A multicenter study to validate the Brief Cognitive Status Examination as a screening tool for the detection of cognitive impairment in a substance use disorder population over 45 years of age in a Spanish population.

Linguistic vulnerabilities in mild cognitive impairment: Evidence from the DTLA-Tr screening battery.

Early-life stressors related to war have been linked to disruptions in children's functional cognition, underscoring the need for occupational therapy practitioners to identify and address these difficulties. To compare functional cognition between cohorts of children before a global crisis and during a prolonged war and to test whether cohort differences vary by educational needs (typical vs. special). Repeated cross-sectional design. Community-based data collection. Mothers of two cohorts of second- and third-grade children: Cohort 1 (precrisis, 2016-2017; n = 129) and Cohort 2 (during war, 2024-2025; n = 190). Functional cognition was assessed with the Behavior Rating Inventory of Executive Function (BRIEF) Parent Questionnaire. The BRIEF Global Executive Composite, Behavioral Regulation Index (BRI), and Metacognition Index (MI) were analyzed. After controlling for gender, age, socioeconomic status, and educational needs, children in the Cohort 2 demonstrated significantly lower functional cognition than children in Cohort 1. Multivariate analysis with cohort and educational needs as independent variables and BRI and MI as dependent variables revealed that children exposed to war and those with special educational needs had functional cognition deficits. A significant interaction between cohort and educational needs indicated that exposure to early-life stressors disproportionately affected children with special educational needs. War-related early-life stressors are associated with reduced functional cognition, particularly among children with special educational needs. The BRIEF Parent Questionnaire may serve as a practical screening measure to identify functional cognition challenges and guide pediatric occupational therapy interventions during and after crises. Plain-Language Summary: Functional cognition supports children's ability to meet the demands of their daily tasks in real-world environments, such as managing daily routines, playing, and participating in school tasks. This study examined how prolonged war-related stress affects children's functional cognition. The study compared children assessed before a global crisis with children assessed during a prolonged war, all from low socioeconomic backgrounds. Mothers reported on their children's everyday functional performance with the Behavior Rating Inventory of Executive Function Parent Questionnaire. The findings showed that children exposed to ongoing war-related stress demonstrated lower functional cognition than children assessed before the war. Children with special educational needs were affected most. These findings highlight the importance of identifying functional cognition difficulties during and after crises. For occupational therapy, the results support the use of functional cognition screening in school settings to guide timely, individualized interventions that promote children's participation in daily activities and learning.

BackgroundCognitive impairment in Parkinson's disease (PD) is often overlooked, despite increased risk of dementia in PD. 'PDCogniCare' is an innovation aiming to improve access to cognitive assessments, for earlier diagnosis and care. This study explored barriers and enablers to cognitive assessment in PD, to inform implementation of 'PDCogniCare'.MethodsParticipants included ten people with PD, one caregiver, and nineteen health professionals within two Australian public health services. Semi-structured interviews were informed by the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR). Deductive and inductive analysis was utilised. Barriers were mapped to the CFIR-ERIC (Expert Recommendations for Implementing Change) matching tool to develop implementation strategies.ResultsSeven themes were identified: 1) lack of discussion about cognitive impairment limits access to cognitive assessments and interventions; 2) clinicians need to 'be on board with cognition'; 3) availability of clinic resources impacts delivery of cognitive screens and assessments; 4) variability of clinician decision-making processes to screen or refer patients for neuropsychological assessment; 5) impact of undergoing neuropsychological assessments on people living with PD; 6) uncertainty over benefits of cognitive assessment in changing clinical management; and 7) perceived advantages of 'PDCogniCare' over current practice. Strategies to address identified barriers included: clinician education and training, additional resource allocation, support and feedback, and involving patient/consumer advocates.ConclusionsSeveral barriers and enablers to cognitive assessment in PD were identified, relating to health professional knowledge, beliefs, context and resources. Strategies that address these may improve clinical practice for more proactive treatment and care.

ABSTRACT Objective We investigated the associations of telephone- and computer-administered cognitive screening instruments for Alzheimer’s disease with in-person measurement in a population-based sample of individuals without a prior diagnosis of dementia-causing neurodegenerative disease. Method We studied 202 TWINGEN participants (126 female) who had in-person administered Consortium to Establish a Registry for Alzheimer’s Disease neuropsychological battery (CERAD-nb) data. The participants were aged 65–85 years and of European ancestry. Telephone-administered instruments were telephone assessment for dementia (TELE) and modified version of Telephone Tnterview for Cognitive Status, and computer-administered instrument was web-based cCOG. We utilized correlation analyses, areas under the receiver operating characteristic curves (AUC) and hierarchical linear mixed-effects models in main analyses. Results Screening instruments exhibited moderate to high correlations with CERAD-nb, with the strongest correlation between cCOG and CERAD-nb (r = .62). Despite exclusion criteria, 20 participants had cognitive impairment according to the CERAD-nb total score. When evaluating the instruments’ ability to distinguish between participants with and without cognitive impairment, AUCs ranged from .65 (95% CI [.53, .78]) for TELE to .76 (95% CI [.67, .86]) for cCOG. All instruments predicted in-person CERAD-nb score in linear mixed-effects models, when controlling for demographic factors. Including both telephone- and computer-administered measures as predictors resulted in better accuracy compared to including only one modality as a predictor. Conclusions Performance in telephone- and computer-administered cognitive screening instruments was associated with performance in in-person neuropsychological battery designed for early detection of Alzheimer’s disease. The results indicate validity of the computerized and telephone-administered tests at the population level.

Clinically relevant anxiety can be detected in patients with amyotrophic lateral sclerosis (ALS), but its prevalence and determinants have not yet been fully assessed. This study aimed at assessing the prevalence and clinical underpinnings of anxiety in ALS. Non-demented ALS patients (N = 433) and healthy controls (N = 313) were administered the State- and Trait-Anxiety Inventory - Form Y (STAI-Y1 for state-anxiety and STAI-Y2 for trait-anxiety) and the Beck Depression Inventory (BDI). Patients were further assessed for cognition (Edinburgh Cognitive and Behavioural ALS Screen), behaviour (Frontal Behavioural Inventory) and motor status (disease duration, ALS Functional Rating Scale-Revised and progression rate). The prevalence of clinically significant state- and trait-anxiety were estimated by applying age-stratified cut-offs to STAI-Y1/-Y2 t-scores. Linear and logistic regressions were run to test the determinants of STAI-Y1/-Y2 scores. STAI-Y1 and -Y2 scores above cut-off were detected in 18.2 and 13.9% of patients, respectively - with proportions being higher in cases versus controls (ps < 0.001). BDI, but neither cognitive/behavioural nor motor variables, was identified as a significant predictor of STAI-Y1/-Y2 scores (ps < 0.003). The cognitive-affective subscale of BDI was the sole predictor of scores above cut-off on both STAI-Y1 and STAI-Y2 (ps < 0.001). Clinically significant levels of state- and trait-anxiety occur in ∼18 and ∼14% of non-demented ALS patients, respectively, mostly driven by cognitive and affective facets of depression, and are independent of motor and cognitive/behavioural features.

ABSTRACT Objectives Given the increasing importance of early cognitive screening and the growing use of the Montreal Cognitive Assessment (MoCA) in diverse populations, this qualitative study explored how older Korean Americans in community settings perceived and experienced the Korean version of the MoCA (MoCA–K). Methods Designed as an ancillary qualitative study, twelve older Korean Americans living in subsidized senior housing in Los Angeles were purposively selected and underwent semi-structured interviews within one week following MoCA–K administration. Encompassing both general and item-specific aspects of the MOCA–K, the interviews were conducted in Korean, audio-recorded, transcribed verbatim, and analyzed using the constant comparative method. Codes were iteratively compared, grouped into categories, and synthesized into overarching themes. Results Three themes emerged: (1) emotional responses to testing; (2) challenges with specific MoCA–K items; and (3) contextual factors affecting performance. Conclusions Cognitive screening functions as both an evaluative and emotionally meaningful experience for older Korean Americans, with item-level and contextual factors influencing performance. Clinical Implications Further attention to the interplay between participant characteristics and contextual conditions may enhance participant engagement and help reduce misclassification in community-based cognitive screening. Findings highlight the importance of culturally and contextually sensitive approaches in future practice and research.

Background: Cognitive impairment is a core feature of schizophrenia and a key determinant of functional outcome, yet local evidence from Latin America remains limited. The objective of this study is to estimate the prevalence of MoCA-defined cognitive impairment and describe clinical correlates in patients with schizophrenia treated at a tertiary psychiatric hospital in Maracaibo, Venezuela. Material and methods: Descriptive, cross-sectional study of 100 consecutive DSM-5-TR schizophrenia patients assessed between November 2023 and October 2024. Cognitive screening used the Montreal Cognitive Assessment (MoCA) with the standard education adjustment. Results: The mean age was 37.9 ± 9.2 years, and 80 % were male. Cognitive impairment was present in 89 % of participants (89/100; 95 % CI, 81.4–93.7), predominantly mild. Mean total MoCA scores were 20.63 ± 4.10 (95 % CI, 19.10–22.16) in patients &lt;35 years and 21.17 ± 5.80 (95 % CI, 19.79-22.55) in those ≥35 years.

ABSTRACT Dementia is a multidimensional syndrome marked by cognitive, behavioral, functional, and social decline, with over 55 million people affected globally. While Alzheimer’s disease is the most recognized subtype, non-Alzheimer variants such as frontotemporal, vascular, and Lewy body dementia present distinct profiles requiring targeted assessment. Traditional tools like the Mini-Mental State Examination and Montreal Cognitive Assessment are limited in detecting early-stage or nonmemory impairments. This review provides a concise synthesis of validated dementia assessment tools across key domains: cognitive screening, neuropsychological batteries, functional staging, behavioral symptom evaluation, social-emotional assessments, and emerging digital and artificial intelligence (AI)-based diagnostics. Each instrument is appraised for clinical utility, psychometric robustness, cultural adaptability, and application context. By integrating conventional and contemporary methods, the review offers clinicians and researchers a practical guide for personalized, domain-specific dementia evaluation. Emphasis is placed on balancing diagnostic sensitivity with feasibility, especially in diverse clinical environments. The inclusion of computerized and AI-driven platforms highlights the field’s transition toward scalable, remote-capable solutions. A multidomain approach remains essential to accurately characterize dementia subtypes and support informed care decisions.

Background Oral health has become a critical area of public health concern. Oral frailty refers to a significant decline in oral function and health, often manifested as impaired chewing and swallowing abilities as well as deterioration of oral structures. Oral frailty not only potentially affects postoperative recovery and quality of life but is also closely associated with various systemic health conditions. However, research on oral frailty in elderly patients undergoing elective surgery remains limited. Objective This secondary analysis of a cross-sectional dataset aimed to investigate the prevalence of oral frailty and identify its associated factors among elderly patients undergoing elective surgery. Methods This study is a secondary analysis of a cross-sectional study conducted in a tertiary general hospital in Shijiazhuang, Hebei Province, China, involving 300 patients undergoing elective surgery from October 2024 to May 2025. Data were collected using a general information questionnaire, the Oral Frailty Index-8 (OFI-8), number of natural teeth, the Mini Nutritional Assessment Short Form (MNA-SF), the FRAIL Scale, and the Rapid Cognitive Screen (RCS) to assess cognitive status. Chi-square tests and logistic regression analyses were performed to identify factors associated with oral frailty among elderly patients undergoing elective surgery. Results The prevalence of oral frailty among elderly patients undergoing elective surgery was 43.0%. Age, female gender, frailty, reduced number of natural teeth, and preoperative cognitive dysfunction were identified as factors associated with oral frailty (all P &amp;lt; 0.05). Conclusion The prevalence of oral frailty is high among elderly patients undergoing elective surgery. Healthcare providers should implement preventive management measures based on identified risk factors to control the occurrence and progression of oral frailty and to promote rapid postoperative recovery.

Early detection of Alzheimer disease and related dementias (ADRD) may influence outcomes for both patients and their family members, yet the risks and benefits of screening for family members are not established. To evaluate the benefits and risks of ADRD screening for family members of older adults screened in primary care (PC). This multisite randomized clinical trial was conducted in 29 PC clinics from October 2018 to September 2023. Dyads of patients aged 65 years and older and a family member were randomized into 1 of 3 groups: screening only, screening plus referral for diagnostic follow-up, and no-screening control. Data were collected at baseline and at 6, 12, 18, and 24 months. Cognitive screening was conducted in-person, by telephone, or secure video using the Mini-Cog, the Memory Impairment Screen Telephone version (MIS-T), or the MIS-T with the clock drawing test. The primary outcome was family member health-related quality of life at 24 months measured using the Short Form Health Survey (SF-36) physical and mental component summary scores. Secondary outcomes included family member depressive and anxiety symptoms, caregiver preparedness, and caregiving self-efficacy, as well as patient health-related quality of life and depressive and anxiety symptoms. A total of 1808 dyads completed baseline assessments. Mean (SD) patient age was 73.7 (5.7) years and 959 (53%) were female. Among family members, 1171 (64.8%) were spouses, 1224 (67.7%) were female, and mean [SD] age was 64.2 [12.9] years. Overall, 62 patients (5.1%) screened positive for cognitive impairment. Among dyads assigned to screen plus, 10 (35.7%) did not pursue diagnostic follow-up. There were no significant differences between the combined screening groups and no-screening group in SF-36 physical (24-month predicted difference, -0.21; 95% CI, -1.26-0.85) or mental (24-month predicted difference, 0.58; 95% CI, -0.18-1.33) component scores. No differences were observed in patient secondary outcomes at 24 months. This randomized clinical trial found that ADRD screening in PC was not associated with improvement in family member health-related quality of life, caregiver preparedness, or caregiving self-efficacy. Screening was also not associated with increased family member depression or anxiety. Low rates of positive screening and high rates of refusal for follow-up diagnostic assessment may help explain these findings. ClinicalTrials.gov Identifier: NCT03300180.

BACKGROUND Cognitive impairment is a well-recognized complication of liver diseases, primarily associated with cirrhotic portal hypertension. However, its spectrum and prevalence in patients with non-cirrhotic portal hypertension due to hepatosplenic schistosomiasis (HSS) remain poorly characterized, particularly regarding domains beyond minimal hepatic encephalopathy (MHE). AIM To characterize cognitive performance and determine the prevalence of deficits across multiple domains in a large cohort of patients with HSS. METHODS This cross-sectional study enrolled 200 adult patients with confirmed HSS at a Brazilian reference center. Participants underwent a comprehensive psychometric battery, including Mini-Mental State Examination for global cognition, the animal verbal fluency test for MHE and semantic fluency, the clock drawing test for visuospatial and executive functions, the digit span test (DST) for attention and working memory, and the Go/no-Go test for inhibitory control. Impairment was defined using established, education-adjusted cut-offs. RESULTS The cohort had a mean age of 56.4 years and limited formal education (mean 4.9 years). Global cognitive impairment, defined as a Mini-Mental Examination Score &lt; 25, was identified in 36.5% of patients. Domain-specific assessment revealed a high prevalence of deficits in visuospatial and planning abilities, affecting 67% of patients according to the clock drawing test. Working memory impairments were detected in 53.5% (forward DST) and 83% (backward DST) of participants. Abnormal performance on the Go/No-Go test, indicating deficits in inhibitory control, was observed in 66.5% of the sample. The animal verbal fluency test identified MHE in 24.5% of participants, a finding significantly associated with lower educational attainment (P &lt; 0.01). Notably, while MHE was strongly linked to the presence of portosystemic shunts (P = 0.0018), deficits in other cognitive domains were highly prevalent regardless of portosystemic shunts status. CONCLUSION Cognitive impairment in HSS is highly prevalent and encompasses a broad range of deficits, extending well beyond MHE. These findings support the implementation of routine, multidimensional cognitive screening in standard management of HSS patients.

ObjectiveTo measure awareness of memory impairment (MI) among individuals with MI, the prevalence of MI among those with memory complaints (MC), and to identify associated factors to both in a nationally representative sample of Brazilians aged ≥50.MethodsMI was defined as a z-score ≤ -1.5 derived from immediate and delayed recall tests, adjusted for demographics. MC were identified by self-report. Logistic regression models examined sociodemographic and health-related factors associated with awareness of MI and with MI among individuals reporting MC.ResultsOf 7831 participants, 739 (9.3%) had MI, of whom 52% were aware of their impairment. Greater awareness was associated with a higher number of chronic illnesses, disability in instrumental activities of daily living (i-ADL), and more depressive symptoms. Among 3402 (41.7%) participants with MC, 11.5% had objective MI. In this group, higher education, lower income, fewer chronic illnesses, disability in i-ADL and advanced ADL (a-ADL), and more depressive symptoms were associated with MI.ConclusionHalf of individuals with objective MI demonstrated awareness of their impairment, and one in ten individuals with MC showed objective cognitive decline. These findings emphasize the need for cognitive screening in middle aged and older adults and for clinical evaluation of other causes of memory complaints, particularly mood and functional factors.

To synthesize evidence on cognitive functioning in adults with cerebral palsy (CP), evaluate the feasibility and validity of cognitive screens, determine whether cognitive functioning declines with age, identify factors associated with cognitive outcomes, and summarize interventions reporting cognitive outcomes. Five databases were searched through 2025. Eligible studies enrolled adults with CP and reported cognitive outcomes. Two reviewers screened and extracted data; quality was appraised with JBI tools and certainty graded using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Findings were synthesized narratively according to cognitive domain. Thirty studies (estimated 1150 adults, 3900 assessments) were included. Executive function, and visuospatial and perceptual-motor skills, were most frequently impaired. Attention and processing speed and episodic memory were also commonly reduced. Certainty was moderate for executive function and very low for other domains because of small samples, bias, inconsistency, and imprecision. Longitudinal and registry data suggested stability from late adolescence through mid-adulthood. Greater motor severity and reduced manual ability were associated with lower cognitive performance. No motor-minimized, CP-validated screening battery was identified across 48 instruments. Adults with CP commonly show domain-specific cognitive difficulties that are established early and remain stable through mid-adulthood. Measurement limitations and selection biases constrain prevalence estimates. Priorities include motor-minimized tools with CP-specific norms, adequately powered trials with standardized cognitive endpoints, and longitudinal cohorts examining modifiable factors.

Older adults with type 2 diabetes mellitus (T2DM) are at a significantly greater risk of cognitive impairment than those without T2DM. Existing screening tools, such as the Montreal Cognitive Assessment (MoCA), are not tailored to the vascular cognitive profile characteristic of T2DM. To address this gap, we designed the Diabetic Cognitive Assessment Tool (DCAT), a simplified instrument for efficient screening of cognitive impairment in older adults with T2DM, and assessed its performance against the MoCA. The associations of glycaemic control, frailty, depression, education, age, and T2DM duration with cognitive performance were also assessed. A cross-sectional study was conducted among 103 adults aged 65 years and older with T2DM attending a tertiary hospital diabetic clinic in Johannesburg, South Africa. Additionally, 55 age- and sex-comparable controls without T2DM were recruited. Cognitive function was assessed using the DCAT and MoCA, whereas frailty and depression were assessed using the FRAIL scale and Geriatric Depression Scale. DCAT performance relative to the MoCA was evaluated using the receiver operating characteristic (ROC) curve analysis and Youden's index identified the optimal cut-off. Associations between clinical and cognitive measures were analysed using Spearman's correlation, and Cohen's d quantified domain-specific effect sizes. The DCAT's area under the curve was 0.81. Using a cut-off score of 13, the DCAT achieved a sensitivity of 78.4% and specificity of 78.7%, with positive and negative predictive values of 89.2%, and 56.9%, respectively. Among participants with T2DM, HbA1c levels correlated negatively with MoCA scores, and depression scores correlated negatively with both DCAT and MoCA scores. In both groups, years of education correlated positively with both cognitive measures. Age and T2DM duration did not correlate significantly with cognitive measures in either group. The executive function and memory domains exhibited large and medium effect sizes, respectively. The DCAT demonstrated good discriminative ability in screening for cognitive impairment among older adults with T2DM. Poorer glycaemic control and depressive symptoms were associated with lower cognitive performance, whereas greater educational attainment was associated with better outcomes. The DCAT effectively assesses key cognitive domains, particularly executive function and memory. Further validation in larger, more diverse cohorts is warranted.

Delirium predicts adverse outcomes in older emergency department (ED) patients, but many acutely ill patients without delirium have underlying cognitive impairment that goes unrecognized. Whether cognitive impairment screening improves risk prediction beyond delirium remains uncertain. We compared practical bedside screening strategies for delirium, cognitive impairment, or both for predicting 90-day functional decline and mortality in older adults admitted from the ED. A prospective cohort comprising patients aged ≥ 65 years admitted from the ED of a large hospital in São Paulo, Brazil. Trained professionals screened for delirium using the brief Confusion Assessment Method (bCAM) and for cognitive impairment using the 10-point Cognitive Screener (10-CS). Patients were classified as having normal cognition (bCAM negative, 10-CS > 5), delirium (bCAM positive), or cognitive impairment without delirium (bCAM negative, 10-CS ≤ 5). Blinded investigators assessed decline in basic activities of daily living (ADL) and mortality within 90 days of admission. Fine-Gray models (death as a competing risk) and Cox models estimated associations with outcomes, adjusting for sociodemographic and clinical factors. Among 830 patients (mean age = 80 ± 9 years; women = 47%), 427 (51.5%) had normal cognition, 171 (20.6%) had delirium, and 232 (27.9%) had cognitive impairment without delirium. Among delirium-negative patients with cognitive impairment, 52% had no documented dementia diagnosis or reported memory problems. Compared with normal cognition, cognitive impairment without delirium was associated with 90-day functional ADL decline (sub-HR = 1.60; 95% CI = 1.03-2.49) and mortality (HR = 2.31; 95% CI = 1.18-4.51), with risks similar to those observed in delirium. A staged strategy (bCAM first, then 10-CS if bCAM negative) showed higher discrimination than delirium-only or 10-CS-only screening. Cognitive impairment without delirium is common, often unrecognized, and predicts 90-day adverse outcomes in older patients admitted from the ED. A brief staged screening strategy integrating delirium assessment with cognitive impairment testing among delirium-negative patients may enhance early detection of cognitive vulnerability and support care planning.

Despite the technological advancements in modern genetic diagnosis, customized genetic panels are still frequently employed for diagnostic purposes due to their rapid, efficient, and cost-effective ability to detect genetic variants. In this study, we utilized a customized genetic panel designed to identify genetic variants associated with neurodegenerative disorders. The panel consisted of 61 genes and was applied to a cohort of 186 unrelated individuals diagnosed with different degenerative cognitive and movement disorders. The identified variants were filtered for a minor allele frequency of less than 1% and classified according to the American College of Medical Genetics (ACMG) guidelines. Our results showed that 20.97% of individuals carried at least one likely pathogenic or pathogenic variant, with 35% of those individuals diagnosed with Alzheimer's disease (AD). The positive diagnostic yield of the panel was 16.67%, calculated based on variant zygosity, inheritance pattern, and concordance with the clinical phenotype. Furthermore, 34.41% of the individuals carried variants of uncertain significance (VUS), and 44.62% carried benign variants. Variants have been found only in 58 genes. Among these, 24.14% showed benign variants, 48.28% had VUS, and 27.59% carried pathogenic or likely pathogenic variants. Principal component analysis analysis based on the variables "age at onset" in addition to the phenotypic scores "MMSE" (global cognitive screening test), "IADL" (instrumental activities of daily living), and "ADL" (basic activities of daily living) distributed the individuals associated with the specific disease and variant in the plot. Notably, the individuals showed AD exhibited an average age at onset of 68 ± 12.5 years and were differentiated in the plot. GBA gene exhibited the highest number of pathogenic variants (9) linked to AD, Parkinson's disease, early onset parkinsonism with epilepsy, fronto-temporal dementia, and mild cognitive impairment. The results highlighted a broad phenotypic heterogeneity associated with genes previously linked to only a limited number of neurodegenerative conditions, underscoring the value of the genetic testing performed. Translationally, although clinical exome sequencing has enabled novel gene discovery in neurodegenerative disorders, targeted genetic panels remain a cost-effective and clinically valuable approach for routine diagnostics. In this context, our study highlights the "real-world" utility and clinical impact of a focused panel-based strategy.

Cognitive impairment is a major public health concern due to its impact on functional independence and its risk of progression to dementia. Early detection is critical, but the estimated prevalence varies substantially depending on the screening tool used and the role of modifiable metabolic risk factors, in accelerating cognitive aging. This study aimed to describe the variability in cognitive performance and the prevalence of low scores across several brief screening tools and cut-offs, and to explore sociodemographic, functional and metabolic factors associated with lower cognitive performance in community-dwelling older adults. A cross-sectional study was conducted with N = 286 community-dwelling participants aged over 60 years, recruited from community pharmacies in Albacete, Spain. Cognitive status was assessed using the MoCA (cut-offs < 26 and < 21), the Short Portable Mental Status Questionnaire, the Memory Impairment Screen, and the Semantic Verbal Fluency Test (animals). Comorbidities were assessed using active medication prescriptions as proxy variables. Cohen's Kappa coefficients were computed to assess concordance, and a binary logistic regression was performed to identify potential predictors of cognitive impairment, defined as a MoCA score < 21. The estimated prevalence of suspected cognitive impairment varied from 71.3% using the highest MoCA cut-off (< 26) to 25.2% using the more conservative MoCA < 21 threshold. Concordance analysis revealed low agreement between MoCA < 26 and the other instruments (Kappa < 0.08). However, using the MoCA < 21 cut-off, the observed agreement improved substantially to over 75% (all Kappa values statistically significant at p < 0.001). The adjusted binary logistic regression model demonstrated that older age significantly increased the odds of cognitive impairment (OR = 1.10, p < 0.001), whereas higher cognitive reserve was a protective factor (OR = 0.75, p < 0.001). The estimated prevalence of suspected cognitive impairment is highly dependent on the screening instrument and threshold selected. The findings support the adoption of a more conservative MoCA cut-off < 21 to enhance agreement with other brief instruments and may reduce potential overestimation of impairment. Additionally, the associations observed between metabolic conditions and lower cognitive performance highlight the importance of integrated preventive strategies in primary care, combining sensitive cognitive screening with cardiometabolic risk management.

Objective: Accurate cognitive screening tests for culturally, linguistically, and educationally diverse populations remain scarce, contributing to diagnostic inequities. To address this, we examined the cross-cultural properties and diagnostic accuracy of the Multicultural Cognitive Examination (MCE) in classifying mild cognitive impairment (MCI), dementia, Alzheimer’s disease (AD) dementia, and non-AD dementia in participants with diverse backgrounds. Method: In this retrospective cross-sectional study, we aggregated data from 1,449 participants across 11 countries. Multiple linear regression models were used to determine the influence of demographic variables on MCE scores, which informed the creation of regression-based normative data. Diagnostic accuracies were examined using Receiver Operating Characteristics (ROC) curves. Results: The cohort consisted of 1001 cognitively intact participants, 140 patients with MCI, and 308 patients with dementia. 54.2% had immigrant backgrounds and originated from 63 different countries. MCE scores were significantly influenced by education and age, but not by sex or immigrant status. The MCE demonstrated high accuracy in differentiating cognitively intact participants from patients with dementia (AUC: .95) and MCI (AUC: .84). The MCE was both accurate for classifying AD dementia (AUC: .97) and non-AD dementia (AUC: .94). Conclusions: This study supports the clinical utility of the MCE as a culturally robust and highly accurate cognitive screening test. Future studies should examine the ability of the MCE to monitor cognitive decline.

ObjectivesTo synthesise the prevalence and patterns of dementia-relevant structural brain MRI abnormalities in adults with suspected or confirmed dementia in low- and middle-income countries (LMICs), and to summarise MRI protocols and the incremental diagnostic contribution of MRI beyond cognitive screening.DesignSystematic review and meta-analysis.Data sourcesPubMed, EMBASE, Web of Science and PsycINFO (January 1990–27 January 2025), plus reference list screening and targeted manual searches.Eligibility criteriaObservational or diagnostic-accuracy studies from World Bank-defined LMICs including adults (≥50 years) with suspected or confirmed dementia who underwent brain MRI as part of diagnostic evaluation.Data extraction and synthesisTwo reviewers independently screened, extracted data and assessed risk of bias using ROBINS-I. Random-effects models pooled prevalence of dementia-relevant MRI abnormalities; diagnostic-accuracy outcomes were synthesised narratively due to heterogeneous reference standards and incomplete reporting.Results39 LMIC studies were included; 23 studies (2513 participants) contributed to the meta-analysis. Dementia-relevant MRI abnormalities (defined as ≥1 clinically relevant structural abnormality per study definition) were present in 1248/2513 participants. The pooled prevalence of dementia-relevant MRI abnormalities was 58% (95% CI 43% to 72%), with substantial heterogeneity (I²=95%) and a wide prediction interval (8–96%), indicating marked between-study variability; this estimate should be interpreted as a descriptive summary of study-level proportions rather than a precise population parameter.ConclusionsBrain MRI frequently demonstrates dementia-relevant pathology in LMIC clinical cohorts, usually with mixed neurodegenerative-vascular patterns. Structured visual ratings may add aetiologic specificity beyond cognitive screening, but pooled estimates should be interpreted as summaries of heterogeneous study-level findings rather than precise population parameters, given high heterogeneity and risk of bias.PROSPERO registration numberCRD42024510241.