Mean Montreal Cognitive Assessment Score Research Articles

Does Cognitive Function Affect Performance and Listening Effort During Bilateral Wireless Streaming in Hearing Aid Users?

: Wireless streaming technology (WT), designed to transmit sounds directly from a mobile phone to hearing aids, was developed to enhance the signal-to-noise ratio. However, the advantages of WT during phone use and the specific demographic that can fully benefit from this technology has not been thoroughly evaluated. We aimed to investigate the benefits and identify predictive factors associated with bilateral wireless streaming among hearing aid users. : Eighteen adults with symmetrical, bilateral hearing loss participated in the study. To assess the benefits of wireless streaming during phone use, researchers assessed sentence/word recognition and listening effort in two scenarios: a noisy background with WT turned "OFF" or "ON." Listening effort was evaluated through self-reported measurements. Cognitive function was also assessed using the Montreal Cognitive Assessment (MoCA) score. : Participant mean age was 57.3 years (range 27-70), and the mean MoCA score was 27.0 (23-30). The activation of WT demonstrated a significant improvement in the sentence/word recognition test and reduced listening effort. The MoCA score showed a significant correlation with WT (ρ=0.59, p=0.01), suggesting a positive association between cognitive function and the benefits of WT. : Bilateral wireless streaming may enhance sentence/word recognition and reduce listening effort during phone use in hearing aid users, with these benefits potentially linked to cognitive function.

#543 Cognitive improvement in end stage renal disease patients post transplantation—a prospective observational study

Abstract Background and Aims Global life expectancy at birth has increased from 66.8 years in 2000 to 73 years in 2019, as per data given by WHO in 2020. With the aging of the population, chronic kidney disease has become one of the common non communicable diseases in the world as well as one of the leading causes of mortality. Cognitive impairment begins early during chronic kidney disease and parallels kidney function decline. Cognitive dysfunction may affect the patient's daily functioning, employment options, medical adherence, medical decision making and is an independent predictor of mortality. Kidney transplantation can correct the metabolic derangements and eliminate the fluid and osmotic shifts that patients can experience on dialysis. However, cognitive impairments still persist post transplant and diagnosing and managing cognitive impairment is critical. Although there is a well established survival benefit of renal transplantation, the evidence of its effect on cognitive function is limited and not entirely consistent. Additional clinically relevant questions include whether existing comorbid conditions and associated endothelial dysfunction result in cognitive impairment that is not reversible with kidney transplant and which domains of cognition improve after transplant. This study aims to determine the proportion of patients showing cognitive improvement 3 months and 6 months post renal transplantation using Montreal Cognitive Assessment and to find the cognitive domains which show improvement post renal transplantation. This study also focusses on various parameters post transplant which may have affect the cognition of kidney transplant recipients. Method This study is a prospective observational study, conducted in a total of 100 patients, age group between 18 to 60 years who underwent renal transplantation in Medanta Hospital, India. Patients were enrolled in the study after taking informed consent. Patient demographics including age, sex, basic disease, co morbidities, dialysis vintage were recorded. Montreal cognitive assessment score was recorded during pre transplant period and was again recorded at 3 months and at 6 months posttransplant during outpatient department visits. Any episodes of infection, rejection or graft loss were recorded up to a period of 6 months post transplantation. Results with Figures 26 patients out of 100 showed improvement in Montreal Cognitive assessment score three months post renal transplantation and 56 patients out of 100 showed improvement in Montreal Cognitive assessment score 6 months post transplantation, when compared to their score at pre transplant level. The Mean Montreal cognitive assessment score at pre transplant level was 24.08 ± 3.08, at 3 months post-transplant was 24.32 ± 2.90 and at 6 months post-transplant was 25.28 ± 3.05. The difference between the mean score at 3 months post transplant when compared to mean score at pre transplant level was not found to be statistically significant p value 0.07. The difference between the mean score at 6 months post transplant when compared to the mean score at pre transplant level was found to be statistically significant p value <0.001. Among the various cognitive domains tested, delayed recall showed significant improvement after 3 months and 6 months post transplant with p values of 0.016 and < 0.001 respectively. Conclusion Significant cognitive improvement was seen 6 months post renal transplant. Delayed recall showed significant improvement after 3 and 6 months post renal transplant. This study concluded that patients who showed improvement in cognition 6 months post transplant did not show any significant correlation between the parameters studied such as serum sodium, calcium, haemoglobin, creatinine, age, rates of rejection and infection or use of any specific induction agent and improvement in Montreal cognitive assessment score. The screening for cognitive functions after kidney transplantation is not yet a routine practice and must be included in the routine follow up of the kidney transplant recipients.

Abstract 7445: Association between C-reactive protein and cognitive impairment in IDH-mutant gliomas

Abstract Cognitive impairment is common in primary brain tumor (PBT) patients, as a result of the disease and secondary damage from directed and systemic therapy. Recently, the risk in patients with IDH-mutant gliomas and role of interconnectivity of the tumor with neurons and the tumor microenvironment has heightened interest in exploration of biomarkers of impairment to inform care. Here, we investigate Montreal Cognitive Assessment (MoCA) scores and peripheral blood levels of C-reactive protein (CRP) in a cross-sectional cohort of 47 adult IDH-mutant PBT patients enrolled in a natural history study (NHS, NCT02851706: PI T. Armstrong). MoCA raw scores (range 0-30) were dichotomized (≤ 25 = cognitive dysfunction). Baseline CRP was quantified in banked serum samples in duplicate using (V-Plex/Vascular Injury Panel-2, Meso Scale Discovery [MSD], Rockville, MD) in a QuickPlex SQ 120 instrument (MSD). Lab personnel were blinded to diagnosis and clinical status. To reduce skewness in CRP raw values, we used log transformation. Descriptive statistics, Pearson’s correlation, and logistic regression were conducted using IBM SPSS and SAS Statistics software. The sample was predominately male (62%), white (70%), with high-grade gliomas (III/IV) (68%) and an average age at diagnosis of 36 years (SD: 9; median: 34; range: 20-53). The mean MoCA score was 25 (SD: 5; median: 26; range: 11-30). Dichotomizing MoCA scores showed that less than half (43%) of participants exhibited moderate-severe (≤ 25) cognitive impairment. MoCA binary group was negatively correlated with levels of CRP (r=-0.42, p<.003). The log mean concentration of CRP was higher in participants with cognitive impairment (7.99, SD=0.47 vs 7.57, SD=0.45, p<.003) than those without impairment. Finally, when controlling for age and sex, CRP remained predictive of cognitive impairment (OR 8.18, 95% CI 1.70,39.23). Higher levels of CRP were associated with lower MoCA scores in a cross-sectional sample of patients with IDH-mutant gliomas, suggesting an association between the severity of inflammation and cognitive impairment in IDH-mutant glioma patients. Further analysis in large, more diverse longitudinal cohorts will be needed to validate these findings in this population and compare to those with IDH-WT tumors and develop predictive models to inform biomarker development. Citation Format: McKenzie C. Kauss, Michelle L. Wright, Dhaivat Raval, Emory Hsieh, Kaitlynn Slattery, Terri S. Armstrong, Tito R. Mendoza, Vivian A. Guedes. Association between C-reactive protein and cognitive impairment in IDH-mutant gliomas [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7445.

Abstract A030: The Montreal Cognitive Assessment (MoCA) administered virtually or via Duo APP in primary brain tumor patients: a preliminary analysis

Abstract Background: Primary brain tumor (PBT) patients experience cognitive dysfunction (CD) because of both their tumor and its treatment. Evaluating CD in PBT populations may inform patient outcomes and clinical management and allow exploration of biologic underpinnings associated with its occurrence. The Montreal Cognitive Assessment (MoCA) is a brief assessment of objective measures of cognition that evaluates 8 specific cognitive domains. Our group has previously reported the feasibility of MoCA, and this study includes using the newly developed MoCA Duo APP to evaluate and report the cognitive function of patients with PBT. Associations between total MoCA scores and clinical and demographic characteristics were explored. Methods: This cohort consisted of adult PBT patients (n=172) enrolled in the NCI-NOB Natural History Study (NCT02851706: PI T. Armstrong). Assessments were performed between February 2020 and July 2023 by MoCA certified assessors and administered in the clinic or via telehealth. MoCA scores range from 0 to 30 (normal cognition ≥ 26). Healthcare providers collected demographic and clinical characteristics, with Karnofsky performance status (KPS) scores categorized as poor (≤ 80) or good (≥ 90). Descriptive statistics, independent t-tests, one-way ANOVAs, and Pearson’s correlation were conducted using IBM SPSS Statistics software. Results: The majority of patients were male (58%), white (81%), had ≥12 years of education (87%), had high-grade (3/4) tumors (65%), and a good KPS score (68%). The mean MoCA score was 25 (median: 26; range: 6-30) with a mean completion time of 10.7 minutes (median: 10; range: 6.1-41.1). Forty-two percent (n=73) were classified as abnormal. The median scores were lowest in the visuospatial/executive (4/5; range: 0-5), abstraction (2/3; range: 0-3) and delayed recall (4/5; range: 0-5) domains. A univariate analysis identified lower MoCA scores in patients with high-grade tumors (p<0.001), poor KPS scores (p<0.001), who underwent two or more surgeries (p=0.004) or treatments (p=0.038), had recurrence (p=0.002), had progression on current imaging (p=0.017), and had current anticonvulsant (p=0.014) and corticosteroid use (p=0.036). Age at diagnosis (r=-0.157, p=0.021) and at visit (r=-0.193, p=0.005) had a weak negative correlation with MoCA scores. Conclusions: Our results indicate that patient age, tumor progression, treatment, and concomitant medications are associated with MoCA scores. Further analysis will evaluate tumor methylation status and blood-based biomarkers associated with occurrence to develop prediction models that can be evaluated in larger cohorts. Future investigations should compare MoCA scores to other forms of cognitive assessment, including patient-reported outcomes, incorporating multiple timepoints to monitor CD in patients throughout their treatment and survivorship care. Citation Format: McKenzie C. Kauss, Elizabeth Vera, Kimberly Reinhart, Hope Miller, Jaime Garcia, Morgan Johnson, Madhura V. Managoli, Maeve Pascoe, Kaitlynn Slattery, Alex R. Wollet, Mark R. Gilbert, Alvina Acquaye-Mallory, Terri S. Armstrong, Vivian A. Guedes. The Montreal Cognitive Assessment (MoCA) administered virtually or via Duo APP in primary brain tumor patients: a preliminary analysis [abstract]. In: Proceedings of the AACR Special Conference on Brain Cancer; 2023 Oct 19-22; Minneapolis, Minnesota. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_1):Abstract nr A030.

The Effects of Health Care Providers Night Shift on Cerebral Oxygen Saturation and its Relationship to Cognitive Function

Background: In-training physicians frequently experience acute periods of sleep deprivation due to the extended durations of on-call shifts. To safeguard the well-being of residents, ensure patient safety, and optimize their performance, it becomes imperative to thoroughly assess and evaluate the cerebral function of in-training physicians subsequent to their shifts. Objective: To elucidate the effects of the nightshifts on regional cerebral oxygen saturation (rScO₂) and cognitive function of 50 in-training pediatricians. Materials and Methods: The rScO₂ was monitored using Near-infrared spectroscopy at specific intervals, pre-on-call (H0), post-call (H16), 24-hours from pre-on-call (H24), and 48-hours from pre-on-call (H48). All physicians continued their duties without a post-call day. The mathematical tests were performed at H0, H16, H24, and H48, while the Montreal cognitive assessment (MoCA) test was conducted at H0 and H24. Results: The mean rScO₂ at post-call at 65.8±5.3% and 24-hours from pre-on-call at 64.6±6.4%, were significantly declined from pre-on-call at 68.2±5.6% (p<0.001), and then returned to baseline at 48-hours from pre-on-call at 68.9±5.5%. The mathematical test scores were not different. The mean MoCA score was significantly decreased at 24-hours from pre-on-call at H0 with 28.4±1.4 to H24 with 27.7±1.8 (p<0.001). Conclusion: The 16-hours nightshifts and continuous working among residents might cause a transient reduction of rScO₂, which could lead to decreased cognitive function scores. Understanding the effects of stress, fatigue, and sleep deprivation on the cognitive performance of medical residents not only benefits each individual resident, but also promotes a culture of continuous improvement and excellence in medical education. Keywords: Cerebral oxygen saturation; In-training physicians; Sleep deprivation; Work-hours; Cognitive function

Olfactory and cognitive decrements in 1991 Gulf War veterans with gulf war illness/chronic multisymptom illness

BackgroundGulf War illness (GWI)/Chronic Multisymptom Illness (CMI) is a disorder related to military service in the 1991 Gulf War (GW). Prominent symptoms of GWI/CMI include fatigue, pain, and cognitive dysfunction. Although anosmia is not a typical GWI/CMI symptom, anecdotally some GW veterans have reported losing their sense smell shortly after the war. Because olfactory deficit is a prodromal symptom of neurodegenerative diseases like Parkinson’s and Alzheimer’s disease, and because we previously reported suggestive evidence that deployed GW veterans may be at increased risk for Mild Cognitive Impairment (MCI) and dementia, the current study examined the relationship between olfactory and cognitive function in deployed GW veterans.MethodsEighty deployed GW veterans (mean age: 59.9 ±7.0; 4 female) were tested remotely with the University of Pennsylvania Smell Identification Test (UPSIT) and the Montreal Cognitive Assessment (MoCA). Veterans also completed self-report questionnaires about their health and deployment-related exposures and experiences. UPSIT and MoCA data from healthy control (HC) participants from the Parkinson’s Progression Markers Initiative (PPMI) study were downloaded for comparison.ResultsGW veterans had a mean UPSIT score of 27.8 ± 6.3 (range 9–37) and a mean MoCA score of 25.3 ± 2.8 (range 19–30). According to age- and sex-specific normative data, 31% of GW veterans (vs. 8% PPMI HCs) had UPSIT scores below the 10th percentile. Nearly half (45%) of GW veterans (vs. 8% PPMI HCs) had MoCA scores below the cut-off for identifying MCI. Among GW veterans, but not PPMI HCs, there was a positive correlation between UPSIT and MoCA scores (Spearman’s ρ = 0.39, p < 0.001). There were no significant differences in UPSIT or MoCA scores between GW veterans with and without history of COVID or between those with and without Kansas GWI exclusionary conditions.ConclusionsWe found evidence of olfactory and cognitive deficits and a significant correlation between UPSIT and MoCA scores in a cohort of 80 deployed GW veterans, 99% of whom had CMI. Because impaired olfactory function has been associated with increased risk for MCI and dementia, it may be prudent to screen aging, deployed GW veterans with smell identification tests so that hypo- and anosmic veterans can be followed longitudinally and offered targeted neuroprotective therapies as they become available.

Subjective cognitive complaints and objective cognitive impairment in patients suspected of obstructive sleep apnea who underwent polysomnography.

Obstructive sleep apnea (OSA) is linked to cognitive impairment. We aimed to investigate subjective cognitive complaints (SCCs) and objective cognitive scores and their relation to polysomnography (PSG) parameters in patients suspected of having OSA. A prospective cohort cross-sectional study was conducted at Siriraj Hospital. Patients suspected of OSA who were scheduled for PSG were recruited. Cognition was assessed using the Montreal Cognitive Assessment (MoCA) and Color Trails Test (CTT). The Memory Index Score (MIS) was calculated from the MoCA. Subjective cognitive complaint presence was assessed through direct questioning of patients and by employing the Cognitive Change Index rated by self or informants (CCI-I). Patients with severe dementia were excluded. Among 258 patients (mean age 61.46±7.05years, 51.2% female), the mean MoCA score was 23.89±3.89. Based on PSG results, patients were categorized into groups as follows: those without OSA or with mild OSA (combined total of 20.1%), moderate OSA (28.3%), or severe OSA (51.6%). Cognitive Change Index rated by self and CCI-I scores correlated significantly (r=0.238, p=0.019) but not with the MoCA score or CTT time. Objective cognitive scores were associated with PSG parameters: total sleep time (TST), sleep onset latency, wake after sleep onset, sleep stages, mean O2 saturation, and time spent with SaO2 below 90% (all p<0.05). Subjective cognitive scores were not associated with PSG parameters, except CCI-I with TST. Participants with objective cognitive impairment had lower education, higher body mass index, more comorbidities, and lower SCC percentage (all p<0.05). Patients with moderate to severe OSA had a higher proportion of objective cognitive impairment (64.1%) but a lower incidence of SCC (38.3%) than patients with no OSA or mild OSA. Thirty patients with severe OSA and cognitive impairment received continuous positive airway pressure (CPAP) treatment for a mean of 12.2months. These patients showed MoCA and MIS improvement, but no significant changes were observed in their CTT and Cognitive Change Index scores. Most patients with OSA had objective cognitive impairment, but SCC was less frequent in patients with more severe OSA. Several PSG parameters correlated with cognitive scores but not with subjective cognitive scores. Patients with severe OSA may benefit cognitively from CPAP treatment.

Is the difference real, is the difference relevant: the minimal detectable and clinically important changes in the Montreal Cognitive Assessment

Background and aimsThe Montreal Cognitive Assessment (MoCA) is a widely used instrument for assessing cognitive function in stroke survivors. To interpret changes in MoCA scores accurately, it is crucial to consider the minimal detectable change (MDC) and minimal clinically important difference (MCID). The aim was to establish the MDC and MCID of the MoCA within 6 months after stroke. MethodsThis cohort study analysed data from the EFFECTS trial. The MoCA was administered at baseline and at 6-month follow-up. The MDC was calculated as the upper limit of the 95 % confidence interval of the standard error of the MoCA mean. The MCID was determined using anchor-based and distribution methods. The visual analogue recovery scale of the Stroke Impact Scale (SIS [primary anchor]) and Euro Quality of Life-5 Dimensions index (EQ-5D [confirmatory anchor]) were used as anchors. The distribution-based method, the Cohen benchmark effect size was chosen. ResultsIn total, 1131 (mean age [SD], 71 [10.6] years) participants were included. The mean (SD) MoCA scores at admission and 6-month follow-up were 22 (5.2) and 25 (4.2), respectively. The MDC of the MoCA was 5.1 points. The anchor method yielded the MCIDs 2 and 1.6 points for SIS and EQ-5D, respectively. Using the distribution method, the MCID for the MoCA was 1 point. ConclusionsEven a small change in MoCA scores can be important for stroke survivors; however, larger differences are required to ensure that any difference in MoCA values is a true change and is not related to the inherent variation in the test. Due to small sample sizes, the results of the anchor analysis need to be interpreted with caution.

Brain Health After COVID-19, Pneumonia, Myocardial Infarction, or Critical Illness

Brain health is most likely compromised after hospitalization for COVID-19; however, long-term prospective investigations with matched control cohorts and face-to-face assessments are lacking. To assess whether long-term cognitive, psychiatric, or neurological complications among patients hospitalized for COVID-19 differ from those among patients hospitalized for other medical conditions of similar severity and from healthy controls. This prospective cohort study with matched controls was conducted at 2 academic hospitals in Copenhagen, Denmark. The case cohort comprised patients with COVID-19 hospitalized between March 1, 2020, and March 31, 2021. Control cohorts consisted of patients hospitalized for pneumonia, myocardial infarction, or non-COVID-19 intensive care-requiring illness between March 1, 2020, and June 30, 2021, and healthy age- and sex-matched individuals. The follow-up period was 18 months; participants were evaluated between November 1, 2021, and February 28, 2023. Hospitalization for COVID-19. The primary outcome was overall cognition, assessed by the Screen for Cognitive Impairment in Psychiatry (SCIP) and the Montreal Cognitive Assessment (MoCA). Secondary outcomes were executive function, anxiety, depressive symptoms, and neurological deficits. The study included 345 participants, including 120 patients with COVID-19 (mean [SD] age, 60.8 [14.4] years; 70 men [58.3%]), 125 hospitalized controls (mean [SD] age, 66.0 [12.0] years; 73 men [58.4%]), and 100 healthy controls (mean [SD] age, 62.9 [15.3] years; 46 men [46.0%]). Patients with COVID-19 had worse cognitive status than healthy controls (estimated mean SCIP score, 59.0 [95% CI, 56.9-61.2] vs 68.8 [95% CI, 66.2-71.5]; estimated mean MoCA score, 26.5 [95% CI, 26.0-27.0] vs 28.2 [95% CI, 27.8-28.6]), but not hospitalized controls (mean SCIP score, 61.6 [95% CI, 59.1-64.1]; mean MoCA score, 27.2 [95% CI, 26.8-27.7]). Patients with COVID-19 also performed worse than healthy controls during all other psychiatric and neurological assessments. However, except for executive dysfunction (Trail Making Test Part B; relative mean difference, 1.15 [95% CI, 1.01-1.31]), the brain health of patients with COVID-19 was not more impaired than among hospitalized control patients. These results remained consistent across various sensitivity analyses. This prospective cohort study suggests that post-COVID-19 brain health was impaired but, overall, no more than the brain health of patients from 3 non-COVID-19 cohorts of comparable disease severity. Long-term associations with brain health might not be specific to COVID-19 but associated with overall illness severity and hospitalization. This information is important for putting understandable concerns about brain health after COVID-19 into perspective.

Non‐physical Leisure Activity patterns and Cognitive Function in 4,121 Hong Kong older adults with no major neurocognitive disorders

AbstractBackgroundEmerging evidence supports the role of lifestyle in maintenance of cognitive function. Physical exercise, diet and sleep are found to play important roles in cognitive health at later life. In this recently completed epidemiological study in Hong Kong, we explored if non‐physical leisure activity participation also contributes to cognitive function in older adults.MethodThe Hong Kong Mental Morbidity Survey for Older People (HKMMSOP) is a commissioned study supported by the Health and Medical Research Fund of the Hong Kong SAR. From 2019 till 2022, we have successfully assessed 4,369 community dwelling older adults (60 years or over). 4,121 participants satisfied clinical Dementia Rating (CDR) of either 0 or 0.5. Assessments included Montreal cognitive assessment (MoCA), cumulative illness rating for physical disease burden, Clinical Interview Schedule – Revised (CIS‐R) for depressive and anxiety symptoms, types of physical exercise (aerobic, mind body, resistance muscle training, stretch), types of non‐physical activities (cognitive, social, spiritual, volunteering, passive solitary) activities were counted as positive if regular practice frequency were once weekly or more.ResultOf the 4,121 participants, 3118 were cognitively healthy (CDR = 0), 1003 had mild neurocognitive disorder with CDR 0.5. The mean age and education (years) was 68.9(SD 6.9)(range 60‐98) and 9(SD 4.5) respectively. 44% were men. The mean MoCA score was 24.4 (SD 4.0). Regression analysis with MoCA score as the dependent variable showed that cognitive, volunteer and spiritual activities were significant factors (after controlling for gender, age, education, physical health burden, psychological symptoms (CIS‐R), and total number of physical exercise)(R2 = 295). In the CDR 0 group, cognitive and spiritual activities are significant factors (R2 = 0.184). In the CDR 0.5 group, cognitive and volunteer activities are significant (R2 = 0.196).ConclusionThe HKMMSOP provides empirical evidence on the association between cognitive function and apparently pro‐mental wellbeing leisure activities. The observation that the introspective spiritual activities being significant factor in healthy, and external volunteering activities being significant in mild cognitively impaired group should invite further replication and exploration on the associated mechanisms.

Visual Cognitive Assessment Test (VCAT): Utility in detecting early dementia in diverse language cohorts

AbstractBackgroundCognitive tests play a crucial role in evaluating mild cognitive impairment (MCI) and dementia. As most tests are originally developed in English‐speaking cohorts, their application in multilingual populations will need to be translated and may affect the test psychometrics. Therefore, the VCAT was developed as a language‐neutral visual‐based assessment to mitigate this issue. Although the VCAT has been validated in Southeast Asian countries, its performance in wider language cohorts remains unclear. Here, we aim to compare the utility of VCAT with established screening tests, Montreal Cognitive Assessment (MoCA) and Mini‐Mental State Examination (MMSE), in distinguishing MCI and dementia from cognitively normal (CN) individuals in a multinational study.MethodThis collaboration between Canada, China, India, Korea and Singapore recruited 614 participants (306 CN, 212 MCI, 94 Dementia). The administration of the cognitive tests were standardized across all study sites. Participants underwent the MMSE, MoCA, and VCAT on the same day, with their scores and demographic data (age, gender, years of education, ethnicity, primary written and spoken language) collected in the centers respectively. The performance of VCAT in distinguishing MCI and dementia from CN were assessed within each sites using the area under the curve (AUC).ResultBaseline demographics of the participants in each site were summarized in Table 1. The mean (SD) MMSE, MoCA and VCAT scores in each diagnostic group across all countries were summarized in Table 2. The mean (SD) VCAT scores across all countries for CN, MCI and dementia were 25.91 (3.14); 21.00 (5.36) and 11.91 (4.79) respectively. Corresponding scores for MoCA were 26.09 (2.76); 22.62 (4.43); 14.02 (5.17) and corresponding scores for MMSE were 28.34 (1.79); 26.55 (2.90); 18.91 (4.81). The AUC of VCAT in detecting cognitive impairment (MCI+Dementia) was found to be 0.83 (95%CI 0.80 to 0.86), which is comparable to the MoCA 0.82 (95%CI 0.78 to 0.85) and the MMSE 0.78 (95%CI 0.74 to 0.81).ConclusionVCAT was comparable to the MoCA and MMSE in distinguishing cognitive impairment from CN in a multinational, multilingual population. Further studies with wider language populations are needed to further validate the utility of VCAT globally.

Cognitive performance and all-cause mortality in community dwellers of Amerindian ancestry living in rural Ecuador: A population-based, longitudinal prospective study

ObjectiveThere is limited information on mortality risk in individuals with cognitive impairment living in rural Latin America. In this study, we assess the association between cognitive impairment and all-cause mortality in adults of Amerindian ancestry living in rural Ecuador. Patients and methodsMiddle-aged and older adults enrolled in the population-based Three Villages Study cohort were followed prospectively in order to estimate mortality risk according to their baseline cognitive performance as determined by the Montreal Cognitive Assessment (MoCA). Results were adjusted for demographics, level of education, traditional cardiovascular risk factors, symptoms of depression, severe tooth loss, and oily fish intake (factors previously associated with mortality in the study population). ResultsAnalysis included 1022 individuals followed for an average of 7.8 ± 3.4 years. Mean MoCA score was 21.2 ± 5.4 points (median: 22 points), with 334 (32.7%) individuals showing cognitive impairment, as evidenced by a MoCA score ≤ 19 points (the cutoff for poor cognitive performance based on previous studies in the same population). A total of 150 (14.7%) individuals died during the follow-up. Crude mortality rate was 2.87 per 100 person-years (95% C.I.: 2.08 – 3.96). For individuals with normal cognition, the mortality rate was 1.21 (95% C.I.: 0.92 – 1.50) while for those with cognitive impairment the rate increased to 3.48 (95% C.I.: 2.73 – 4.23). A multivariate Cox-proportional hazards model, confirmed that individuals with cognitive impairment had a significantly higher mortality risk than those without cognitive impairment (HR: 1.52; 95% C.I.: 1.05 – 2.18). ConclusionsCognitive impairment is associated with mortality in the study population.

COVID-19 and the Brain: A Psychological and Resting-state Functional Magnetic Resonance Imagin (fMRI) Study of the Whole-brain Functional Connectivity

Introduction: Coronavirus-2019 (COVID-19) spreads rapidly worldwide and causes severe acute respiratory syndrome. The current study aims to evaluate the relationship between the whole-brain functional connections in a resting state and cognitive impairments in patients with COVID-19 compared to the healthy control group. Methods: Resting-state functional magnetic resonance imaging (rs-fMRI) and Montreal cognitive assessment (MoCA) data were obtained from 29 patients of the acute stage of COVID-19 on the third day of admission and 20 healthy controls. Cross-correlation of the mean resting-state signals was determined in the voxels of 23 independent components (IC) of brain neural circuits. To assess cognitive function and neuropsychological status, MoCA was performed on all participants. The relationship between rs-fMRI information, neuropsychological status, and paraclinical data was analyzed. Results: The COVID-19 group got a lower mean MoCA score and showed a significant reduction in the functional connectivity of the IC14 (P&lt;0.001) and IC38 (P&lt;0.001) regions compared to the controls. The increase in functional connectivity was observed in the COVID-19 group compared to the controls at baseline in the default mode network (DMN) IC00 (P&lt;0.001) and dorsal attention network (DAN) IC08 (P&lt;0.001) regions. Furthermore, the alternation of functional connectivity in the mentioned ICs was significantly correlated with the mean MoCA scores and inflammatory parameters, i.e. erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Conclusion: Functional connectivity abnormalities in four brain neural circuits are associated with cognitive impairment and increased inflammatory markers in patients with COVID-19.

55 Tracking Cognitive Change in Huntington’s Disease with the Mini Mental State Exam and the Montreal Cognitive Assessment

Objective:To assess the utility of the Mini Mental State Exam (MMSE) and Montreal Cognitive Assessment (MoCA) for tracking cognitive changes Huntington’s Disease.Participants and Methods:Currently, the most frequently used brief assessment of global cognitive functioning is the MMSE. Although the MMSE is helpful for distinguishing individuals without significant cognitive impairment from those with dementia, it is not particularly sensitive to more subtle cognitive deficits. The MoCA is another brief cognitive screening tool that has been shown to be more sensitive to mild impairment and may have greater usefulness in subcortical dementias because of its more extensive assessment of executive function. Although the MoCA appears to have high sensitivity and specificity in a variety of neurological populations, there is currently little known about its efficacy in tracking cognitive decline in individuals with HD. We used a mixed effects model to analyze MMSE and MoCA scores collected prospectively during 5 years of follow-up for 163 patients with HD seen at one academic HDSA Center of Excellence. Baseline mean age for the HD cohort was 51.35 years, mean education 14.46 years, and a mean CAG repeat length 43.95. Mean follow-up time was 3.33 years.Results:Mean MMSE and MoCA scores at baseline were 25.13 (SD=1.66) and 22.76 (SD=3.70) respectively. At baseline, age and gender were not associated with MMSE and MoCA scores, while years of education were. Neither age nor gender predicted rate of decline for the MoCA while years of education predicted rate of decline for the MMSE. For the MMSE, each year of education predicted on average 0.51 points higher score at enrollment; for the MoCA, each year of education predicted on average 0.79 points higher score at enrollment. The mean rates of decline on the MMSE was 0.48 points per year (p&lt;.001) while that on the MoCA was only 0.31 points annually (p&lt;.001) in the first five years of observation.Conclusions:The MMSE and MoCA decline significantly over time in an unselected HD population. The smaller rate of decline in the MoCA may be due, in part, to the greater variability in baseline, MoCA (SD=3.70) vs MMSE (SD=1.66) scores in our HD cohort. Unlike cortical dementias, such as Alzheimer’s disease (AD), where declines of 2-3 points per year have been described for the MMSE and MoCA, much lower annual rates of decline have been reported in subcortical dementias such as Parkinson’s disease. To our knowledge, this is the first report of rate of cognitive decline on the MMSE and MoCA in HD: such information is vital for adequately preparing patients and families for future needs, in addition to planning for interventional/treatment trials in HD.

Progression of brain cholinergic dysfunction in patients with isolated rapid eye movement sleep behavior disorder.

Reduced cortical acetylcholinesterase activity, as measured by 11 C-donepezil positron emission tomography (PET), has been reported in patients with isolated rapid eye movement (REM) sleep behavior disorder (iRBD). However, its progression and clinical implications have not been fully investigated. Here, we explored the relationship between longitudinal changes in brain acetylcholinesterase activity and cognitive function in iRBD. Twelve iRBD patients underwent 11 C-donepezil PET at baseline and after 3 years. PET images were interrogated with statistical parametric mapping (SPM) and a regions of interest (ROI) approach. Clinical progression was assessed with the Movement Disorder Society-Unified Parkinson's Disease Rating Scale-Part III (MDS-UPDRS-III). Cognitive function was rated using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). From baseline to follow-up, the mean 11 C-donepezil distribution volume ratio (DVR) decreased in the cortex (p = 0.006), thalamus (p = 0.013), and caudate (p = 0.013) ROI. Despite no significant changes in the group mean MMSE or MoCA scores being observed, individually, seven patients showed a decline in their scores on these cognitive tests. Subgroup analysis showed that only the subgroup of patients with a decline in cognitive scores had a significant reduction in mean cortical 11 C-donepezil DVR. Our results show that severity of brain cholinergic dysfunction in iRBD patients increases significantly over 3 years, and those changes are more severe in those with a decline in cognitive test scores.

B - 33 Characterization of Subjective Cognitive Complaints in a Population-Based Sample.

Subjective cognitive complaints (SCCs) represent one's perception of cognitive change that may relate to cognitive decline. This study characterized SCC endorsement and objective cognitive performance in minority populations. Participants from a population-based, multiethnic cardiovascular risk study (N = 2653; Age = (18-85); Female = 58%; Black = 51%; Hispanic = 14%) responded to questions about their subjective cognitive functioning prior to completing the Montreal Cognitive Assessment (MoCA). Participants endorsed "Yes" or "No" to the following items: 1) Do you have consistent memory problems, 2) If YES, do they interfere with everyday activities, and 3) do you have trouble figuring things out/solving problems. Descriptive and chi-squared analyses characterized endorsement among ethnoracial groups. One-way ANCOVA controlling for age, race/ethnicity, and education compared MoCA scores by endorsement pattern. Nineteen percent (N = 520) of participants endorsed SCCs, in which blacks endorsed SCCs at a higher rate (22.4%; p < 0.008) than other ethnoracial groups (White = 16.3%; Hispanic = 17.8%). ANCOVA revealed significantly higher mean MoCA scores in those without cognitive complaints (MoCA = 23.4, N = 2122) than those who endorsed Item 3 (MoCA = 21.7, N = 42, p = 0.002, η2 = 0.001), Items 1&3 (MoCA = 21.8, N = 42, p = 0.004, η2 = 0.002), and Items 1,2, &3 (MoCA = 19.6, N = 100, p = <0.001, η2 = 0.024), respectively. Black individuals were more likely to endorse SCC's than other ethnoracial groups. Interestingly, memory complaints alone were not associated with cognitive performance, while those with problem solving concerns (with or without memory concerns) showed poorer cognitive performance. While a self-appraisal of executive functioning produced the strongest effect, future investigations are needed to characterize and distinguish the most sensitive SCCs to enhance clinical utility of brief screeners.

The effect of melatonin on sleep quality and cognitive function of individuals undergoing hemodialysis

Backgroundand purpose: This study aimed to investigate the effect of melatonin on sleep quality and cognitive function of individuals undergoing hemodialysis. Materials and methodsIn this randomized controlled clinical trial, 102 eligible individuals were assigned to two equal intervention and control groups. The intervention group received melatonin 3 mg tablets half an hour before going to bed for six weeks, while the control group was given a placebo with similar conditions. ResultsThis study had 102 participants who were divided into intervention and control groups. The mean age of the participants was 58.30 (SD = 12.10). Among the participants, 54.90% were female. Moreover, 33.33% of the individuals received dialysis for four years or longer. After the intervention, the mean and standard deviation of the Pittsburgh Sleep Quality Index (PSQI) was 12.66 (SD = 3.09) in the intervention group and 18.86 (SD = 3.8) in the control group (P < 0.001). Moreover, the mean sleep quality index in the intervention group showed a statistically significant difference before and after the intervention (P < 0.001); the PSQI score declined from 20.21 to 12.66. Likewise, there was a statistically significant difference between the two groups after intervention in the mean Montreal Cognitive Assessment (MoCA) index (P = 0.002); it was 24.27 (SD = 3.42) in the intervention group and 22.15 (SD = 2.3) in the control group. The mean MoCA score in the intervention group showed a significant difference before and after the intervention (P < 0.001), increasing from 21.19 to 24.27. ConclusionAccording to the study's findings, melatonin can improve individuals undergoing hemodialysis' cognitive function and sleep quality.

Psychosocial risk factors and cognitive decline in people living with HIV: results from the Malaysian HIV and aging (MHIVA) study

ABSTRACT HIV-associated mortality has improved with the advent of antiretroviral therapy, yet neurocognitive decline persists. We assessed the association between psychosocial risk factors and cognitive function among Malaysian PLWH. Data of virally suppressed PLWH (n = 331) on stable ART, from the Malaysian HIV and Aging study was assessed. Psychosocial factors were assessed using the Lubben Social Network Scale-6 (social isolation) and Depression Anxiety Stress Scale-21 (DASS-21). The Montreal Cognitive Assessment (MoCA) with normative standards for the Malaysian population was used to determine cognitive function. Linear and logistic regression were used to assess the associations between cognition, and psychosocial risk factors. Median age of participants was 43.8 years (IQR 37.7–51.0). Participants were predominantly male (82.8%), with secondary education or higher (85.2%). Participants were on ART for 5.7 years (IQR 3.0–9.7), with a mean MoCA score of 24.6 (±3.7). Social isolation was found in 34.6% of participants, and severe depression, severe stress, and severe anxiety in 10.6%, 15.4%, and 6.0% respectively. After adjusting for demographic, clinical, and HIV parameters, MoCA scores were significantly associated with severe stress (β = −0.11, p = 0.02) and having marginal friendship ties (β = −0.13, p = 0.03). Social isolation and severe stress are associated with neurocognitive impairment in PLWH.

Cognitive impairment in adults under compulsory psychiatric care: association with psychotic symptoms and high-dose antipsychotics

Background There is limited evidence on the association between cognitive function, psychotic symptoms and doses of antipsychotics in adults under compulsory psychiatric care. Aims We assessed (a) the degree of cognitive impairment in adults involuntarily hospitalised for compulsory psychiatric care and (b) correlation of Montreal Cognitive Assessment (MoCA) score with psychotic symptoms, polypharmacy and prescription of high-dose antipsychotics. Method This was a nationwide, cross-sectional study, conducted at the only referral state hospital for compulsory psychiatric care in Cyprus (December 2016–February 2018). Τhe MoCA was applied for the assessment of cognitive functioning. The Positive and Negative Syndrome Scale (PANSS) was applied for the assessment of psychotic symptoms. Results The sample comprised 187 men and 116 women. The mean MoCA score was 22.09 (reported scale range (RSR): 3–30); the mean PANSS general symptoms subscale score was 49.60 (RSR = 41–162). The participants who reported positive psychiatric history (mean 21.71, s.d. 5.37), non-adherence to pharmacotherapy (mean 21.32, s.d. 5.56) and prescription of high-dose antipsychotics (with medication prescribed as needed: mean 21.31, s.d. 5.70; without medication prescribed as needed: mean 20.71, s.d. 5.78) had lower mean MoCA scores compared with those who reported negative psychiatric history (mean 23.42, s.d. 4.51; P = 0.017), adherence to pharmacotherapy (mean 23.10, s.d. 6.61; P = 0.003) and no prescription of high-dose antipsychotics (with medication prescribed as needed: mean 22.56, s.d. 4.90; without medication prescribed as needed: mean 22.60 s.d. 4.94; P = 0.045–0.005), respectively. Mean MoCA score was mildly and inversely associated with total PANSS score (r = −0.15, P = 0.03), PANSS general (r = −0.18, P = 0.002) and PANSS negative (r = −0.16, P = 0.005) symptoms subscales, respectively. Conclusions Our findings support the evaluation of cognitive functioning in adults under compulsory psychiatric care via the MoCA tool, with focus on those prescribed high-dose antipsychotics, with positive mental health history and non-adherence to pharmacotherapy.

#5200 IMPACT OF MINERAL BONE PARAMETERS IN COGNITIVE IMPAIRMENT IN DIALYSIS PATIENTS

Abstract Background and Aims Mineral bone disease and cognitive impairment are related diseases in the CKD population. Vascular calcification, a marker of MBD, may play a role in the early detection of cognitive decline. This study aims to identify a relationship between MBD biomarkers and cognitive function and to identify dialysis patients with a high risk of dementia. Method A total of 98 patients participated in this cross-sectional study, with 63 on hemodialysis and 35 on peritoneal dialysis. They underwent the Montreal Cognitive Assessment (MoCA) questionnaire, which categorized mild, moderate, severe, and severe based on scoring. PTH, P, Ca, ALP, and Mg serum concentrations and vascular calcification were measured as MBD biomarkers. The Adragaos score was applied to graphs of the hands and pelvis to evaluate vascular calcification. Results The mean MoCA score was 20,28±5.8. Based on the responses, it was concluded that 70% of HD patients had mild cognitive impairment, compared to 63% of PD patients. According to the descriptive data, patients whose underlying CKD was caused by nephroangisclerosis had the lowest MOCA test results compared to other groups (p&amp;lt;0.001). The degree of calcification was observed to have an adverse effect on cognitive performance in both groups (p&amp;lt;0.012); the high Adragaos score contributed to the decline in the MoCA test score. In multivariate logistic regression analysis, hypercalcemia and hypomagnesemia were independent variables for cognitive function impairment (p = 0.006 and p = 0.04, respectively). The serum concentration of PTH (p = 0.008) and ALP (p = 0.001) were found to be risk factors for HD patients during the evaluation of the MoCA test in each of the groups. Conclusion Vascular calcifications are considered a risk factor for cognitive impairment. In our study, vascular calcification risk is positively impacted by indicators such as hyperparathyroidism, hypercalcemia, high levels of ALP, and hypomagnesemia. Recently research has demonstrated the effectiveness of magnesium as a vascular calcification inhibitor. So, nephrologists should be more careful in monitoring levels of MBD biomarkers.