Screening Test For Dementia Research Articles

The feasibility of using the go/no-go task as a dementia screening test assessed with a cross-sectional design

The Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Frontal Assessment Battery are screening tests for dementia. The go/no-go task offers an alternative approach for evaluating dementia patients. However, its role in screening for dementia remains unclear. We aimed to explore the feasibility of using the go/no-go task as a screening test for dementia via a cross-sectional design. Twenty-four Japanese individuals were evaluated using the go/no-go task, the MMSE, and the MoCA. The total MMSE and MoCA scores were correlated with the total number of errors in the go/no-go task (r=-0.699, p < 0.01; r=-0.756, p < 0.01). Moreover, When the MoCA cutoff value was 25 for MCI, the optimal cutoff score for the total number of error in the go/no-go task to detect MCI was 2, with an Area Under curve (AUC) of 0.98, a sensitivity of 0.94. When the MMSE cutoff value was 27 for MCI, the optimal cutoff score for the total number of error in the go/no-go task to detect MCI was 6, with an AUC of 0.89, a sensitivity of 0.76, showed respectively values close to 1. The go/no-go task is possible a practical screening test for dementia.

Eye-Tracking-Based Cognitive Assessment Efficiently Detects Mild Cognitive Decline in the Predementia Stage

Introduction: The early detection of cognitive decline is key to maximizing the benefits of preventive and therapeutic interventions against dementia. Generally, dementia is first assessed by interview-based neuropsychological tests, but the lengthy interview and mental stress during the assessment process make screenings inefficient. We previously developed a rapid screening test for dementia using an eye-tracking technology (eye-tracking-based cognitive assessment [ETCA]) and reported its utility for clinically detecting cognitive impairment in dementia cases. However, the ETCA’s performance in detecting people with mild cognitive decline, which is the major target population for dementia prevention strategies, remains insufficiently examined. Therefore, this study aimed to evaluate the ETCA’s performance in individuals aged 40 years and older (n = 94, mean age: 61.0 [SD 13.1] years) without being formally diagnosed with dementia. Methods: All participants underwent both the ETCA and neuropsychological tests, including the Mini-Mental State Examination (MMSE), Rivermead Behavioral Memory Test (RBMT), and Addenbrooke’s Cognitive Examination-III (ACE-III) on the same day. We examined the correlations in scores between the ETCA and each neuropsychological test. Furthermore, we selected participants who earned normal scores in each neuropsychological test and evaluated the ETCA’s performance in this subgroup. Results: Participants’ ETCA scores correlated significantly with their scores on neuropsychological tests, including the MMSE, RBMT, and ACE-III. Notably, the ETCA scores correlated with the RBMT or ACE-III scores in individuals who showed normal scores in each neuropsychological test. Conclusion: The ETCA has the potential to screen mild cognitive decline efficiently at the predementia stage in nonclinical settings.

The Effectiveness of Centella asiatica Extract and Aerobic Exercise on Plasma Levels of Amyloid Beta-42 and Phosphorylated Tau in Older Women with Dementia

Urgency: Effect of Centella asiatica (CA) and aerobic exercise on Amyloid beta-42 (Aβ42) and phosphorylated tau (p-tau) as biomarkers of dementia is not yet known. Objectives: This study aimed to analyze the effect of CA, aerobic exercise, and their combination on Aβ42 and p-tau in older women with dementia. Design: It was a 24-week randomized, double-blind controlled trial. Partisipants: Subjects were divided into four groups: the Centella asiatica group (CA, 1x500 mg/day, n = 16), the aerobic exercise group (AE, 3x60 minutes/week, n = 16), the CA-AE combination group (1x500 mg/day and exercise, n = 15), and the placebo group (n = 15). Instruments: The dementia screening test used the Mini Mental State Examination (Intraclass correlation coefficients : ranging from 0.60 to 0.93, sensitivity of 88.3%) and Clinical Dementia Rating questionnaires (sensitivity 93.6% and specificity 100%). The Wilcoxon, Kruskal-Wallis, and Mann-Whitney tests were used to analyze the data. Results: Plasma amyloid beta-42 showed an increase in all groups: CA (p

Exploration of the Hungarian Version of Test Your Memory in General Practice: A Cross-Sectional Correlational Study of a Convenience Sample of Middle-Aged and Older Adults.

Dementia is a significant health issue worldwide. Mild cognitive impairment (MCI) can transform into dementia over time. General practitioners (GPs) may be the first to notice the cognitive deficit; therefore, it is crucial for them to have access to a screening test that can be administered quickly and efficiently. We explored the Hungarian version of the Test Your Memory self-administered dementia screening test in general practice for the early detection of dementia and cognitive impairment. In the four Hungarian cities with medical universities, 368 patients over the age of 50 attending GPs filled out the questionnaire within the framework of our cross-sectional study. The total scores of the test showed a significant correlation with education and type of occupation and a significant negative correlation with age. The results of this research showed that the clock drawing and recall subtest scores deteriorate at the earliest age. The test can be filled out in a GP's office easily and two of its subtests can raise the possibility that patients may need further assessment, especially if they have symptoms, at an earlier age than the other subtests.

Visual processing speed and its association with future dementia development in a population-based prospective cohort: EPIC-Norfolk

Visual processing deficits have frequently been reported when studied in individuals with dementia, which suggests their potential utility in supporting dementia screening. The study uses EPIC-Norfolk Prospective Population Cohort Study data (n = 8623) to investigate the role of visual processing speed assessed by the Visual Sensitivity Test (VST) in identifying the risk of future dementia using Cox regression analyses. Individuals with lower scores on the simple and complex VST had a higher probability of a future dementia diagnosis HR1.39 (95% CI 1.12, 1.67, P < 0.01) and HR 1.56 (95% CI 1.27, 1.90, P < 0.01), respectively. Although other more commonly used cognitive dementia screening tests were better predictors of future dementia risk (HR 3.45 for HVLT and HR 2.66, for SF-EMSE), the complex VST showed greater sensitivity to variables frequently associated with dementia risk. Reduced complex visual processing speed is significantly associated with a high likelihood of a future dementia diagnosis and risk/protective factors in this cohort. Combining visual processing tests with other neuropsychological tests could improve the identification of future dementia risk.

Attention to the domains of Revised Hasegawa Dementia Scale and Mini-Mental State Examination in patients with Alzheimer's disease dementia.

In Japan, Alzheimer's disease dementia (AD) is the most common cognitive disease, and the most widely used dementia screening tests are the Revised Hasegawa Dementia Scale (HDS-R) and Mini-Mental State Examination (MMSE). This study sought to elucidate the relationships of the individual domains of these tests with age and duration of school education in a large group of patients with AD. Participants were 505 new outpatients diagnosed with AD who completed the HDS-R and MMSE at the first visit. We investigated the relationships of total and individual domains of these tests with age and duration of school education using the least squares method. Next, we plotted regression lines of the individual domain scores against the total test scores. Younger age and longer duration of school education were significantly associated with higher total HDS-R and MMSE scores in AD. Domain-specific results indicated that younger age was significantly associated with a higher immediate memory score on both the HDS-R and MMSE and with a higher orientation (time), repetition score on the MMSE. Longer duration of school education was significantly associated with a higher working memory score on the HDS-R and with higher serial 7, repetition and writing scores on the MMSE. In addition, shorter duration of school education was significantly associated with higher naming score on the MMSE. The regression lines of orientation of time, remote memory, visual memory, and verbal frequency hit the bottom on the HDS-R (4/30, 8/30, 4/30, and 6/30, respectively) and of orientation of time, serial 7, remote memory, and writing also hit the bottom on the MMSE (8/30, 9/30, 11/30, and 8/30, respectively). We should pay attention to age, duration of school education, and the individual domains when using the HDS-R or MMSE to assess patients with AD.

Face Recognition Characteristics in Patients with Age-Related Macular Degeneration Determined Using a Virtual Reality Headset with Eye Tracking.

Face recognition is one of the most serious disabilities of patients with age-related macular degeneration (AMD). Our purpose was to study face recognition using a novel method incorporating virtual reality (VR) and eye tracking. Eighteen patients with AMD (seven male; median age 83 years; 89% with bilateral advanced AMD) and nineteen healthy controls (five male; median age 68 years) underwent the face recognition test IC FACES (Synthesius, Ljubljna, Slovenia) on a VR headset with built-in eye tracking sensors. Analysis included recognition accuracy, recognition time and fixation patterns. Additionally, a screening test for dementia and imaging with fundus autofluorescence and optical coherence tomography was performed. AMD patients had significantly lower face recognition accuracy (42% vs. 92%; p < 0.001) and longer recognition time (median 4.0 vs. 2.0 s; p < 0.001) in comparison to controls. Both parameters were significantly worse in patients with lower visual acuity. In both groups, eye-tracking data revealed the two classical characteristics of the face recognition process, i.e., fixations clustering mainly in the nose-eyes-mouth triangle and starting observation in the nasal area. The study demonstrates usability of a VR headset with eye tracking for studying visual perception in real-world situations which could be applicable in the design of clinical studies.

Impact of repetitive negative thinking on subjective cognitive decline: insights into cognition and brain structure.

Individuals with subjective cognitive decline (SCD) express concern about self-perceived cognitive decline despite no objective impairment and are at higher risk of developing Alzheimer's disease. Despite documented links between SCD and repetitive negative thinking (RNT), the specific impact of RNT on brain integrity and cognition in exacerbating the SCD condition remains unclear. We aimed to investigate the influence of RNT on global cognition and brain integrity, and their interrelationships among healthy middle-aged and older adults experiencing SCD. Out of 616 individuals with neuroimaging and neuropsychological data available, 89 (mean age = 56.18 years; 68.54% females) met SCD criteria. Eighty-nine non-SCD individuals matched by age, sex, and education were also selected and represented the control group (mean age = 56.09 years; 68.54% females). Global cognition was measured using the preclinical Alzheimer's cognitive composite (PACC5), which includes dementia screening, episodic memory, processing speed, and category fluency tests. RNT was calculated through three questionnaires assessing intrusive thoughts, persistent worry, and rumination. We generated cortical thickness (CTh) maps and quantified the volume of white matter lesions (WML) in the whole brain, as grey and white matter integrity measures, respectively. SCD individuals exhibited higher RNT scores, and thinner right temporal cortex compared to controls. No differences were observed in PACC5 and WML burden between groups. Only the SCD group demonstrated positive associations in the CTh-PACC5, CTh-RNT, and WML-RNT relationships. In this cross-sectional study, RNT was exclusively associated with brain integrity in SCD. Even though our findings align with the broader importance of investigating treatable psychological factors in SCD, further research may reveal a modulatory effect of RNT on the relationship between cognition and brain integrity in SCD.

Diagnosing Alzheimer's disease: Which dementia screening test to use in elderly Puerto Ricans with mild cognitive impairment and early Alzheimer's disease?

Typically, Alzheimer's disease (AD) diagnosis is not made at its earliest period, for instance, at mild cognitive impairment (MCI) and early AD (E-AD). Our study aims to demonstrate a correlation between the screening tools, including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Clinical Dementia Rating (CDR), and the biological biomarkers in the cerebrospinal fluid (CSF) amyloid beta 1-42 (Aβ42), phosphorylated tau (p-tau) proteins and total tau (t-tau)/Aβ42 ratio in Puerto Ricans>55 years old with MCI and E-AD. We evaluated 30 participants, including demographics, memory scales, and CSF biomarkers. Twenty-eight CSF biomarkers (Aβ42, p-tau protein, and t-tau/Aβ42 ratio) were analyzed using the Meso Scale Discovery Platform (MSD). Associations between memory scales (MoCA, MMSE, CDR) and CSF markers were performed using Spearman rho correlation. Our study revealed a statistical association favoring a direct relationship between MMSE and MoCA with t-tau/Aβ42 ratio in CSF (P=0.022, P=0.035, respectively). We found a trend toward significance with an inverse relationship with MMSE and Aβ42 (P=0.069) and a direct relationship with MMSE and p-tau (P=0.098). MMSE and MoCA screening tests were identified with a statistically significant association with the CSF biomarkers, specifically t-tau/Aβ42 ratio, in elderly Puerto Ricans with MCI and E-AD. Puerto Ricans>55 years old with MCI and E-AD could be screened confidently with MMSE and MoCA for a higher likelihood of earlier detection and, thus, initiation of disease-modifying treatment and prompt non-pharmacological interventions.

A comparison of word‐list and story recall tests for prediction of biomarker‐determined Alzheimer’s disease

AbstractBackgroundWord‐list and story recall tests are routinely employed in clinical practice for dementia screening. Previous research has shown that both types of tests are predictive of subsequent clinical diagnoses of dementia, including when examining process scores such as forgetting rate. In this study, our aim was to establish how well standard clinical metrics compared to process scores derived from word‐list and story recall tests in predicting biomarker‐determined Alzheimer’s disease (bdAD), as defined by CSF p‐tau/Abeta42 ratio.MethodData from 381 participants (mean age = 65, ± 9) were drawn from the University of Wisconsin – Madison Alzheimer’s Disease Research Center (ADRC) and Wisconsin Registry for Alzheimer’s Prevention (WRAP). Rey’s Auditory Verbal Learning Test (AVLT; word‐list) and Logical Memory Test (LMT; story) data were available. The conventional clinical scores examined were: AVLT total recall, AVLT delayed recall, LMT immediate recall, and LMT delayed recall. The process scores examined were: AVLT recency ratio (i.e., recency forgetting), AVLT total forgetting, LMT recency ratio, LMT total forgetting, and LMT primacy ratio (i.e., primacy forgetting). Bayesian linear regression analyses were carried out with either the nearest or farthest CSF p‐tau/Abeta42 ratio as outcome; the standard and process baseline memory scores as predictors; and baseline age, time elapsed from baseline to lumbar puncture, APOE risk score, sex, and years of education as control variables. Sensitivity analyses were carried out with logistic regressions using a cut‐off of 0.038 CSF p‐tau/Abeta42 ratio as outcome, to assess diagnosticity. CSF biomarkers were measured using the NeuroToolKit (Roche Diagnostics International Ltd, Rotkreuz, Switzerland).ResultLMT recency ratio and LMT primacy ratio were the best performing predictors (BF10 &gt; 1 billion) both when evaluating the nearest (Figure 1a) and the farthest (Figure 1b) outcomes. However, sensitivity analyses with a binary cut‐off favored the primacy ratio. Areas under the curve (AUCs) ranged from 0.86 to 0.87 (including covariates). Specificity was consistently high for primacy ratio with 94% probability of correctly identifying individuals without bdAD.ConclusionOur study shows that story recall tests may be better than word‐list tests for dementia screening, especially when employing process scores alongside conventional clinical scores.

Cross‐cultural properties of the Cross‐cultural Dementia Screening test and the European Cross‐Cultural Neuropsychological Test Battery

AbstractBackgroundCross‐cultural neuropsychological tests are essential to avoid potential cultural biases during the performance and score interpretation in diverse populations. We aimed to compare the performance of healthy controls in the Cross‐cultural Dementia Screening test and the European Cross‐Cultural Neuropsychological Test Battery in the majority and minority populations living in Spain.MethodThree hundred cognitively healthy participants were enrolled (58% women, age range 18‐90). One hundred from majority population (Spaniards), one hundred from minority population from Colombia, and one hundred from different minority populations, including participants from Latin America (66%, excluding participants from Colombia), Spaniards of Romani (gipsy) ethnicity (14%), Arab League (10%), and East Europe (10%). We matched the three groups controlling for sex, age, and level of education. All scores on CCD and CNTB were compared and correlated with an acculturation scale, controlling for age and years of education.ResultThere were no differences between groups in most of the items. Only processing speed measures of the CCD (Sun‐Moon test) and verbal fluency tasks of the CNBT showed statistically significant differences between groups. Scores on the acculturation scale were not associated with the neuropsychological test performance of all participants.ConclusionThe absence of differences between groups or acculturation influence on the scores supports the favourable cross‐cultural properties of the CCD and the CNTB. However, some tasks could still be more influenced, especially those associated with processing speed and verbal fluency, which suggests the need to further study and develop new tests and paradigms with better cross‐cultural properties.

Machine Learning‐Based Brief Screening Instrument for Dementia: “Six‐Questions Based Dementia Screen Test”

AbstractBackgroundMachine learning (ML) applied to healthcare is increasingly and it provides innovative solutions to solve complex real‐world problems. In dementia, ML has been applied to dementia detection, discriminating different types of dementia, and prediction progression of diseases. The aim of the study was to develop a new, brief clinical tool based on machine learning for dementia screening.MethodThe training data was from 533 participants (311 dementia and 202 non‐demented participants) screened with “Six‐Question Dementia Screening Test” (6Q‐DS). The 6Q‐DS contained six simple questions to evaluate mood, memory, orientation, and concentration. We used e‐Xtreme Gradient Boosting (XGBoost) algorithm, an ensemble ML based on decision trees, to establish the prediction model for dementia.ResultA total 533 participants, 186 men and 347 women with mean age 77.6 ± 8.2 (mean± SD) years, were recruited. The dementia group was significantly older and had lower education years compared to non‐dementia group (p &lt; 0.01 for both). The receiver‐operator characteristic (ROC) analysis showed that the area under the curve (AUC) was 0.91 for discriminating non‐dementia vs. dementia, with the sensitivity as 0.86, specificity 0.81 and accuracy 0.84. We found that the top 3 features are the second calculations for serial 3’s test, feeling of depression and the third calculations for serial 3’s test. We hypothesized that the second and third calculations required more cognitive demands because of holding information longer and depression is frequent in dementia. In our sixth question “Please count down 100 by 3 for 5 times (Serial 3’s)”, we found that the second and third calculations for serial 3’s test were important features to discriminating dementia from non‐dementia. We also found that the feeling of depression is the second important feature to distinguish dementia in our data set.ConclusionWe proposed the new, ease‐to‐use instrument with good classification of screening dementia based on ML. The 6Q‐DS showed an acceptable accuracy with a relatively high sensitivity and specificity. Further works are warranted to validate the model in different clinical settings and disease severity.

Three‐objects‐three‐places test as a screening test for prodromal and mild dementia: validation in a memory clinic population

AbstractBackgroundThe Three‐Objects‐Three‐Places (3O3P) test has been developed as a quick screen for episodic memory impairment due to Alzheimer’s Disease (AD). The examiner shows the patient three objects and hides them in three separate places. The patient is later asked what the objects and hiding places were, and which object was hidden where, producing a score out of 9. The aim of this study was to investigate the convergent, discriminant, and diagnostic validity of the test.Method1685 unselected patients from the Geneva Memory Center cohort who underwent the 3O3P test as a screen test in the context of routine assessment were included. The convergent and discriminant validity of the 3O3P test was assessed using an exploratory factor analysis. The known‐group validity was assessed in Cognitively Unimpaired (CU) vs Mild Cognitive Impairment (MCI) and demented using the Area Under the Curve (AUC) and comparing AUCs of the 3O3P test with those of other widely used cognitive tests (MMSE and Delayed recall ‐ DTR). The known‐group validity of the 3O3P was tested also in patients with AD biomarkers.ResultsMean age was 72 years (SD 11.5), 53% were female, mean years of education was 13 (SD 4.4), and mean MMSE was 28.5 (SD 1.5, N = 436) for CU, 25.6 (3.0, N = 767) for MCI and 19.5 (SD 5.2, N = 481). The 3O3P and DTR tests loaded strongly on the same (“memory”) factor, with a saturation of ‐0.89 and ‐0.88 respectively, and weakly on other (“non‐memory”) factors. The 3O3P test can discriminate CU versus MCI with an AUC of 0.71 and versus dementia with an AUC of 0.91. However, MMSE (AUC = 0.83 CU vs MCI; 0.97 CU vs dementia) and DTR (AUC = 0.78 CU vs MCI; 0.93 CU vs dementia) performed significantly better (p&lt;0.001). Patients who were amyloid positive, tau positive, and with significant neurodegeneration achieved lower 3O3P scores.ConclusionThe 3O3P test has demonstrated good convergent and discriminant validity supporting the notion that the test assesses the construct of episodic memory. Although the MMSE and DTR tests generally distinguished between diagnostic groups more effectively, the 3O3P test carries several advantages over these tests, such as its short duration, easy administration, culture‐ and language‐ free nature.

A Cognitive Screening Test for detecting Alzheimer’s Disease Dementia in the Deaf older adults in Austria, and Greece: the De‐Sign Erasmus+ project

AbstractBackgroundUntil now there is a lack of cognitive screening tests for Deaf older adults to detect Alzheimer’s Disease Dementia (ADD) across Europe, as well as limited access to the therapeutic methods imposed. Therefore, the Deaf population has little access to dementia services.MethodTo fill this gap, the current Erasmus+ project aims to adapt the first dementia screening test for Deaf people in Austria and Greece being initially available for the British Deaf older adults and therefore, provide a valid and reliable tool to detect cognitive deficits by means of ADD in this population.ResultFor the project’s purposes, a group of experts will translate and adapt the CST in Austrian (ÖGS) and Greek sign languages (GSL), and after piloting the new CST versions, they will be administered in approximately 100 Deaf older adults in each country. Additionally, the following tests will be also administered: the Montreal Cognitive Assessment (MoCA), the Verbal Learning and Memory Test, and the Digit Span (forwards and backwards). To assess the psychometric properties of the new versions of CST, internal reliability, test retest reliability, as well as concurrent validity will be calculated. Finally, a digital web‐based platform including tests’ administration guidelines along with the test per se will be developed. To disseminate the project’s results, detailed seminars on the test administration as well as the use of the platform will be implemented to experts from the fields of dementia and sign languages.ConclusionTo introduce dementia screening as well as ADD detection in the Deaf in Austria and Greece.

Cognitive decline assessed using a brief screening test and cardiovascular and non-cardiovascular events in older patients with heart failure.

Although cognitive decline is recognized as a prognostic factor of heart failure (HF), the association of cognitive decline with specific clinical outcomes in patients with HF remains unclear. This study examines the relationship between cognitive decline using a brief test and cardiovascular and non-cardiovascular events in older patients with HF. This study included 146 hospitalised patients with HF (median age, 77years; male, 56.8%). Cognitive decline was defined as a score of ≤ 9 points on the Rapid Dementia Screening Test at the time of discharge. Cumulative incidence of cardiovascular events after discharge was twofold higher in patients with cognitive decline (Model 1 adjusted for basic characteristics, hazard ratio (HR) = 2.01, 95% confidence interval (CI): 0.94-4.31; Model 2 adjusted for potential confounders, HR = 2.30, 95% CI: 1.07-4.97). The association between cognitive decline and non-cardiovascular events decreased after adjusting for potential confounders. The results of this study emphasize the clinical utility of cognitive assessment for risk stratification of worsening cardiovascular conditions, including HF.

The Effect of Dementia Screening Tests on Subsequent Kidney Function in the Elderly

The Effect of Dementia Screening Tests on Subsequent Kidney Function in the Elderly

A pilot study for a practical screening tool for dementia: validation of 5-minute cognitive test in a geriatric population.

The aim of this study is to validate the Turkish version of the 5-minute cognitive test (FCT) in a geriatric population. In total, 61 participants aged ≥65 years with normal cognitive functions, mild cognitive impairment (MCI), and early stage dementia were included. The FCT was compared to the standardised Mini Mental State Examination (MMSE) and the Qmci-TR (quick mild cognitive impairment) test. Test reliability for the FCT was strong (Cronbach's α = 0.747). We demonstrated a strong correlation of FCT scores with MMSE and Qmci-TR scores (respectively, r = 0.730, P < 0.001, r = 0.723, P < 0.001). The fact that the scores obtained in the dementia group were significantly lower also showed that the test can be used reliably in the differentiation of MCI and early dementia (P < 0.001). The FCT is a brief, reliable, and valid cognitive screening test for screening dementia at early stages in a Turkish geriatric population.

Application of the Semantic Fluency Test in the Screening of Mandarin-Chinese-Speaking Older Adults with Mild Dementia of the Alzheimer Type.

Semantic fluency tests have been widely used as a screening test for dementia of Alzheimer type. However, few studies have explored the application of semantic fluency tests in Mandarin Chinese speakers. This study aimed to explore the feasibility of using different semantic fluency test categories to distinguish between older adults without cognitive impairments and those with dementia of Alzheimer type in Taiwan. A total of 58 healthy older adults and 54 individuals with dementia of Alzheimer type were recruited. Semantic categories of "animals", "fruits", "vegetables", "birds", "means of transportations" and "musical instruments" were administered to participants. The scores from two groups of participants for each category were analyzed. Significant differences in the test scores of each category between two groups of participants were found. The results also revealed that the variables related to whether the participant had dementia, gender, age, and years of schooling significantly influenced the semantic fluency scores for each category. Among all the demographic characteristic of participants, the diagnosis of dementia was the most determining factor. Furthermore, this study proposed optimal cutoff points and calculated the AUC for various test durations (i.e., 30 s, 45 s and 60 s) and semantic categories in the semantic fluency test, which may serve as a reference that would help clinical personnel distinguish between older adults without cognitive impairments and those with dementia of Alzheimer type in Taiwan.

Digital Cognitive Tests for Dementia Screening: A Systematic Review

Context: The number of people with dementia is increasing dramatically. With the outbreak of the COVID-19 pandemic, digital screening tests can play a significant role in the remote and timely detection of people with dementia. This study aimed to review digital cognitive tests for dementia screening. Methods: We searched Web of Science, ProQuest, PubMed, Scopus, and Cochrane using related terms such as “dementia,” “mobile,” “digital,” “computer,” and “cognitive assessment,” leading to the emergence of 1,348 articles. Titles, abstracts, and full texts were screened to select the relevant articles based on inclusion/exclusion criteria. Study characteristics and digital test features such as diagnostic performance and deploying platforms were extracted from selected articles. The risk of bias and reporting quality were evaluated in the included studies. Results: Out of 1,348 identified articles, 32 were eligible for inclusion. We categorized digital cognitive tests into 3 groups based on deploying platforms: (1) Mobile-based screening tests (59.5%), (2) desktop-based screening tests (28%), and (3) web-based screening tests (12.5%). Conclusions: Digital cognitive tests, especially mobile-based screening tests, facilitate the timely diagnosis of dementia. The development of AI-based screening tests and the use of technologies such as virtual reality and chatbots will set a bright future in the early detection of dementia.

Validation of the German Montreal-Cognitive-Assessment-H for hearing-impaired.

Hearing loss and dementia are highly prevalent in older age and often co-occur. Most neurocognitive screening tests are auditory-based, and performance can be affected by hearing loss. To address the need for a cognitive screening test suitable for people with hearing loss, a visual version of the Montreal-Cognitive-Assessment was developed and recently validated in English (MoCA-H), with good sensitivity and specificity for identifying cases of dementia. As the MoCA is known to perform differently across languages, revalidation of the German MoCA-H was necessary. The aim of the present study was to assess the diagnostic accuracy of the German MoCA-H among those with normal cognition, mild cognitive impairment (MCI) and dementia and to determine an appropriate performance cut- off. A total of 346 participants aged 60-97 years (M = 77.18, SD = 9.56) were included; 160 were cognitively healthy, 79 with MCI and 107 were living with dementia based on the GPCOG and a detailed medical questionnaire as well as a comprehensive examination by a neurologist in case of cognitive impairment. Performance cut-offs for normal cognition, MCI and dementia were estimated for the MoCA-H score and z-scores using the English MoCA-H cut-off, the balanced cut-off and the Youden's Index. A mean score of 25.49 (SD = 3.01) points in the German MoCA-H was achieved in cognitively healthy participants, 20.08 (SD = 2.29) in the MCI and 15.80 (SD = 3.85) in the dementia group. The optimum cut-off for the detection of dementia was ≤21 points with a sensitivity of 96.3% and a specificity of 90%. In the MCI group, a cut-off range between 22 and 24 points is proposed to increase diagnostic accuracy to a sensitivity and specificity of 97.5 and 90%, respectively. The German MoCA-H seems to be a sensitive screening test for MCI and dementia and should replace commonly used auditory-based cognitive screening tests in older adults. The choice of a cut-off range might help to better reflect the difficulty in clinical reality in detecting MCI. However, screening test batteries cannot replace a comprehensive cognitive evaluation.