Different Levels Of Cognitive Impairment Research Articles

Comparing psychometric characteristics of a computerized cognitive test (BrainCheck Assess) against the Montreal cognitive assessment

IntroductionPrevious validation studies demonstrated that BrainCheck Assess (BC-Assess), a computerized cognitive test battery, can reliably and sensitively distinguish individuals with different levels of cognitive impairment (i.e., normal cognition (NC), mild cognitive impairment (MCI), and dementia). Compared with other traditional paper-based cognitive screening instruments commonly used in clinical practice, the Montreal Cognitive Assessment (MoCA) is generally accepted to be among the most comprehensive and robust screening tools, with high sensitivity/specificity in distinguishing MCI from NC and dementia. In this study, we examined: (1) the linear relationship between BC-Assess and MoCA and their equivalent cut-off scores, and (2) the extent to which they agree on their impressions of an individual’s cognitive status.MethodsA subset of participants (N = 55; age range 54–94, mean/SD = 80/9.5) from two previous studies who took both the MoCA and BC-Assess were included in this analysis. Linear regression was used to calculate equivalent cut-off scores for BC-Assess based on those originally recommended for the MoCA to differentiate MCI from NC (cut-off = 26), and dementia from MCI (cut-off = 19). Impression agreement between the two instruments were measured through overall agreement (OA), positive percent agreement (PPA), and negative percent agreement (NPA).ResultsA high Pearson correlation coefficient of 0.77 (CI = 0.63–0.86) was observed between the two scores. According to this relationship, MoCA cutoffs of 26 and 19 correspond to BC-Assess scores of 89.6 and 68.5, respectively. These scores are highly consistent with the currently recommended BC-Assess cutoffs (i.e., 85 and 70). The two instruments also show a high degree of agreement in their impressions based on their recommended cut-offs: (i) OA = 70.9%, PPA = 70.4%, NPA = 71.4% for differentiating dementia from MCI/NC; (ii) OA = 83.6%, PPA = 84.1%, NPA = 81.8% for differentiating dementia/MCI from NC.DiscussionThis study provides further validation of BC-Assess in a sample of older adults by showing its high correlation and agreement in impression with the widely used MoCA.

Differential neuropsychological profiles in children and adolescents with motor disability in an inclusive educational setting

ABSTRACT The aim of this study was to determine the potential cognitive impairment associated with motor disability in a group of children attending regular schools and to analyze whether there were different cognitive profiles according to the type of motor disability they presented. The study had 87 participants, 31 healthy and 56 with three types of motor disability: Neuromuscular Diseases (NMD Group), Cerebral Palsy-Hemiparesis (CP- HPx Group) and Cerebral Palsy-Diplegia (CP-DP). Ages ranged from 6 to 18 years and they had medium and medium-high socioeconomic and cultural levels. All participants attended regular state-funded and independent schools in an inclusive modality. The neuropsychological assessment included the following cognitive domains: processing speed, working memory, verbal and visual episodic memory, language, visuo-perception and constructive praxis and executive functioning. A second analysis was performed with the groups with CP: one based on the severity of gross motor impairment (GMFCS-E&R scale) and the other based on the levels of manual dexterity (MACS scale). ANCOVAs were performed controlling for age and processing speed in the three analyses. The group with CP-HPx was shown to be the most cognitively impaired of the three groups, with significant deficits in visuo-perception, verbal working memory, and visuo-spatial memory. Subjects with greater gross motor dysfunction (GMFCS-E&R) did not show the greatest cognitive impairment, while those with worse manual dexterity (MACS) exhibited greater cognitive impairment. Children and adolescents with motor disabilities, a priori cognitively normal, present different levels of cognitive impairment. This should be considered when planning educational adaptations for this infant-juvenile population.

Differences in the pattern of influencing factors on instrumental activities of daily living in persons at different stages of mildly impaired cognition

AbstractBackgroundInstrumental Activities of Daily Living (IADL) are crucial for a person’s autonomy. A better understanding of potentially influencing factors at different levels of cognitive impairment is relevant for diagnostic and therapeutic purposes. Therefore, we aimed to explore whether the pattern of influencing factors varies between persons with mild cognitive impairment (MCI) and mild dementia.MethodWe exploratively extended the secondary analysis of a cohort, including persons with amnestic (a‐)MCI and mild Alzheimer’s dementia (MD). We fitted linear regression models to the data within the two subgroups, with IADL as the response variable measured using the Brussels Integrated Activities of Daily Living Inventory (BIA) [1]. Selection of the predictors followed a multi‐step approach, including criterion‐based model selection and model fit. We used multivariate imputation by chained equations to estimate the coefficients of the final models and standardized coefficient estimates to relate and compare the effects of the predictors.ResultPersons with a‐MCI (n = 64, mean age 81.7 years, 69% females) and with MD (n = 41, mean age 82.3 years, 73% females) differed in their mean BIA scores (p<0.001). In persons with MCI, the final model (R2 = 0.46) included memory, attention, executive function, mobility, balance, vision, hearing, education, and living situation. Mobility was the only significant predictor and the predictor with the most considerable effect, followed by memory and attention. The final model (R2 = 0.21) in persons with MD included the same predictors; however, executive function and attention were derived from other assessments. The predictors with the most considerable effect were the living situation, mobility, and executive function, yet none was significant.ConclusionThe pattern of potentially influencing factors on IADL functioning differs between persons with aMCI and MD. Our results suggest that physical function plays an essential role in IADL functioning in persons with aMCI, whereas in MD, no significant predictor was detected. Furthermore, our results indicate that IADL functioning may be used to differentiate between diagnostic groups.[1] De Vriendt P, Cornelis E, Cools W, Gorus E. The Usefulness of Evaluating Performance of Activities in Daily Living in the Diagnosis of Mild Cognitive Disorders. International Journal of Environmental Research and Public Health. 2021;18(21):11623.

INTERFACE OF INFORMAL AND FORMAL SUPPORT IN THE LINKAGE BETWEEN COGNITIVE DECLINE AND LONELINESS

Abstract Older adults with cognitive impairment are at risk of higher loneliness due to increasing challenges to retain essential social skills and decreasing social networks. This study explores ways to reduce the relationship between cognitive function and loneliness. Drawing on the cognitive discrepancy theory of loneliness, we hypothesized loneliness may be reduced by improving an individual’s actual level of social interaction, creating opportunities for social relationships. This study examined complex relationships among informal (frequency of social contact with family members and friends) and formal support (use of home- and community-bound services, HCBS), and loneliness, among older adults with different levels of cognitive impairment. Data came from the Health and Retirement Study (2012) (N=651) with the sample included respondents 51+ years who completed a modified Telephone Interview for Cognitive Status. Results from hierarchical regression showed older people with a lower level of cognitive function were less likely to experience loneliness (b=-.15, p<.01). Although frequent social contact with family and friends reduces loneliness (b=-.24, p<.001), it did not moderate the relationship between cognitive function and loneliness. Interestingly, the use of HSBC also turned out to be not a significant protective factor. Our findings suggest merely increasing social interaction levels with family and friends may not necessarily curb loneliness for older adults with cognitive impairment. Given the current characteristics and nature of HCBS primarily focus on providing basic physical needs of older adults, prioritizing the development of emotional comfort and recreational activities that alleviate their psychological loneliness is essential, especially amidst the pandemic.

The Benton Visual Form Discrimination Test as a Predictor of Neurocognitive Disorder in Older Veterans.

The Benton Visual Form Discrimination Test (VFDT) is a commonly used measure of visual discrimination and visual recognition memory and has shown promise in distinguishing between different levels of cognitive impairment. We assess the predictive diagnostic utility of the VFDT in a sample of older Veterans with cognitive concerns. Subjects included a total of 172 mostly male Veterans over the age of 64 (mean = 76.0; SD = 7.6) recruited from a VA clinic specializing in neuropsychological assessment of older Veterans. The clinical sample included 56 subjects diagnosed with Major Neurocognitive Disorder, 74 diagnosed with Mild Neurocognitive Disorder, and 42 with No Neurocognitive Impairment. Impairment categories were modeled in separate multinomial logistic regressions with two versions of the VFDT as predictors: the Visual Form Discrimination Test-Recognition Subtest (VFDT-Rec) test (visual recognition memory) and the Visual Form Discrimination Test-Matching Subtest VFDT-Mat test (visual form discrimination). Years of education were included as a covariate. After adjusting for education, higher VFDT-Rec total scores were associated with lower odds of being categorized with a greater degree of cognitive/functional impairment (OR 0.66-0.83, p < .001). VFDT-Mat scores showed a similar pattern, but only reached statistical significance for the Major versus No Neurocognitive Impairment (OR = 0.77, p = .0010) and Major versus Mild comparisons (OR = 0.89, p = .0233). The VFDT may enhance the confidence of differential diagnosis of dementia in older adult Veterans. Formal education-adjusted norms need to be established for clinical use.

The Effects of the 2020 COVID-19 Visitor Ban on Mood, Behavior, and Social and Cognitive Functioning in Older Long-Term Care Residents

In order to prevent the spread of COVID-19 the Dutch government imposed a visitor ban on long term care facilities (LTCFs) on March 20,2020. We aimed to explore the association of this COVID-19 lockdown with changes in mood, behavior and functioning of LTCF residents prospectively. Mixed methods:1.Longitudinal analysis of Dutch interRAI LTCF assessments of residents ≥60 years. The group of residents who had been assessed during the Dutch visitor ban (March 20- May 24 2020) were compared with a group of other residents of the same LTCF wards who had two assessments prior to the lockdown. We used mixed models and GEE analyses to explore the difference between the two groups. Differences in changes over time were explored in: mood symptoms, withdrawal & aggressive behavior, loneliness & conflict with other residents and care staff, and cognition & delirium. We also explored whether the effect of the visitor ban differed for different subgroups, such as residents with different levels of cognitive impairment and residents who were assessed during the first/second half of the lockdown.2.In two digital focus groups, LTCF care professionals, ranging from nursing staff to elderly care physicians, reflected on the results of the quantitative analyses. 1.The lockdown group existed of 298 residents of 71 wards in 30 facilities. 625 residents of the same departments comprised the control group. In general the change in outcomes did not differ between the groups. Self-reported mood symptoms tended to show a greater increase in the lockdown group. This difference primarily existed in the first half of the lockdown. The subgroup of residents with at least moderate cognitive impairment showed a decrease in withdrawal during the lockdown, while the residents in the other subgroups showed an increase.2.Care professionals who participated in the focus groups described both negative and positive effects of the lockdown on residents. Possibly the effects of the lockdown were mitigated by, for example, video calling with family members and innovative and small-scale activities within the LTCF departments. The tranquility and coziness in the common rooms during the lockdown was experienced to have positive effects on some residents. Several facilities have undertaken efforts to preserve this tranquility, for example by continuing to organize more small-scale activities in the common room. We found no evidence for a group level effect of the lockdown on changes in mood, behavior, social and cognitive functioning in residents of Dutch LTCFs. In focus groups, care professionals described a great degree of individual variation in the effect of the lockdown on residents. Possibly, the efforts of care staff mitigated the effect of the lockdown at the group level. LTCFs have learned lessons from this historical event which they continue to apply.

Developing a pragmatic evaluation of ICTs for older adults with cognitive impairment at scale: the IN LIFE experience

Implementing information and communications technology (ICT) at scale requires evaluation processes to capture the impact on users as well as the infrastructure into which it is being introduced. For older adults living with cognitive impairment, this requires evaluation that can accommodate different levels of cognitive impairment, alongside input from family and formal caregivers, plus stakeholder organisations. The European Horizon 2020 project INdependent LIving support Functions for the Elderly (IN LIFE) set out to integrate 17 technologies into a single digital platform for older people living with cognitive impairment plus their families, care providers and stakeholders. The IN LIFE evaluation took place across six national pilot sites to examine a number of variables including impact on the users, user acceptance of the individual services and the overall platform, plus the economic case for the IN LIFE platform. The results confirmed the interest and need among older adults, family caregivers, formal caregivers and stakeholders, for information and communications technology (ICT). Relative to the baseline, quality of life improved and cognition stabilised; however, there was an overall reluctance to pay for the platform. The findings provide insights into existing barriers and challenges for adoption of ICT for older people living with cognitive impairment.

The Effect of the APOE-ε4 Allele on the Cholinergic Circuitry for Subjects With Different Levels of Cognitive Impairment.

Background: Cholinergic deficiency has been suggested to associate with the abnormal accumulation of Aβ and tau for patients with Alzheimer's disease (AD). However, no studies have investigated the effect of APOE-ε4 and group differences in modulating the cholinergic basal forebrain–amygdala network for subjects with different levels of cognitive impairment. We evaluated the effect of APOE-ε4 on the cholinergic structural association and the neurocognitive performance for subjects with different levels of cognitive impairment.Methods: We used the structural brain magnetic resonance imaging scans from the Alzheimer's Disease Neuroimaging Initiative dataset. The study included cognitively normal (CN, n = 167) subjects and subjects with significant memory concern (SMC, n = 96), early mild cognitive impairment (EMCI, n = 146), late cognitive impairment (LMCI, n = 138), and AD (n = 121). Subjects were further categorized according to the APOE-ε4 allele carrier status. The main effects of APOE-ε4 and group difference on the brain volumetric measurements were assessed. Regression analyses were conducted to evaluate the associations among cholinergic structural changes, APOE-ε4 status, and cognitive performance.Results: We found that APOE-ε4 carriers in the disease group showed higher brain atrophy than non-carriers in the cholinergic pathway, while there is no difference between carriers and non-carriers in the CN group. APOE-ε4 allele carriers in the disease groups also exhibited a stronger cholinergic structural correlation than non-carriers did, while there is no difference between the carriers and non-carriers in the CN subjects. Disease subjects exhibited a stronger structural correlation in the cholinergic pathway than CN subjects did. Moreover, APOE-ε4 allele carriers in the disease group exhibited a stronger correlation between the volumetric changes and cognitive performance than non-carriers did, while there is no difference between carriers and non-carriers in CN subjects. Disease subjects exhibited a stronger correlation between the volumetric changes and cognitive performance than CN subjects did.Conclusion: Our results confirmed the effect of APOE-ε4 on and group differences in the associations with the cholinergic structural changes that may reflect impaired brain function underlying neurocognitive degeneration in AD.

Resting-state functional magnetic resonance imaging in a randomized clinical trial for Alzheimer's disease

Resting-state functional connectivity has been used to study Alzheimer's disease, revealing underlying differences between groups of individuals at different levels of cognitive impairment, or groupwise changes over time. Most of these studies have employed a single scanner and/or a single scan per subject. In this study, we used data collected from a substudy to two randomized clinical trials in patients with mild-to-moderate Alzheimer's Disease to investigate the robustness of functional connectivity in a multicenter, longitudinal setting. This substudy was not powered to detect drug treatment effects. With a basic imaging charter for inter-site acquisition standardization, we found no changes to functional connectivity over time in the placebo group, despite observable changes in clinical test scores and regional brain atrophy. We infer that functional connectivity, as implemented in our study, is not sensitive enough to detect disease progression in our patients. Using an 8-week interval between scans (in both treatment and placebo groups), we found that our test-retest reproducibility was comparable with other published results. We also found that the dominant source of measurement variability was within individuals over time, compared with variability between subjects and sites. Finally, we propose a simple method of visual inspection to identify scans that should be excluded from longitudinal analysis.

Construction of Essential Care Service Package for People Living with Dementia in Smoke-free Environment under Disease Pandemic in China

Objectives: In recent years, the harm of smoking has attracted more and more public attention. Creating a healthy smoke-free environment has been widely favored and supported by the public. Smokeless environment has a certain positive effect on the rehabilitation of dementia patients. Sustained smoking cessation is associated with significantly decreased the future prevalence of dementia. Therefore, hospitals often establish a special organizational structure and management model for tobacco control, and carry out training and assessment for all staff. The nursing group also took it as the basic nursing standard. The 2019 disease pandemic has posed unique health threats to people living with dementia (PLWD). Therefore, a strict smoke-free environment is more necessary for the nursing group. One of the key challenges is scaling up long-term care services to meet the needs of the rapidly growing population of PLWD in developing countries. The aim of the study is to explore the care service needs, utilization and build an essential care service package (ECSP) for PLWD under the disease pandemic in China. Methods: From July 2018 to October 2019, a total of 1255 elderly with dementia in six cities in China by a cluster sampling were investigated with the self-designed questionnaire. Care service needs and utilization for PLWD with different levels of cognitive impairment were summarized. Results: The ECSP for PLWD was composed of 30 service items (7 for core care) in order to guarantee that all PLWD enjoy equal care services, basing on public financing and implementing strategies and taking China's situations into account. The selection plan for ECSP at different levels is designed as 'General Care Services + Selective Care Services ', in which respective service items for low, mid, and high-level care for PLWD are 7+3, 7+6, and 7+10, and requires 151.41 hours, 201.88 hours, and 252.35 hours per month, respectively. Conclusion: The present study provides the first large-scale data on care service needs and utilization for PLWD in mainland China. The ECSP for PLWD based on the needs advanced in the paper was a practicable and effective quantitative management means that deserves a large-scale application. Some safeguard mechanisms and operational implementing pathways of ECSP for PLWD during and after the disease pandemic in China are proposed.

A Comparative Efficacy Study of Robotic Priming of Bilateral Approach in Stroke Rehabilitation.

Background: Stroke survivors can remain impaired in body functions, activity, and participation. A novel rehabilitation regimen is required to obtain scientific evidence and to help clinicians determine effective interventions for stroke. Mirror therapy (MT) and bilateral upper limb training (BULT) are based on the tenet of bilateral movement practice; however, the additional effect of bilateral robotic priming combined with these two therapies is unclear.Objectives: This study examined the effects of two hybrid therapies, robotic priming combined with MT and robotic priming combined with BULT, in stroke survivors.Methodology: The study randomized 31 participants to groups that received robotic priming combined with MT (n = 15) or robotic priming combined with BULT (n = 16). Outcome measures included the Fugl–Meyer Assessment (FMA), the revised Nottingham Sensory Assessment (rNSA), the Chedoke Arm and Hand Activity Inventory (CAHAI), and accelerometer data.Results: Both groups showed statistically significant within-group improvements in most outcome measures. Significant between-group differences and medium-to-large effect sizes were found in favor of the group that received robotic priming combined with MT based on the FMA distal part subscale scores, FMA total scores, and accelerometer data.Conclusion: Robotic priming combined with MT may have beneficial effects for patients in the improvements of overall and distal arm motor impairment as well as affected arm use in real life. Additional follow-up, a larger sample size, and consideration of the effect of lesion location or different levels of cognitive impairment are warranted to validate our findings in future studies.Clinical trial registration: www.ClinicalTrials.gov, identifier NCT03773653.

Relationships between cognitive functioning and power wheelchair performance, confidence and life-space mobility among experienced power wheelchair users: An exploratory study.

ObjectivesTo explore: (i) relationships between power wheelchair performance, confidence, mobility and the severity of user’s cognitive impairment; (ii) relationships between cognitive functioning and power wheelchair performance, confidence and mobility; and (iii) how cognitive scores influence power wheelchair performance, confidence and mobility.DesignCross-sectional exploratory study.SubjectsIndependent power wheelchair users; ≥18 years.Outcome measuresCognitive assessments (Montreal Cognitive Assessment, Motor-Free Visual Perception Test, and Dysexecutive Questionnaire) and power wheelchair driving assessments (Power mobility Indoor Driving Assessment, Wheelchair-Skills-Test-Questionnaire, and Life-Space Assessment). Analyses were completed using multivariate analysis of variance and principal component analysis.ResultsThere were a total of 30 participants (with a mean (SD) age of 58 (15) years, who had a mean (SD) of 3 (6.2) years of experience of power wheelchair use, and a mean (SD) score of 22 (5) on the Montreal Cognitive Assessment. There were statistically significant differences in all power wheelchair driving assessments, depending on the severity of cognitive impairment (moderate, p = 0.009; mild, p = <0.001; none, p = 0.009). The first principal component suggested that cognitive functioning, visual perception, and performance explained 69% of the variability in the first principle componenent. The second and third principal components suggested that confidence and the built and social environments also played significant roles in power wheelchair use.ConclusionThere are correlations between cognitive functioning and power wheelchair use in experienced users, with the severity of cognitive impairment influencing power wheelchair driving outcomes.LAY ABSTRACTClinicians report cognitive impairment as a concern when providing power wheelchairs. This study explored differences in power wheelchair use (performance, confidence and mobility) between users with different levels of cognitive impairment, and determined how cognitive impairment influenced power wheelchair use. A total of 30 power wheelchair users completed power wheelchair, cognitive and perceptual assessments. There were statistically significant differences in all power wheelchair assessments depending on the severity of the subject’s cognitive impairment. Cognitive functioning and visual perception were important for power wheelchair performance. Cognitive functioning also influenced power wheelchair confidence, while the built and social environments played significant roles in power wheelchair use. In clinical practice, Montreal Cognitive Assessment scores may provide information to complement power wheelchair assessments, but when used alone may miss some important information. The Power mobility Indoor Driving Assessment, Wheelchair Skills Test Questionnaire, and Life-Space Assessment represent complementary power wheelchair assessments to understand power wheelchair use in adults.

Metabolic brain changes across different levels of cognitive impairment in ALS: a 18F-FDG-PET study

ObjectiveTo identify the metabolic changes related to the various levels of cognitive deficits in amyotrophic lateral sclerosis (ALS) using 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) imaging.Methods274 ALS patients underwent neuropsychological assessment...

Systematic Analysis of Protein-Protein and Gene-Environment Interactions to Decipher the Cognitive Mechanisms of Autism Spectrum Disorder.

Autism spectrum disorder (ASD), a heterogeneous neurodevelopmental disorder resulting from both genetic and environmental risk factors, is manifested by deficits in cognitive function. Elucidating the cognitive disorder-relevant biological mechanisms may open up promising therapeutic approaches. In this work, we mined ASD cognitive phenotype proteins to construct and analyze protein-protein and gene-environment interaction networks. Incorporating the protein-protein interaction (PPI), human cognition proteins, and connections of autism-cognition proteins enabled us to generate an autism-cognition network (ACN). With the topological analysis of ACN, important proteins, highly clustered modules, and 3-node motifs were identified. Moreover, the impact of environmental exposures in cognitive impairment was investigated through chemicals that target the cognition-related proteins. Functional enrichment analysis of the ACN-associated modules and chemical targets revealed biological processes involved in the cognitive deficits of ASD. Among the 17 identified hub-bottlenecks in the ACN, PSD-95 was recognized as an important protein through analyzing the module and motif interactions. PSD-95 and its interacting partners constructed a cognitive-specific module. This hub-bottleneck interacted with the 89 cognition-related 3-node motifs. The identification of gene-environment interactions indicated that most of the cognitive-related proteins interact withbisphenol A (BPA) and valproic acid (VPA). Moreover, we detected significant expression changes of 56 cognitive-specific genes using four ASD microarray datasets in the GEO database, including GSE28521, GSE26415, GSE18123 and GSE29691. Our outcomes suggest future endeavors for dissecting the PSD-95 function in ASD and evaluating the various environmental conditions to discover possible mechanisms of the different levels of cognitive impairment.

Reliability, validity, and diagnostic accuracy of Parkinson's Disease-Cognitive Rating Scale in Iranian patients with idiopathic Parkinson's disease

Purpose To investigate the reliability and validity of Parkinson’s Disease-Cognitive Rating Scale (PD-CRS) in Iranian patients with idiopathic PD. Methods One hundred and eighty patients with PD and 60 age-, gender-, and educational level-matched healthy individuals participated in this study. Inter-rater and test–retest reliability of the Persian version of PD-CRS was investigated in 80 patients with PD. To evaluate the construct validity of the PD-CRS, its correlation with the Scales for Outcomes in Parkinson's disease-Cognition (SCOPA-Cog), Mini-Mental State Examination, Montreal Cognitive Assessment, Clock Drawing Test, Unified Parkinson’s Disease Rating Scale-Section I, and Quick Dementia Rating System was assessed. To assess the diagnostic accuracy of the PD-CRS, patients with PD were classified as groups with normal cognitive function, mild cognitive impairment (MCI), and dementia using the Clinical Dementia Rating. Results Test–retest and inter-rater reliability (ICC > 0.90), as well as internal consistency (α = 0.94) of the Persian version of PD-CRS, were excellent. A high positive correlation was found between the PD-CRS and SCOPA-Cog. A cut-off point of ≤79 (sensitivity 98.15% and specificity 98.04%) and ≤62 (sensitivity 100%, and specificity 100%) on the PD-CRS total score was obtained for detecting MCI and dementia in PD patients, respectively. Conclusions The results of this study showed that the Persian version of PD-CRS is a reliable and valid measure with high sensitivity and specificity to identify MCI and dementia in patients with PD. Implications for rehabilitation The PD-CRS has an excellent test–retest and inter-rater reliability and validity in Iranian patients with PD. The PD-CRS has high sensitivity and specificity for discriminating between different levels of cognitive impairment (i.e. no cognitive impairment, mild cognitive impairment, and dementia) in Iranian patients with PD.

A time-efficient screening tool for activities of daily living functions in Parkinson’s disease dementia

ABSTRACT Instruction In Parkinson’s disease (PD), activities of daily living (ADL) impairments are crucial for diagnosis of dementia (PDD). Performance-based tests are promising tools to discriminate between different levels of cognitive impairment in PD; however, the value of those tests for diagnosis of PDD is only sparsely investigated. Therefore, we evaluated the Erlangen Test of Activities of Daily Living (E-ADL), a time-efficient performance-based ADL test, in PD. Method In this cross-sectional study, 40 PD patients with normal cognition (PD-NC), 45 patients with mild cognitive impairment (PD-MCI) and 21 patients with PDD were assessed with a comprehensive ADL and cognitive test battery. Results Interrater reliability (rs =.86) indicated high consistency of the standardized E-ADL scoring system between raters. The E-ADL correlated significantly with other tests of ADL functions (p <.01), highest with an alternative performance-based ADL test (rs = −.52), and lowest with self-ratings and a physician-rated scale. The E-ADL was also associated with cognitive impairment (p <.01), but also with motor impairment. A binary logistic regression model verified that the E-ADL (p =.04) was an independent predictor of PDD, in addition to motor impairment explaining 53.3% of variance. Receiver operating characteristic curve analysis of the E-ADL revealed an area under the curve of 0.78, a specificity of 77%, and a sensitivity of 67% for diagnosis PDD. Conclusions The standardized, easy, and quick to administer E-ADL showed acceptable levels of reliability, and validity in PD and measures cognitive-driven ADL functions. Therefore, it might be a suitable test to support diagnosis of PDD in the clinical daily routine.

A-197 Utility of the Addenbrooke’s Cognitive Examination—Third Edition (ACE-III) to Predict Neuropsychological Test Performance in Older Adults Referred for Neurocognitive Evaluation

Abstract Objective The ACE-III is a brief cognitive screener with high sensitivity and specificity in detecting neurocognitive disorders. We examined the utility of ACE-III subscale scores (Attention/Orientation, Memory, Fluency, Language, Visuospatial) to predict performance on expanded neuropsychological evaluation and detect diagnostic group differences. Data Selection 217 patients (Mag = 74.0, Medu = 15.78) with neurocognitive concerns completed the ACE-III followed by a comprehensive neuropsychological evaluation, including Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Digit Span Backward (DSB), Trail Making Test Part B (TMT B), Boston Naming Test (BNT), Controlled Oral Word Association Test (COWAT), Category Fluency (Vegetables), Wechsler Memory Scale-IV (WMS-IV) Logical Memory (LM), and WAIS-IV Block Design (BD). Patients were diagnosed as having Normal Cognition (NC), Mild Cognitive Impairment (MCI), or Major Neurocognitive Disorder (MND) from clinical history and overall performance (67-NC, 105-MCI, 45-MND). Within-construct performances on comprehensive testing were regressed on ACE-III subscales. Group differences in ACE-III subscales and total scores were also examined. Data Synthesis Each ACE-III subscale score predicted within-construct performance on expanded testing with moderate-strong effects (p’s &amp;lt; .001): Attention/Orientation predictive of WAIS-IV DSB and TMT B; Memory predictive of WMS-IV LM immediate and delayed; Fluency predictive of COWAT and Category Fluency; Language predictive of BNT; Visuospatial predictive of WAIS-IV BD. ACE-III subscale and total scores also distinguished between groups (NC &amp;gt; MCI &amp;gt; MND; p’s &amp;lt; .001). Conclusions Across severity of cognitive impairment, ACE-III subscales are predictive of within-construct performance on expanded testing. The ACE-III may be a useful proxy for a comprehensive neuropsychological evaluation and demonstrates diagnostic utility in distinguishing different levels of cognitive impairment in older adults referred for neurocognitive concerns.

Nursing Education Intervention Effects on Pain Intensity of Nursing Home Residents with Different Levels of Cognitive Impairment: A Cluster-Randomized Controlled Trial.

PurposePain management in nursing homes is challenging and pain prevalence remains high. The objective of this study was to improve the pain situation of nursing home residents following a nursing-related educational intervention within a cluster-randomized controlled trial (2016–2018).ParticipantsClusters were nursing homes from one nursing home operator in Bavaria, Germany. Nursing home residents who were permanently registered in the facilities, at least 60 years of age, and who themselves or their legal guardians provided informed consent were included.InterventionIn addition to the implementation of pain nurses and pain care assistants, staff of the intervention group received an educational intervention in pain management, containing classroom (quality circles) and web-based training for nurses.MethodsBased on the Mini-Mental State Examination (MMSE), residents were either interviewed (MMSE 10–30) using self-report instruments or observed (MMSE 0–9) by proxy assessment. The primary outcome in residents able to self-report was maximum pain intensity according to Brief Pain Inventory (BPI); in those not able to self-report treatment-relevant pain above cut-off (≥2) on the Pain Assessment in Advanced Dementia (PAINAD).ResultsOut of 20 randomly selected clusters, 9 nursing homes from the control, and 6 nursing homes from the intervention group participated. Multilevel linear (n=347 residents, MMSE 10–30) and logistic regression (n=222 residents, MMSE 0–9) analyses were conducted. Maximum pain intensity was higher after intervention (B=1.32, p<0.01), decreased with a better quality of life (B=−0.07, p<0.001), and was lower when dementia diagnoses were present (B=−1.12, p<0.01). PAINAD scores before and after intervention did not differ significantly (OR=0.89, p=0.724), but chances to exhibit treatment-related pain were higher with decreasing MMSE (OR=0.94, p<0.05).ConclusionWhile no significant positive intervention effect was measured, findings suggest nurses’ raised awareness towards pain management. Overall results indicate that large-scale educational interventions seem to be less effective in complex nursing home settings without also including specific individual-based intervention measures.

COGNITIVE IMPAIRMENT AND DEPRESSION ARE THE MOST IMPORTANT RISK FACTORS FOR FRAILTY

Background : Frailty is a condition that causes a decline or failure in homeostasis mechanism on older people resulting in increased susceptibility to stressor. The risk factors of frailty include: cognitive impairment and depression. Objective : To prove the relation between cognitive impairment and depression with frailty. Methods : This study is using cross-sectional approach. Samples are collected from 222 citizens from the elderly population of Malang using accidental sampling method. Variables measured in this study are frailty that is determined by Fried Criteria, cognitive impairment that is determined by MMSE score and depression status that is determined by GDS score. Results: The analysis result of relation between cognitive impairment and depression and frailty using the Spearman correlation test produces the value of p = 0,000 and the correlation coefficients for rare 0,500 and 0,508 respectively. Different levels of cognitive impairment and depression in the frail group compared to pre-frail and robust groups resulted in p = 0,000, whereas the level of cognitive impairment and depression in the pre-frail group compared to robust group yielding p values of 0.735 and 0.944 respectively. Conclusion: There is a relation between cognitive impairment and depression on frailty. There was a significant difference in the levels of cognitive impairment and depression in the frail group compared to the pre-frail and robust groups, whereas in the pre-frail group compared to robust group the levels of cognitive impairment and depression did not have a significant difference.

Cognitive Performance Profile in Pediatric Moyamoya Disease Patients and Its Relationship With Regional Cerebral Blood Perfusion.

Object: Moyamoya disease affects the cognitive function of pediatric patients, and compromised cerebral blood flow might be the potential cause. We aimed to explore the specific correlation between cognitive impairment and regional perfusion status in pediatric moyamoya disease patients.Methods: We prospectively enrolled consecutive pediatric moyamoya disease patients admitted to Beijing Tiantan Hospital from July 2017 to March 2019. Arterial spin-labeling magnetic resonance and the Wechsler Intelligence Scale for Children (the 4th edition) were performed on all participants. The cognitive performance of patients was analyzed, and its correlation to cerebral perfusion status was also investigated in the region of interest-based analysis.Results: A total of 21 patients met the inclusion criteria (mean aged 11.14 ± 2.82, male: female = 11:10). Six patients (28.6%) showed no cognitive deficits in any index score, while 15 (71.4%) showed cognitive deficits with differing severity. Nine (42.9%) patients showed overall cognitive impairment, and all cognitive index scores except for Verbal Comprehension Index were significantly lower than the mean scores of normative data with corresponding age. Perceptual Reasoning Index (p = 0.019) were statistically lower in patients with radiologically confirmed cerebral infarction. Suzuki stage of the left hemisphere negatively correlated to Full-scale Intelligence Quotient (r = −0.452, p = 0.039). Region of Interest analysis showed that cerebral blood flow of the left temporal lobe independently associated with the Processing Speed Index (β = 0.535, p = 0.041).Conclusion: Pediatric moyamoya disease patients exhibited different levels of cognitive impairment. Cerebral infarction is related to poorer perceptual reasoning ability. Cerebral blood flow in the left temporal lobe positively correlates with processing speed.