Average Montreal Cognitive Assessment Research Articles

The assessment of the impact of antiepileptic drugs on cognitive functions via N-200/P-300 potentials and neuropsychological measures.

The effects of antiseizure medications (ASMs) on cognitive functions have not been fully elucidated. The primary aim of this study was to demonstrate potential changes in cognitive functions in patients diagnosed with epilepsy from both neuropsychological and electrophysiological perspectives. Our secondary objective was to assess the effects of administered ASM on cognitive functions by categorizing patients into different monotherapy and polytherapy groups. A single-center, prospective patient registry study was conducted between May 2022 and June 2023. The inclusion criteria included epilepsy patients aged 18 to 50 years who were receiving ASM) treatment, either as inpatients or outpatients, and who did not have any syndromic diagnosis that may lead to cognitive disfunciton (such as primary progressive myoclonic epilepsies, Down syndrome and so on), and did not diagnosed previously or during examination that could affect dementia or cognitive functions. Patients who were scheduled to initiate new ASM treatment were evaluated using the Montreal Cognitive Assessment (MoCA) scale and Event-Related Potentials (ERP) assessment both before commencing treatment and three months thereafter. A total of 320 participants were included in the study; 20 healthy controls and 300 epilepsy patients were included. Statistically significant differences were observed between the healthy control group and the epilepsy group in terms of average Montreal Cognitive Assessment (MoCA) scores and event-related potentials (ERPs) (n200, p300 latencies, n2p3 amplitudes) (p<0.05). Similarly, statistically significant differences were observed between the monotherapy and polytherapy groups in terms of average MoCA and ERP scores (p<0.05). This study demonstrated the detrimental effects of certain ASMs, particularly topiramate and carbamazepine, on cognitive functions. Furthermore, the negative impact on cognitive performance became more pronounced with an increasing number of concurrently used ASMs (polytherapy), with topiramate showing notable effects.

Comprehensive Assessment of the Impact of Alcohol Use on Cognitive Deficits in People with HIV

Human immunodeficiency virus (HIV) infection profoundly impacts the nervous system, leading to neurological deficits such as HIV-associated neurocognitive disorder (HAND). HAND represents the most common neurological comorbidity among people with HIV (PWH), and alcohol use may exacerbate the cognitive deficits seen in this condition, especially in underserved populations. This study aimed to investigate the relationship between alcohol use patterns and cognitive performance in an underserved cohort of PWH, with the hypothesis that alcohol misuse would exacerbate cognitive deficits in this population. Data collected from participants (n=259; 66.7% male; mean age 52 ± 10 years) enrolled in the New Orleans Alcohol Use in HIV (NOAH) study were utilized for cross-sectional analysis. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and alcohol use was comprehensively measured by four metrics: Alcohol Use Disorders Identification Test (AUDIT), 30-day timeline followback (TLFB), lifetime drinking history, and phosphatidylethanol (PEth) levels. The average MoCA score among participants was 20.7 ± 4.5, with 86.5% demonstrating cognitive impairment (MoCA &lt; 26). Notably, individuals with total MoCA scores below 18 (classified as moderately or severely cognitively impaired) had a higher frequency of recent severe alcohol misuse (as assessed by PEth levels) and greater lifetime alcohol consumption. Participants at increased risk for AUD (as assessed by the AUDIT) also had worse global cognition and memory task performance, particularly those aged 50 and older. Further analysis of MoCA sub-score data indicated that participants with increased AUD risk had significant impairments in the cognitive domains of language, delayed recall, and memory. These findings highlight the importance of considering alcohol use and AUD risk as important factors that may exacerbate cognitive decline in vulnerable populations, including older patients and PWH. Future analyses will compare the relationship between cognition and alcohol in these HIV-positive patients with a cohort of HIV-negative patients to better understand the impact of concurrent HIV and alcohol misuse on cognitive function. This research was supported by grant #F30AA030941, #T32AA007577, and #P60AA009803 from the NIAAA at the National Institutes of Health. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Spontaneous brain activity in the hippocampal regions could characterize cognitive impairment in patients with Parkinson's disease.

This study aimed to investigate whether spontaneous brain activity can be used as a prospective indicator to identify cognitive impairment in patients with Parkinson's disease (PD). Resting-state functional magnetic resonance imaging (RS-fMRI) was performed on PD patients. The cognitive level of patients was assessed by the Montreal Cognitive Assessment (MoCA) scale. The fractional amplitude of low-frequency fluctuation (fALFF) was applied to measure the strength of spontaneous brain activity. Correlation analysis and between-group comparisons of fMRI data were conducted using Rest 1.8. By overlaying cognitively characterized brain regions and defining regions of interest (ROIs) based on their spatial distribution for subsequent cognitive stratification studies. A total of 58 PD patients were enrolled in this study. They were divided into three groups: normal cognition (NC) group (27 patients, average MoCA was 27.96), mild cognitive impairment (MCI) group (21 patients, average MoCA was 23.52), and severe cognitive impairment (SCI) group (10 patients, average MoCA was 17.3). It is noteworthy to mention that those within the SCI group exhibited the most advanced chronological age, with an average of 74.4 years, whereas the MCI group displayed a higher prevalence of male participants at 85.7%. It was found hippocampal regions were a stable representative brain region of cognition according to the correlation analysis between the fALFF of the whole brain and cognition, and the comparison of fALFF between different cognitive groups. The parahippocampal gyrus was the only region with statistically significant differences in fALFF among the three cognitive groups, and it was also the only brain region to identify MCI from NC, with an AUC of 0.673. The paracentral lobule, postcentral gyrus was the region that identified SCI from NC, with an AUC of 0.941. The midbrain, hippocampus, and parahippocampa gyrus was the region that identified SCI from MCI, with an AUC of 0.926. The parahippocampal gyrus was the potential brain region for recognizing cognitive impairment in PD, specifically for identifying MCI. Thus, the fALFF of parahippocampal gyrus is expected to contribute to future study as a multimodal fingerprint for early warning.

A nomogram to predict the risk of cognitive impairment in patients with depressive disorder.

This study was to describe the cognitive function status in patients with depressive disorder and to construct a nomogram model to predict the risk factors of cognitive impairment in these patients. From October 2019 to February 2021, a total of 141 patients with depressive disorder completed the survey in two hospitals. The Montreal cognitive assessment (MoCA) was used with a cutoff score of 26 to differentiate cognitive impairment. Univariable and multivariable logistic regression analyses were conducted to identify independent risk factors. A nomogram was then constructed based on the results of the multivariable logistic regression analysis. The patients had an average MoCA score of 23.99 ± 3.02. The multivariable logistic regression analysis revealed that age (OR: 1.096, 95% CI: 1.042-1.153, p < 0.001), education (OR: 0.065, 95% CI: 0.016-0.263, p < 0.001), depression severity (OR: 1.878, 95% CI: 1.021-3.456, p = 0.043), and sleep quality (OR: 2.454, 95% CI: 1.400-4.301, p = 0.002) were independent risk factors for cognitive impairment in patients with depressive disorder. The area under receiver operating characteristic (ROC) curves was 0.868 (95% CI: 0.807-0.929), indicating good discriminability of the model. The calibration curve of the model and the Hosmer-Lemeshow test (p = 0.571) demonstrated a well-fitted model with high calibration. Age, education, depression severity, and sleep quality were found to be significant predictors of cognitive function. A nomogram model was developed to predict cognitive impairment in patients with depressive disorder, providing a solid foundation for clinical interventions.

Abstract 042: Cognitive outcomes in patients with carotid insufficiency after undergoing direct extracranial‐intracranial bypass

Introduction Extracranial‐intracranial (EC‐IC) bypass is a niche procedure that has been selectively used for flow augmentation or flow restoration in patients with intracranial carotid insufficiency.1 The underlying etiology varies but is most commonly related to Moya Moya disease (MMD) or intracranial carotid atherosclerotic disease (ICAD).2 Patients are often managed non‐operatively until they begin to develop symptoms such as transient ischemic attacks (TIAs) or strokes that are recalcitrant to maximal medical management, at which point bypass is pursued.1 This lag period, however, could put patients at risk for long term deficit, not only in the form of focal neurological deficits but also in terms of overall neurocognitive capability.3 Several reports have previously demonstrated some level of association between EC‐IC bypass and neurocognitive outcomes, though in isolated populations of either MMD or ICAD.4,5 We therefore aim to further assess the relationship between EC‐IC bypass and neurocognitive outcomes in patients with intracranial carotid insufficiency. Methods Patients ages 18 years and up undergoing EC‐IC bypass were identified from a single institution database between January 2020 and December 2021. Patient records were reviewed for demographic data including age and sex, as well as preoperative clinical information including comorbidities, operative indication, anticoagulation/antiplatelet therapy usage, prior ischemic stroke, modified Rankin score (mRS), and Montreal Cognitive Assessment (MOCA) score. Radiographic data was also collected including Suzuki grade, collateralization, and perfusion. Post‐operative clinical information including complications, discharge mRS, and discharge MOCA scores were identified. Follow‐up duration, MOCA scores, and mRS were also identified and recorded. Results Of the forty‐four patients that underwent EC‐IC bypass during the specified period, ten had cognitive assessments before and after surgery available for review. The indications for bypass in these cases were ICA steno‐occlusive disease resulting in strokes despite maximal medical management in 9 cases, and MMD in one case. Suzuki grade was IV in the MMD case. Pial collaterals were present in 7 cases, and ECA collaterals were present in 5. Prior ischemic strokes were present in 8 cases, with a preoperative mRS range from 1‐4 (median 1), and average MOCA of 20. Perfusion imaging demonstrated a Tmax mismatch in eight cases, with an average volume of 73.6 cc at risk. All patients underwent direct superficial temporal artery to middle cerebral artery bypass, with additional encephaloduroarteriomyosynangiosis (EDAMS). Follow up MOCA score was improved in 8 cases, unchanged in one case, and worsened in one case (average MOCA increased from 20 to 23). Follow up mRS ranged from 0‐2. Additionally, CT perfusion demonstrated notable improvements in Tmax &gt;4 seconds (decrease from 176 cc to 110 cc), Tmax &gt;6 seconds (decrease from 59 cc to 29 cc), and mismatch (decrease from 59 cc to 17 cc) at 6 month follow up. Conclusion Patients with carotid insufficiency from MMD or ICAD undergoing EC‐IC bypass demonstrate well below normal preoperative MOCA scores. This is suggestive of ongoing neurocognitive decline, which is an often overlooked issue in patients with these pathologies. MOCA and mRS both appear to improve in patients after bypass at longer term follow‐up, suggesting that bypass may be an effective method of addressing the issue of neurocognitive decline in patients with carotid insufficiency.

15 The Role of Race and Adverse Childhood Experiences on Predicting Cognitive Ability on the Montreal Cognitive Assessment (MoCA).

Objective:Awareness of risk factors associated with any form of impairment is critical for formulating optimal prevention and treatment planning. Millions worldwide suffer from some form of cognitive impairment, with the highest rates amongst Black and Hispanic populations. The latter have also been found to achieve lower scores on standardized neurocognitive testing than other racial/ethnic groups. Understanding the socio-demographic risk factors that lead to this discrepancy in neurocognitive functioning across racial groups is crucial. Adverse childhood experiences (ACEs), are one aspect of social determinants of health. ACES have been linked to a greater risk of future memory impairment, such as dementia. Moreover, higher instances of ACEs have been found amongst racial minorities. Considering the current literature, the purpose of this exploratory research is to better understand how social determinants, more specifically, ACEs, may play a role in the development of cognitive impairment.Participants and Methods:This cross-sectional study included data from an urban, public Midwestern academic medical center. There was a total of 64 adult clinical patients that were referred for a neuropsychological evaluation. All patients were administered a standardized neurocognitive battery that included the Montreal Cognitive Assessment (MoCA) as well as a 10-item ACE questionnaire, which measures levels of adverse childhood experiences. The sample was 73% Black and 27% White. The average age was 66 (SD=8.6) and average education was 12.6 years (SD=3.4). A two-way ANOVA was conducted to evaluate the interaction of racial identity (White; Black) and ACE score on MoCA total score. An ACE score &gt;4 was categorized as “high”; ACE &lt;4 was categorized as “low.”Results:There was not a significant interaction of race and ACE group on MoCA score (p=.929) nor a significant main effect of ACE score (p=.541). Interestingly, there was a significant main effect of Race on MoCA (p=.029). White patients had an average MoCA score of 21.82 (sd=4.77). Black patients had an average MoCA score of 17.54 (sd=5.91).Conclusions:Overall, Black patients demonstrated statistically lower scores on the MoCA than White patients. There was no significant difference on MoCA score between races when also accounting for ACE scores. Given this study’s findings, one’s level of adverse childhood experiences does not appear to impact one’s cognitive ability later in life. There is a significant difference in cognitive ability between races, specifically Black and White people, which suggests there may be social determinants other than childhood experiences to be explored that influence cognitive impairment.

Cognitive Function and Postoperative Outcomes in Patients with Head and Neck Cancer.

Determine the relationship between cognitive function and postoperative outcomes. This IRB-approved retrospective cohort study included all patients treated between August 2015 and March 2020 undergoing major surgery for aerodigestive cancer or cutaneous/thyroid cancer that required free-flap reconstruction at Henry Ford Hospital. Routine administration of the Montreal Cognitive Assessment (MoCA) was completed as part of preoperative psychosocial evaluation. Outcomes included postoperative diagnosis of delirium, discharge disposition, return to the emergency department within 30 days of surgery, and readmission within 30 days of surgery. Univariate and multivariate logistic regression were used to determine the associations between preoperative MoCA score and each outcome measure. One hundred thirty-five patients with HNC were included in the study (mean [SD] age, 60.7 [±10.8] years; 70.4% [n=95] male; 83.0% [n=112] White, 16.3% [n=22] Black). The average preoperative MoCA score was 23.4 (SD ± 4.5). Based on the MoCA score, 35% (n=47) scored ≥26 (i.e., normal cognitive status), 55.6% (n=75) scored between 18 and 25 (i.e., mild impairment), 8.1% (n=11) scored between 10 and 17 (i.e., moderate impairment), and 1.5% (n=2) scored <10 (i.e., severe impairment). After adjusting for other variables, a lower MoCA score was associated with discharge disposition to a location other than home and prolonged length of hospital stay. Preoperative cognitive function in patients undergoing major head and neck surgery for head and neck cancer was associated with discharge destination and length of stay. 3 Laryngoscope, 133:2999-3005, 2023.

Montreal Cognitive Assessment scores of Veterans and Canadian Armed Forces personnel seeking mental health treatment

LAY SUMMARY The Montreal Cognitive Assessment (MoCA) is a test of mild cognitive impairment that is commonly administered to military personnel seeking mental health treatment. However, there is little research on the average MoCA score for military Veterans. This study looked at MoCA scores provided by Canadian Armed Forces members and Veterans receiving services for an operational-related mental health condition. Scores below the cut-off for mild cognitive impairment were not uncommon and were related to education level, as well as to severity of posttraumatic stress disorder and depression. These findings will help clinicians better contextualize score variation among clients.

Prevalence and factors associated with cognitive impairment in Chinese heart failure patients: A pilot study.

BackgroundThe prevalence of Cognitive impairment (CI) is high in patients with heart failure (HF). It leads to poor prognosis, such as self-care, hospital readmission and increased mortality. However, such information among Chinese population is unclear.ObjectiveThe purpose of this study was to examine the prevalence of CI in Chinese patients with HF, and explore its correlation with biomarkers and clinical factors to better manage HF patients with CI.MethodsThis study is a cross-sectional study of 200 hospitalized HF patients in China. The cognitive function of HF patients was assessed by the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE).ResultsThe majority are male (62.5%, n = 125), have primary school and below level of education (57.5%, n = 115), NYHA III and above (62%, n = 124). They have an average MoCA score of 15.10 ± 8.18, MMSE score of 19.55 ± 8.23. Age, NYHA class, and atrial fibrillation were independently associated with CI (p < 0.05). There was a significant association between CI and the 4th quartile of TNT (p = 0.013), and the 3rd and 4th quartile of NT-proBNP (p = 0.015, p = 0.038).ConclusionsThe prevalence of undiagnosed CI in Chinese HF patients is high (81%). HF patients with high levels of TNT or NT-proBNP or both values may be at risk of developing CI. Therefore, we suggest that HF patients with older age, atrial fibrillation, NYHA class II and III, as well as elevated TNT or NT-proBNP or both values to be followed up with a formal evaluation for CI. Nurses need to provide targeted health education program for cognitively impaired HF population to improve their self-care ability and nursing outcome.

Longitudinal evaluation of neurologic-post acute sequelae SARS-CoV-2 infection symptoms.

ObjectiveTo assess the initial features and evolution of neurologic Postacute Sequelae of SARS‐CoV‐2 infection (neuro‐PASC) in patients with and without prior neurologic disease.MethodsParticipants with neurologic symptoms following acute SARS‐CoV‐2 infection were recruited from October 9, 2020 to October 11, 2021. Clinical data included a SARS‐CoV‐2 infection history, neurologic review of systems, neurologic exam, Montreal cognitive assessment (MoCA), and symptom‐based self‐reported surveys at baseline (conducted after acute infection) and 6‐month follow‐up assessments.ResultsFifty‐six participants (69% female, mean age 50 years, 29% with prior neurologic disease such as multiple sclerosis) were enrolled, of which 27 had completed the 6‐month follow‐up visit in this ongoing study. SARS‐CoV‐2 infection severity was largely described as mild (39.3%) or moderate (42.9%). At baseline, following acute infection, the most common neurologic symptoms were fatigue (89.3%) and headaches (80.4%). At the 6‐month follow‐up, memory impairment (68.8%) and decreased concentration (61.5%) were the most prevalent, though on average all symptoms showed a reduction in reported severity score at the follow‐up. Complete symptom resolution was reported in 33.3% of participants by 6 months. From baseline to 6 months, average MoCA scores improved overall though 26.3% of participants’ scores decreased. A syndrome consisting of tremor, ataxia, and cognitive dysfunction (PASC‐TAC) was observed in 7.1% of patients.InterpretationEarly in the neuro‐PASC syndrome, fatigue and headache are the most commonly reported symptoms. At 6 months, memory impairment and decreased concentration were most prominent. Only one‐third of participants had completed resolution of neuro‐PASC at 6 months, although persistent symptoms trended toward improvement at follow‐up.

The Clinical Utility of the MOCA in iNPH Assessment.

ObjectivesWe sought to estimate reliable change thresholds for the Montreal Cognitive Assessment (MoCA) for older adults with suspected Idiopathic Normal Pressure Hydrocephalus (iNPH). Furthermore, we aimed to determine the likelihood that shunted patients will demonstrate significant improvement on the MoCA, and to identify possible predictors of this improvement.MethodsPatients (N = 224) presenting with symptoms of iNPH were given a MoCA assessment at their first clinic visit, and also before and after tap test (TT) or extended lumbar drainage (ELD). Patients who were determined to be good candidates for shunts (N = 71, 31.7%) took another MoCA assessment following shunt insertion. Reliable change thresholds for MoCA were derived using baseline visit to pre-TT/ELD assessment using nine different methodologies. Baseline characteristics of patients whose post-shunt MoCA did and did not exceed the reliable change threshold were compared.ResultsAll nine of reliable change methods indicated that a 5-point increase in MoCA would be reliable for patients with a baseline MoCA from 16 to 22 (38.4% of patients). Furthermore, a majority of reliable change methods indicated that a 5-point increase in MoCA would be reliable for patients with a baseline MoCA from 14 to 25. Reliable change thresholds varied across methods from 4 to 7 points for patients outside of this range. 10.1% had at least a 5-point increase from baseline to post-TT/ELD. Compared to patients who did not receive a shunt, patients who received a shunt did not have lower average MoCA at baseline (p = 0.88) or have better improvement in MoCA scores after the tap test (p = 0.17). Among shunted patients, 23.4% improved by at least 5 points on the MoCA from baseline to post-shunt. Time since onset of memory problems and post-TT/ELD gait function were the only clinical factors significantly associated with having a reliable change in MoCA after shunt insertion (p = 0.019; p = 0.03, respectively).ConclusionsIn patients with iNPH, clinicians could consider using a threshold of 5 points for determining whether iNPH-symptomatic patients have experienced cognitive benefits from cerebrospinal fluid drainage at an individual level. However, a reliable change cannot be detected for patients with a baseline MoCA of 26 or greater, necessitating a different cognitive assessment tool for these patients.

Abstract PO-090: The impacts of depression and socioeconomic factors on cognitive function among low-income Asian and African American elderly aged 65 and above

Abstract Background: Alzheimer's disease (AD) and Alzheimer's disease and related dementias (ADRD) have been a public health problem in the United States for a long time, and its adverse impact on the health of minority elderly population has been increasing since 2000. Nearly 40% of ADRD patients suffer from depression. However, the burden of ADRD and depression comorbidity among Asian and African Americans elderly was understudied. Methods: Participants aged 65 and older were recruited from Chinese, Vietnamese, and African American community-based organizations in the Greater Philadelphia Region and New York City. We conducted a cross sectional survey to assess their ADRD-related knowledge, depression symptoms, sociodemographic and health related factors. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), depression severity was tested with Patient Health Questionnaire (PHQ-9), and stressful life events (SLE) impact score was measured with a 6-item scale with excellent internal consistency (Cronbach's alpha=0.94). A p value that is smaller than 0.05 is considered statistically significant, while a p value that is smaller than 0.1 indicates marginally significant level. Results: Overall, the participants (n=306, 12.21% African Americans, 54.79% Chinese Americans, and 33% Vietnamese Americans) had an average age of 73.57; 89.56% of them had &amp;lt; $20k annual household income, and 62.13% did not have a college degree. The average MoCA score was 21.24, which was significantly lower than the normal criteria 26, indicating mild cognitive impairment. Bivariate analysis showed that depression (r=-0.51, p&amp;lt;0.001) and SLE impact (r=-0.33, p&amp;lt;0.001) were significantly negatively correlated to MoCA scores. After controlling for demographics, depression severity (Coef. =-0.42, p&amp;lt;0.001) remained a significant predictor of cognitive function. Multivariate analysis also found that age (Coef. =-0.15, p=0.016) and education levels (Coef. =2.11, p&amp;lt;0.001) were significant predictors of MoCA score. Compared with those who did not speak English at all, participants who speak some English (Coef. =3.10, p&amp;lt;0.001) and good at English speaking (Coef. =4.54, p=0.034) were more likely to have higher cognitive scores. Moreover, being retired (Coef. =-3.23, p=0.054) and having &amp;gt;$40k annual household income (Coef. =-3.73, p=0.091) showed marginally negative associations with cognitive function level. Conclusion: The preliminary findings demonstrate an association between depression and mild cognitive impairment among Asian and African American elderly. With the remaining experimental work, targeted interventions will be identified in improving ADRD knowledge, cognitive performance, and mental health among understudied older Asian and African Americans. Citation Format: Wenyue Lu, Lin Zhu, Michael Coronado, Guercie E. Guerrier, Yin Tan, Grace X. Ma. The impacts of depression and socioeconomic factors on cognitive function among low-income Asian and African American elderly aged 65 and above [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-090.

NCOG-44. FEASIBILITY AND UTILITY OF THE MONTREAL COGNITIVE ASSESSMENT IN ROUTINE CLINICAL EXAMS AND TELEHEALTH VISITS IN NEURO-ONCOLOGY

Abstract Cognitive dysfunction (CD) is common among primary brain tumor (PBT) patients and adds to the overall symptom burden. Standardized assessments able to be incorporated into routine clinical in-person and telehealth care are needed. Here, we report the feasibility, utility, and satisfaction with use of the Montreal Cognitive Assessment (MoCA) in telehealth and clinical settings by trained clinical providers. Feasibility and provider satisfaction were assessed through survey responses, and patient performance on the MoCA, after a reliability check, was reported through descriptive statistics. Seventy-nine MoCAs on 71 patients were completed in clinic (n=55) or telehealth (n=24). Majority of patients were white (83%) males (54%) with high grade PBTs (66%), and half of patients had completed at least a college education. In clinic, providers (n=9) reported the MoCA took 5-20 minutes to complete, was easy to incorporate into routine practice (78%), believed it was accurate in assessing cognition (67%), and was useful in determining treatment (88%). The average in-person MoCA score was 25 (range: 6 to 30), with 31% of scores classified as abnormal (≤26). In telehealth, providers (n=11) found the administration of the MoCA prior to attending participation in the telehealth visit helpful (75%), discussed the results with their clinical team (75%) and patient (63%), and believed the MoCA was accurate in assessing cognition remotely (63%). On average, patients took 13 minutes (9-22) to complete testing, with three tests discordant on reliability scoring and one patient unable to complete testing. The average telehealth MoCA score was 26 (12-30), with 29% of scores classified as abnormal. Overall, testing was feasible in both clinical and telehealth settings, and providers reported satisfaction with its use. Future studies should evaluate validity in a larger sample and include analysis of relevant cut-off scores, impact of disease, tumor treatment, and genomic predispositions.

Stabilometric analysis as a cognitive function predictor in adults over the age of 50: A cross-sectional study conducted in a Memory Clinic

BackgroundThe aging process reduces adaptive balance responses. Two-thirds of older adults with cognitive problems suffer at least one fall every year, a rate three times higher than that observed in older adults without dementia. This cross-sectional study aims to analyze the relationship between balance and cognitive status in adults older than 50 years. MethodsIndividuals over the age of 50, who attended a Memory Clinic, were evaluated for balance changes using stabilometry, with analysis of the center of pressure (CoP). The following CoP parameters were assessed using an S-Plate pressure platform: 1) sway length, 2) sway area, and 3) anteroposterior and laterolateral sway (width, mean deviation, and speed). The individuals were evaluated with eyes open and closed for 30 s in each test. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive status. ResultsEighty-seven subjects participated in the study. The average age was 67.8 years, 81.4% were female, and the average MoCA score was 19.8 points. Greater CoP oscillation was observed in the eyes closed condition, demonstrating greater postural imbalance. We found a significant and direct effect of MoCA score on the CoP area in the eyes open condition. Conclusion: The results suggest that stabilometric analysis may be a predictor of cognitive function.

Cognitive dysfunction among people with systemic lupus erythematosus is associated with reduced participation in daily life.

This study aimed to investigate the distribution of cognitive function in people with systemic lupus erythematosus (SLE) by objective and self-report measures and associations between cognition and participation among people with SLE. Fifty-five volunteers with SLE (age: 39.7 ± 12.7yrs, female: 92.7%) completed the Montreal Cognitive Assessment (MoCA) to measure cognitive ability objectively, the Cognitive Symptom Inventory (CSI) and PROMIS Cognitive Function 8a (CF) to assess self-reported everyday cognition, and PROMIS-43 Profile to assess self-reported ability to participate in social roles and activities (participation) and other disease-associated symptoms (e.g., depression, pain, fatigue). The average MoCA score was 25.3 ± 3.1, with 47.3% of participants scoring <26, which is indicative of cognitive impairment. Group average CSI (35.8 ± 7.9), CF (T-score = 45.0 ± 8.5), and participation (T-score = 46.9 ± 11.2) scores suggest mildly impaired functional cognition and participation compared to normative data. Participation correlated with self-reported everyday cognition measures (r ≥ 0.56, p < 0.01) but not with MoCA (r = 0.25, p = 0.06). In hierarchical linear regression analysis, CSI, fatigue, and pain were each significant independent predictors of participation (R2 = 0.78, p < 0.01). We found that cognitive dysfunction is common among people with SLE. Along with pain and fatigue, reduced everyday cognitive function contributes to reduced participation in social, leisure, work, and family-related activities.

Association between Pre-Transplantation Cognitive Impairment and Early Post-Transplantation Outcomes

Purpose Solid organ transplantation is increasingly being offered to older, more medically complex patients. Advancing age and organ failure increases the risk of cognitive impairment, which may be associated with adverse post-transplantation outcomes. We sought to characterize the prevalence of cognitive impairment in heart and lung transplantation candidates and assess whether pre-transplantation cognition was associated with post-transplantation length of stay (LOS) or delirium. Methods Frailty and Sarcopenia in Organ Transplantation (FROST) is a prospective single-center cohort study of 240 adults listed for organ transplantation. We characterized the prevalence of cognitive impairment (CI) in 78 heart and lung transplantation candidates pre-transplantation using the Montreal Cognitive Assessment (MoCA). Charts were reviewed to determine post-transplantation LOS and whether patients developed delirium requiring pharmacotherapy or psychiatry consult. Using median regression adjusted for age, gender, and type of transplantation, we determined whether CI was associated with post-transplantation length of stay. We used logistic regression to assess whether MoCA was associated with delirium post-transplantation, adjusted for age and gender. Results The average age of candidates was 57.1 (standard deviation 13.6), and 45% were female. The average MoCA score was 26.5 (SD 2.68, range 16-30) and 24 candidates (31%) had a MoCA Conclusion Although a significant proportion of transplant candidates in this sample had CI, the observed differences in LOS post-transplantation, and risk of delirium in subjects with CI did not achieve statistical significance. This evidence does not support CI being a barrier to transplantation candidacy to reduce early adverse post-transplantation outcomes. Studies in larger cohorts and post-transplantation cognitive testing may further elucidate the clinical implications of CI in thoracic organ transplantation candidates.

Early Post-stroke Cognition: In-hospital Predictors and the Association With Functional Outcome.

Purpose: To characterize and predict early post-stroke cognitive impairment by describing cognitive changes in stroke patients 4–8 weeks post-infarct, determining the relationship between cognitive ability and functional status at this early time point, and identifying the in-hospital risk factors associated with early dysfunction.Materials and Methods: Data were collected for 214 patients with ischemic stroke and 39 non-stroke controls. Montreal Cognitive Assessment (MoCA) exams were administered at post-hospitalization clinic visits approximately 4–8 weeks after infarct. MoCA scores were compared for patients with: no stroke, minor stroke [NIH Stroke Scale (NIHSS) < 5], and major stroke. Ordinal logistic regression was performed to assess the relationship between MoCA score and functional status [modified Rankin Scale score (mRS)] at follow-up. Predictors of MoCA < 26 and < 19 (cutoffs for mild and severe cognitive impairment, respectively) at follow-up were identified by multivariable logistic regression using variables available during hospitalization.Results: Post stroke cognitive impairment was common, with 66.8% of patients scoring < 26 on the MoCA and 22.9% < 19. The average total MoCA score at follow-up was 18.7 (SD 7.0) among major strokes, 23.6 (SD 4.8) among minor strokes, and 27.2 (SD 13.0) among non-strokes (p = <0.0001). The follow-up MoCA score was associated with the follow-up mRS in adjusted analysis (OR 0.69; 95% C.I. 0.59–0.82). Among patients with no prior cognitive impairment (N = 201), a lack of pre-stroke employment, admission NIHSS > 6, and left-sided infarct predicted a follow-up MoCA < 26 (c-statistic 0.75); while admission NIHSS > 6 and infarct volume > 17 cc predicted a MoCA < 19 (c-statistic 0.75) at follow-up.Conclusion: Many patients experience early post-stroke cognitive dysfunction that significantly impacts function during a critical time period for decision-making regarding return to work and future independence. Dysfunction measured at 4–8 weeks can be predicted during the inpatient hospitalization. These high-risk individuals should be identified for targeted rehabilitation and counseling to improve longer-term post-stroke outcomes.

Occupational exposure as a risk factor for cognitive impairment in Vietnamese nail salon workers

AbstractBackgroundNail salon technicians are continuously exposed to neurotoxic and carcinogenic properties in nail products that may put them at risk for central nervous system impairments linked to Alzheimer’s disease. However, there are very few studies of the nail‐care workplace, and even fewer focus on Vietnamese female nail technicians, who make up the overwhelming part of the workforce. This study provides preliminary data on clinical assessments that will inform the cognitive functioning of a vulnerable population.MethodSample includes 300 Vietnamese females aged 50 or above in Northern California. The nail‐technician group (n=155) self‐identified as a current or former full or part‐time nail technician. The non‐nail group (n=145) are those who have never worked in the cosmetic industry, including nail or hair salons, but were an approximate match with the nail technicians on demographics and acculturation variables. Participants completed the Montreal Cognitive Assessment (MoCA), the Center for Epidemiologic Studies Depression Scale (CES‐D), and a self‐reported bilingual survey regarding their occupational exposure and demographics.ResultThe average MoCA score was 18.8 (SD ±4.50) for non‐nail technicians, which is significantly higher than 17.60 (SD ±4.30) for nail technicians (p = 0.017). However, there was no significant difference between the two groups on the average CES‐D score (p = 0.22). Based on results of multiple linear regression, with an increase of 100 in exposure index (i.e., years working in current nail salon x hours worked per week), the MoCA score is expected to decrease by 0.29 (95% CI: 0.05, 0.53, p = 0.017).ConclusionAfter adjusting for potential confounders, Vietnamese nail technicians were found to have lower cognitive functioning that those without occupational exposure to nail salon work. The results of this study suggest the need for future longitudinal research to better elucidate the processes underlying this association.

Associations between unmet palliative care needs and cognitive impairment in a sample of diverse, community-based older adults.

Given a large number of community-based older adults with mild cognitive impairment, it is essential to better understand the relationship between unmet palliative care (PC) needs and mild cognitive impairment in community-based samples. Participants consisted of adults ages 60+ receiving services at senior centers located in New York City. The Montreal Cognitive Assessment (MoCA) and the Unmet Palliative Care Needs screening tool were used to assess participants' cognitive status and PC needs. Our results revealed a quadratic relationship between unmet PC needs and mild cognitive impairment, controlling for gender, living status, and age. Participants with either low or high MoCA scores reported lower PC needs than participants with average MoCA scores, mean difference of the contrast (low and high vs. middle) = 2.15, P = 0.08. This study is a first step toward elucidating the relationship between cognitive impairment and PC needs in a diverse community sample of older adults. More research is needed to better understand the unique PC needs of older adults with cognitive impairment living in the community.

Carotid Endarterectomy Is Associated With Postoperative Neurocognitive Improvement in Both Symptomatic and Asymptomatic Patients

While stroke after carotid endarterectomy (CEA) is rare, magnetic resonance imaging shows that “silent” microinfarctions after surgery are much more common. These microinfarcts have been correlated with neurocognitive decline. However, there is also evidence that revascularization may improve overall cognition due to improved cerebral blood flow and elimination of embolic source. As part of a trial of remote ischemic preconditioning as a possible neuroprotective mechanism during CEA, we examined the overall impact of carotid revascularization on cognitive function. This is an interim noncomparative analysis of the cohort enrolled in an institutional randomized trial for the role of remote ischemic preconditioning for CEA (RIP-CEA, NCT02808754). All patients underwent baseline neurocognitive testing using the Montreal-Cognitive Assessment (MoCA) and National Institutes of Health Toolbox (Flanker Inhibitory Control and Attention Test, the Dimensional Change Card Sort Test, and the Pattern Comparison Processing Speed Test). These tests specifically assess executive function and processing speed. MoCA was also conducted on postoperative day 1 in the hospital. The full neurocognitive testing battery was conducted again at the 1-month follow-up in the office. Score changes from baseline were examined at the follow-up time points. Eighty patients with a mean age of 71.3 ± 7.1 years (65% male, and 30% symptomatic) were enrolled. The average baseline MoCA score was 24.7 ± 2.8 and this was similar between symptomatic and asymptomatic patients (P = .6). Forty-seven percent of patients met criteria for cognitive decline (MoCA < 26) at baseline. While MoCA scores remained unchanged immediately postoperatively, patients experienced significant improvements in MoCA scores by 1 month after CEA (average MoCA score of 26.3 and only 26% qualifying as cognitive decline; P < .001). Similarly, patients experienced significant improvements in executive function (26.4 ± 4.7 months before CEA vs 28.3 ± 2.3 1 months after CEA; P < .001) and processing speed at 1 month after CEA (31.8 ± 9.2 months before CEA vs 35.8 ± 8.4 1 months after CEA; P < .001) as assessed by the National Institutes of Health toolbox. There was no difference in the number or degree of cognitive improvement between symptomatic and asymptomatic patients. Statin use was a significant predictor of improvement on MoCA score at 1 month (OR, 3.9; P < .05). Carotid revascularization with CEA is associated with significant improvements in neurocognitive function by one month post operatively across multiple domains. Statin use may be further protective. Longer term follow-up is needed to see the magnitude and durability of these cognitive improvements. Neurocognitive improvement following CEA may justify reconsideration of the role of carotid revascularization in asymptomatic patients.