Cognitive Testing In Patients Research Articles

Evaluation of a multimodal diagnostic algorithm for prediction of cognitive impairment in elderly patients with dizziness

BackgroundThe current diagnostic workup for chronic dizziness in elderly patients often neglects neuropsychological assessment, thus missing a relevant proportion of patients, who perceive dizziness as a subjective chief complaint of a concomitant cognitive impairment. This study aimed to establish risk prediction models for cognitive impairment in chronic dizzy patients based on data sources routinely collected in a dizziness center.MethodsOne hundred patients (age: 74.7 ±\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\pm$$\\end{document} 7.1 years, 41.0% women) with chronic dizziness were prospectively characterized by (1) neuro-otological testing, (2) quantitative gait assessment, (3) graduation of focal brain atrophy and white matter lesion load, and (4) cognitive screening (MoCA). A linear regression model was trained to predict patients’ total MoCA score based on 16 clinical features derived from demographics, vestibular testing, gait analysis, and imaging scales. Additionally, we trained a binary logistic regression model on the same data sources to identify those patients with a cognitive impairment (i.e., MoCA < 25).ResultsThe linear regression model explained almost half of the variance of patients’ total MoCA score (R2 = 0.49; mean absolute error: 1.7). The most important risk-predictors of cognitive impairment were age (β = − 0.75), pathological Romberg’s sign (β = − 1.05), normal caloric test results (β = − 0.8), slower timed-up-and-go test (β = − 0.67), frontal (β = − 0.6) and temporal (β = − 0.54) brain atrophy. The binary classification yielded an area under the curve of 0.84 (95% CI 0.70–0.98) in distinguishing between cognitively normal and impaired patients.ConclusionsThe need for cognitive testing in patients with chronic dizziness can be efficiently approximated by available data sources from routine diagnostic workup in a dizziness center.

Cognition and saccadic eye movement performance are impaired in chronic rhinosinusitis.

Patients with chronic rhinosinusitis (CRS) can experience cognitive dysfunction. The literature on this topic mostly reflects patient-reported measurements. Our goal was to assess cognitive function in patients with CRS using objective measures, including saccadic eye movements-a behavioral response reflecting cognitive and sensory information integration that is often compromised in conditions with impaired cognition. Participants (N=24 with CRS, N=23 non-CRS healthy controls) enrolled from rhinology clinic underwent sinonasal evaluation, quality of life assessment (Sino-nasal Outcome Test 22 [SNOT-22]), and cognitive assessment with the Neuro-QOL Cognitive Function-Short Form, the Montreal Cognitive Assessment (MoCA), and recording of eye movements using video-oculography. Participants with CRS were more likely to report cognitive dysfunction (Neuro-QOL; 45.8%vs. 8.7%; p=0.005) and demonstrate mild or greater cognitive impairment (MoCA; 41.7%vs. 8.7%; p=0.005) than controls. Additionally, participants with CRS performed worse on the MoCA overall and within the executive functioning and memory domains (all p<0.05) and on the anti-saccade (p=0.014) and delay saccade (p=0.044) eye movement tasks. Poorer performance on the MoCA (r=-0.422; p=0.003) and the anti-saccade (r=-0.347; p=0.017) and delay saccade (r=-0.419; p=0.004) eye movement tasks correlated with worse CRS severity according to SNOT-22 scores. This study is the first to utilize objective eye movement assessments in addition to researcher-administered cognitive testing in patients with CRS. These patients demonstrated a high prevalence of cognitive dysfunction, most notably within executive functioning and memory domains, with the degree of dysfunction correlating with the severity of CRS.

Clinical and psychometric characteristics of cognitive and negative disorders in schizophrenia

To establish the characteristics of clinical manifestations and cognitive tests in patients with schizophrenia, with a predominance of cognitive and negative disorders. We examined 76 patients, 66 in the main group, 10 in the comparison group, who were treated in Psychiatric Hospital No. 1 and Psychiatric Hospital No. 4 (Moscow). Clinical-psychopathological, psychometric and statistical methods were used. Features of cognitive functioning were studied using the Frontal Assessment Battery (FAB) and the Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis (ALS) Screen (ECAS). Emotional intelligence scores were assessed using the Ekman Face Emotion Recognition (EFER) test. Patients with schizophrenia showed dominance of one of 3 types of deficit symptoms: cognitive, emotional, and volitional. Cognitive functions were significantly reduced in patients with schizophrenia when compared with the comparison group (mean FAB score (M±SD) 13.44±2.97 in patients with schizophrenia vs. 16.10±1.70 in the comparison group; t=4.10; p<0.001). Cognitive functions were particularly reduced in patients with volitional deficit (mean EFER total score 42.40±9.0 in patients with volitional deficit vs. 47.21±633 in patients with cognitive deficit; t=2.12; p=0.039; mean FAB score 12.83±3.29 in patients with volitional deficit vs. 16.10±1.70 in the comparison group; t=4.24; p<0.001; mean ECAS score specific to ALS 78.80±9.07 in patients with volitional deficit vs. 84.50±6.71 in the comparison group; t=2.18; p=0.034). The greatest contribution to the development of cognitive disorders in schizophrenia is made by dysfunction of frontal (especially) and temporal cortex. Executive functions, speech skills and verbal fluency are most severely damaged.

Comparative evaluation of functional and clinical indicators of nasal obstruction and cognitive tests in patients with chronic rhinosinusitis with nasal polyps

Comparative evaluation of functional and clinical indicators of nasal obstruction and cognitive tests in patients with chronic rhinosinusitis with nasal polyps

Education, digital tools, and diagnostic support to increase PCP‐based cognitive testing in patients 65 years and older

AbstractIn the United States, primary care clinicians (PCPs) typically diagnose and treat most patients who have or who may be developing neurocognitive disorders (NCDs). However, as many as two‐thirds of patients remain underdiagnosed, misdiagnosed or experience a delay in the diagnosis. Many barriers to care have been cited for these failures in diagnosis, including PCP limitations in time and expertise, as well as inadequate technical, financial, and staffing resources. Diagnostic delays may particularly impact minority populations, exacerbating the disparate burden these communities bear from dementing disorders. In contrast, an early diagnosis is an impetus to advanced care planning, to strategizing for patient safety, and to initiating interventions that may preserve cognitive function and enhance quality of life.The main objective for this proposal is to increase the rate of cognitive screening in patients 65 years and older. PCP practices that serve diverse communities are early implementation sites. This proposal focuses on addressing barriers to testing by providing PCPs with educational resources to enhance the efficiency and quality of care for patients with neurocognitive disorders. The goal is to educate PCPs on the importance of early cognitive screening and to provide tools to help manage their patients with cognitive disorders and dementia more efficiently. Primary care providers are offered multiple educational and practice supports for managing patients who have an abnormal cognitive screen. The BrainCheck digital cognitive testing tool allows clinical support staff to rapidly test patients for cognitive impairment. Educational tools include succinct didactic lectures; a SharePoint site that serves as a resource hub for and weekly Project ECHO® based Memory Care Case Conferences (CME provided). EHR tools include simple order sets and templates. The practice support tool is an implementation of eConsults to quickly link PCPs to dementia experts in order to answer questions about patient care.The outcomes of this project measured in terms of PCP feedback, cognitive testing gains, educational participation, and tool usage will allow us to design more effective strategies for increasing cognitive testing and improving the management of patients with dementia at the health system level.

The correlation of conventional and advanced MRI findings with cognitive function in multiple sclerosis: A systematic review and meta-analysis

There are limited data on the possible association between conventional and advanced magnetic resonance imaging (MRI) findings and cognitive function in patients with multiple sclerosis (MS). Therefore, this systematic review and meta-analysis aimed to explore the correlation between MRI-derived metrics and cognitive tests in patients with MS. An electronic literature search of the PubMed, Web of Sciences, Embase, and Scopus databases was performed to identify related studies. The correlation coefficients of the MRI indices and cognitive tests were pooled. Thirteen studies were selected for inclusion of 824 patients diagnosed with MS. Most evaluated patients (60.44%) had relapsing-remitting MS (RRMS). The Paced Auditory Serial Addition Test (PASAT-3), Brief Visuospatial Memory Test (BVMT), and Symbol Digit Modalities Test (SDMT) were inversely correlated with the mean diffusivity (MD) of the brain with pooled correlation coefficient of -0.225, -0.361, and -0.438, respectively (P&lt;0.0001). The SDMT test positively correlated with fractional anisotropy (FA) with a correlation coefficient of 0.351 (P&lt;0.0001) and inversely correlated with T2 lesion volume with a correlation coefficient of -0.367 (P&lt;0.0001). In the case of other tests, there was low number of studies with significant correlations being reported. We found significant correlations between some neuropsychological tests and MRI findings in patients with MS. Brain atrophy might disrupt the process of correct registration between anatomical and MRI diffusion scans. However, we did not have enough studies with exactly matched anatomical areas to evaluate correlations and we recommend that histological validation of diffusion tensor imaging (DTI) findings for brain atrophy is needed as a basis for picture processing procedures and correlation with cognition status.

The relationship between cognitive functions and disinhibition: Observations of cognitively impaired patients

Inhibitory control exhibits a significant correlation with overall cognitive abilities. Past research largely measured disinhibition using experimental protocols, predominantly featuring healthy or youthful participants, or caregiver-supplied information, potentially neglecting an objective assessment of pronounced disinhibition within a naturalistic context. We posit that the observation of prominent disinhibition behaviors across various cognitive assessment tasks provides an objective measurement of innate disinhibition, bypassing the need for participant awareness or concentrated effort toward inhibition. The present study, designed as a secondary analysis of prior research, aims to explore the relationship between cognitive functions and observed disinhibition behavior during cognitive testing in patients exhibiting cognitive impairment symptoms. A retrospective analysis was performed on the records of 224 patients' cognitive tests, including recorded disinhibition behavior, without employing any exclusion criteria. Findings revealed that patients demonstrating at least one instance of disinhibition during testing presented significantly lower overall cognitive functions, excluding long-term memory, than their counterparts without disinhibition. Notably, multiple regression analysis identified comprehension and conceptualization abilities as significant predictors of disinhibition severity. These findings, aligning with earlier research, serve to strengthen the credibility of previous studies on this topic.

Computerized cognitive testing in patients with Parkinson's disease: an Indian perspective.

Aim: This study investigates perspectives on computer-based assessments among elderly individuals with Parkinson's disease (PD)in India for more efficient usability of digital assessments for this population. Materials & methods: Content analysis was conducted on 30 participants diagnosed with PD, who were interviewed for their preferences and perspectives on integrating technology in healthcare assessments. Results: Elderly individuals with PDin India favored paper-pencil assessments over computer-based alternatives due to limited technological familiarity, resistance to change, lack of trust in healthcare technologyand PD-related motor challenges. Conclusion: Elderly patients with Parkinson's in India indicated their discomfort with computer-based based cognitive assessment. Addressing barriers toward digital assessments in India is crucial for their successful implementation in healthcare.

CoGNIT Automated Tablet Computer Cognitive Testing in Patients With Mild Cognitive Impairment: Feasibility Study.

BackgroundEarly diagnosis of cognitive disorders is becoming increasingly important. Limited resources for specialist assessment and an increasing demographical challenge warrants the need for efficient methods of evaluation. In response, CoGNIT, a tablet app for automatic, standardized, and efficient assessment of cognitive function, was developed. Included tests span the cognitive domains regarded as important for assessment in a general memory clinic (memory, language, psychomotor speed, executive function, attention, visuospatial ability, manual dexterity, and symptoms of depression).ObjectiveThe aim of this study was to assess the feasibility of automatic cognitive testing with CoGNIT in older patients with symptoms of mild cognitive impairment (MCI).MethodsPatients older than 55 years with symptoms of MCI (n=36) were recruited at the research clinic at the Blekinge Institute of Technology (BTH), Karlskrona, Sweden. A research nurse administered the Mini-Mental State Exam (MMSE) and the CoGNIT app on a tablet computer. Technical and testing issues were documented.ResultsThe test battery was completed by all 36 patients. One test, the four-finger–tapping test, was performed incorrectly by 42% of the patients. Issues regarding clarity of instructions were found in 2 tests (block design test and the one finger-tapping test). Minor software bugs were identified.ConclusionsThe overall feasibility of automatic cognitive testing with the CoGNIT app in patients with symptoms of MCI was good. The study highlighted tests that did not function optimally. The four-finger–tapping test will be discarded, and minor improvements to the software will be added before further studies and deployment in the clinic.

Abstract P56: Diffusion Tensor Imaging at the Time of Stroke is Associated With Cognitive Performance 4 Months Later

Introduction: Cognitive impairment after stroke is associated with stroke severity and baseline brain health. We hypothesized that acute diffusion tensor imaging (DTI) metrics would identify patients at risk for post-stroke cognitive impairment. Methods: Patients were enrolled prospectively in an observational study that involves serial MRI and cognitive testing in patients with recent stroke and moderate white matter disease on MRI but without dementia. DTI was performed at the time of stroke; cognitive testing with the MOCA and the Telephone Interview for Cognitive Status (TICS) were performed 3 months later. DTI was used to calculate Peak Skeletonized Mean Diffusivity (PSMD), a measure of global white matter microstructural integrity previously validated in cerebral small vessel disease. Fractional anisotropy maps were skeletonized (figure panel A) and a histogram of the corresponding MD values was used to calculate the peak width in the non-stroke hemisphere (panel B). Linear regression was used to test whether acute PSMD in the non-stroke hemisphere, acute stroke volume, or baseline NIHSS predicted cognitive performance 3 months later. Results: Fourteen patients followed-up at a median of 123 days. Patients had a median age of 73 years, mean baseline NIHSS of 1.2 (IQR 0-1.75), mean infarct volume of 4cc (range 0-16cc), mean MOCA of 25 (range 19-30), mean TICS of 33 (range 23-41), and 50% were women. Using multivariable linear regression, only acute PSMD predicted follow-up MOCA (std beta= -0.64, adj R 2 = 0.37, p= 0.013) while compared to baseline NIHSS, PSMD showed a stronger association with follow-up TICS score (std beta= -0.57 vs -0.44, p= 0.017; model adj R 2 = 0.476, p= 0.011)(Panel C). Conclusions: In this cohort of patients with small strokes we found that acute contralateral PSMD provided a measure of brain health that appears to predict cognitive performance at 3 months better than stroke size or severity. These are preliminary findings from an ongoing study.

Validation of the Oxford Cognitive Screen‐Plus: Tablet‐based cognitive testing in patients with amnestic mild cognitive impairment

AbstractBackgroundThe Oxford Cognitive Screen ‐ Plus (OCS‐Plus) is a tablet‐based cognitive screen developed for detection of mild cognitive impairment in various settings. We validated it in the target group of aMCI/dementia patients.MethodsPatients with aMCI (N=57) and mild dementia (N=13) were assessed with OCS‐Plus at the Jena University Hospital Memory Center. Comparison of their data with a) those of established dementia testing, third part interview and depression and anxiety questionnaire and b) with those of a demographically matched control group (N = 67) were conducted to explore construct validity and discriminatory power.ResultsSignificant correlations of the OCS‐Plus scores with those of established assessments indicated good convergent validity, divergent validity was indicated by a lack of significant correlations with depression and anxiety scores. Among different scores, the delayed memory score demonstrated the best discriminatory power with sensitivity of .74 and specificity of .75.ConclusionThe OCS‐Plus is able validly to differentiate between healthy control participants and aMCI patients and potentially to differentiate aMCI from mild dementia.

Cognitive Changes in Comorbidity Alcohol Dependence and Affective Disorders

In this study, we sought to assess the level of cognitive functioning in patients with comorbid alcohol dependence and affective disorder, as well as to compare the detected changes with the indicators of cognitive tests in patients suffering only from alcoholism or affective disorder. It is suggested that patients with comorbidity may have a more severe cognitive deficit than patients with a single diagnosis.Materials and methods. We examined 100 patients aged 30–50 years before treatment: 30 patients with affective disorders, 40 patients with alcohol dependence and 30 patients with comorbid alcohol dependence and affective disorder. As a control group, 30 mentally and somatically healthy individuals were examined. The level of cognitive functioning was assessed using computer tests Go/No-go, Corsi and Stroop.Results. Statistically significantly lower indicators of cognitive functioning were found in patients with comorbid alcohol dependence and affective disorder in comparison with all the studied groups.Conclusion. The data obtained in the study indicate that the presence of comorbidity of alcohol dependence and affective disorder in patients leads to a significant deterioration in cognitive functions: Executive control, working memory, attention and cognitive flexibility compared to healthy individuals, as well as patients suffering only from alcohol dependence or affective disorder.

Feasibility and validity of mobile cognitive testing in patients with substance use disorders and healthy controls.

Mobile testing of executive deficits in substance-related addictions is highly novel but requires validation. Sixty-one individuals (34 patients, 27 healthy controls) completed Ecological Momentary Assessments with mobile executive tests. Compliance with the tests was high (78% to 91%) in both the patient and control groups. No fatigue effects were detected, practice effects were observed for controls only, and convergent validity was found relative to neuropsychological assessments. Conclusions The use of mobile cognitive testing is feasible and valid in this population. Scientific Significance Mobile cognitive tests provide new opportunities for both research and clinical intervention. (Am J Addict 2018;27:553-556).

The prospective memory of patients with idiopathic REM sleep behavior disorder

BackgroundIdiopathic rapid eye movement sleep behavior disorder (iRBD) likely represents the prodromal stage of synucleinopathy. The present study was to investigate if there was prospective memory (PM) impairment and the relationship between different PM tasks and traditional cognitive tests in patients with iRBD. MethodsA total of 28 patients with iRBD, 25 with Parkinson's disease (PD) and 21 healthy controls were included. The Cambridge Prospective Memory Test (CAMPROMPT) was used to measure the PM including time-based (TBPM) and event-based PM (EBPM). Standard cognitive tests were administered to all participants. ResultsEBPM scores were lower only in patients with iRBD, while the obvious PM abnormalities were found in patients with PD. The patients with iRBD and PD performed worse on delayed recall of the Rey Auditory Verbal Learning Test (RAVLT) and copy of the Rey–Osterrieth complex figure (ROCF). The EBPM correlated with attention, executive function, and immediate memory besides working memory in patients with iRBD. The PM tasks involved in more memory functions in PD patients. ConclusionsThe patients with iRBD were impaired on both episodic memory and EBPM tasks that correlated with attention, executive function, and immediate memory. The PM abnormality was an early cognitive change in iRBD to which more attention should be paid more attention.

Mobile cognitive testing in patients with schizophrenia: A controlled study of feasibility and validity

Summary There is now abundant evidence that cognitive deficits are a core component of schizophrenia. Ecological momentary assessment (EMA) uses mobile technologies to provide lacking information concerning fluctuations in the cognitive functions and their immediate association with the expression of symptoms among individuals with this disorder. The present investigation examines the compliance rates, biases, and validity indicators of this methodology in patients with schizophrenia compared to healthy controls. Twenty-two outpatients with schizophrenia (50% with comorbid substance dependence comorbidity) and 27 healthy controls participated in this study. All participants received a traditional battery of neuropsychological assessments including the Stroop test and Letter-verbal fluency. EMA was also used to provide five electronic interviews per day over a one-week period. Two different versions of a brief cognitive test were administered alternately during the electronic interviews to assess executive functioning (a color-word interference task and letter-word generation task). Feasibility was examined as a function of compliance, fatigue and practice effects. Convergent validity was assessed by examining the correlation between neuropsychological test scores and the corresponding EMA executive assessments. Our findings indicate strong support for the overall feasibility of mobile cognitive testing in this population, and significant correlations between mobile cognitive tests and standard clinical measures support their convergent validity.

P.6.f.009 - Feasibility and validity of mobile cognitive testing in patients with substance use disorders

P.6.f.009 - Feasibility and validity of mobile cognitive testing in patients with substance use disorders

Assessment of cognitive impairment

Objective: assessment of the usefulness of quantitative electroencephalographic analysis as an indicator of cognitive impairment, we examined the correlation between Mini-Mental State Examination (MMSE) scores & Montreal Cognitive Assessment(MoCA) & intelligence quotation (IQ) on one hand and quantitative electroencephalographic (QEEG) power values in elderly patients and healthy controls on the other hand and conducting Stepwise multiple regression analysis to calculate the predicted MMSE score from the QEEG power values. Methods: We evaluated brain function using QEEG in 29 elderly patients with memory complaints and 29 healthy volunteer and compared their results with their MMSE &MoCA& IQ scores. Results: in our study we reached to a significant negative correlation between MMSE &MoCA& IQ scores. and QEEG relative theta Ɵ and delta δ power values and significant positive correlation was found between MMSE &MoCA& IQ scores. and QEEG relative alpha α and beta β power values. And the regression model created using relative QEEG and gender for predicting MMSE scores had an adjusted R2 of 0.69. Conclusions: These results suggest that QEEG analysis can be a helpful tool of cognitive testing in patients with abnormalities in memory

Cognitive Testing in Patients with CKD: The Problem of Missing Cases.

Cognitive testing is only valid in individuals with sufficient visual and motor skills and motivation to participate. Patients on dialysis usually suffer from limitations, such as impaired vision, motor difficulties, and depression. Hence, it is doubtful that the true value of cognitive functioning can be measured without bias. Consequently, many patients are excluded from cognitive testing. We focused on reasons for exclusion and analyzed characteristics of nontestable patients. Within the Choice of Renal Replacement Therapy Project (baseline survey: May 2014 to May 2015), n=767 patients on peritoneal dialysis (n=240) or hemodialysis (n=527) were tested with the Trail Making Test-B and the German d2-Revision Test and completed the Kidney Disease Quality of Life Short Form cognition subscale. We divided the sample into patients with missing cognitive testing data and patients with full cognitive testing data, analyzed reasons for nonfeasibility, and compared subsamples with regard to psychosocial and physical metrics. The exclusion categories were linked to patient characteristics potentially associated with missing data (age, comorbidity, depression, and education level) by calculation of λ-coefficient. The subsamples consisted of n=366 (48%) patients with missing data (peritoneal dialysis =62, hemodialysis =304) and n=401 patients with full cognitive testing data (peritoneal dialysis =178, hemodialysis =223). Patients were excluded due to visual impairment (49%), lack of motivation (31%), and motor impairment (13%). The remaining 8% did not follow instructions, suffered from medical incidents, or had language difficulties. Compared with patients with full cognitive testing data, they were more likely to have depression; be treated with hemodialysis; be older, nonworking, or more comorbid; and experience poorer shared decision making. Reasons for exclusion were not related to levels of age, comorbidity score, depression score, or education level. We excluded almost one half of eligible patients from cognitive testing due to visual, motivational, or motor difficulties. Our findings are consistent with exclusion categories reported from the literature. We should be aware that, because of disease-related limitations, conclusions about cognitive functioning in the CKD population may be biased. In the future, nonvisual and nonverbal cognitive testing can be a valuable resource.

Time of Day and Performance on Cognitive Tests in Patients with Mild Dementia

Time of Day and Performance on Cognitive Tests in Patients with Mild Dementia

Polymorphism of genes associated with increased cardiovascular risk and cognitive function in patients with chronic heart failure and in healthy persons: the pilot study

There was studied the relationship between polymorphic variants of APOC3 (rs2854117), PON1 (rs854560, rs662), AGT (rs4762, rs699) and AGTR1 (rs5186) genes with the results of cognitive tests in patients with chronic heart failure (СHF) of ischemic genesis and healthy persons. The general group included 50 patients with CHF of II-IV functional classes, the control group - 50 healthy volunteers. Cognitive functions were estimated by 5th and 7th subtests of Wexler and Burdon's test. There was revealed statistically significant correlation between the polymorphism of APOC3, PON1, AGT, AGTR1 genes and the results of cognitive tests in patients with CHF and healthy persons. These data suggest that the polymorphism of the studied genes may be important in the genetic susceptibility to the formation and progression of cognitive disorders.