Cognitive Screening Instrument Research Articles

Historic Cognitive Function Trajectories as Predictors of Sedentary Behavior and Physical Activity in Older Adults.

We examined whether trajectories of cognitive function over 10 years predict later-life physical activity (PA), sedentary time (ST), and sleep. Participants were from the Adult Changes in Thought (ACT) cohort study. We included 611 ACT participants who wore accelerometers and had 3+ measures of cognition in the 10 years prior to accelerometer wear. The Cognitive Assessment Screening Instrument (CASI) measured cognition and was scored using item-response theory (IRT). activPAL and ActiGraph accelerometers worn over 7 days measured ST and PA outcomes. Self-reported time in bed and sleep quality measured sleep outcomes. Analyses used growth mixture modeling to classify CASI-IRT scores into latent groups and examine associations with PA, ST, and sleep including demographic and health covariates. Participants (Mean age = 80.3 (6.5) years, 90.3% White, 57.1% female, 29.3% had less than 16 years of education) fell into 3 latent trajectory groups: average stable CASI (56.1%), high stable CASI (34.0%), and declining CASI (9.8%). The declining group had 16 minutes less stepping time (95% confidence interval [95% CI]: 0.6, 31.4), 1517 fewer steps per day (95% CI: 138, 2896), and 16.3 minutes per day less moderate-to-vigorous PA (95% CI: 1.3, 31.3) compared to the average stable group. There were no associations between CASI trajectory and sedentary or sleep outcomes. Declining cognition predicted lower PA providing some evidence of a reverse relationship between PA and cognition in older adults. However, this conclusion is limited by having outcomes at only one time point, a nonrepresentative sample, self-reported sleep outcomes, and using a global cognition measure.

#3042 Prevalence and associations of impaired cognitive function for people with chronic kidney disease: baseline findings from the NURTuRE-CKD cohort study

Abstract Background and Aims Chronic kidney disease (CKD) is known to be associated with impaired cognitive function, with lower estimated glomerular filtration rate (eGFR) associated with poorer cognitive performance [1]. Though CKD prevalence increases with age, the association with cognitive disorders is not entirely explained by age distribution. Cognitive impairment in CKD is multifactorial with potential biochemical, cardiovascular, medication and socio-economic mediators. As with other long-term conditions, self-management of kidney disease becomes more difficult in the context of cognitive impairment. The prevalence and associations of cognitive impairment in people referred to secondary care with CKD is not well described. This study therefore aimed to identify the prevalence and associations of impaired cognitive function among a referred population of people with CKD. Method The NURTuRE-CKD cohort recruited 2996 people with an estimated Glomerular Filtration Rate (eGFR) of 15-59 ml/min/1.73 m2 (CKD-EPI equation) or ≥60 ml/min/1.73 m2 with a urine albumin to creatinine ratio (uACR) of more than 30 mg/mmol referred to one of 16 secondary care nephrology clinics. Baseline data were collected between 2017-2019 including sociodemographic, anthropometric, biochemical, and clinical information and included the 6-item cognitive impairment test (6-CIT), a commonly used cognitive screening instrument. Other scores collected included the Hospital Anxiety and Depression score (HADS), EQ-5D-5L as a health-related quality of life (HRQoL) measure and Single Item Literacy Screener (SILS). Prevalence of impaired cognitive function (defined as 6-CIT score of 8 or more out of 28) was calculated and multivariable mixed effects logistic regression models used to identify associations with impaired cognitive function. The multivariable model was adjusted for known factors impacting cognitive impairment and recruitment region as a random effect. Results A total of 2743/2996 (91.6%) participants had complete 6-CIT data. Median age was 66 years and 41% were female. Median eGFR was 34 ml/min/1.73 m2. Prevalence of cognitive impairment was 8.7% (240/2743), rising from 5.3% in those <65 to 10.6% in those ≥65 years. eGFR was not associated with cognitive impairment on univariate analysis. After adjustment, greater likelihood of cognitive impairment was independently associated with older age, Asian and Black ethnicity (compared to white), and limited health literacy. Lower likelihood of cognitive impairment was associated with better HRQoL and higher education attainment (Figs 1 and 2). Conclusion Cognitive impairment was relatively common in this cohort of people with CKD. Similar associations for cognitive impairment with age and education in a CKD population had also been identified in CKD-REIN—a prospective cohort of CKD patients recruited from secondary care in France, though using a different cognitive function measure. Associations of limited health literacy, ethnicity, and HRQoL with cognitive impairment were identified risk factors that could aid clinicians in recognising high risk patients to prompt screening and improve management. Follow-up data will allow longitudinal analyses to explore associations between impaired cognitive function and health-related outcomes, between kidney function and change in cognitive function and risk factors for change in cognitive function, including the role of inflammatory markers. Limitations: this analysis only used baseline data so causality cannot be established, 6-CIT is a screening rather than diagnostic tool for cognitive impairment.

Longitudinal neuropsychological performance of post-stroke adults with and without rehabilitation

This study compared the neuropsychological performance of two post-stroke groups, one undergoing rehabilitation and the other not receiving any intervention, on the acute and chronic stroke phases, and explored sociodemographic and neurological variables associated with changes in performance over time. Sixty-three adults underwent neuropsychological assessment with the Cognitive Screening Instrument (TRIACOG) less than thirty days after having a stroke and were reassessed three to six months after stroke. Thirty-eight participants did not undertake rehabilitation and twenty-five did physiotherapy and/or speech therapy between the two time points. The frequency of cognitive deficits (between groups) and the range of cognitive assessment scores over time (between and within groups) were analyzed. There was a significant decrease in the frequency of neuropsychological deficits and improvement on neuropsychological assessment scores over time only in the group undergoing rehabilitation. Severity of the neurological condition, years of education and being in rehabilitation explained the longitudinal changes in several cognitive domains measured by TRIACOG. Engaging in rehabilitation within three to six months post-stroke is crucial for enhancing the recovery of neuropsychological deficits. Cognitive screening instruments like TRIACOG can be used by health professionals to identify stroke-related neuropsychological changes and plan interventions.

Cognitive screening in elderly people

Elderly people are exposed to functional losses, which can either be natural transformations (senescence), or pathological (senility). Cognitive screening tests identify cognitive impairment and risk of developing dementia. This article aims to assess the effectiveness of three cognitive screening instruments in detecting cognitive impairment in elderly individuals with limited education. The study involved 920 individuals over the age of 60, who were recruited from driver’s license centers in various Brazilian states. Participants were assessed using the cognitive screening tools: Battery Routes of Attention (BRA), to attentional capacity; Nonverbal General Intelligence Matrices (MIG), to non-verbal intelligence; and Visual Recognition Memory Test (Memore), to short-term memory. The study examined the correlation between the total scores on tests and the participants' profile (mean=69.10 and SD=6.54), according to sex, age, age group, education level, and state of Brazil. The analysis found a positive correlation between the total scores of the cognitive tests and the level of education of the participants, with higher levels of education serving as a protective factor for cognition. There was moderate correlation between visual recognition memory and sex, indicating better mnemonic performances for female participants. Age was found to have a negative correlation with all cognitive screening tests. The use of cognitive screening batteries can provide relevant indicators to plan appropriate interventions with elderly people. Furthermore, these test results emphasize the significance of further research to enhance the credibility of cognitive screening tests and broaden their applicability to elderly populations with diverse cultural backgrounds.

Convergent Validity and Classification Agreement Between Traditional Cognitive Screening Instruments and a Novel, Electronic-based, Voice-recognition Cognitive Screening Tool (P5-9.004)

Convergent Validity and Classification Agreement Between Traditional Cognitive Screening Instruments and a Novel, Electronic-based, Voice-recognition Cognitive Screening Tool (P5-9.004)

A novel speech analysis algorithm to detect cognitive impairment in a Spanish population.

Early detection of cognitive impairment in the elderly is crucial for diagnosis and appropriate care. Brief, cost-effective cognitive screening instruments are needed to help identify individuals who require further evaluation. This study presents preliminary data on a new screening technology using automated voice recording analysis software in a Spanish population. Data were collected from 174 Spanish-speaking individuals clinically diagnosed as cognitively normal (CN, n = 87) or impaired (mild cognitive impairment [MCI], n = 63; all-cause dementia, n = 24). Participants were recorded performing four common language tasks (Animal fluency, alternating fluency [sports and fruits], phonemic "F" fluency, and Cookie Theft Description). Recordings were processed via text-transcription and digital-signal processing techniques to capture neuropsychological variables and audio characteristics. A training sample of 122 subjects with similar demographics across groups was used to develop an algorithm to detect cognitive impairment. Speech and task features were used to develop five independent machine learning (ML) models to compute scores between 0 and 1, and a final algorithm was constructed using repeated cross-validation. A socio-demographically balanced subset of 52 participants was used to test the algorithm. Analysis of covariance (ANCOVA), covarying for demographic characteristics, was used to predict logistically-transformed algorithm scores. Mean logit algorithm scores were significantly different across groups in the testing sample (p < 0.01). Comparisons of CN with impaired (MCI + dementia) and MCI groups using the final algorithm resulted in an AUC of 0.93/0.90, with overall accuracy of 88.4%/87.5%, sensitivity of 87.5/83.3, and specificity of 89.2/89.2, respectively. Findings provide initial support for the utility of this automated speech analysis algorithm as a screening tool for cognitive impairment in Spanish speakers. Additional study is needed to validate this technology in larger and more diverse clinical populations.

On the Dependence of the Critical Success Index (CSI) on Prevalence.

The critical success index (CSI) is an established metric used in meteorology to verify the accuracy of weather forecasts. It is defined as the ratio of hits to the sum of hits, false alarms, and misses. Translationally, CSI has gained popularity as a unitary outcome measure in various clinical situations where large numbers of true negatives may influence the interpretation of other, more traditional, outcome measures, such as specificity (Spec) and negative predictive value (NPV), or when unified interpretation of positive predictive value (PPV) and sensitivity (Sens) is needed. The derivation of CSI from measures including PPV has prompted questions as to whether and how CSI values may vary with disease prevalence (P), just as PPV estimates are dependent on P, and hence whether CSI values are generalizable between studies with differing prevalences. As no detailed study of the relation of CSI to prevalence has been undertaken hitherto, the dataset of a previously published test accuracy study of a cognitive screening instrument was interrogated to address this question. Three different methods were used to examine the change in CSI across a range of prevalences, using both the Bayes formula and equations directly relating CSI to Sens, PPV, P, and the test threshold (Q). These approaches showed that, as expected, CSI does vary with prevalence, but the dependence differs according to the method of calculation that is adopted. Bayesian rescaling of both Sens and PPV generates a concave curve, suggesting that CSI will be maximal at a particular prevalence, which may vary according to the particular dataset.

The Memory Assessment Scale: A Population-based Cognitive Impairment Screening Instrument

This study re-examined the Memory Assessment Scale (MAS), a brief memory test developed in Hawai‘i in 1987, to assess whether it remains a valid and reliable cognitive impairment screening tool in Hawai‘i. Patients suspected of having neurocognitive dysfunction were divided into 2 groups (those with and without mild cognitive impairment) based on their results on a battery of neuropsychological tests. No differences in MAS scores were found between patients with and without mild cognitive impairment. Further research with the MAS comparing patients with mild cognitive disorder to healthy controls is indicated to further examine the efficacy of this population-based test.

Impact of Parkinsonism comorbid depression on cognitive functions

BackgroundParkinson's disease (PD) is a chronic progressive neurodegenerative disabling disease and involves about 1–3% of the worldwide population over the age of 60. A significant prevalence of psychopathological symptoms has been recorded as most patients with PD developed over their disease course neuropsychiatric symptoms such as depression, anxiety, sleep disorders, psychosis, and cognitive and behavioral abnormalities. These non-motor symptoms, which could appear decades before motor ones, become disturbing symptoms during the later phases of the disease. Hence, the current research aims to study depressive symptoms in Parkinson's disease patients. Thirty-six patients with Parkinson’s disease aged from 40 to 65 years (20 males and 16 females) and 36 age and sex-matched controls (19 males and 17 females) were included in the study. Unified Parkinson’s Disease Rating Scale (UPDRS), Hoehn and Yahr scale, Schwab and England’s scale, Mini-Mental State Examination, Cognitive Ability Screening Instrument, and Hamilton Depression Rating Scale were applied to assess depression in both groups.ResultsPatients were 20 males and 16 females (mean age 52.44 ± 7.45), mean duration of Parkinsonism was 3.88 years. The mean value for Hoehn and Yahr scale was 1.97 ± 1.42, for UPDRS T was 42.41 ± 20.91 and Schwab England's scale was 74.77 ± 17.78. Concerning cognition, MMSE was significantly lower among patients 25.33 ± 3.63, than in the control group and CAS total was significantly lower in patients (16 ± 71.35) than in the control group 9.81 ± 84.62.ConclusionDepressive symptoms are widespread in Parkinson's disease. Depression should be strictly determined and addressed, particularly in patients with more advanced cognitive impairment who are at a higher risk of developing or worsening depression.

Effectiveness of Early Multimodal Non-pharmacological Interventions in Cognitive Preservation in the Elderly.

Multimodal non-pharmacological interventions (MNPI) have been determined as effective in delaying cognitive deterioration. The effectiveness of timing of such interventions in elderly is less discussed. We compared the different effectiveness of MNPI in cognitive preservation in elderly subjects with and without dementia. We enrolled volunteer the elderly subjects. Subjects were classified as dementia group and non-dementia group by instrument of ascertainment of dementia 8. All were assigned to attend 3 hours of MNPI (physical fitness training, Chinese capillary, and Chinese drawings and paintings) twice a week over a 16-week period. Neuropsychiatric tests, including Mini-Mental State Examination (MMSE), Cognitive Assessment Screening Instrument (CASI), clinical dementia rating (CDR), and neuropsychiatric inventory (NPI), were administered before and 1 year after MNPI. We demonstrated the changes of cognition and behavioral and psychological symptoms of dementia (BPSD) before and after MNPI. We compared the different effectiveness of cognition preservation between two groups. In total, there were 43 participants in our study, including 18 with non-dementia and 25 with dementia. The non-dementia group had a significantly higher proportion of cognitive preservation in remote memory (100.0% vs 68.0%, P = .007), orientation (94.4% vs 48.0%, P = .001), drawing (94.4% vs 64.0%, P = .021) and language (77.8% vs 48.0%, P = .049) than the dementia group. The highest proportion of preserved cognition after MNPI was remote memory (100%), followed by orientation (94.4%) and drawing (94.4%) in the non-dementia group. The highest proportion of preserved cognition after MNPI was attention (72%) followed by remote memory (68%), recent memory (64%) and drawing (64%) in the dementia group. Overall, their improved rate in behavioral and psychological symptoms was 55.6%. Our study concluded the benefits of early MNPI in cognition preservation in the elderly, especially in the field of remote memory, orientation, drawing and language.

A novel sociodemographically‐neutral speech analysis algorithm to detect cognitive impairment in a Spanish population

AbstractBackgroundEarly detection of mild cognitive impairment (MCI) and dementia is crucial for initiation of care. Brief, cost‐effective cognitive screening instruments are needed to identify individuals who require further evaluation. This study presents preliminary data on a new screening technology using automated recordings analysis software in a Spanish population.MethodData were collected from 148 Spanish‐speakings in Spain (MAge = 74.4, MEducation = 12.93, 43.3% males), clinically diagnosed as cognitively normal (CN, n = 78) or impaired (MCI, n = 49; all‐cause dementia, n = 21). Participants were recorded performing four language tasks [Animal fluency, alternating fluency (sports and fruits), phonemic “F” fluency and Cookie Theft Description]. Recordings were processed via text‐transcription and digital‐signal processing techniques to capture neuropsychological variables and audio characteristics. A training sample of 103 subjects with similar demographics (age, sex, education) across groups was used to develop an algorithm to detect cognitive impairment. The features of each task and of speech were used separately to develop five algorithms to compute scores between 0 and 1, and a final algorithm was constructed from these using repeated cross‐validation. Of the 45 remaining original participants, an age‐balanced subset of 28 subjects was used to test the algorithm. General linear modeling was used to quantify demographic biases in the data and in the predicted logistically‐transformed algorithm scores.ResultMean logit algorithm scores were significantly different across groups in both test/training samples (p&lt;1e‐3). Sex‐bias in the test dataset (psex = 1.3e‐5) was reduced by predicted logit scores (psex = 0.01); other demographic variables were not significant across samples (page = 0.31→0.21; peducatiom = 0.69→0.58; pmultilingualism = 0.74→0.32). The final algorithm in test/training samples obtained an AUC of 0.908/0.956, with overall accuracy of 89%/89%, sensitivity of 0.85/0.95, and specificity of 0.92/0.83 in discriminating CN and impaired groups.ConclusionThese findings provide initial support for the utility of this automated speech analysis algorithm as a screening tool for cognitive impairment that does not explicitly use memory tests. Further research is needed to validate algorithm in other languages and cultures.

Psychometric Properties of the Chinese Version of the ElectroConvulsive Therapy Cognitive Assessment: An Electroconvulsive Therapy-Specific Cognitive Screening Tool.

Electroconvulsive therapy (ECT) is an effective somatic treatment, but it may be limited by cognitive adverse effects. The existing cognitive screening instruments often lack specificity to ECT-associated cognitive deficits. The ElectroConvulsive Therapy Cognitive Assessment was developed and validated in a clinical setting, but the reliability and validity of the Chinese version of ElectroConvulsive Therapy Cognitive Assessment (ECCA-C) have not been studied in a large clinical sample. The ECCA-C and the Montreal Cognitive Assessment (MoCA) were administered to patients with major depressive disorder (MDD) undergoing ECT at 3 time points: pretreatment (baseline), before the fifth treatment, and 1 week posttreatment. The instruments were also administered to a sample of healthy subjects. Sixty-five patients with MDD and 50 age- and sex-matched healthy controls were recruited in this study. Overall, the patient group had statistically significantly lower MoCA and ECCA-C scores than the control group (both P values <0.001). The Cronbach α of the ECCA-C was 0.88 at baseline. Statistically significant decreases over time were observed in ECCA-C: pre-ECT (23.9 ± 4.0) > mid-ECT (21.3 ± 3.4) > post-ECT (18.7 ± 4.8) (all P values <0.001), whereas no statistically significant changes in MoCA scores were found at these 3 time points (F = 1.86, P = 0.165). A cutoff score of 26.5 on the ECCA-C was found to best differentiate between MDD patients and healthy controls. The ECCA-C showed satisfactory psychometric properties and may be a more sensitive instrument than the MoCA to assess cognitive impairment associated with ECT.

78 Preliminary Exploration of a Novel Speech Analysis Algorithm to Detect Cognitive Impairment in a Spanish Population

Objective:Early detection of mild cognitive impairment (MCI) and dementia is crucial for initiation of treatment and access to appropriate care. While comprehensive neuropsychological assessment is often an intrinsic part of the diagnostic process, access to services may be limited and cannot be utilized effectively on a large scale. For these reasons, cognitive screening instruments are used as brief and cost-effective methods to identify individuals who require further evaluation. Novel technologies and automated software systems to screen for cognitive changes in older individuals are evolving as new avenues for early detection. The present study presents preliminary data on a new technology that uses automated linguistic analysis software to screen for MCI and dementia.Participants and Methods:Data were collected from 148 Spanish-speaking individuals recruited in Spain (MAge=74.4, MEducation=12.93, 56.7% females) of whom 78 were diagnosed as cognitively normal [CN; Mmmse = 28.51 (1.39)], 49 as MCI [MMMSE = 25.65 (2.94)], and 21 as all-cause dementia [MMMSE = 22.52 (2.06)]. Participants were recorded performing various verbal tasks [Animal fluency, phonemic (F) fluency, Cookie Theft Description, and CERAD list learning task]. Recordings were processed via text-transcription and sound signal processing techniques to capture neuropsychological variables and audio characteristics. Features from each task were used in the development of an algorithm (for that task) to compute a score between 0 or 1 (healthy to more impairment), and a fifth algorithm was constructed using audio characteristics from all tasks. These five classifiers were combined algorithmically to provide the final algorithm. Receiver Operating Characteristic (ROC) analysis was conducted to determine sensitivity and specificity of predicted algorithm performance [CN vs. impaired (MCI or dementia)] against clinical diagnoses, and additional general linear modeling was used to test whether age, sex, education, and multilingualism significantly predicted logistically transformed weighted algorithm scores.Results:Scores were transformed to logit scores, with significant differences in mean logit scores between all groups (p &lt;.001). Logit-inverse transformation of mean logit scores (possible range 0 -1) resulted in values of 0.06 for CN, 0.90 for MCI, and 0.99 for all-cause dementia groups. ROC curve analyses revealed the algorithm obtained a total area under the curve of 0.92, with an overall accuracy of 86.8%, a sensitivity of 0.92, and specificity of 0.82. Age was identified as a significant predictor (beta = 0.22; p &lt;0.01) of algorithm output, whereas years of education (beta = -0.04; p = 0.64), sex (beta = 0.38; p = 0.02, did not survive correction for type-1 error), and multilingualism (beta = -0.24; p = 0.22) were non-significant.Conclusions:These findings provide initial support for the utility of an automated speech analysis algorithm to detect cognitive impairment quickly and efficiently in a Spanish-speaking population. Although sociodemographic variables were not included in the algorithm, age significantly predicted algorithm output, and should be further explored to determine if age-adjusted formulas would improve algorithm accuracy for younger versus older individuals. Additional research is needed to validate this novel methodology in other languages, as this may represent a promising cross-cultural screening method for MCI and dementia detection.

Clock Drawing Test Common Errors in Older People with Cancer

The Clock drawing test (CDT) is a time-efficient cognitive screening instrument validated in older patients with cancer. Our aim was to describe the CDT patterns of errors in a sample of older patients with different cancer diagnosis

A - 182 Comparison of the Short Test of Mental Status to Traditional Neuropsychological Tests.

The Short Test of Mental Status (STMS) was developed by Kokmen and colleagues as a brief cognitive screening test. Existing research has found the STMS to be sensitive in detecting cognitive impairment in patients with Mild Cognitive Impairment (MCI). The STMS has also been shown to be comparable to other cognitive screening instruments, including the Montreal Cognitive Assessment (MoCA). However, the relationship between the STMS and traditional neuropsychological tests has yet to be evaluated. This study sought to explore the concordance between the STMS test items and neuropsychological test variables in a mixed clinical sample. Neuropsychological test data was collected from an archival database for 150 adults (Mean age = 71.4years) referred to an interdisciplinary dementia care clinic at an academic medical center. Descriptive statistics for the demographic and test variables were produced. Pearson correlations were used to examine the relationships between the STMS total score, STMS item scores, and the neuropsychological test variables. Statistically significant correlations were found between the STMS item scores and their corresponding neuropsychological tests: Orientation (r = 0.46-0.56), Attention (r = 0.39-0.51), Registration-Trials (r = 0.32-0.50), Calculations (r = 0.30-0.41), Construction (r = 0.43), Information (r = 0.56), and Recall (r = 0.61-0.71). The STMS total score was significantly correlated with all neuropsychological test scores (r = 0.30-72). The STMS shows strong concordance with traditional neuropsychological tests in a dementia clinic sample. Future analyses will include examining construct validity of the STMS with different clinical groups and diagnoses as well as an exploration of the underlying factor structure of the STMS.

Validation of a Harmonised, Three-Item Cognitive Screening Instrument for the Survey of Health, Ageing and Retirement in Europe (SHARE-Cog).

More accurate and standardised screening and assessment instruments are needed for studies to better understand the epidemiology of mild cognitive impairment (MCI) and dementia in Europe. The Survey of Health, Ageing and Retirement in Europe (SHARE) does not have a harmonised multi-domain cognitive test available. The current study proposes and validates a new instrument, the SHARE cognitive instrument (SHARE-Cog), for this large European longitudinal cohort. Three cognitive domains/sub-tests were available across all main waves of the SHARE and incorporated into SHARE-Cog; these included 10-word registration, verbal fluency (animal naming) and 10-word recall. Subtests were weighted using regression analysis. Diagnostic accuracy was assessed from the area under the curve (AUC) of receiver operating characteristic curves. Diagnostic categories included normal cognition (NC), subjective memory complaints (SMC), MCI and dementia. A total of 20,752 participants were included from wave 8, with a mean age of 75 years; 55% were female. A 45-point SHARE-Cog was developed and validated and had excellent diagnostic accuracy for identifying dementia (AUC = 0.91); very good diagnostic accuracy for cognitive impairment (MCI + dementia), (AUC = 0.81); and good diagnostic accuracy for distinguishing MCI from dementia (AUC = 0.76) and MCI from SMC + NC (AUC = 0.77). SHARE-Cog is a new, short cognitive screening instrument developed and validated to assess cognition in the SHARE. In this cross-sectional analysis, it has good-excellent diagnostic accuracy for identifying cognitive impairment in this wave of SHARE, but further study is required to confirm this in previous waves and over time.

A Comparison of Cognitive Performance, Depressive Symptoms, and Incidence of Falls in Brazilian Older Women with and without a Confirmed History of COVID-19.

The study aimed to compare cognitive performance, depressive symptoms, and the incidence of falls in Brazilian older women with and without a confirmed history of COVID-19. This cross-sectional study included 188 women (60-89 years), divided into two groups: one with a history of COVID-19 (n = 139), and one without any history of COVID-19 (n = 49). The instruments used were the Cognitive Telephone Screening Instrument (COGTEL) test battery, the Trail Making Test (TMT), the Geriatric Depression Scale (GDS-15), and the self-reported history of falls since the beginning of mandatory confinement. The higher the age, the higher the incidence of falls. The highest prevalence of falls (57.1%) occurred in the COVID-19 group (p = 0.001), the members of which also indicated a better cognitive performance in the COGTEL test (p = 0.017), TMT-B (p = 0.004), and ∆TMT (B-A) (p = 0.004). In turn, the depressive symptoms were more severe in the COVID-19 group (p < 0.001). We observed that COVID-19 infection without hospitalization did not affect the cognitive performance of older adult women. Future studies should be carried out to monitor the mental health of older adult Brazilian women. Moreover, regardless of their history of COVID-19, older adults should participate in a physical training program focused on preventing falls.

Montreal Cognitive Assessment (MoCA): An update normative study for the Portuguese population

The Montreal Cognitive Assessment (MoCA) is a brief cognitive screening instrument that is known for its good psychometric properties and sensitivity to detect mild cognitive impairment (MCI). After ten years, it became relevant to update the previous Portuguese normative study due to changes in the population and some limitations present in the study itself. The study sample was composed of 860 cognitively healthy adults, stratified according to verified distribution of the Portuguese population across several sociodemographic variables. All participants completed a neuropsychological assessment battery, in which the MoCA was included. The analysis of the relationships between the sociodemographic variables and the MoCA show that age and educational level had a significant effect on MoCA scores, with educational level being the better predictor. These results foster the consideration of age and educational level in the development of normative data. The present study contributes to a reliable update of the normative data of MoCA. The new age groups and more stratified norms comply with the natural changes on the Portuguese population, providing an increase of power and clinical accuracy. The presented norms consider the cognitive domains subscores, consequently improving the comprehension and utility of the results obtained from the MoCA test.

Usefulness of the Montreal Cognitive Assessment in Older Adults With Type 1 Diabetes.

Older adults with type 1 diabetes are at high risk for cognitive impairment, yet the usefulness of common cognitive screening instruments has not been evaluated in this population. A total of 201 adults ≥60 years of age with type 1 diabetes completed a battery of neuropsychological measures and the Montreal Cognitive Assessment (MoCA). Receiver operating characteristic (ROC) curves and Youden indices were used to evaluate overall screening test performance and to select an optimal MoCA cutoff score for detecting low cognitive performance, as defined as two or more neuropsychological test performances ≥1.5 SD below demographically corrected normative data. The ROC area under the curve (AUC) was 0.745 (P < 0.001). The publisher-recommended cutoff score of <26 resulted in sensitivity of 60.4% and specificity of 71.4%, whereas a cutoff score of <27 resulted in sensitivity of 75.0% and specificity of 61.0%. The Youden indices for these cutoff scores were 0.318 and 0.360, respectively. Minimally acceptable sensitivity (i.e., >0.80) was obtained when using a cutoff score of <28, whereas >0.80 specificity was obtained with a cutoff score of <25. The MoCA has modest overall performance (AUC 0.745) as a cognitive screening instrument in older adults with type 1 diabetes. The standard cutoff score of <26/30 may not adequately detect individuals with neuropsychological testing-defined abnormal cognition. The optimal MoCA cutoff score (based on the Youden index) was <27/30. A score of <28 resulted in acceptable sensitivity but was accompanied by low specificity (42%). Future studies with a more diverse population are needed to confirm these findings.

Association of Perceived Neighborhood Environments With Cognitive Function in Older Adults.

The current study examined the associations between perceptions of the social and physical neighborhood environments and cognitive function in older adults. This cross-sectional study analyzed 821 adults aged ≥65 years from the Adult Changes in Thought study. Perceived neighborhood attributes were measured by the Physical Activity Neighborhood Environment Scale. Cognitive function was assessed using the Cognitive Ability Screening Instrument. The associations were tested using multivariate linear regression. One point greater perceived access to public transit was associated with 0.56 points greater cognitive function score (95% confidence interval [CI] [0.25, 0.88]), and an additional one point of perceived sidewalk coverage was related to 0.22 points higher cognitive function score (95% CI [0.00, 0.45]) after controlling for sociodemographic factors. The perception of neighborhood attributes alongside physical infrastructure may play an important role in supporting older adults' cognitive function. [Journal of Gerontological Nursing, 49(8), 35-41.].