Cognitive Impairment In Persons Research Articles

Clinical utility of brief screening measures during neuropsychological consultation for pediatric onset multiple sclerosis.

Pediatric-onset multiple sclerosis (POMS) accounts for approximately 2 to 5% of all individuals with MS and is associated with an increased risk for cognitive impairment. In recent years, neuropsychological screening questionnaires have been increasingly utilized for pediatric populations in multidisciplinary settings. This study examines the clinical utility of the Colorado Learning Difficulties Questionnaire (CLDQ) and Pediatric Perceived Cognitive Functioning (Peds PCF) screening measures for identifying cognitive impairment in persons with POMS during a target neuropsychological evaluation. Retrospective data was gathered from electronic medical records at a single pediatric hospital. Forty-nine participants were included (69% female; 43% Hispanic/Latinx; mean age = 16.1 years old, range = 9.9 to 20.6 years old). Correlation analyses demonstrated strong interrelatedness between caregiver ratings on screening measures and performance on traditional neuropsychological measures. Effect sizes were medium across comparisons (CLDQ: Spearman's rho = -.321 to -.563; PedsPCF: Spearman's rho = .308 to .444). Exploratory cut-points using receiver operating characteristic analysis and Youden indices are also discussed. Comparison of scores across caregiver rating questionnaires and on a targeted neuropsychological battery suggests that the screening surveys alone may not be sensitive enough to identify children with cognitive impairments, but ratings may provide qualitatively meaningful information along with neuropsychological testing. This study illustrates how pediatric neuropsychologists can leverage screening tools to focus consultative interviews and effectively triage referrals for evaluation within an academic medical setting.

APOE3 Christchurch Heterozygosity and Autosomal Dominant Alzheimer’s Disease

BackgroundVariants in APOE and PSEN1 (encoding apolipoprotein E and presenilin 1, respectively) alter the risk of Alzheimer’s disease. We previously reported a delay of cognitive impairment in a person with autosomal dominant Alzheimer’s disease caused by the PSEN1E280A variant who also had two copies of the apolipoprotein E3 Christchurch variant (APOE3Ch). Heterozygosity for the APOE3Ch variant may influence the age at which the onset of cognitive impairment occurs. We assessed this hypothesis in a population in which the PSEN1E280A variant is prevalent.MethodsWe analyzed data from 27 participants with one copy of the APOE3Ch variant among 1077 carriers of the PSEN1E280A variant in a kindred from Antioquia, Colombia, to estimate the age at the onset of cognitive impairment and dementia in this group as compared with persons without the APOE3Ch variant. Two participants underwent brain imaging, and autopsy was performed in four participants.ResultsAmong carriers of PSEN1E280A who were heterozygous for the APOE3Ch variant, the median age at the onset of cognitive impairment was 52 years (95% confidence interval [CI], 51 to 58), in contrast to a matched group of PSEN1E280A carriers without the APOE3Ch variant, among whom the median age at the onset was 47 years (95% CI, 47 to 49). In two participants with the APOE3Ch and PSEN1E280A variants who underwent brain imaging, 18F-fluorodeoxyglucose positron-emission tomographic (PET) imaging showed relatively preserved metabolic activity in areas typically involved in Alzheimer’s disease. In one of these participants, who underwent 18F-flortaucipir PET imaging, tau findings were limited as compared with persons with PSEN1E280A in whom cognitive impairment occurred at the typical age in this kindred. Four studies of autopsy material obtained from persons with the APOE3Ch and PSEN1E280A variants showed fewer vascular amyloid pathologic features than were seen in material obtained from persons who had the PSEN1E280A variant but not the APOE3Ch variant.ConclusionsClinical data supported a delayed onset of cognitive impairment in persons who were heterozygous for the APOE3Ch variant in a kindred with a high prevalence of autosomal dominant Alzheimer’s disease. (Funded by Good Ventures and others.)

Impact of elevated body mass index (BMI) on cognitive functioning and inflammation in persons with post-COVID-19 condition: a secondary analysis.

Individuals who have recovered from the acute stage of SARS-CoV-2 infection may be at risk of developing post-COVID-19 condition (PCC), characterised by a spectrum of persisting, non-specific, and functionally impairing symptoms across multiple organ systems. Obesity has been implicated as a risk factor for PCC, mediated by chronic systemic inflammation. The foregoing has also been separately reported to mediate cognitive dysfunction in PCC. This is a post-hoc analysis of a randomised, double-blinded, placebo-controlled clinical trial evaluating vortioxetine treatment for cognitive impairments in persons with PCC who received vortioxetine or placebo for eight weeks. This analysis comprises baseline data, examining the impact of BMI on cognitive functioning measured by the Digit Symbol Substitution Test (DSST) and Trails Making Tests (TMT)-A/B, as well as inflammation, via serum c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Complete data from 70 participants were statistically analysed and adjusted for age and sex. BMI was negatively correlated with performance on the DSST (β = -0.003, p = 0.047), TMT-A (β = -0.006, p = 0.025), and TMT-B (β = -0.006, p = 0.002). BMI was positively correlated with serum CRP (unstandardized β = 0.193, standardized β = 0.612, p < 0.001) and ESR (β = 0.039, p < 0.001) levels. We observed a significant negative correlation between BMI and cognitive functioning, and a significant positive correlation between BMI and inflammation in persons with PCC, suggesting a bidirectional interplay between BMI, PCC, and cognitive function; individuals with an elevated BMI may be at a greater risk of developing PCC and/or presenting with greater cognitive deficits mediated by chronic systemic inflammation.

Looking Beyond Physical Disability: Cognitive Impairment in Persons With Multiple Sclerosis.

Cognitive impairment (CI) is an underestimated part of disability in persons with multiple sclerosis (PwMS). The purpose of this evidence-based project was to influence clinicians treating PwMS by education of the current guidelines on cognition and multiple sclerosis and to screen CI with a valid neuropsychological tool. Staff were educated on the 2018 National Multiple Sclerosis Society guidelines about CI in PwMS. The Processing Speed Test (PST) measured CI. Of 50 eligible patients in a 3-month period, 21 (42%) PwMS were cognitively screened. Of the 21 enrolled patients, nine (42.9%) patients were cognitively impaired. Employed patients' PST scores tended to be higher than unemployed patients. As age increased, PST raw scores decreased. In this project, less than half of eligible patients received cognitive screening after an extensive education program. Thus, education alone was not sufficient to change behavior. Other strategies to influence change may be more effective.

Testing a Feedback‐controlled Heated Vest to Treat Thermoregulatory Dysfunction in Persons with Spinal Cord Injury

Study ObjectiveAfter spinal cord injury (SCI), The ability to maintain a constant core body temperature (Tcore) is compromised. Persons with higher levels of SCI (Hi‐SCI: above the first thoracic vertebrae) are far more vulnerable to hypothermia (Tcore &lt;35°C) when exposed to cool ambient temperatures. A decrease in Tcore in persons with Hi‐SCI has been associated with impaired cognitive performance after limited exposure to cool environmental conditions (2 hours at 18°C). The objective of this pilot study is to determine the efficacy of a feedback‐controlled heated vest (HV) to minimize the decrease in Tcore and associated cognitive impairment in persons with Hi‐SCI when exposed to cool ambient conditions.MethodsThree participants with Hi‐SCI (C4‐C7, AIS A‐B) were recruited to study under two conditions [HV and non‐heated vest (NHV)] in random order on 2 separate visits when exposed to a cool challenge (CC). To obtain Tcore in a continuous manner, participants ingested a CorTempR capsule 1‐3 hours before initiation of the study. Abdominal (Tabd) and distal (Tdsk) skin temperatures were measured. Fifteen minutes of baseline (BL) data were collected while seated at thermoneutral (25°C). At the end of BL, a cognitive battery that consisted of the Montreal Cognitive Assessment (MoCA) and Stroop Color and Word Test (SCWT) was administered. Participants were then fitted with either HV or NHV and transferred into an 18°C room for 2 hours, after which the cognitive battery was once again administered.Results: During Cool Challenge (values are expressed as BL‐ CC): The decrease in Tcore was less when wearing the HV (‐0.22°C) than when wearing the NHV (‐0.54°C). The increase in Tabd was greater when wearing the HV (4.34°C) than when wearing the NHV (0.90°C). When wearing the HV, Tdsk of the fingers was higher (6.48°C HV vs. 4.20°C NHV), but not of the toes (6.46°C HV vs. 7.92°C NHV). The decrease in performance for the MoCA was less when wearing the HV (‐8.33%) than when wearing the NHV (‐43.33%). The decrease in score for the Stroop word test was less when wearing the HV (‐0.17%) than when wearing the NHV (‐3.32%). Of note, the Stroop Color and Color‐Word score increased when wearing the HV (10.12% and 5.73%, respectively) but decreased when wearing the NHV (‐0.97% and ‐4.9%, respectively).ConclusionIn persons with Hi‐SCI, our preliminary findings demonstrate the ability of the HV to minimize the expected decline in Tcore when exposed to the CC and decreased the decline in cognitive performance. While our results are quite encouraging, they require confirmation in a larger number of participants. However, once confirmed, our HV may offer persons with Hi‐SCI protection against adverse declines in Tcore when exposed to cool environmental conditions.

The Impact of Cognitive Impairment on Disaster Preparedness: A Cross-sectional Study of Older Adults over the Age of 75 Requiring Special Care in Japan

ABSTRACT Disaster preparedness is the most important measure that can be taken to reduce damage. However, disaster preparedness is predicted to be difficult for older adults with cognitive impairment. Thus, we investigated the effects on disaster preparedness of cognitive impairment in persons requiring special care who are 75 or older. The survey included subject characteristics such as demographic indicators, physical function, cognitive function impairments, community involvement, and disaster preparedness. Cross-sectional data from 711 subjects were divided into two groups, a cognitive impairment group and an unimpaired group. Next, to show the effects of subject characteristics in each group on disaster preparedness, a binomial logistic regression analysis was performed. Then, the effects on disaster preparedness were compared between the two groups. This study showed that persons requiring special care who are 75 or older, and have the characteristics of “living alone,” “requiring care,” and “needing mobility assistance” in addition to cognitive impairment, have increased difficulty making disaster preparedness. Government officials and community supporters therefore need to recognize that these people should be supported on a priority basis, and to provide continuing support for disaster preparedness.

Features of intracranial interictal epileptiform discharges associated with memory encoding.

Interictal epileptiform discharges (IEDs) were shown to be associated with cognitive impairment in persons with epilepsy. Previous studies indicated that IED rate, location, timing, and spatial relation to the seizure onset zone could predict an IED's impact on memory encoding and retrieval if they occurred in lateral temporal, mesial temporal, or parietal regions. In this study, we explore the influence that other IED properties (e.g., amplitude, duration, white matter classification) have on memory performance. We were specifically interested in investigating the influence that lateral temporal IEDs have on memory encoding. Two hundred sixty-one subjects with medication-refractory epilepsy undergoing intracranial electroencephalographic monitoring performed multiple sessions of a delayed free-recall task (n=671). Generalized linear mixed models were utilized to examine the relationship between IED properties and memory performance. We found that increased IED rate, IEDs propagating in white matter, and IEDs localized to the left middle temporal region were associated with poorer memory performance. For lateral temporal IEDs, we observed a significant interaction between IED white matter categorization and amplitude, where IEDs with an increased amplitude and white matter propagation were associated with reduced memory performance. Additionally, changes in alpha power after an IED showed a significant positive correlation with memory performance. Our results suggest that IED properties may be useful for predicting the impact an IED has on memory encoding. We provide an essential step toward understanding pathological versus potentially beneficial interictal epileptiform activity.

Certain risk factors for the development of cognitive impairment in persons with epilepsy and new therapeutic options

Epilepsy is a common chronic neurological disease. The problems of people with epilepsy go well beyond epileptic seizures. Comorbidities in epilepsy are very common and often cause more problems to the patients than the seizures themselves. Although seizures are the most prominent clinical presentation of epilepsy, people with epilepsy are exposed to risk of not only seizures, but also of many health problems. Both children and adults with epilepsy often complain of memory impairment. It is commonly believed that cognitive dysfunction in epilepsy is multifactorial. The components that deteriorate cognitive functions include active seizures and especially generalized tonic-clonic seizures, traumatic brain injuries, structural epilepsy, and drug therapy. Cognitive dysfunction is very often present as far back as during the onset of epilepsy. The cognitive dysfunction detected in patients with epilepsy depend on the localization of the epileptic focus, the frequency and type of epileptic seizures, and changes in the interictal electroencephalogram. Seizures can be controlled with antiepileptic drugs in most patients with epilepsy. Therapy of cognitive dysfunction in patients with epilepsy presents significant difficulties, as there is no evidence of the efficacy of various drugs in cognitive disorders. The article presents a new Russian antiepileptic drug based on phenosanic acid as part of combination therapy in patients with partial epileptic seizures with or without secondary generalization, which can improve cognitive functions in patients with epilepsy.

Sensory-Motor and Affective-Fatigue Factors are Associated with Symbol Digit Performance in Multiple Sclerosis.

The oral Symbol Digit Modalities Test (SDMT) has become the standard for the brief screening of cognitive impairment in persons with multiple sclerosis (PwMS). It has been shown to be sensitive to sensory-motor factors involving rudimentary oral motor speed and visual acuity, as well as multiple sclerosis (MS) affective-fatigue factors including depression, fatigue, and anxiety. The present study was designed to provide a greater understanding of these noncognitive factors that might contribute to the oral SDMT by examining all these variables in the same sample. We examined 50 PwMS and 49 healthy controls (HCs). All participants were administered the oral SDMT, two sensory-motor tasks (visual acuity and oral motor speed), and three affective-fatigue measures (depression, fatigue, and anxiety). Partially consistent with hypotheses, we found that sensory-motor skills, but not affective-fatigue factors, accounted for some of the group differences between the MS and HC groups on the oral SDMT, reducing the MS/HC group variance predicted from 10% to 4%. Also, PwMS with below average sensory-motor abilities had oral SDMT scores that were lower than PwMS with intact sensory-motor skills (p<.05). Finally, 71% of PwMS in the below-average sensory-motor group were impaired on the oral SDMT compared with 14% of the intact group (p=.006). When the oral SDMT is used as the sole screening tool for cognitive impairment in MS, clinicians should know that limitations in visual acuity and rudimentary oral motor speed should be considered as possibly being associated with performance on it in MS.

Moving on From HAND: Why We Need New Criteria for Cognitive Impairment in Persons Living With Human Immunodeficiency Virus and a Proposed Way Forward.

Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) criteria are frequently used to describe cognitive impairment in persons living with HIV (PLWH) across diverse populations globally. These criteria typically find 20-60% of PLWH meet criteria for HAND, which does not tally with clinical observations in the modern era that cognitive disorders present relatively infrequently. Most with HAND have asymptomatic neurocognitive impairment; however, the significance of low cognitive test performance without symptoms is uncertain. Methods underlying HAND criteria carry a false-positive rate that can exceed 20%. Comorbidities, education, and complex socioeconomic factors can influence cognitive test performance, further increasing the potential for misclassification. We propose a new framework to characterize cognitive impairment in PLWH that requires a clinical history and acknowledges the multifactorial nature of low cognitive test performance. This framework is intended to be applicable across diverse populations globally, be more aligned with clinical observations, and more closely represent HIV brain pathology.

Restless legs syndrome, sleep quality, and perceived cognitive impairment in adults with multiple sclerosis

BackgroundRestless Legs Syndrome (RLS) is a prominent sleep disorder that often worsens sleep quality and perhaps cognitive function in adults with multiple sclerosis (MS). The present study examined the relationships among RLS prevalence and severity, sleep quality, and perceived cognitive impairment in adults with MS. MethodsParticipants (N=275) completed the Cambridge-Hopkins Restless Legs Syndrome Questionnaire, the International Restless Legs Syndrome Study Group (IRLS) Scale, the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ), the Pittsburgh Sleep Quality Index (PSQI), the Patient Determined Disease Steps (PDDS), and a demographic and clinical characteristics questionnaire. ResultsPersons with MS who had RLS (i.e., MS+RLS; n=74) reported significantly worse perceived cognitive impairment compared with those who did not have RLS (n=201; p=0.015). Bivariate correlation analyses within the MS+RLS group indicated that greater RLS severity was significantly associated with more severe perceived cognitive impairment (r=0.274) and sleep quality (r=0.380), and worse perceived cognitive impairment was significantly associated with worse sleep quality (r=0.438). Linear, step-wise regression analyses indicated that RLS severity significantly predicted perceived cognitive impairment (β=0.274), but the inclusion of sleep quality (β=0.391) accounted for the relationship between RLS severity and perceived cognitive impairment (β=0.126). ConclusionsOur results suggest that sleep impairment may be an intermediary factor in the association between RLS severity and cognitive impairment in persons with MS who present with RLS. The diagnosis and treatment of RLS symptoms and other effectors of sleep quality could improve neuropsychological consequences of MS.

Development of the Reading Cognitive Test Kyoto (ReaCT Kyoto) for Early Detection of Cognitive Decline in Patients with Hearing Loss.

Background:Early detection of cognitive decline allows timely intervention to delay progression of dementia. However, current cognitive evaluation tools often include items delivered via verbal forms of instruction, which can cause poor performance in patients with hearing loss.Objective:To develop and validate a cognitive screening battery, the Reading Cognitive Test Kyoto (ReaCT Kyoto), comprising test items given through non-verbal instruction.Methods:A cross-sectional and multi-center study was conducted in the three medical institutes. ReaCT Kyoto was designed to evaluate domains of “registration,” “repetition,” “delayed recall,” “visuospatial recognition,” “orientation in time and place,” and “executive function.” The Japanese version of the Mini-Mental State Examination Test (MMSE-J) and ReaCT Kyoto were applied by experienced psychotherapists. Concurrent validity was evaluated between the ReaCT Kyoto Test and MMSE-J and between the ReaCT Kyoto Test and physician-diagnosed dementia.Results:ReaCT Kyoto was validated in a sample of 115 participants. The mean age of subjects was 81.0±6.4 years, and the sample comprised 53.0% females. The area under the receiver operating curves was 0.95 for detecting physician-diagnosed dementia. When classifying patients in accordance with presence or absence of hearing loss, the AUCs were 0.93 and 0.97 for those with and without hearing loss, respectively. With a cut-off score of < 29 points for suspected dementia, ReaCT Kyoto correctly classified 90.4% of the subjects as belonging to the group with or without physician-diagnosed dementia.Conclusion:ReaCT Kyoto provides an appropriate solution for detection of cognitive impairment in persons with or without hearing loss.

Baseline 10-Year Cardiovascular Risk Scores Predict Cognitive Function in Older Persons, and Particularly Women, Living With Human Immunodeficiency Virus Infection

Cardiovascular disease (CVD) and associated comorbidities increase the risk of cognitive impairment in persons living with human immunodeficiency virus (PLWH). Given the potential composite effect of multiple cardiovascular risk factors on cognition, we examined the ability of the Atherosclerotic Cardiovascular Disease (ASCVD) risk score and the Framingham Heart Study Global CVD risk score (FRS) to predict future cognitive function in older PLWH. We constructed linear regression models evaluating the association between baseline 10-year cardiovascular risk scores and cognitive function (measured by a summary z-score, the NPZ-4) at a year 4 follow-up visit. Among 988 participants (mean age, 52 years; 20% women), mean 10-year ASCVD risk score at entry into the cohort was 6.8% (standard deviation [SD], 7.1%) and FRS was 13.1% (SD, 10.7%). In models adjusted only for cognitive function at entry, the ASCVD risk score significantly predicted year 4 NPZ-4 in the entire cohort and after stratification by sex (for every 1% higher ASCVD risk, year 4 NPZ-4 was lower by 0.84 [SD, 0.28] overall, P = .003; lower by 2.17 [SD, 0.67] in women, P = .001; lower by 0.78 [SD, 0.32] in men, P = .016). A similar relationship was observed between FRS and year 4 NPZ-4. In multivariable models, higher 10-year ASCVD risk and FRS predicted lower NPZ-4 in women. Baseline 10-year ASCVD risk and FRS predicted future cognitive function in older PLWH with well-controlled infection. Cardiovascular risk scores may help to identify PLWH, especially women, who are at risk for worse cognition over time.

Preliminary results of cross – Sectional research for moderate cognitive impairments among persons over 60 years in the Kazakh population

Today, about two million elderly people live in Kazakhstan, which is more than 10% of the population, thus crossing the seven percent threshold for the definition of an “aging” country in the world. Data on the prevalence of mild cognitive impairment (MCI) and dementia are absent in Central Asia, particularly in Kazakhstan. The Global prevalence pattern of dementia depends on several factors, from life expectancy to the health status, last but not least from the particular environment. It is very difficult to determine a particular factor for it. To study the prevalence of cognitive impairment in persons of the Kazakh population over 60 years old in Almaty 150 respondents aged from 60 to 84 years (Mean age 67.6) took part in the screening. The material was collected using the Champ Clinic Questionnaire Questionnaire and the MOCA test (cut point <26) on the basis of the Almaty city polyclinic. Mild cognitive impairment was detected - 39.9%, light cognitive impairment - 33,4%, normal cognitive function - 26.7%. Expected risk factors for MCI: arterial hypertension – 86.89%, Cardiac ischemia, angina pectoris – 70.21%, pathology of the thyroid gland and pancreas (Diabetes, hyperthyroidism and hypothyroidism) – 29.50%, atherosclerotic vascular disease – 29.9%, brain trauma – 18.22%, level of education – 4.24%, depression – 0.6%, respectively. Kazakhstan is a middle-income country with a growing tendency of an aging population, and we have an urgent need to continue screening the population for the identification of moderate cognitive impairment in individuals in the Kazakh population.

Cognitive impairment in patients with rheumatoid arthritis

BackgroundNeurological manifestations of Rheumatoid Arthritis (RA) are usually uncommon. However, a number of recent studies have reported that the burden of cognitive impairment in RA could be significant. We sought to explore the prevalence and clinical predictors of cognitive impairment in persons with RA. MethodsThis is a cross-sectional case-control study with patients with RA. Different trained and blinded interviewers registered clinical-epidemiological data and applied a standardized neurological assessment for each subject of the study. At baseline, functional limitations were characterized using the Health Assessment Questionnaire (HAQ). Cognitive impairment was evaluated with the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) while neuropsychiatric symptoms were investigated with the Hospital Anxiety and Depression Scale (HADS). Using a proper statistical analysis, we compared the neurological outcomes between case and controls and we determined the clinical predictors of cognitive decline. ResultsA total of 210 patients with RA and 70 healthy controls were included in our study. More than two thirds of our patients were classified as cognitively impaired. The mean MMSE and MoCA scores were significantly lower in RA subjects compared to the control group (p < 0.001). Neuropshychiatric impairment was more prevalent in RA patients (59.5%) than in controls (17.1%) as well (p < 0.001). Greater functional limitations were correlated with worse MMSE, MoCA and HADS scores (p < 0.001). ConclusionThe findings of this study suggest that there is evidence of cognitive impairment in adults with RA.

Serum neurofilament light chain levels associations with gray matter pathology: a 5-year longitudinal study.

BackgroundGray matter (GM) pathology is closely associated with physical and cognitive impairment in persons with multiple sclerosis (PwMS). Similarly, serum neurofilament light chain (sNfL) levels are related to MS disease activity and progression.ObjectivesTo assess the cross–sectional and longitudinal associations between sNfL and MRI–derived lesion and brain volume outcomes in PwMS and age–matched healthy controls (HCs).Materials and MethodsForty‐seven HCs and 120 PwMS were followed over 5 years. All subjects underwent baseline and follow–up 3T MRI and sNfL examinations. Lesion volumes (LV) and global, tissue–specific and regional brain volumes were assessed. sNfL levels were analyzed using single molecule array (Simoa) assay and quantified in pg/mL. The associations between sNfL levels and MRI outcomes were investigated using regression analyses adjusted for age, sex, baseline disease modifying treatment (DMT) use and change in DMT over the follow‐up. False discovery rate (FDR)–adjusted q‐values <0.05 were considered significant.ResultsIn PwMS, baseline sNfL was associated with baseline T1‐, T2‐ and gadolinium‐LV (q = 0.002, q = 0.001 and q < 0.001, respectively), but not with their longitudinal changes. Higher baseline sNfL levels were associated with lower baseline deep GM (β = −0.257, q = 0.017), thalamus (β = −0.216, q = 0.0017), caudate (β = −0.263, q = 0.014) and hippocampus (β = −0.267, q = 0.015) volumes. Baseline sNfL was associated with longitudinal decline of deep GM (β = −0.386, q < 0.001), putamen (β = −0.395, q < 0.001), whole brain (β = −0.356, q = 0.002), thalamus (β = −0.272, q = 0.049), globus pallidus (β = −0.284, q = 0.017), and GM (β = −0.264, q = 0.042) volumes. No associations between sNfL and MRI–derived measures were seen in the HCs.ConclusionHigher sNfL levels were associated with baseline LVs and greater development of GM atrophy in PwMS.

Measuring theory of mind in schizophrenia research: Cross-cultural validation

Theory of mind (ToM) is the ability to understand mental states of others and it is crucial for building sensitivity to other persons or events. Measuring ToM is important for understanding and rehabilitating social cognitive impairments in persons with schizophrenia. The Social Attribution Task-Multiple Choice (SAT-MC) has been successfully employed to measure ToM between individuals with schizophrenia (SZ) and healthy controls (HC) in North America. Given that the SAT-MC uses geometric shapes, is nonverbal and less culturally loaded than other social cognition measures, it may serve for measuring ToM in schizophrenia across cultures.A total of 120 participants (30 per group; Korean SZ; Korean HC; North American SZ; North American HC) were selected from existing databases to examine the reliability and validity of the SAT-MC. Internal consistency, factor structure, measurement invariance, discriminant validity, and convergent/divergent validity were examined.The SAT-MC had good internal consistency regardless of the clinical and cultural group as evidence by Cronbach's α ≥ 0.78 in all groups. Confirmatory factor analysis confirmed the one-factor model with a good model fit (χ2 = 188.122, TLI = 0.958, CFI = 0.963, RMSEA = 0.045). The SAT-MC was sensitive to detect individual differences in ToM of SZ and HC, regardless of culture (p < 0.001), and significantly correlated with other social cognition tasks (Hinting and Reading the Mind in the Eyes Test) among Korean and North American patients.The SAT-MC is a reliable measure for evaluating ToM in both Koreans and North Americans with or without schizophrenia, supporting its potential utility in diverse language and cultures for schizophrenia research.

Prevalence of and risk factors for cerebral microbleeds among adult patients with haemophilia A or B.

Cerebral microbleeds (CMBs) represent clinically silent haemorrhagic events. Cerebral microbleeds (CMBs) portend negative neurovascular and cognitive outcomes in the general population and are associated with cognitive impairment in persons with haemophilia (PWH). Prevalence, patterns, and risk factors for CMBs in PWH have not been directly compared to persons without coagulopathy. To examine prevalence, patterns, and risk factors for CMBs in PWH vs normal controls. Adults with haemophilia A or B and haemostatically normal controls were recruited. Subjects were excluded if taking an antithrombotic agent other than low-dose aspirin (<100mg). All subjects underwent T2*MRI of the brain; scans were reviewed independently by two neuroradiologists blinded to subject group to determine the presence of CMBs. We recruited 31 PWH and 32 controls. Human immunodeficiency virus (HIV) and history of hepatitis C virus (HCV) infection were more prevalent in PWH; smoking was more common among controls. Cardiovascular (CV) risk factors were similar between groups. Prevalence of CMBs was 35% in PWH and 25% in controls (P=.42). Among PWH, advanced age, history of HCV infection, and CV risk factors were associated with CMBs. Multiple and large (>5mm) CMBs were seen only in PWH. Cerebral microbleeds (CMBs) are common in adults with haemophilia, but not clearly more prevalent than in haemostatically normal controls. In PWH, older age, HCV infection, CV risk factors, and the presence of an inhibitor were associated with CMBs. Large CMBs and multiple CMBs may be more prevalent in PWH than in the general population. The clinical impact of CMBs in PWH requires further study.

Cognitive Frailty in China: Results from China Comprehensive Geriatric Assessment Study.

Cognitive frailty (CF) refers to the co-occurrence of physical frailty (PF) and cognitive impairment in persons without dementia. We aimed to explore the prevalence and associated factors of CF in China. Data were obtained from the China Comprehensive Geriatric Assessment Study. A total of 5,708 community-dwelling older adults without dementia were included. CF was assessed using the Mini-Mental State Examination for the evaluation of cognitive status and the Comprehensive Geriatric Assessment-Frailty Index for the evaluation of PF. Participants with both cognitive impairment and PF were classified as having CF. Sociodemographic and clinical history was also collected. Logistic analysis was used to explore the association between the associated factors and CF. The overall crude prevalence of CF was 3.3% [95% confidence interval (CI) = 3.0-4.0], and the standard prevalence of CF was 2.7% (95% CI = 2.0-3.0). The prevalence of CF was significantly higher in women than men and higher in residents of rural areas than urban areas. Moreover, the prevalence of CF was found to increase with age. Multiple factor analysis showed that depression (OR = 2.462, 95% CI = 1.066-5.687) and hearing impairment (OR = 2.713, 95% CI = 1.114-6.608) were independent associated factors of CF in elderly individuals with PF. Our results provide the first empirical evidence of CF in China. We have identified several associated factors with CF which should be considered while assessing older adults. More studies in Chinese population with CF are demanded to confirm with our findings.

Getting clocked: screening for TBI-related cognitive impairment with the clock drawing test

ABSTRACTPrimary Objective: Undetected cognitive impairment resulting from Traumatic Brain Injuries (TBIs), particularly the 75–95% classified as mild (mTBI), poses a significant public health challenge as untreated symptoms, can persist and cause lasting disability. These cognitive deficits are often missed by standard screening tests, creating a need for alternative cognitive screening tools. The Clock Drawing Test (CDT), a popular, brief cognitive screening instrument, was used to evaluate cognition in persons with TBI.Design: The effectiveness of the CDT was assessed on its own and in tandem with a validated computerised screening battery, including the Stroop Test, Symbol Digit Modalities Test (SDMT), and Paced Visual Serial Addition Test 2-second trials (PVSAT-2).Methods and Procedures: The clock drawing component of the Montreal Cognitive Assessment (MoCA) of 223 subjects attending an outpatient TBI clinic was scored using two different methods.Main Outcomes and Results: The CDT screened for cognitive impairment most effectively when scored using the Clock Drawing Interpretation Scale (CDIS). Cognitive impairment was detected in 19.4% of the elusive cohort of persons with mTBI.Conclusions: The results of this study suggest that the CDT is effective at screening for cognitive impairment in persons with TBI. The CDT could be a valuable supplementary tool in TBI clinics as well as an effective cognitive screening instrument in busy primary care settings.