Detection Of Cognitive Deficits Research Articles

The Montreal Cognitive Assessment detects cognitive deficits that go unnoticed during clinical observation in the acute phase after stroke

ABSTRACT Background Detecting cognitive impairments early after stroke is essential for appropriate referrals. Although recommended in stroke guidelines, early cognitive screening is not always implemented. We assessed whether the Montreal Cognitive Assessment (MoCA) adds diagnostic value compared to clinical observation alone. In addition, discharge destinations for stroke patients with and without cognitive deficits detected with the screening tool or the treatment team were explored. Methods Forty-four stroke patients were screened with the MoCA during stroke unit admission. Their charts were studied for cognitive impairments reported by the stroke care team, who were blinded to screening scores. Proportions of detected cognitive deficits were compared between screening (score <26) and patient charts. Discharge destination distribution (home vs. rehabilitation) was explored. Results The proportion of cognitively impaired patients indicated by the MoCA (84%) and reported in patients’ charts (25%) differed significantly (p < 0.001). The distribution of discharge destination did not suggest an association with the detection of cognitive deficits by the treatment team or the cognitive screening. Conclusions The MoCA detects more cognitive deficits than clinical impression alone, emphasizing the importance of standard screening for cognitive impairments in acute stroke patients. Ultimately, systematic screening may enhance discharge planning and improve long-term outcomes.

Cognition in older offenders in North Rhine-Westphalia: A comparison of prisoners and patients in forensic psychiatry hospitals

The number of elderly delinquent individuals living in prisons and forensic hospitals is increasing. For both settings, complex needs have been described for the elderly related to age-related changes and frequent somatic disorders as well as mental disorders, primarily depressive symptoms.. One of the biggest challenges are cognitive impairments which have been described for both groups, probably not least due to frequent risk factors (e.g., substance abuse, depressive symptoms). Given that the group of forensic patients has a manifest mental illness, which is usually treated with psychopharmaceuticals, the question arises as to what extent cognitive deficits are more frequent here. For both groups, the detection of cognitive deficits with regard to therapy and release planning is of relevance. In sum, studies on cognitive function in both populations are rare, and the results are hard to compare due to different instruments to assess cognition.Sociodemographic, health-, and incarceration-related data were collected as well as neuropsychological functions using established instruments to evaluate global cognitive functioning (Mini-Mental State Examination [MMSE], DemTect), executive function (Frontal Assessment Battery [FAB], and Trail Making Test [TMT]).In the final sample, 57 prisoners and 34 forensic inpatients from North Rhine Westphalia, Germany being 60 years and older were included. The groups were comparable in age (prisoners: M = 66.5 years, SD ± 5.3; forensic inpatients: M = 66.8 years, SD ± 7.5) and education (prisoners: M = 11.47, SD ± 2.91; forensic inpatients: M = 11.39, SD ± 3.64), but the offenders in forensic psychiatry had spent significantly more time in the correctional setting than prisoners (prisoners: M = 8.6, SD ± 10.8; forensic inpatients: M = 15.6 years, SD ± 11.9). In both groups cognitive deficits were frequent. Depending on the tests and population, between 42% and 64% showed impairments in global cognition, and between 22% and 70% were classified with impaired executive functioning. We found no significant differences in global cognition or executive functions assessed with the TMT between the two groups. However, forensic inpatients were significantly more impaired in the FAB compared to the prisoners.The results emphasize the high frequency of cognitive dysfunction in both settings and a possibly higher frequency of “frontal” dysfunction in forensic inpatients, and, thus, indicate the relevance of routine neuropsychological diagnostic and treatment procedures in these settings.

The screen for cognitive impairment in psychiatry (SCIP) as a routinely applied screening tool: pathology of acute psychiatric inpatients and cluster analysis

BackgroundCognitive dysfunction has been reported in acute psychiatric patients for a long time. The detection of cognitive deficits is crucial both for clinical treatment and for predicting the psychosocial functional level in the further course of the disease. The SCIP is a well-evaluated screening instrument for the examination of cognitive performance in psychiatric patients. We recently integrated the SCIP into our routine admission and discharge assessments on two inpatient wards, and we examined the cognitive profiles of patients with psychotic and affective disorders over the course of their admission.MethodsShortly after admission, and prior to discharge, patients were routinely referred for examination with the SCIP. A total of 529 assessments were completed on admission, and 227 returned for SCIP at the time of discharge. After standardization of the test results against a normative sample, we examined the normalized test values in terms of percentages of pathological cognitive performance based on the total SCIP score, and each of the SCIP subscale scores. We conducted cluster analysis to identify cognitive subgroups within the clinical sample.ResultsMore than 70% of the SCIP results on admission were pathological. At discharge, improvements were observed, especially on tests with attention and speed components. Cluster analysis identified two groups. The cluster with chronic patients showed poorer results at admission, but greater improvement and reached the level of the others at discharge.ConclusionsThe SCIP appears to have value in routine diagnostic assessments, and in the quantification of improvements in cognitive performance during an inpatient stay. The greatest benefit was observed in chronically ill patients with many previous stays.Trial registrationDRKS00019825 (retrospectively registered on 03.12.2019).

Evaluation of Cognitive Functioning in the Context of Rehabilitation for Visual Impairment in Older Adults: A Case Series

ABSTRACTAims: As the risk of visual impairment increases with age, so does the risk of developing cognitive impairment. Detection of cognitive deficits in people with visual impairments is a challenge and it remains unclear to what extent cognitive issues impact daily habits and the rehabilitation process. The present study aimed to (1) verify the consistency between the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) (“Blind” versions) and the therapist's observations of elderly individuals in low-vision rehabilitation (LVR), and (2) document how cognitive difficulties may influence LVR and the satisfactory carrying-out of life habits. Methods: Six elderly individuals who received LVR completed the MMSE and MoCA (“Blind” versions) and Assessment of Life Habits (LIFE-H). The therapist rated the achievement of rehabilitation objectives, clients' cognitive functioning and its impact on the rehabilitation process. Results: All participants obtained scores within the normative score range for both tests except for one participant on the MoCA. The therapist perceived that four out of six participants had cognitive difficulties significant enough to hinder the rehabilitation process and these persons required more adaptations to therapy. All participants were satisfied with their life habits despite remaining functional limitations and the need for assistance. Conclusions: In this sample, standardized cognitive tests had limited utility to predict the complexity of LVR. Even if present, cognitive difficulties do not preclude rehabilitation for even severe visual impairment in elderly persons and does not imply significantly longer or more intense rehabilitation.

Validity of the Montreal Cognitive Assessment Screener in Adolescents and Young Adults With and Without Congenital Heart Disease

Cognitive deficits are common, long-term sequelae in children and adolescents with congenital heart disease (CHD) who have undergone surgical palliation. However, there is a lack of a validated brief cognitive screening tool appropriate for the outpatient setting for adolescents with CHD. One candidate instrument is the Montreal Cognitive Assessment (MoCA) questionnaire. The purpose of the research was to validate scores from the MoCA against the General Memory Index (GMI) of the Wide Range Assessment of Memory and Learning, 2nd Edition (WRAML2), a widely accepted measure of cognition/memory, in adolescents and young adults with CHD. We administered the MoCA and the WRAML2 to 156 adolescents and young adults ages 14-21 (80 youth with CHD and 76 healthy controls who were gender and age matched). Spearman's rank order correlations were used to assess concurrent validity. To assess construct validity, the Mann-Whitney U test was used to compare differences in scores in youth with CHD and the healthy control group. Receiver operating characteristic curves were created and area under the curve, sensitivity, specificity, positive predictive value, and negative predictive value were also calculated. The MoCA median scores in the CHD versus healthy controls were (23, range 15-29 vs. 28, range 22-30; p < .001), respectively. With the screening cutoff scores at <26 points for the MoCA and 85 for GMI (<1 SD, M = 100, SD = 15), the CHD versus healthy control groups showed sensitivity of .96 and specificity of .67 versus sensitivity of .75 and specificity of .90, respectively, in the detection of cognitive deficits. A cutoff score of 26 on the MoCA was optimal in the CHD group; a cutoff of 25 had similar properties except for a lower negative predictive value. The area under the receiver operating characteristic curve (95% CI) for the MoCA was 0.84 (95% CI [0.75, 0.93], p < .001) and 0.84 (95% CI [0.62, 1.00], p = .02) for the CHD and controls, respectively. Scores on the MoCA were valid for screening to detect cognitive deficits in adolescents and young adults aged 14-21 with CHD when a cutoff score of 26 is used to differentiate youth with and without significant cognitive impairment. Future studies are needed in other adolescent disease groups with known cognitive deficits and healthy populations to explore the generalizability of validity of MoCA scores in adolescents and young adults.

Utility of the Neuropsychological Assessment Battery in detecting cognitive impairment after unilateral stroke

This study evaluated the clinical utility of the Neuropsychological Assessment Battery (NAB) in a stroke sample by examining the NAB's ability to differentiate a chronic stroke group with radiologically confirmed unilateral damage (n = 42) and a demographically matched healthy control (HC) group (n = 36). The stroke group performed more poorly than the control group across NAB Total score and all five Domain scores. Receiver operator curves (ROC) were derived and area under the curve (AUC) showed moderate diagnostic effectiveness (AUC .70 to .90) for NAB Total score, all five Domain scores, a motor composite, and a Global Deficit Score (GDS) that has been shown to closely approximate clinical ratings of neuropsychological impairment. The NAB Total, GDS, and motor composite had comparable clinical utility, whereas the Attention and Executive domain scores demonstrated better classification utility compared with the Memory domain. Because 90.5% of our stroke sample had middle cerebral artery territory strokes, the comparison of motor and cognitive classification utility may be biased. However, follow-up analyses showed that the NAB accounted for additional variance even when motor composite was included in the model. Sensitivity, specificity, and odds ratios at various clinical cutoffs are provided. These results suggest that the NAB is a useful clinical tool for detection of cognitive deficits in individuals with chronic unilateral stroke, although lenient clinical cutoffs appear warranted to maximize sensitivity.

Emergency psychiatry: rapid screening for cognitive impairment in the psychiatric emergency service: II. A flexible test strategy.

tion of cognitive screens may enhance diagnostic and treatment decisions in the psychiatric emergency service while minimizing the time, resources, and cost of delivering services to patients who present for emergency services. In the first column in this series (5), we reviewed cognitive screening batteries that may be used in the psychiatric emergency service. In this follow-up column, we highlight the use of four cognitive tests that can be used alone or in combination in a flexible strategic approach to aid in the detection of cognitive deficits and facilitate triage decisions in the psychiatric emergency service.

Deficiencies in the detection of cognitive deficits.

Deficiencies in the detection of cognitive deficits.

Deficiencies in the detection of cognitive deficits.

Numerous studies purport to show that cardiopulmonary bypass (CPB) surgery is associated with persistent postoperative cognitive decline. In J. R. Keith et al. (2002), the authors argued that reports of post-CPB cognitive declines have often been quantified using data analysis methods that were based on tenuous assumptions and overlooked problems associated with familywise Type I errors. Four peers who are recognized for their expertise in neuropsychological outcomes research evaluated the arguments developed in the J. R. Keith et al. article, critiqued the study presented in that article, and offered suggestions for how to investigate whether cognitive decline occurs reliably after CPB. In this reply article, the authors respond to the open-peer commentaries made regarding the J. R. Keith et al. study.

Identification of a screening buttery for the detection of cognitive deficits associated with lead toxicity: A pilot study

Identification of a screening buttery for the detection of cognitive deficits associated with lead toxicity: A pilot study

Identification of a screening buttery for the detection of cognitive deficits associated with lead toxicity: A pilot study

Identification of a screening buttery for the detection of cognitive deficits associated with lead toxicity: A pilot study

The Use of Proverb Interpretation in the Detection of Cognitive Deficits

Medical professionals commonly use proverb interpretation as part of a screening process for cognitive deficiency. The value of using proverbs for this purpose was examined with a random sample of 205 English-speaking residents of suburban Adelaide. Subjects interpreted three proverbs typical of those used for assessment. Only 15% of subjects correctly interpreted all three proverbs, and over a quarter of subjects did not correctly interpret any proverb, suggesting that proverb interpretation may lack specificity in identifying cognitive deficits. Performance was influenced by age, sex, educational achievement, and occupational classification. Normative data, which can allow for the effects of these factors, are not usually available for individual proverbs. Proverb interpretation as a screening test for cognitive deficiency should be used with caution.

Detection of cognitive deficits by a brief mental status examination: The Cognitive Capacity Screening Examination, a reappraisal and a review

Results of a brief mental status questionnaire, the Cognitive Capacity Screening Examination (CCSE), were compared with the clinical evaluations of 59 patients on a neurology service. In 71% of the cases, the CCSE scores correctly indicated a cognitive deficit (true-positive) or the absence of one (true-negative); false-negative results were observed in 15% and questionable negative results were found in 10%. Abnormal neurologic physical signs were present in 90% of all patients with cognitive deficits. In this population, although positive CCSE scores were reliable, negative scores were often misleading. Mild diffuse intellectual dysfunction (dementia) and some discrete intellectual deficits (aphasia and anosognosia) went undetected. Cognitive deficits associated with major cerebral disease were unappreciated in nine patients. Caution is recommended in interpreting negative CCSE scores. Abbreviated screening devices are only a preliminary approach to mental status evaluation; this test requires further refinement.