we know with the TMT, Part B is more cognitively demanding (in various ways) than Part A. The greater Physical Demand with Part B is a somewhat more complex finding, needing a solid explanation. Finally, the NASA-TLX appears to be a valid instrument of workload with a standard neuropsychologist test. We argue it can provide useful interesting information in the assessment of cognitive status in clinical populations.

Cognitive Concerns are a Risk Factor for Mortality in People with Human Immunodeficiency Virus and COVID-19 (S21.003)

<h3>Objective:</h3> To assess the contribution of cognitive symptoms to risk of mortality from COVID-19 in people with HIV (PWH). <h3>Background:</h3> Despite higher prevalence of cognitive disorders in PWH and dementia being a risk factor for COVID-19 mortality, the association between cognitive impairment and adverse outcomes in PWH with COVID-19 has not been well established. <h3>Design/Methods:</h3> Matched case-control study (1:10) of PWH and without (PWoH) with documented SARS-CoV-2 PCR positivity from March 2020-March 2021 evaluated at a Boston-based healthcare system. Data were extracted from the electronic health record. Matching was on age, sex, race, and zip code. Primary exposures were dementia (ICD-10 code) and cognitive concerns (concern for impairment within 12 months pre-COVID-19, ascertained using a semi-automated chart annotation tool). VACS2.0 Index (including general and HIV-specific biomarkers) was calculated. VACS2.0 Index-adjusted logistic regression models assessed effect of dementia and cognitive concerns on odds of death (OR[95% confidence interval]). <h3>Results:</h3> Among 14,129 patients with COVID-19, 64 PWH were identified and matched to 463 PWoH. Among PWH, 89% were on antiretroviral therapy, 87% had an HIV-1 viral load &lt;200 copies/mL, and 19% had CD4 &lt;200 cells/μL. VACS2.0 score predicted level of care and mortality in both PWH and PWoH. PWH had higher prevalence of dementia (16% vs. 6%, p=0.01) and cognitive concerns (22% vs. 16%, p=0.04). Death was more frequent in PWH (17% vs. 6%, p&lt;0.01), at younger ages (58 vs. 66 years, p=0.03). VACS2.0-adjusted regression models found cognitive concerns (2.4[1.1–5.3], p=0.03) and dementia (2.4[1.0–5.8], p=0.05) significantly associated with odds of death in the overall group. Among PWH only, aOR for cognitive concern approached significance (3.9[0.81–20.19], p=0.09), while dementia (1.75[0.29–8.71], p=0.50) did not. <h3>Conclusions:</h3> Dementia and cognitive concerns were associated with mortality among people with COVID-19, and the magnitude of the effect of cognitive impairment may be greater in PWH. Assessment of cognitive status is an important component to care for PWH in the COVID-19 era. <b>Disclosure:</b> Ms. Rudmann has nothing to disclose. Dr. Wilcox has nothing to disclose. Elissa Ye has received personal compensation for serving as an employee of Massachusetts General Hospital. Mr. Noori has nothing to disclose. Colin Magdamo has received research support from National Institutes of Health. Aayushee Jain has nothing to disclose. Dr. Alabsi has received personal compensation for serving as an employee of Biogen. Virginia Triant has nothing to disclose. The institution of Gregory Robbins has received research support from Gilead Sciences. The institution of Gregory Robbins has received research support from Citius Pharm. The institution of Gregory Robbins has received research support from Emergent Biosolutions. The institution of Gregory Robbins has received research support from Pfizer. The institution of Gregory Robbins has received research support from Leonard Meron Biosciences. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to AAN interests or activities. An immediate family member of Sudeshna Das has received personal compensation for serving as an employee of Alix Partners. An immediate family member of Sudeshna Das has received stock or an ownership interest from Alix Partners. The institution of Sudeshna Das has received research support from NIA. The institution of Sudeshna Das has received research support from Mass Life Sciences Center. The institution of Sudeshna Das has received research support from IOS Press. Dr. Mukerji has stock in Gilead Science. The institution of Dr. Mukerji has received research support from NIH. The institution of Dr. Mukerji has received research support from Massachusetts General Hospital.

Prediction of postoperative cognitive dysfunction in patients with coronary artery disease after on­pump coronary artery bypass grafting

Coronary artery disease is the most common cause of death world­wide. On­pump coronary artery bypass grafting and cardioplegia remains the gold standard for the treatment of multivessel coronary disease. However, this method of surgical treatment has a number of perioperative complications, the most common of which is post­operative cognitive dysfunction (POCD).Aim. To develop a mathematical model for predicting the binary outcome "presence/absence of POCD deterioration" using Mini­Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) for timely prevention of cognitive impairment in the early postoperative period.Material and methods. The study included 180 patients with coronary artery disease with stable angina who underwent on­pump coronary artery bypass grafting. The patients’ age [Me (Q25­-Q75)] was 62 [56­-67] years. After the operation, all patients were divided into 2 groups: 108 patients without POCD and 72 patients with cognitive deficit of various severity. The study was conducted in three stages: stage I — 2 days before surgery; stage II — during the operation; stage III — 7 days after the operation. Assessment of cognitive status using FAB, MMSE tests was carried out at stages I and III. At the second stage, biochemical parameters were assessed: in arterial blood — lactate and hemoglobin levels, in venous blood — pH, partial pressure of carbon dioxide (pCO2, mm Hg) and partial pressure of oxygen (pO2, mm Hg), as well as the duration of operation, cardiopulmonary bypass and myocardial anoxia. Discriminant analysis was used to develop a mathematical model for predicting a binary outcome.Results. Two groups of the most informative indicators were identified that were included in prediction algorithms for binary outcomes "presence/absence of negative dynamics of POCD" for MMSE and FAB. Group 1 included perioperative MMSE values, atrial fibrillation before surgery, cardiopulmonary bypass time and pO2. Group 2 included cardiopulmonary bypass time and intraoperative venous pH. Conclusion. Mathematical models have been developed for predicting the binary outcome "presence/absence of POCD deterioration" ac­cording to the MMSE and FAB cognitive tests, which make it possible to assess the possibility of postoperative cognitive dysfunction. The proposed algorithms are implemented using spreadsheets and a computer program.

Cognitive disorders in the elderly persons and their psychometric markers

IntroductionPopulation aging is accompanied by an increase in mental disorders of late age, cognitive impairment and dementia, which makes research on their diagnosis, prevention and therapy particularly relevant.ObjectivesIn order to improve the diagnosis of cognitive disorders in elderly patients, a comparative characteristic of the MMSE and MoCA psychometric scales is presented. Due to the lack of differentiation of results in the MoCA - test according to the severity of cognitive disorders, ranking was carried out to determine the scoring levels of cognitive decline.MethodsOn the clinical basis of the scientific department of gerontopsychiatry of the Moscow Research Institute of Psychiatry - branch of the V. Serbsky National Medical Research Center for Psychiatry and Narcology, 46 people over 60 years old were examined. The identified mental disorders were coded under the ICD-10 F00-F09 rubric “Organic, including symptomatic mental disorders”. Cognitive status assessment was carried out by psychometric scales MMSE and MoCA. Psychometric and statistical research methods were used. To compare MoCA and MMSE scores, an equal-percentage alignment method was usedResultsIn patients examined by MMSE and MoCA, different point values were determined in assessing cognitive functions. In most observations, the MoCA- test indicators were lower than the MMSE values. The following correspondences of the score values of the scales were revealed: MOCA 23-30 - MMSE 28-30 points; MOCA 22-18 - MMSE 27-25; MOCA 17-12 – MMSE 23-20; MOCA 12-0 – MMSE 19-0.ConclusionsSuch features of the MMSE scale as insufficient sensitivity in assessing memory impairment and differentiation of non-dementia levels of cognitive impairment, regulatory functions of programming and goal-setting, lexical fluency were revealed. The advantages of the MoCA - test were the ability to assess visual-constructive and executive skills, praxis, a more accurate assessment of memory impairments, mobility of mental processes and the ability to switch, logical thinking, the possibility of topical diagnosis of brain damage. The disadvantages of the MoCA - test were the duration of its implementation, the fatigue of patients, the lack of tasks for assessing written speech and motor praxis.The MoCA - test is a more sensitive method for detecting and differentiating cognitive impairment compared to the MMSE scale, which makes it possible to recommend it for widespread introduction into psychiatric practice. Relevant in further studies are the determination of indicators of moderate cognitive impairment as a threshold value between mild cognitive impairment (MCI) and incipient dementia, clarification of the point values of different levels of dementia.Disclosure of InterestNone Declared

Assessment of cognitive status in pediatric anti-NMDA receptor encephalitis during inpatient rehabilitation: A retrospective cohort

ObjectivesAnti-NMDA receptor autoimmune encephalitis (NMDARE) is a common pediatric encephalitis, resulting in neuropsychiatric symptoms. Predicting severity and course is challenging, with objective cognitive assessments lacking in NMDARE, especially in children. The CASE (Clinical Assessment Scale in Autoimmune Encephalitis) measures severity in autoimmune encephalitis. The CALS (Cognitive and Linguistic Scale) assesses cognitive-linguistic recovery in children with acquired brain injury. This study examines severity and cognitive status in pediatric NMDARE by comparing objectives measures: modified Rankin score (mRS), CASE, and CALS. MethodsTwenty-one patients were identified via retrospective chart review with a confirmed NMDARE diagnosis (ages of 3–18 years) who required inpatient rehabilitation. The mRS, CASE, and CALS were assessed at admission and discharge. ResultsScores demonstrated improvement from admission to discharge, with variability in individual recovery trajectories. CALS identified three clusters of patients with differential rates of early recovery. CALS <30 was associated with minimal improvement and poor outcomes. CALS ≥30 had a likelihood ratio score of 12.0 to predict improvement. CASE and CALS were moderately correlated, but neither correlated with mRS. DiscussionCALS and CASE appear to be complementary measures for assessing severity and cognitive status in pediatric NMDARE, including those with low responsiveness, with implications for treatment and outcomes.

Procjena kognitivnog statusa kod starijih osoba u zajednici

Objective. Aging is characterized by the loss of abilities in the psychological and physical sense. Detailed assessment of cognitive status may enable early identification of high-risk patients who are candidates for dementia. The aim of this research was to examine the cognitive status of elderly people over 65 years of age living in the community and potential risk factors that contribute to the onset of dementia. Methods. The research was designed according to the principle of a cross-sectional study. The research used a general questionnaire, subjective and objective assessment of respondents, Mini Kog assessment. The ch2 square test was used for statistical tests. The usual value of p&lt;0.05 was taken as the level of statistical significance. Results. Females (80.2%) had better cognitive status than males (84.6%) (ch2 =0.189; p=0.664). Respondents with the lowest level of education (primary school) had a worse cognitive status (23.5%) compared to 13.3% of respondents with an intermediate level of education (ch2 =9.139; p=0.010). 8.8% of respondents who socialize with friends had a good cognitive score compared to 0% of respondents with a good cognitive score who do not socialize with friends (ch2 =18.243; p=0.000), also, the cognitive status was worse in those respondents who used different aids (75%) versus 17% of those who do not use different aids for their functional mobility (ch2 =8.832; p=0.003). Conclusion. Dementia is present in a high percentage among elderly people. The level of education and the use of aids are potential risk factors for the onset of dementia.

2358. Dementia and Cognitive Concerns are Risk Factors for Mortality in People with Human Immunodeficiency Virus and COVID-19

Abstract Background Despite higher prevalence of cognitive disorders in people with human immunodeficiency virus (PWH) and dementia being a risk factor for COVID-19 mortality, the association between dementia and adverse outcomes in PWH with COVID-19 has not been well established. Methods This was a matched case-control study (1:10) of patients with and without HIV at an academic institution with documented SARS-CoV-2 polymerase chain reaction (PCR) positivity from March 2020-March 2021. Data were extracted from the electronic health record data registry. PWH were matched to people without HIV (PWoH) by age, sex, race, and zip code. The primary exposures were dementia (identified using International Classification of Diseases, Tenth Revision codes) and cognitive concerns, defined as documentation of possible cognitive impairment up to 12 months prior to COVID-19 diagnosis and ascertained using a semi-automated natural language processing annotation tool. VACS 2.0 Index (including age, sex, body mass index, CD4+ T-cell count and HIV-1 RNA) was calculated. Logistic regression models assessed the effect of dementia and cognitive concerns on the odds of death (OR [95% confidence interval]), adjusted for VACS 2.0 Index. Results Sixty-four (0.45%) PWH were identified among 14129 patients with COVID-19 and were matched to 463 PWoH. Among PWH, 59% were virally suppressed, and 14% had CD4&amp;lt; 200 cells/μL. Compared to 463 matched PWoH, PWH had higher prevalence of dementia (16% vs. 6%, p=0.01) and cognitive concerns (22% vs. 16%, p=0.04). Death was more frequent in PWH (17% vs. 6%, p&amp;lt; 0.01) and at younger ages (58 vs. 66 years, p=0.03). Cognitive concerns (2.5 [1.1–5.9], p=0.03) and dementia (3.4 [1.3–8.1], p=0.01) were significantly associated with increased adjusted odds of death in the overall group. Among PWH, cognitive concerns (7.2 [1.1–48], p=0.04) and dementia (6.0 [0.8–43.8], p=0.08) remained associated with mortality. Conclusion Dementia and cognitive concerns were associated with mortality among PWH with COVID-19. The magnitude of the effect of cognitive impairment on COVID-19 outcomes may be greater in HIV, and additional studies with larger cohorts will help to assess this association further. Assessment of cognitive status is an important component to care for aging PWH in the COVID-19 era. Disclosures All Authors: No reported disclosures.

Cognitive adverse effects of epilepsy and its predictors attending outpatient department of South Gondar zone hospitals, Amhara Region, Ethiopia 2020 /2021.

Epilepsy is the most common neurologic disorder which is further complicated by neurobehavioral co-morbidities, cognitive impairment, psychiatric disorders, and social problems. However, assessments of cognitive status of epileptic patients are far too low during clinical visits. This calls for early neuropsychological assessment soon after the diagnosis of epilepsy for a better treatment plan and outcome for epileptic patients. This study aimed to assess the cognitive adverse effects of epilepsy and its predictors attending outpatient departments of South Gondar Zone hospitals Amhara region Ethiopia 2020/2021. A multi-center institutional-based cross-sectional study was conducted. A total of 509 respondents were included with a response rate of 93.9%. Previously adapted pretested structured questionnaire was used containing, socio-demographic, clinical, and seizure related factors. Mini-Mental State Examination (MMSE) was used to measure cognitive impairment. A systematic random sampling technique was applied. Data were entered into Epi data version 4.4.2 then exported to SPSS version 24 for analysis. Descriptive statistics, bivariable and multivariable binary logistic regressions with odds ratios and 95% confidence interval were employed. The level of significance of association was determined at a p-value < 0.05. Prevalence of cognitive impairment in this study was 69.2% (95%CI; 65.4, 73.1). Rural residents (AOR = 4.16,95%CI, 1.99,8.67), respondents who couldn't read and write (AOR = 2.62, 95%CI; 1.24, 5.5,) longer duration of seizure disorder (AOR = 4.59,95%CI; 2.01,10.52), taking combined Phenobarbital and Phenytoin (AOR = 4.69,95%CI; 1.88,11.69), having history of head injury (AOR = 3.29,95%CI;1.30,8.32), having depression (AOR = 4.76,95%CI;2.83,7.98), and anxiety (AOR = 3.11,95%CI; 1.58,6.12) were significantly associated with cognitive impairment. Prevalence of cognitive impairment in this study was high. Regular neuropsychiatric assessment of patients with epilepsy should be encouraged especially for those participants with longer durations of illness, who are rural residents, who take combined Phenobarbital and Phenytoin, participants who had a history of head injury, depression, and anxiety.

Identifying delirium in advanced dementia in the ECT‐AD clinical trial

AbstractBackgroundDelirium and dementia are common causes of cognitive impairment in older adults and frequently co‐exist. Delirium is associated with poor clinical outcomes when comorbid with dementia. Identifying delirium superimposed on dementia (DSD) is clinically challenging given the overlap in symptoms, including inattention, cognitive impairment, and altered level of consciousness, especially in advanced stages of dementia. Recognition of delirium is also critical in ADRD (Alzheimer’s Disease and Related Dementias) clinical trials for both validity and safety reasons. The ECT‐AD study is one such trial investigating the safety and efficacy of electroconvulsive therapy (ECT) for treatment‐refractory agitation and aggression in individuals with advanced ADRD. Herein we review the Confusion Assessment Method (CAM) for identifying delirium in the ECT‐AD study.MethodInclusion criteria for ECT‐AD are hospitalized individuals diagnosed with ADRD (ages 55–89, MMSE ≤ 15) and refractory agitation/aggression, as measured by the Cohen‐Mansfield Agitation Inventory (CMAI). Procedures for detecting baseline and treatment‐emergent delirium involve a 3‐step approach conducted by raters trained in the CAM, which assesses inattention, disorganized thinking, altered levels of consciousness, and fluctuating mental status. Step 1 involves gathering information from nurse informants regarding the patient’s mental status over the past 24 hours. Step 2 involves collecting observational data through informal patient interaction (e.g., brief conversation). Step 3 is an objective assessment of cognitive status using the Severe Impairment Battery – 8 Item (SIB‐8), while also making qualitative observations about delirium features (e.g., level of consciousness). The rater then codes the CAM and determines delirium status based on these 3 steps.ResultOf our 6 consented subjects, 1 experienced delirium detected by the CAM during the Randomization Phase. The subject received three positive CAMs on consecutive treatment days, citing change in mental status, inability to arouse, restlessness, psychomotor agitation, and swearing. ECT/S‐ECT was held each treatment day and the subject was withdrawn from the Randomization Phase.ConclusionIdentifying DSD is challenging due to overlapping symptoms and the fluctuating nature of delirium. The CAM may be useful in this regard by using a multi‐step approach that incorporates observations from reliable informants, direct patient interactions, and structured cognitive assessments.

Cognitive Status is Better in Older Adults under Colchicine Treatment: A Case-Control Study

ABSTRACT Purpose We aimed to investigate the effects of colchicine, an important anti-inflammatory agent, on cognitive functions in a geriatric population diagnosed with gout or osteoarthritis by comparing it to non-colchicine users. Methods 138 geriatric patients (67 colchicine users and 71 non-users) were enrolled. Within comprehensive geriatric assessment (CGA), cognitive status assessment via Mini-Mental State Examination test (MMSE), Quick Mild Cognitive Impairment Screening test (Qmci), clock drowning test (CDT), and digit span tests were performed. Results Median age was 68 (65–72), and there were 82 female (59.4%) patients. The scores of CDT, Backward Digit Span Test, MMSE-Total, MMSE-Attention, MMSE-Motor Function, Qmci-Total Score, Qmci-Clock drawing, and Qmci-Logical Memory were significantly higher in the colchicine user group (p < .005), showing better cognitive function. Adjusted model analysis showed that colchicine usage is independently correlated with higher Qmci-Total Score and Qmci-Logical Memory Score (For Qmci total score β = 7.87 95%CI = 5.48–10.27, p = <0.0001, and for Qmci Logical memory score β = 3.52, 95%CI = 2.12–4.91, p = <0.0001). Conclusion To the best of our knowledge, this is the first study revealing that colchicine usage is associated with better cognitive performance in older adults. Further investigations with a prospective, larger-sampled and randomized design are needed to show the causal relationship between colchicine and cognition.

Dynamic electric neurostimulation in the cognitive rehabilitation of patients in the early recovery period of ischemic stroke

BACKGROUND: Post-stroke cognitive impairments negatively affect the results of rehabilitation, worsening the outcomes of motor functions recovery, daily activity, and also increase the likelihood of recurrent stroke and premature death. Therapeutic physical factors contribute to the activation of the body's reserve capabilities and aim at correcting metabolic and vascular disorders, improving the functional status of the nervous system, which allows them to be used in a complex of rehabilitation measures.&#x0D; AIM: to substantiate the use of dynamic electric neurostimulation in the correction of cognitive impairment in patients in the early recovery period of ischemic stroke.&#x0D; MATERIALS AND METHODS: A prospective cohort study of 60 patients in the early recovery period of ischemic stroke, with mild and moderate cognitive impairment, at an average age of 62.44.5 years, divided by random sampling into 3 groups: group 1 (n=25), in addition to the basic rehabilitation complex, which included medication, sessions with a neuropsychologist, massage and physical exercise therapy, received a 15-day course of dynamic electric neurostimulation from the "Neurodance-PCM" device; group 2 (n=20) received the basic rehabilitation complex and procedures from the placebo device similar to procedures on "Neurodance-PCM"; group 3 (n=15) received only the basic rehabilitation treatment. All patients underwent an assessment of cognitive status using the Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB) and the study of psychophysiological status on the psycho-physiological tester "NS-Psychotest", using the following tests: tapping test, the SchultePlatonov tables with red-black cells, test of simple visual-motor reaction, reaction to a moving object test.&#x0D; RESULTS: Over the two-week rehabilitation, it was found that the inclusion of dynamic electrical stimulation, in addition to the standard therapy of cognitive impairment in patients in the early recovery period of ischemic stroke, improves attention, memory, speech fluency, generalization functions, complicated choice reaction, increases the functions of visual attention and the speed of sensorimotor response, which was not noted in the comparison groups.&#x0D; CONCLUSIONS: The inclusion of dynamic electric neurostimulation in the rehabilitation complex of patients in the early recovery period of ischemic stroke with mild and moderate cognitive impairment may affect cognitive functions by stimulating the third block of the brain according to A.R. Luria and improving the neurodynamic support of higher mental functions.

211 ASSOCIATION OF PLASMA ANTIOXIDANTS AND COGNITIVE OUTCOMES IN NORTHERN IRISH MEN FROM PROSPECTIVE EPIDEMIOLOGICAL STUDY OF MYOCARDIAL INFARCTION (PRIME) STUDY

Abstract Background Oxidative stress and chronic inflammation have been demonstrated to contribute to cognitive decline in older age and the development of neurodegenerative disorders. Antioxidants have been revealed to help mitigate the effects of the damage caused by oxidative stress and inflammation, but their relationship with cognitive decline is not yet fully understood. The aim of this study was to investigate the association between various plasma antioxidant levels and cognitive status in participants from the Prospective Epidemiological Study of Myocardial Infarction (PRIME) study. Methods 10,600 men were recruited to the PRIME study between 1991-1993 and have been followed up across eleven time points. Baseline health and lifestyle characteristics were assessed, and plasma antioxidants were obtained and quantified. Baseline cognitive status was screened in 2000 using Mini-Mental State Examination (MMSE). Follow up assessment of cognitive status was performed in 2015 with MMSE and Addenbrooke’s Cognitive Examination-Revised (ACE-R) examinations. Results 2,009 men underwent cognitive assessment in 2000 and 873 men in 2015. At both 2000 and 2015 with the use of the MMSE and ACE-R examinations to assess cognitive status, serum concentration of all the antioxidants except for gamma-tocopherol and lycopene were higher in the men with better cognitive performance at a significant level of p&amp;lt;0.05. Better cognitive performance was associated with more time spent in education and higher level of education achieved at a statistically significant level (p&amp;lt;0.01). Furthermore, those with cognitive impairment were more likely to be older. After adjustments for lifestyle variables with a linear regression model, the only significant variable associated with cognition was time spent in education (B = 0.521, p= 0.02). Conclusion The findings suggest that the concentration of plasma antioxidants is associated with cognitive status. Smoking and education, as well as other lifestyle factors were, demonstrated to have an impact on cognitive status.

CARBAMAZEPINE-ASSOCIATED HYPERAMMONEMIC ENCEPHALOPATHY (HE)

CARBAMAZEPINE-ASSOCIATED HYPERAMMONEMIC ENCEPHALOPATHY (HE)

Association between Vitamin D and Cognitive Deficiency in Alcohol Dependence.

There are still not enough findings to elucidate how exactly alcohol use impairs cognitive abilities. Some studies have shown that there is a link between alcohol intake and vitamin D levels, but these findings are inconsistent so further research is needed. The aim of this study was to investigate the association between serum vitamin D levels and cognitive impairment in alcohol-dependent individuals. A case-control study was carried out including a total of N = 132 respondents with a medical history of alcoholism, and healthy volunteers. The Montreal Cognitive Assessment (MoCa) and Addenbrooke’s Cognitive Examination-Revised (ACE-R) screening tools were used for cognitive status assessment and serum vitamin D levels analysis (blood samples of respondents). Significant difference (p = 0.022), was found in vitamin D levels in the alcohol-dependent group with cognitive deficiency 13.7 ± 9.4 (ng/mL), alcohol-dependent group without cognitive deficiency 19.5 ± 11.2 (ng/mL) and healthy controls 19.9 ± 11.1 (ng/mL), respectively. Furthermore, vitamin D levels were significantly different across all groups based on MoCa (p = 0.016) and ACE-R (p = 0.004) scores. All three groups exhibited vitamin D deficiency. A significant correlation was found between vitamin D deficiency and cognitive impairment, but it yielded no significant difference in alcohol-dependent individuals.

A-123 Problem Solving and Mental Workload in Binge and Non-Binge Drinking College Students

Abstract Objective: Chronic sustained alcohol abuse is known to impact cognitive functioning. We examined potential differences in problem solving ability and mental workload in a more short-term population, binge-drinking college students. Method: Binge-drinking (BD) (n = 129) and non-binge-drinking (NBD) (n = 163) college students completed a computerized test of problem solving, a 3-disk and 4-disk version of the Tower of Hanoi (TOH). After each TOH session, they also completed an assessment of mental workload via the NASA-Task Load Index (NASA-TLX). Mental workload was defined as the Mental Demand subscale of the NASA-TLX. Results: No significant group difference was found in mean number of moves to complete the TOH in either the 3-disk version or 4-disk version. For mental workload, no difference was evident for the 3-disk TOH (BD M = 28.81, SD = 21.05 vs NBD M = 27.09, SD = 21.59, p = 0.497), but there was a difference for the 4-disk TOH condition (BD M = 47.22, SD = 21.86 vs NBD M = 41.84, SD = 22.94, p = 0.044). Conclusion(s): While no group differences in test performance were evident, there was a difference in mental workload on the more difficult TOH condition. We propose that mental workload, which is not normally considered in neuropsychology, might be a valuable tool in assessment of cognitive status, especially when there are subtle cognitive differences. In this case, even with similar test performance, cognitive status might not necessarily be the same between the two groups, with the BD group showing greater mental workload.