Mean MoCA Score Research Articles

Associations of endogenous estrogens, plasma Alzheimer's disease biomarkers, and APOE4 carrier status on regional brain volumes in postmenopausal women.

Women carrying the APOE4 allele are at greater risk of developing Alzheimer's disease (AD) from ages 65-75 years compared to men. To better understand the elevated risk conferred by APOE4 carrier status among midlife women, we investigated the separate and interactive associations of endogenous estrogens, plasma AD biomarkers, and APOE4 carrier status on regional brain volumes in a sample of late midlife postmenopausal women. Participants were enrolled in MsBrain, a cohort study of postmenopausal women (n = 171, mean age = 59.4 years, mean MoCA score = 26.9; race = 83.2% white, APOE4 carriers = 40). Serum estrone (E1) and estradiol (E2) levels were assessed using liquid chromatography-tandem mass spectrometry. APOE genotype was determined using TaqMan SNP genotyping assays. Plasma AD biomarkers were measured using single molecule array technology. Cortical volume was measured and segmented by FreeSurfer software using individual T1w MPRAGE images. Multiple linear regression models were conducted to determine whether separate and interactive associations between endogenous estrogen levels, plasma AD biomarkers (Aβ42/Aβ40, Aβ42/p-tau181), and APOE4 carrier status predict regional brain volume (21 regions per hemisphere, selected a priori); and, whether significant interactive associations between estrogens and AD biomarkers on brain volume differed by APOE4 carrier status. There was no main effect of APOE4 carrier status on regional brain volumes, endogenous estrogen levels, or plasma AD biomarkers. Estrogens did not associate with regional brain volumes, except for positive associations with left caudal middle frontal gyrus and fusiform volumes. The interactive association of estrogens and APOE4 carrier status on brain volume was not significant for any region. The interactive association of estrogens and plasma AD biomarkers predicted brain volume of several regions. Higher E1 and E2 were more strongly associated with greater regional brain volumes among women with a poorer AD biomarker profile (lower Aβ42/40, lower Aβ42/p-tau181 ratios). In APOE4-stratified analyses, these interactions were driven by non-APOE4 carriers. We demonstrate that the brain volumes of postmenopausal women with poorer AD biomarker profiles benefit most from higher endogenous estrogen levels. These findings are driven by non-APOE4 carriers, suggesting that APOE4 carriers may be insensitive to the favorable effects of estrogens on brain volume in the postmenopause.

Acoustic Stimulation to Improve Slow-Wave Sleep in Alzheimer's Disease: A Multiple Night At-Home Intervention

ObjectivesTo investigate the efficacy of closed-loop acoustic stimulation (CLAS) during slow-wave sleep (SWS) to enhance slow-wave activity (SWA) and SWS in patients with Alzheimer's disease (AD) across multiple nights and to explore associations between stimulation, participant characteristics, and individuals’ SWS response. DesignA 2-week, open-label at-home intervention study utilizing the DREEM2 headband to record sleep data and administer CLAS during SWS. Setting and participantsFifteen older patients with AD (6 women, mean age: 76.27 [SD = 6.06], mean MOCA-score: 16.07 [SD = 6.94]), living at home with their partner, completed the trial. InterventionPatients first wore the device for two baseline nights, followed by 14 nights during which the device was programmed to randomly either deliver acoustic stimulations of 50 ms pink noise (± 40 dB) targeted to the slow-wave up-phase during SWS or only mark the wave (sham). ResultsOn a group level, stimulation significantly enhanced SWA and SWS with consistent SWS enhancement throughout the intervention. However, substantial variability existed in individual responses to stimulation. Individuals received more stimulations on nights with increased SWS compared to baseline than on nights with no change or a decrease. In individuals, having lower baseline SWS correlated with receiving fewer stimulations on average during the intervention. ConclusionCLAS during SWS is a promising nonpharmacological method to enhance SWA and SWS in AD. However, patients with lower baseline SWS received fewer stimulations during the intervention, possibly resulting in less SWS enhancement. Individual variability in response to stimulation underscores the need to address personalized stimulation parameters in future research and therapy development.

Cognitive function in Mexican older adults 6-months after recovering from SARS-CoV-2 infection

BackgroundSARS-CoV-2 infection has been associated with multiple short- and long-term complications including depression, and cognitive impairment (CI). However, older adults with CI after COVID-19 have not been fully documented. ObjectiveTo evaluate cognitive function in Mexican adults post-recovery from SARS-CoV-2 infection. MethodsIn this prospective observational cohort study, we assess cognitive function (CF) by the Montreal Cognitive Assessment (MOCA) test with a cut-off less than 26 points, and functional status via telemedicine. Eligible patients with a history of moderate–severe COVID-19 aged ≥60 years, cognitively healthy (evaluated by Everyday Cognition Scale) and required admission to an intensive care unit (ICU) were included. Patients with history of dementia, stroke, and delirium during the cognitive evaluation were excluded. The association between CI and COVID-19 was assessed with a Cox regression model. ResultsFrom the 634 patients admitted to the ICU, 415 survived, afterward 308 were excluded and 107 were analyzed. Mean age was 70 years, 58% were female, and 53% had severe COVID.The mean MoCA score was 21±5 points, CI was present in 61 patients (57%). Infection severity (RR 1.87; 95% CI: 1.11–3.15, p<0.05), lower education (RR 0.92; 95% CI: 0.87–0.97, p<0.01), and activity daily living disability (RR 1.87; 95% CI: 1.07–3.26, p<0.05) were the main factors associated with CI (unadjusted model by age and sex). The delayed recall, orientation, and language (83.2, 77.6 and 72.9% respectively) domains were the most affected in patients with CI. ConclusionsFifty-seven percent of patients analyzed developed CI six months post-ICU discharge due to SARS-CoV-2, and COVID severity was the main factor associated to its outcome.

Impact of Single Compared to Dual Sensory Loss in People with Dementia on Care Partner Outcomes

AbstractBackgroundBoth hearing and vision loss impact significantly on outcomes in people with dementia as well as their care partners. The study aimed to compare the impact on care partner outcomes of hearing loss alone and dual sensory (both hearing and vision) loss in people with dementiaMethodsThe study sample includes data from the SENSE‐Cog Trial (www.sense‐cog.eu). Care partner psychological distress was ascertained using the 12‐item General Health Questionnaire and the Hospital Anxiety and Depression Scale. Caregiving intensity was assessed using the care partner items of the RUD Lite. Dementia symptoms were assessed with the MOCA, the 12‐item Neuropsychiatric Inventory and the Bristol Activities of Daily Living scale. Vision loss was defined by the presence of binocular visual acuity of not more than 6/9.5 and greater than 6/60 in Snellen metric using the Portable Eye Examination Kit (PEEK) vision tool and visual field greater than 10° using confrontation visual field test. Hearing loss was defined by a bilateral hearing difficulty, indicated by failure of a pure tone hearing screening test in both ears. Statistical analyses included comparison between groups with different sensory losses (hearing‐ vs. dual loss) and regression analyses.ResultsData of dyads of people with dementia and either hearing loss (N = 150) or dual sensory loss (N = 92) and their care partners (female 72.5%; male 27.5%) were considered. Participants had Alzheimer’s dementia (65%), vascular dementia (16%) or mixed dementia (19%), with mean MOCA score 16.6 (range 10 – 28). 73% of patients lived with partner or family and 24% alone. Higher caregiving intensity and higher psychological distress were observed in care partners of patients with dual sensory loss compared to care partners of people with hearing loss only after controlling for the impact of cognitive deficits, neuropsychiatric symptoms, performance on activities of daily living and demographic characteristics.ConclusionsDual sensory loss in people with dementia increases care partner distress and caregiving intensity compared to single hearing loss. Shedding light on sensory loss in dementia may pave new ways towards more effective symptom management and higher quality of life of both patients and their care partners.

Examining the relationships between cognitive function and physical and mental health: interim findings from HKMMSOP

AbstractBackgroundPopulation ageing is associated with an increase in the number of persons with dementia, which constitutes a significant public health issue. The Hong Kong Mental Morbidity Survey for Older People (HKMMSOP) was carried out to evaluate the local prevalence of dementia and the factors that modulated the disease development.MethodParticipants aged 60 or over, stratified with age groups, were recruited through random sampling of residential addresses in Hong Kong. They underwent an assessment of their cognitive function (Montreal Cognitive Assessment, MoCA; Clinical Dementia Rating, CDR), physical health (Cumulative Illness Rating Scale, CIRS) and mental health (Clinical Interview Schedule‐Revised, CIS‐R; Short Warwick‐Edinburgh Mental Wellbeing Scale, SWEMWBS). Associative factors of neurocognitive disorders were determined by multinomial regression, with neurocognitive disorders as dependent variables.ResultIn this interim analysis, 4369 participants of HKMMSOP were included. Their mean age was 69.6, and there was a slight female preponderance (56.3%). On average, they received 8.8 years of education, and their mean MoCA score was 23.8 (SD 4.9). Using CDR, 71.8% were evaluated as having normal cognition, 23.1% with a mild neurocognitive disorder (ND), and 5.2% with a major ND. Older or less educated participants had a higher risk of developing mild and major ND (p&lt;0.001). But the relationships between cognition and physical and mental health differed in the mild and major ND groups. Among those with mild ND, a higher CIRS total score (p&lt;0.001), a higher CIS‐R total score (p&lt;0.001) and a lower SWEMWBS score (p = 0.002) were significantly associated with CDR. However, only CIRS total score (p = 0.004) and SWEMWBS score (p&lt;0.001) remained significant in the major ND group.ConclusionPoorer physical and mental health and lower mental well‐being and life satisfaction were associated with an increased risk of mild ND. But as the disease progressed, lower mental well‐being and life satisfaction and poorer physical health remained significant factors. On the contrary, a higher level of mental symptoms, as exemplified by CIS‐R, was not significantly associated with major ND. It sheds some light on the factors that may modulate the course of the disease and appropriate preventive measures.

Impact of White Matter Hyperintensity Changes on Cognition One Year After Mild Ischemic Stroke

AbstractBackgroundWhite matter hyperintensities (WMH) are a main MRI feature of cerebral small vessel disease, and are associated with increased risk of stroke and dementia. Progression can lead to cognitive decline, but some evidence suggests that WMH can also regress. Regression might relate to better clinical outcomes, but this is not well examined yet. We explored if net WMH volume change accounts for changes in cognition 1‐year after mild ischemic stroke. We also explore tissue signatures in areas of white matter change using brain diffusion imaging.MethodIn a prospective study, we assessed vascular risk factors (VRF), structural and diffusion‐tensor brain MRI and cognition (Montreal Cognitive Assessment; MoCA) at baseline (≤3 months post‐stroke) and at 1‐year. We assessed change in cognition over 1‐year using a linear mixed model. Predictors were age, sex, stroke severity (National Institutes of Health Stroke Scale; NIHSS), combined VRFs, disability (modified Rankin Score), occurrence of incidental infarct in‐between visits and WMH volume (%intracranial volume). We studied tissue areas of stable normal‐appearing white matter (NAWM), stable WMH, regressing and progressing WMH (Figure1) and measured diffusion‐tensor fractional anisotropy (FA) and mean diffusivity (MD), to assess microstructure in each areaResultAt baseline, mean age = 67.5 (SD = 11.1), 66% male (N = 229), mean MoCA score = 25.0 (SD = 3.5). Between baseline and 1‐year post‐stroke, MoCA score decreased with older age (standardized B[95%CI]: ‐0.271[‐0.383; ‐0.159]) and increasing NIHSS (‐0.193[‐0.287; ‐0.099]). Areas of NAWM that progress to WMH already have lower FA and higher MD at baseline than NAWM that stays NAWM (N = 191; Figure2). WMH that regress to NAWM have higher FA and lower MD than stable WMH. At 1‐year, MD values seem higher and FA values seem lower in progressing WMH than at baseline.ConclusionCognition deteriorates 1 year post‐stroke with older age and higher stroke severity, but not with WMH changes, when considering net WMH volume. Areas of WMH changes exist within individuals, these areas show different underlying tissue structures before becoming apparent on conventional MRI, indicating that WMH regression is real. Separate areas of WMH progression and regression might be more sensitive to cognitive changes and potentially be intervention targets.

Home Cognitive Stimulation Activity in Thai Patients with Mild Cognitive Impairment and Mild Dementia

AbstractBackgroundThis study aims to investigate the characteristics of home cognitive stimulation activities for Thai patients with mild cognitive impairment (MCI) and mild dementia.MethodA cross‐sectional, questionnaire‐based study was conducted on Thai patients with the diagnosis of MCI and mild dementia. Patients’ characteristics, ability to use IT device or telecommunication technology, and home cognitive stimulation activities were collected. All activities were divided and calculated into sub‐scores of cognitive, religion‐related, and physical activities according to its frequency.ResultThere were 157 patients with a mean age of 76.2±7.9 years, 65.6% were female. 46.5% were diagnosed with MCI, and 53.5% with mild dementia. 47.1% had a graduate or higher degree. The mean MoCA score was 20.8±4.7. 51% of patients were able to use IT devices (smartphones, tablets, or computers). Patients with MCI were able to use IT devices more than patients with mild dementia (79.5% vs. 26.2%, p&lt;0.001). As many as 29.3% of them were able to use a teleconference technology such as video call or Zoom application. Among the 25 home cognitive stimulation activities collected (excluding watching television), only 7 activities that participants ≥30% rated as frequent (≥3 days per week) were doing chores (63.1%), working out (51.0%), listening to music (50.3%), praying (43.3%), reading (38.2%), cooking (33.1%), and texting via mobile (31.8%). The activities they engaged the least were playing cards, board games, doing crossword puzzles, and drawing (rated as frequent 0.6%). Compared with patients with mild dementia, patients with MCI exhibited higher scores in all sub‐scores (all p&lt;0.01). The cognitive activity sub‐score had an inverse correlation with the patient’s age and geriatric depression scale (r = ‐0.340 and ‐0.171, both p&lt;0.05). Patients who were able to use smart devices or video call/conference applications were found to be more likely to have higher scores in every activity sub‐scores (all p&lt;0.01).ConclusionIn this study, Thai patients had limited home activities, particularly those with dementia. However, about half of them were able to use IT devices, which may correlate with a higher cognitive activity score. Thai individuals with MCI or mild dementia may have room for improvement in the cognitive intervention delivered at home via teleconference.

Use of cerebrospinal fluid biomarkers for accurate diagnosis of Alzheimer’s disease in a tertiary care memory center

AbstractBackgroundAccurate clinical‐biological diagnosis of dementia and of Alzheimer’s disease (AD) is important for exclusion of treatable modifiable conditions, to differentiate AD from conditions with similar clinical manifestations, and for consideration of novel disease‐modifying therapeutic agents. Recently, it has become possible to measure protein biomarkers that reflect the pathology of AD. Our aim was to examine our initial experience of running a “cognitive” CSF biomarker service and bank at our institute.MethodThe service operates since June 2020. All subjects underwent physical, neurological and cognitive evaluation, imaging and laboratory work‐up. Consenting patients presenting at young age or with atypical or unclear manifestations of cognitive and/or behavioral deterioration underwent lumbar puncture for CSF examination, tailored according to the clinical differential diagnosis [cells, protein, glucose, chloride, cytology, AD biomarkers‐ total tau (tTau), 181‐phosphorylated tau (pTau181), amyloid‐β42 (Aβ42)]. When appropriate, antibody analysis and microbiological studies were added.ResultAD biomarkers results were available for 63 subjects presenting with cognitive/behavioral impairment, mean age 59 (range 31‐78) years, 34 (54%) were men. Mean MMSE score was 21/30 (range 6‐30), mean MoCA score was 18/30 (range 6‐28). Pre CSF analysis, 27 (43%) subjects were clinically diagnosed with possible AD (CDAD) and 36 (57%) with clinically diagnosed possible non‐AD (CDNAD) (FTD, LBD, CBD, vascular disease, autoimmune encephalopathy, unclear etiology). In our sample 28 (44%) were biomarkers positive for AD. Among 27 subjects with CDAD in 5 AD was excluded and among 36 with CDNAD 6 were biomarker positive AD (clinical sensitivity 78%, false positive 18.5%, false negative 16.6%).ConclusionOur study emphasizes the added value of biomarker supported diagnosis in subjects with cognitive/behavioral impairment, to avoid incorrectly labeling AD or misdiagnosis and for disclosure recommendation in the era of disease‐modifying therapies.

Exploring the association between self-care behaviour, knowledge and cognition in patients with heart failure: a secondary analysis from the HF-Wii study

Abstract Background Self-care is vital for patients with heart failure and is influenced by different factors, Knowledge and the ability to reflect on behaviors is important to make decisions on self-care. Cognition may also be an important factor in relation to both knowledge and self-care. It has been found that cognitive impairment in patients with heart failure is common, with a reported prevalence of 20–80%. Aim To explore association between self-care behaviour, knowledge and cognition in patients with heart failure. Methods This is a secondary analysis of the baseline measures from the HF-Wii study with data from 605 patients, mean age 70 ± 12, 29% female, 30 % in New York Heart Association Class III-IV. Data on self-care was collected with European Self-care Behaviour Scale (EHFScBS) (possible range 0-100). Knowledge was collected with the Dutch HF Knowledge Scale (possible range 0-15 points). Cognition was assessed Montreal Cognitive Assessment (MoCA). Knowledge was dichotomised into low vs. high knowledge (cut off 13) and cognition into mild, moderate or severe cognitive problems vs. no or light cognitive problems. Results The total score on the EHFScBS was 64.6 ± 21.0 with 41% (N=245) of the patients performing good self-care (score &amp;gt; 70). The mean score on the Dutch HF Knowledge Scale was 12.3 ± 1.9 and 308 patients had high knowledge (score &amp;gt; 13). The majority of the patients (61%; N=371) had mild cognitive problems and 195 (32%) had no or light cognitive problems with a mean MOCA score of 24.4 ± 3.8. Self-care was significantly correlated to total knowledge (r = .23; p &amp;lt; .001), but it was not correlated to cognition. Furthermore, there was a positive correlation between total knowledge and cognition (r = .43; p &amp;lt;.001). Out of the 308 patients with high level of knowledge (&amp;gt;13), 130 had mild, moderate or severe cognitive problems. The other 178 patients with high knowledge had no or only light cognitive problems. Patients with high knowledge had a significantly higher score on the self-care behavior scale, independently of their cognitive function. In a multivariable logistic regression analysis, higher age [odds ratio (OR) 1.03; 95% confidence interval (CI) 1.02-1.06), better quality of life (OR .95; 95% CI .90 - .99) and higher levels of knowledge (OR 1.25; OR 1.13 – 1.38) were independently related to self-care. Conclusion HF knowledge and cognition are related in patients with heart failure, but only knowledge, not cognition, was independently related to self-care.

225 The pattern of ICPOP service use according to the clinical frailty scale

Abstract Background We are a specialist integrated team working with older people to co-ordinate and provide enhanced health and social care services through Comprehensive Geriatric Assessment (CGA) and intervention working across a large geographical region. Methods New patients who underwent CGA from January–May 2023 were suitable for inclusion in this retrospective study. Key parameters including demographics, cognitive and functional status were recorded and analysed according to the following categories of clinical frailty scale (CFS); 1–3 (non-frail), 4–6 (frail) and ≥ 7 (severely frail). Results Of 249 patients who underwent CGA, 64% (n = 159) were female with a mean age of 82, and median MOCA score of 17. Reasons for referral were new or unexpected change in cognition (52%) frailty (40%) and falls (37%). Among this cohort 20% (n = 51) were non-frail, 71% (n = 177) were frail and 8.4% (n = 21) were severely frail. There was no significant difference in mean MOCA score by level of frailty (p = 0.49). Impairment in Instrumental Activities of Daily Living (IADL) was identified in 26% of non-frail, 77% of frail and 100% of severely frail patients. 27% of non-frail, 43% of frail and 33% of severely frail patients were living alone with carer strain reported in 70% of those with severe frailty. Informal care was regularly provided to 35% of non-frail, 60% of frail and 90% of severely frail patients. Conclusion Patients attending our service are frail, older and predominantly female. We identified a cohort who are not classified as frail but have cognitive impairment, are dependent for support in IADLs and reliant on informal care to allow them to live independently. In addition, we are supporting a severely frail, heavily dependent cohort and their caregivers. This demonstrates the complex case load within our ICPOP service which requires ongoing evaluation to ensure delivery of high quality person-centred interventions.

Social connections and participation among people with mild cognitive impairment: barriers and recommendations.

Social connections and participation are essential for individuals with mild cognitive impairment (MCI) to prevent the progression of cognitive decline and enhance their overall well-being. However, existing research has primarily focused on environmental barriers, overlooking personal factors and the interconnected nature of these barriers. Moreover, there is a lack of understanding regarding social connections and participation challenges specific to people with MCI in low- and middle-income countries. Therefore, this study aimed to explore the barriers that hinder social connections and participation among people with MCI in China and investigate opportunities to design appropriate supportive interventions. Thirty-one people with MCI (13 males and 18 females; mean age = 82.74 years, SD = 7.69; mean MoCA score = 21.26, SD = 2.44) and 13 caregivers were recruited to attend focus groups. In addition, 10 therapists were interviewed using a semi-structured interview guide. Focus groups and interviews were audio-recorded, transcribed, and analyzed using a framework analysis approach. We found that the ability to build social connections among people with MCI is affected by mobility challenges, intensive grandparenting responsibilities, availability of suitable activities, and feelings of exclusion in a closed-minded community environment. Personal reasons, such as lower social efficacy, inability to find suitable social activities, and intensive family responsibilities, discourage people with MCI from social participation. The digital literacy of people with MCI depends on their motivation to learn and use digital tools; people with MCI who live in a community have a higher digital literacy than those living in care centers. The motivation to achieve digital literacy is affected by perceived benefits, costs of technology use, and social influence. Multidimensional initiatives are needed to address barriers to social connections, participation, and technology adoption among individuals with MCI. This includes organizing and engaging in social activities, promoting awareness and education on the importance of social participation, and exploring technology-based interventions to improve memory and storytelling abilities. These efforts can create a supportive environment and empower individuals with MCI to participate actively in social interactions, enhancing their overall well-being.

P.124 Delayed cerebral ischemia and cognitive outcomes after aneurysmal subarachnoid hemorrhage: an exploratory analysis

Background: Neuropsychological outcomes are an important component of the morbidity after aneurysmal subarachnoid hemorrhage (aSAH). Data on the relationship between delayed cereberal ischemia (DCI) and neuropsychological outcomes remains sparse. We herein assess the relationship between DCI and neuropsychological outcomes, as measured by the Montreal Cognitive Assessment score (MoCA) at 90 days in patients with aSAH. Methods: We performed a post-hoc analysis of the Nimodipine Microparticles to Enhance Recovery While Reducing Toxicity After Subarachnoid Hemorrhage (NEWTON-2) clinical trial. Patients were grouped based on whether they developed delayed cerebral ischemia. We assessed the relationship between MoCA scores and DCI with Student’s t-test and regression modeling. Age, sex, history of hypertension, and WFNS grade were included as covariates in the model. Results: Two-hundred and fifteen patients were included in our analysis. Mean MoCA score at 90 days in our population was 22. Mean MoCA scores were significantly lower in patients who developed DCI compared to those who did not (23.7 vs 18.4, p&lt;0.001). Age, WFNS grade, and development of DCI were independently associated with MoCA scores in the regression model (p &lt; 0.05). Conclusions: DCI is a predictor of decreased neuropsychological outcomes in aSAH survivors and may contribute to the morbidity burden in this population.

Higher Initial Platelet Procoagulant Potential is Associated with Lower Cognitive Scores at 14 Months after COVID-19 (P2-12.004)

<h3>Objective:</h3> To examine whether coated-platelet levels measured at the time of acute SARS-CoV-2 infection predict cognitive impairment after recovery from COVID-19. <h3>Background:</h3> Coated-platelets are a subset of highly procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin. Coated-platelet levels are increased in ischemic stroke compared to controls, and higher levels are associated with stroke recurrence. Previously, we have shown that higher coated-platelet levels at baseline are predictive of death at 90 days in COVID-19. Cognitive symptoms are frequently reported after recovery from SARS-CoV-2 infection. <h3>Design/Methods:</h3> After consent, patients with acute SARS-CoV-2 infection were enrolled. Coated-platelet levels were assayed at the time of admission and then weekly during the hospitalization. Symptoms of post-COVID-19 syndrome were evaluated using the CDC questionnaire. Cognitive screening was completed by telephone using the MoCA test for the blind, version 8.1. Regression analysis was used to evaluate the effect of clinical variables, demographics and coated-platelet levels on MoCA score. <h3>Results:</h3> We recruited 38 patients admitted with COVID-19. The 32 surviving patients were interviewed by telephone for long COVID symptoms at 14.8±2.4 months after infection. Twenty subjects (67%) reported having ≥1 long-COVID symptoms, most often brain fog and fatigue (39.4%). Among the 29 subjects (average age 65.5 years, range 33–88) who agreed to complete MoCA testing, mean MoCA score was 16.6 (range 10–21), with 17 (58.6%) screening positive for cognitive impairment. Coated-platelet levels drawn at enrollment during hospitalization for COVID-19 were inversely associated with MoCA scores after adjusting for age and time from symptom onset (adjusted R²=0.2, p=0.037). A 10% absolute increase in baseline coated-platelet levels corresponded to a 1.3-point decrease in MoCA score (p=0.009). <h3>Conclusions:</h3> These findings suggest that platelet procoagulant potential is linked to long-term lower cognitive performance after SARS-CoV-2 infection. Future work is needed to investigate coated-platelets and post-COVID cognitive decline. <b>Disclosure:</b> Dr. Delpirou Nouh has nothing to disclose. The institution of Dr. Prodan has received research support from US Department of Veterans Affairs (Merit award CX000340). Chao Xu has nothing to disclose. Andrea Vincent has received personal compensation for serving as an employee of Vista LifeSciences, Inc.. Eleanor Mathews has nothing to disclose. Leslie Guthery has nothing to disclose. Mr. Sharps has nothing to disclose. Jim Scott has nothing to disclose. George Dale has nothing to disclose. Angelia Kirkpatrick has nothing to disclose.

Long-term survival, functional capacity and quality of life after refractory out-of-hospital cardiac arrest treated with mechanical circulatory support

IntroductionStudies on long-term outcomes after refractory out-of-hospital cardiac arrest (OHCA) treated with mechanical circulatory support (MCS) are limited. This study aimed to evaluate long-term neurologically intact survival, functional capacity and quality of life after refractory OHCA treated with MCS. MethodsThis was a follow-up study of survivors after refractory OHCA treated with MCS. Follow-up examinations comprised clinical assessment with transthoracic echocardiography and cardiopulmonary exercise test (CPX). Neurological and cognitive screening was evaluated with the Cerebral Performance Category (CPC) and Montreal Cognitive Assessment (MoCA test). A good neurological outcome was defined as CPC 1 or CPC 2. Health-related quality of life was measured by questionnaires (Short Form-36 (SF-36)). ResultsA total of 101 patients with refractory OHCA were treated with MCS at Aarhus University Hospital between 2015 and 2019. The total low-flow time was median 105 min [IQR, 94–123] minutes. The hospital discharge rate was 27%. At a mean follow-up time of 4.8 years ± 1.6 (range 2.8–6.1 years), 21 patients remained alive of whom 15 consented to participate in the present study. Good neurological outcome with CPC 1–2 was found in 93% (14/15) patients. No severe cognitive function was discovered; mean MoCA score of 26.4 ± 3.1. Functional capacity examined by CPX showed acceptable VO2 max values (23.9 ± 6.3 mL/kg/min). Mean SF-36 scores revealed an overall high level of quality of life in long-term survivors. ConclusionsLong-term survival with a good neurological outcome with functional recovery was high in patients with refractory OHCA treated with MCS. These patients may expect a reasonable quality of life after discharge despite prolonged resuscitation.

Assessment of cognitive function using the Montreal cognitive assessment test and its association with glycemic control in diabetes mellitus patients

Background: Diabetes mellitus (DM) is associated with decreased performance on cognitive domains. Diabetic patients have poor memory and attention. Cognitive dysfunction has emerged as significant morbidity of DM nowadays. Cognitive function can be screened rapidly by Montreal cognitive assessment test (MoCA). Aims and Objectives: The objective of this study was to study the effect of blood glucose levels and diabetic duration on MoCA score in diabetic patients. Materials and Methods: DM patients of both type 1(30) and type 2(30) from NCD clinic were selected as cases. Thirty persons with good health from master health checkup were selected as controls. Cognitive function was assessed in all the participants with MoCA after getting informed consent. Fasting and postprandial blood sugars were assessed with 2 mL of venous blood. Results: The mean MoCA score has decreased among diabetic cases than controls. Among cases, T1DM has decreased mean MoCA score than T2DM. Fasting blood sugar (FBS), post prandial blood sugar (PPBS), and diabetic duration were found to be correlated negatively with the score obtained in MoCA in controls and T1DM cases. In T2DM cases, FBS and PPBS were found to be correlated negatively with the score obtained in MoCA, but weak positive correlation was found between duration and MoCA score. Conclusion: Our study concludes an association between FBS, PPBS, and duration of diabetes with MoCA score in diabetic patients of both types. Strict glycemic control and regular screening for cognitive dysfunction can prevent dementia.

Baseline and Longitudinal Ioflupane SPECT Findings in DLB and MCI‐LB

AbstractBackgroundReduced striatal uptake on ioflupane SPECT is considered an indicative biomarker for Dementia with Lewy Bodies (DLB), and has been proposed as an indicative biomarker for Mild Cognitive Impairment with Lewy Bodies (MCI‐LB). Little data exists on the profile of uptake on key striatal regions of interest (ROIs) in DLB or MCI‐LB.MethodParticipants with DLB or MCI‐LB at baseline based on the presence of ≥2 core clinical DLB features, and ≥2 ioflupane SPECT scans performed approximately annually, were identified from the Mayo ADRC database. Minimum brain laterality z‐score values for the putamen (whole, anterior and posterior), caudate and striatum were determined using DaTQUANT 2 software. Baseline clinical and scan data was used for all analyses, and the annualized minimum putamen z‐change was determined on serial scans. The scan was considered abnormal if the minimum putamen z‐score was &lt;‐0.98 based on clinicopathologic data.Result27 participants were included (21 DLB and 6 MCI‐LB, 96% male). Compared to MCI‐LB, DLB had a lower mean MoCA score and a trend toward a higher UPDRS score compared to MCI‐LB; there were no statistically significant differences in age, sex, onset age or duration of cognitive decline, or presence of other core DLB features. The majority (89%) had an abnormal scan at baseline. All ROI z‐scores showed the expected general trend of DLB&lt;MCI‐LB, and the annualized z‐change was more negative in DLB, but none of the findings reached statistical significance.ConclusionThese findings suggest in MCI‐LB and DLB that 1) an abnormal ioflupane SPECT scan is frequently present at diagnosis, 2) z‐scores become more negative over time, and 3) the annualized z‐change is similar. Similar findings in larger cohorts would support the use of ioflupane SPECT as a biomarker in both MCI‐LB and DLB clinical trials.

Prevalence of Neurocognitive Impairment for NPC Survivors after Definitive Intensity-Modulated Radiotherapy: A Cross-Sectional Study

<h3>Purpose/Objective(s)</h3> High-dose intensity-modulated radiotherapy (IMRT) has led to excellent prognosis in patients with localized nasopharyngeal carcinoma (NPC). Given the relatively young age of onset and the close anatomic relationship between the nasopharynx and the central nervous system, post-radiation neurocognitive impairment among long-term survivors represents an under-recognized late complication. This study aims to determine the prevalence and the affected cognitive domains in post-IMRT NPC survivors. <h3>Materials/Methods</h3> We undertook a cross-sectional study in a high-volume tertiary oncology center in Hong Kong. NPC survivors who underwent IMRT with a minimal post-radiotherapy interval of 1 year were eligible. All patients underwent an initial screening using the Montreal Cognitive Assessment-Hong Kong (MoCA-HK) test, followed by a 2-hour comprehensive battery of neurocognitive assessments covering 8 distinct domains: intellectual capacity (WAIS-IV), attention span (WAIS-IV digit span, WMS-III Visual Spatial Span), visual memory (WMS-III Visual reproduction span), verbal memory (Auditory Verbal Learning Test), processing speed (Color Trail Test), executive function (Stroop Test), motor dexterity (Grooved Pegboard Test) and language ability (Verbal Fluency Test). Mean percentiles and Z-scores of all neurocognitive assessments were compared with age- and/or education-matched population normative data using one-sample t-tests. Correlation of cognitive outcomes with clinical factors were analyzed using multivariable linear regression. <h3>Results</h3> A total of 182 NPC survivors were enrolled. The median post-radiotherapy interval was 6.9 years, 129 (70.9%) were long-term survivors at least 5 years beyond radiotherapy. The median age was 56 years old, 89% of the enrolled patients had stage III-IVA NPC by AJCC/UICC 8^th Edition, and 87% of patients received chemotherapy. The mean MoCA score was 23.6, 25.8% of patients were considered cognitively impaired. NPC survivors demonstrated significant cognitive impairment in verbal memory (p<0.001), processing speed (p<0.001), executive function (p<0.001), motor dexterity (p<0.001) and language ability (p=0.001). Most significant impairment was observed in executive function, mean z-scores of which were -1.76 to -1.38 below normative data. Post-IMRT interval, disease stage and chemotherapy usage showed no significant association with the degree of neurocognitive impairment. <h3>Conclusion</h3> Post-IMRT neurocognitive impairment was prevalent in NPC survivors. Neurocognitive function was not impaired globally but occurred predominantly in selected domains, particularly executive function. Cognitive assessment and training should be considered a part of survivorship care for NPC patients. Future research on the correlation between neurocognitive function and radiation dosimetry of various brain subsites would be informative.

Evaluation of cognitive, mental, and sleep patterns of post-acute COVID-19 patients and their correlation with thorax CT.

ObjectiveIn this study, we have evaluated the cognitive, mental, and sleep patterns of post-COVID patients 2 months after their hospitalization, and after scoring their hospitalization thorax CTs, we have compared the degree of the lung involvement with cognitive and mental states of the patients.Materials and methodsForty post-COVID patients were included in our study. Patients who were hospitalized due to COVID-19 and who had thorax CT scan at the admission were included in the study. Thorax CT scans of the patients were scored using chest severity scoring (CT-SS). The Mini-Mental State Examination test (MMSE), the Montreal Cognitive Assessment Test (MoCA), the Pittsburgh Sleep Quality Index, and the Hamilton Depression and Hamilton Anxiety scales of all the participants were evaluated by the same person.ResultsEarly stage cognitive impairment was detected in 15% of post-COVID patients in the MMSE test and mean MMSE test score was 26.9 ± 2.1. The MoCA test detected cognitive impairment in 55% of the patients, and the mean MoCA score was 19.6 ± 5.2. Furthermore, all patients showed depressive symptoms in Hamilton Depression Scoring System and 57.5% of the patients showed anxiety symptoms in the Hamilton Anxiety Scoring System. The mean Pittsburg Sleep Quality Index of the patients was 10.7 ± 3.1, and it was found to be higher than normal. The mean CT-SS scores, which used to evaluate the lung involvement, of the patients were 4.7 ± 5.6. We did not find any correlation between patients’ cognitive tests and CT-SS scores.ConclusionWhen these results are taken into consideration, our study has shown that the neuropsychiatric symptoms of the patients who had COVID-19 continued even after 2 months of their illness. Therefore, long-term rehabilitation of these patients, including cognitive education and psychological services, should be continued.

Feasibility of a Multimodal Telemedical Intervention for Patients with Parkinson's Disease-A Pilot Study.

Symptoms of Parkinson’s disease (PD) can be controlled well, but treatment often requires expert judgment. Telemedicine and sensor-based assessments can allow physicians to better observe the evolvement of symptoms over time, in particular with motor fluctuations. In addition, they potentially allow less frequent visits to the expert’s office and facilitate care in rural areas. A variety of systems with different strengths and shortcomings has been investigated in recent years. We designed a multimodal telehealth intervention (TelePark) to mitigate the shortcomings of individual systems and assessed the feasibility of our approach in 12 patients with PD over 12 weeks in preparation for a larger randomized controlled trial. TelePark uses video visits, a smartphone app, a camera system, and wearable sensors. Structured training included setting up the equipment in patients’ homes and group-based online training. Usability was assessed by questionnaires and semi-standardized telephone interviews. Overall, 11 out of 12 patients completed the trial (5 female, 6 male). Mean age was 65 years, mean disease duration 7 years, mean MoCA score 27. Adherence was stable throughout the study and 79% for a short questionnaire administered every second day, 62% for medication confirmation, and 33% for an electronic Hauser diary. Quality of life did not change in the course of the study, and a larger cohort will be required to determine the effect on motor symptoms. Interviews with trial participants identified motivations to use such systems and areas for improvements. These insights can be helpful in designing similar trials.

Lower Extremity Artery Disease and Cognitive Impairment

BackgroundThe association between cerebrovascular disease and cognitive impairment is well known, but the impact of lower extremity arterial disease (LEAD) on neuropsychological performance is less established.ObjectivesThe aim of this study was to investigate the influence of LEAD on cognitive impairment.Materials and MethodsA total of 20 patients with LEAD, classified by Fountain’s stage IIB, qualified for revascularization surgery has been included in this prospective study. Neuropsychological assessments have been done using MoCA and CANTAB test. Fifteen patients qualified for hernia surgery, without peripheral artery disease served as a control group. Linear regression model has been applied to assess the connection between LEAD and cognitive impairment.ResultsDifferences between the study groups reach significance in both MoCA and CANTAB test. In MoCA test, patients with LEAD had lower levels of performance in attention (p = 0.0254), visuospatial/executive (p = 0.0343) and delayed recall (p = 0.0032). The mean MoCA score was below 26 points. In CANTAB test, patients with LEAD performed worse in visual memory and learning. After adjusted for common cerebrovascular risk factors, LEAD was significantly correlated with cognitive impairment defined as MoCA score < 26 points.ConclusionsLower extremity artery disease is associated with cognitive impairment independently of cerebrovascular risk factors.