Mean Montreal Cognitive Assessment Research Articles

A Pilot Clinical Trial of Repetitive Transcranial Magnetic Stimulation in Mild Cognitive Impairment

Background: Mild cognitive impairment (MCI) is defined as a progressive memory dysfunction. There are controversies with regards to whether repetitive transcranial magnetic stimulation (rTMS) could improve the condition. Methods: In a randomized, self-control, crossover clinical trial, effect of rTMS on cognitive performance in patients with MCI was assessed. Patients were randomized into two study groups (A and B) and received both rTMS procedure and sham therapy in sequence, with each lasting for 8 weeks. Montreal cognitive assessment (MoCA) test was performed as a cognition battery at baseline and 1 week after each 8-week period of interventions. Results: Sixteen patients were enrolled in the study. Baseline measures of MoCA were statistically equal between two groups (P value = 0.10). Mean MoCA score significantly increased in group A at nine-week follow-up compared to both group B (P value < 0.001) and its baseline (P value = 0.01). However, at 18-week follow-up, mean MoCA scores were increased in both groups compared to their baseline (both P values < 0.001) with no significant differences between study groups (P value = 0.87). No adverse effects were reported. Conclusions: The rTMS is suggested as an effective and safe therapeutic option for cognitive improvement in patients with MCI. J Neurol Res. 2020;10(5):188-192 doi: https://doi.org/10.14740/jnr622

Cognitive outcomes after unruptured intracranial aneurysm treatment with endovascular coiling

BackgroundWe aimed to determine the effects of endovascular coiling of unruptured intracranial aneurysms (UIAs) on cognition to inform treatment decisions. We present the first study using the Montreal Cognitive Assessment...

Subjective and objective cognition 6-week post-coronary artery bypass graft surgery: A descriptive pilot study.

BackgroundCoronary artery bypass graft (CABG) surgery has been found to be associated with post-operative cognitive decline. Despite the large and growing numbers being conducted in South Africa, the associated or ensuing cognitive symptoms or impairment have received little research attention.AimThe aim of this pilot study was to describe the nature and extent of subjective cognitive complaints (SCCs) and objective cognitive impairments in patients 6-week post-CABG surgery in a clinical sample in KwaZulu-Natal (KZN) Province, South Africa.SettingA cross-sectional survey was conducted among outpatients attending their 6-week post-CABG surgical review at a cardiology clinic in a KZN provincial hospital.MethodSocio-demographic and clinical data were captured, with SCCs being determined by using standardised questions; cognition was assessed with the Montreal cognitive assessment (MoCA).ResultsThe mean age of the sample (n = 28) was 58.72 years. The mean MoCA score was 23.96 (SD = 4.32); 60.71% (n = 17) screening positive (< 25/30) and more likely to be older, male, hypertensive and diabetic. A third (n = 9; 35.71%) reported at least one new SCC; their mean age was 55.36 years which was lower than those without subjective complaints (59.81).ConclusionsSubjective and objective cognitive impairments were evident in patients 6-week post-CABG surgery identifying a need for longitudinal cognitive screening both pre- and post- operatively in patients undergoing CABG surgery.

Hearing-impaired population performance and the effect of hearing interventions on Montreal Cognitive Assessment (MoCA): Systematic review and meta-analysis.

Older adults are at high risk of developing age-related hearing loss (HL) and/or cognitive impairment. However, cognitive screening tools rely on oral administration of instructions and stimuli that may be impacted by HL. This systematic review aims to investigate (a) whether people with HL perform worse than those without HL on the Montreal Cognitive Assessment (MoCA), a widely used screening tool for cognitive impairment, and what the effect size of that difference is (b) whether HL treatment mitigates the impact of HL. We conducted a systematic review and meta-analysis including studies that reported mean MoCA scores and SDs for individuals with HL. People with HL performed significantly worse on the MoCA (4 studies, N = 533) with a pooled mean difference of -1.66 points (95% confidence interval CI -2.74 to -0.58). There was no significant difference in MoCA score between the pre- vs post-hearing intervention (3 studies, N = 75). However, sensitivity analysis in the cochlear implant studies (2 studies, N = 33) showed improvement of the MoCA score by 1.73 (95% CI 0.18 to 3.28). People with HL score significantly lower than individuals with normal hearing on the standard orally administered MoCA. Clinicians should consider listening conditions when administering the MoCA and report the hearing status of the tested individuals, if known, taking this into account in interpretation or make note of any hearing difficulty during consultations which may warrant onward referral. Cochlear implants may improve the MoCA score of individuals with HL, and more evidence is required on other treatments. J Am Geriatr Soc 68:-, 2020.

THU0134 COGNITIVE IMPAIRMENT IN RHEUMATOID ARTHRITIS

Background:Increasing evidence suggests that systemic inflammation may be associated with an increased risk of developing cognitive dysfunction and Alzheimer’s disease (AD). Some studies have found an association between rheumatoid arthritis (RA) and neurodegeneration with several finding increased incidence of mild cognitive impairment (MCI) in those with RA compared to healthy controls.Objectives:This study aims to use preliminary data from theRheumatoid arthritis, medication and memorystudy (RESIST) to investigate the prevalence of MCI in a population of patients with RA and explore the relationship between MCI and specific demographic and clinical characteristics.Methods:The Montreal Cognitive Assessment (MoCA) was used as a cognitive screening tool and was administered to subjects ≥55 years of age who had been diagnosed with RA according to the ACR/EULAR criteria. Demographic and clinical data was recorded at screening in face-to-face interviews and included age, gender, date of RA diagnosis and RA medication. RA disease activity score from 28 joints (DAS28), rheumatoid factor (RF) level, anti-cyclic citrullinated peptide (anti-CCP) level, erythrocyte sedimentation rate (ESR) were recorded. 260 participants completed both screening and baseline visits as part of the RESIST longitudinal study, MoCA scores from baseline were analysed for these participants. Statistical analysis was used to provide descriptive statistics and explore possible predictors of cognitive impairment.Results:A total of 636 participants (mean age 68.1 yrs, female 67.5%) were screened between May 2018 and December 2019. The mean MoCA for screened participants was 25.4; 45.3% scored &lt;26 in the MoCA and were considered to have mild cognitive impairment. Age was negatively correlated with MoCA score and was the only significant predictor of cognitive impairment. For each year of increase in age the MoCA score reduced by a mean of 0.08 points (p&lt;0.05). There was little evidence of a difference in mean MoCA score by gender, RA medication, duration of disease, DAS28 score, ESR, anti-CCP or RF levels. The mean MoCA scores increased by 0.4 points between screening and baseline (P&lt;0.001).Conclusion:A large proportion of participants scored below the proposed cut-off for normal cognition in the MoCA suggesting a high prevalence of MCI in adults &gt;55 years with moderately active RA. This provides further support for the role of chronic inflammation in cognitive dysfunction and AD. Screening for MCI in rheumatology clinics might be clinically useful.DemographicsOutcomeAge mean years (+/-SD) (n=633)68.1 (8.01)Gender (n=636)Female n (%)429 (67.5)RA Medication (n=636)csDMARD n (%)TNFi n (%)368 (57.9)268 (42.1)Duration of RA mean years (+/-SD) (n=484)14.4 (13.9)DAS28 mean (+/-SD) (n=306)3.5 (2.04)ESR mean (+/-SD) (n=501)23.4 (22.0)Anti-CCP (n=387)Positive n (%)236 (61)Rheumatoid Factor (n=377)Positive n (%)277 (73.5)MoCA Score points (n=636)≥26, n (%)&lt;26 n (%)348 (54.7)288 (45.3)Subjective memory concerns (n=430)Yes n (%)No n (%)95 (22.1)335 (77.9)Disclosure of Interests:Christopher Edwards Grant/research support from: Abbvie, Biogen, Roche, Consultant of: Abbvie, Samsung, Speakers bureau: Abbvie, BMS, Biogen, Celgene, Fresenius, Gilead, Janssen, Lilly, Mundipharma, Pfizer, MSD, Novartis, Roche, Samsung, Sanofi, UCB, Bethany McDowell: None declared, Chris Holroyd: None declared, Chris Cardwell: None declared, Michelle McHenry Speakers bureau: Novartis, Pfizer, AbbVie, Celgene, Lilly, Gary Meenagh: None declared, Clive Holmes: None declared, Bernadette McGuiness: None declared

Montreal Cognitive Assessment (MoCA) Performance and Domain-Specific Index Scores in Amnestic Versus Aphasic Dementia.

The Montreal Cognitive Assessment (MoCA) is a popular and simple-to-administer screening instrument to detect cognitive impairment. The MoCA generates a total score and six domain-specific index scores: (1) Memory, (2) Executive Functioning, (3) Attention, (4) Language, (5) Visuospatial, and (6) Orientation. It is unclear whether these MoCA scores can differentiate between distinct clinical dementia syndromes. This study compared MoCA Index scores between amnestic dementia of the Alzheimer's type (DAT) and primary progressive aphasia (PPA), a language-based dementia. Baseline MoCA data were analyzed from 33 DAT, 37 PPA, and 83 cognitively normal individuals enrolled in the Clinical Core of the Northwestern Alzheimer's Disease Center. A one-way analysis of covariance adjusted for age was used to compare MoCA scores among groups. A logistic regression model was implemented to observe individual likelihood of group affiliation based on MoCA Index scores. The mean MoCA total score was significantly higher in controls compared to both patient groups (p < .001) but did not differ between DAT and PPA groups. However, in accordance with salient clinical features commonly observed in DAT versus PPA, Memory and Orientation Index scores were lowest in the DAT group (p < .001), whereas Language and Attention Index scores were lowest in the PPA group (p < .001). Multivariate logistic regression analysis showed that the individual effects of Memory (p = .001), Language (p = .002), and Orientation (p = .025) Indices were significant. MoCA Index scores can help differentiate among distinct cognitive syndromes, suggesting it may be a useful brief screening tool to detect domain-specific cognitive impairment.

Editors' note: Dietary patterns during adulthood and cognitive performance in midlife: The CARDIA study

In “Dietary patterns during adulthood and cognitive performance in midlife,” McEvoy et al. assessed the relationship between dietary patterns and cognitive function over a 30-year period and found that greater adherence to the Mediterranean diet (MedDiet) and A Priori Diet Quality Score (APDQS) in early adulthood was associated with better midlife cognitive performance. Muñoz-Garcia et al. complimented the authors on their use of multiple dietary questionnaires, long-term follow-up, and serial cognitive evaluations and recommended ongoing follow-up to assess cognitive function beyond middle age. However, they question the use of a cutoff of 20 on the Montreal Cognitive Assessment (MoCA), given that the literature describes a cutoff of 24/25/26. McEvoy responded that 21 was selected as the MoCA cutoff because it is one standard deviation below the sample mean MoCA of 24. The author further notes that 45% of the study cohort was black and that previous studies found the mean MoCA in black middle-aged adults in the United States to be between 19.8 and 22. In an editor's comment on behalf of the Equity, Diversity, and Inclusion Committee, Hamilton emphasizes that performance on tests such as the MoCA may relate to a number of social factors, such as quality of education, rather than to a biological difference among persons of different racial or ethnic backgrounds. In “Dietary patterns during adulthood and cognitive performance in midlife,” McEvoy et al. assessed the relationship between dietary patterns and cognitive function over a 30-year period and found that greater adherence to the Mediterranean diet (MedDiet) and A Priori Diet Quality Score (APDQS) in early adulthood was associated with better midlife cognitive performance. Muñoz-Garcia et al. complimented the authors on their use of multiple dietary questionnaires, long-term follow-up, and serial cognitive evaluations and recommended ongoing follow-up to assess cognitive function beyond middle age. However, they question the use of a cutoff of 20 on the Montreal Cognitive Assessment (MoCA), given that the literature describes a cutoff of 24/25/26. McEvoy responded that 21 was selected as the MoCA cutoff because it is one standard deviation below the sample mean MoCA of 24. The author further notes that 45% of the study cohort was black and that previous studies found the mean MoCA in black middle-aged adults in the United States to be between 19.8 and 22. In an editor's comment on behalf of the Equity, Diversity, and Inclusion Committee, Hamilton emphasizes that performance on tests such as the MoCA may relate to a number of social factors, such as quality of education, rather than to a biological difference among persons of different racial or ethnic backgrounds.

The validity of the Montreal cognitive assessment (MoCA) for the screening of vascular cognitive impairment after ischemic stroke.

Vascular cognitive impairment (VCI) is a common feature of vascular brain lesions. The heterogeneity of clinical presentation after a stroke makes it challenging to find. However, the Montreal Cognitive Assessment Scale (MoCA) may be suitable for such purpose. Aim of the present study was to validate the Slovenian version of MoCA for detecting cognitive impairment after ischemic stroke. Seventy patients up to three months after ischemic stroke and 69 age-matched healthy control were included. All performed the MoCA and Hachinski Ischemic Scale (HIS). Cut-off value, sensitivity, specificity and likelihood ratio of MoCA were calculated with the receiver operating characteristic curve. Mean age of healthy controls was 67.1 (SD 9.2)years, mean MoCA was 25.8 (SD 2.6) points, and mean HIS was [1.9 (SD 1.5). There were no age differences between healthy controls and patients [70.4 (SD 10.9)years]. However, patients performed significantly worse on MoCA [mean 18.7 (SD 6.3) points) and had higher HIS score (7.6 (SD 0.3) points]. Optimal cut-off values for MoCA were 24/25 points. The area under the curve was 0.86, sensitivity was 81%, and specificity was 70%. A negative correlation was found between MoCA and education and age. Our results demonstrate that an optimal cut-off for screening for VCI in the Slovenian population is 24/25 points on MoCA, which is similar to other studies performed on patients with different cultural background. The test is easy to perform and could be used in daily clinical practice.

Effect of mirabegron on cognitive function in elderly patients with overactive bladder: MoCA results from a phase 4 randomized, placebo-controlled study (PILLAR)

BackgroundAntimuscarinics are often used for treatment of overactive bladder (OAB), but exposure to medications such as antimuscarinics that have anticholinergic properties has been linked to adverse cognitive effects. A phase 4 placebo-controlled study (PILLAR; NCT02216214) described the efficacy and safety of mirabegron, a β3-adrenoreceptor agonist, for treatment of wet OAB in patients aged ≥65 years. This pre-planned analysis aimed to measure differences in cognitive function between mirabegron and placebo, using a rapid screening instrument for mild cognitive impairment: the Montreal Cognitive Assessment (MoCA).MethodsOutpatients aged ≥65 years with wet OAB were randomized 1:1 to mirabegron or placebo, stratified by age (<75/≥75 years). There were no exclusion criteria regarding cognitive status. Patients randomized to mirabegron initially received 25 mg/day with an optional increase to 50 mg/day after week 4/8 based on patient/investigator discretion. The MoCA was administered at baseline and end of treatment (EoT, week 12). The study protocol was Independent Ethics Committee/Institutional Review Board-approved.ResultsOf the 887 randomized patients who received ≥1 dose of study drug, 72.3% were female, 79.5% were white, and 28.1% were aged ≥75 years. All patients had ≥1 comorbidity and 94.3% were receiving ≥1 concomitant medication. One third of patients had a history of psychiatric disorders, the most common being depression (17.2%), insomnia (15.7%), and anxiety (11.4%). Baseline mean (standard error, SE) MoCA total scores were 26.9 (0.1) and 26.8 (0.1) in the mirabegron and placebo groups, respectively. Among patients with MoCA data available at baseline/EoT, 27.1% (115/425) and 25.8% (106/411) of mirabegron and placebo group patients, respectively, had impaired cognitive function at baseline (MoCA total score <26). There was no statistically significant change in adjusted mean (SE) MoCA total score from baseline to EoT in the mirabegron group (−0.2 [0.1]) or the placebo group (−0.1 [0.1]).ConclusionsTreatment with mirabegron for 12 weeks did not contribute to drug-related cognitive side effects in patients aged ≥65 years, as measured by the MoCA. Furthermore, the pattern of change in cognition over time in an older OAB trial population does not appear to differ from that of subjects receiving placebo.Trial registrationNCT02216214 (prospectively registered August 13, 2014).

EVALUATING THE COGNITIVE EFFECTS OF EXERCISE PRIMING AND TRANSCRANIAL DIRECT CURRENT STIMULATION IN MILD COGNITIVE IMPAIRMENT AND MILD ALZHEIMER'S DISEASE: THE EXPRESS STUDY

Introduction Current pharmacotherapies for Alzheimer's disease (AD) are only modestly effective. There remains a critical need for treatments focused on early stages of the disease, when quality of life is still potentially excellent. While transcranial direct current stimulation (tDCS) has been shown to improve memory in some people with Mild Cognitive Impairment (MCI) and mild AD with minimal side-effects, recent evidence suggests that tDCS works better when brain circuits are active. As exercise increases brain activity using mechanisms that may support tDCS response, it may be an effective primer given before tDCS. This study assesses whether exercise priming with tDCS can help improve memory in MCI and mild AD, and whether this combination improves memory better than exercise or tDCS alone. Methods In this 5-week, randomized, blinded, sham-controlled clinical trial, eligible patients receive either 1) combined exercise and tDCS, 2) exercise and sham tDCS, or 3) exercise education only and tDCS. Repeated measures analyses of covariance will be conducted to evaluate between-group differences on cognitive outcomes over time. Results Blinded preliminary findings are presented (N=10, mean age=74±6?years, 50% female, mean years of education=16.2±2.5?years, mean Montreal Cognitive Assessment (MoCA) score= 21.5±2.9). There was a significant effect of treatment over time on Word Recall scores (F(2,7)=5.5, p=0.036). There were no statistically significant differences between groups over times on MoCA (F(2,7)=3.6, p=0.085) or Word Recognition scores (F(2,7)=4.5, p=0.054). Participants randomized to exercise education only with tDCS did not increase their exercise frequency or intensity according to the Leisure Time Exercise Questionnaire. Participants randomized to exercise priming were able to exercise at a moderate-intensity level for the last two weeks of the study when receiving combined tDCS or sham tDCS treatment. Overall adherence to study interventions was 98%. Conclusions Recruitment is ongoing (N=10/30). Updated results will be presented. This study may identify a new, feasible, non-invasive combination therapy that improves cognitive function in MCI and early stages of AD, therefore having major health implications. This research was funded by: Canadian Institutes of Health Research

THE SOUND OF MUSIC: SHORT-TERM EFFECTS OF LIVE MUSIC PERFORMANCE ON THE COGNITIVE AND EMOTIONAL STATUSES OF RESIDENTIAL PATIENTS WITH MAJOR NEUROCOGNITIVE DISORDER

Introduction Patients with neurocognitive disorders (NCD) commonly experience a range of psychiatric symptoms such as depression, anxiety, psychosis, and agitation. 1 These comorbidities complicate the course of treatment for these patients as well as exacerbate caregiver burden. Since pharmacologic interventions are known to pose significant risks to these patients, there is great urgency to find additional non-pharmacologic options to improve quality of care. 1 Music therapy is becoming a more frequently used tool in different treatment settings and has been shown to improve anxiety and depression, however intensive and structured music therapy can also be a cost burden for residential facilities. 2 , 3 This study's aim was to assess the short-term benefits of a live music performance for residential patients with mild and moderate major NCD. Methods This is a prospective, non-blinded, longitudinal comparison study. Inclusion criteria were age 65-100, English speaking, and had either a diagnosis of major NCD, cognitive disorder, or dementia of the mild to moderate stage that required institutionalization at a residential facility. Exclusion criteria were severe presbycusis, and diagnosis of dementia or NCD of the severe stage. Participating residential facilities with connections to the Symphony of Soul Foundation and St. David's Foundation were asked to publicize this study to residents and their legally authorized representatives (LAR). The participants would then provide informed assent and consent, respectively, to enroll. The study intervention was a 30 minute live-performance of a set list of popular music from the 1930s-1950s (English language), given by a standard performer. The main statistical analysis will be a multivariate repeated measures comparison of scores that assess cognition, depression, and quality of life using the Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), and the Cornell-Brown Scale for Quality of Life (CBSQoL). The scales were administered 1 week before the study intervention to participating subjects for baseline scores, and then re-administered 1 week after the intervention. Different versions of the MoCA (v.1 and v.2) were used for the pre- and post-intervention assessments. Results A total of 8 subjects (n=8) and their respective LARs provided assent and consent to participate in the study. There was 1 complete dropout before the study began. The mean MoCA score pre-intervention, MoCApre = 7.3, with a 95% CI = [2.36, 12.25]; the mean MoCA score post-intervention, MoCApost = 9.4, with a 95% CI = [3.41, 15.39]; the difference between the two mean MoCA scores was not statistically significant, since the 95% CI for this difference was [-5.65, 9.85]. Subjects did not have scores that indicated clinical depression throughout the study, with a mean GDSpre = 1.5, and a mean GDSpost = 2.2. The mean CBSQoLpre = -3.67, with a 95% CI = [-10.91, 3.57]; the mean CBSQoLpost = 17, with a 95% CI = [10.86, 23.14]; the CBSQoL scores between the two groups had statistically significant difference as evident in non-overlapping CIs; the 95% CI for the difference between the two mean CBSQoL scores was [11.19, 30.15]. Conclusions This study's initial results suggested that there was a statistically significant improvement in the subjects’ quality of life after a brief, live-musical performance. However there were no significant differences in the subjects’ cognition and mood. The labor intensity that was required for the subjects to complete the pre- and post- intervention assessments was a notable barrier for them to participate effectively as evident by the dropout rate, and was also a deterrent for additional eligible subjects to enroll in the study. Decreasing the difficulty for subjects to participate in the future (e.g., through optimizing the testing environment, shortening the music performance) might therefore increase the sample size and improve the study's power and validity This research was funded by: Symphony of Soul Foundation, St. David's Foundation

The Montreal Cognitive Test Intervention: The Relationship Between Cognitive-Impaired Patients and Readmissions.

The purpose of this study is to determine whether there is a relationship between cognitive impairment among Medicare patients and hospital readmissions. Although there has been research on cognitive impairment and readmissions, seldom action has been done in regard to economic costs with hospitals. The Affordable Care Act (ACA) established the Hospital Readmission Reduction Program in 2012. Hospitals may not be fully reimbursed for Medicare patient readmissions within 30 days (). An ethnographic approach was utilized with purposive sampling.This was a nonrandomized purposive sampling intervention study using data from Epic health systems database. The intervention spanned over 5 months and the MoCA (Montreal Cognitive Assessment) intervention was conducted in the hospital in a 3-phase study. The purpose of the study was for quality improvement and to detect cognitive impairment among Medicare readmitted patients. The result shows cognitive impairment is prevalent among the Medicare population. Seventy-one (61%) had evidence of cognitive impairment (i.e., obtained a score below 25). The mean MoCA score for the 71 patients identified as having evidence of cognitive impairment was 17.84 (SD, ±5.06; range, 5-24). MoCA is useful in the acute care setting for identifying patients who are at increased risk for readmission. A randomly assigned controlled clinical trial test is warranted to further validate the association between cognitive impairment and readmissions. The ACA aims to improve case management by improving effective outcomes for individuals, care coordination among hospital professionals, economic efficiency, cost-effectiveness, and the collaborative process that services the patient. Hospitals across the country are implementing polices that adhere to patient-centered care. Before the ACA was passed, health care services were value metric. The ACA regulates hospitals toward holistic care or quality metrics. Case management will be critical, as hospitals look toward innovative methods to evaluate their patients.

Recombinant Human Growth Hormone Ameliorates Cognitive Impairment in Stroke Patients.

We aimed to determine the effects of recombinant human growth hormone (rhGH) replacement on cognitive function in subjects with poststroke cognitive impairment using resting-state functional magnetic resonance imaging. We included 60 patients with a first-ever stroke for 3 months and a diagnosis of cognitive impairment who were randomized 1:1 to receive either rhGH subcutaneously or placebo injection for 6 months. All subjects were required to receive the same rehabilitative therapy program. Both groups were subjected to pretreatment and posttreatment neuropsychological assessment using the Montreal Cognitive Assessment, serum neurotrophic factors, biomarkers of glucose and lipid metabolism, and functional magnetic resonance imaging during 6 months of the study period. The pattern of brain activity was determined by examining the functional connectivity and amplitude of low-frequency fluctuations (ALFF) of blood oxygen level dependent signal. Forty-three (82.7%) completed the study. Treatment with rhGH reduced levels of triglycerides and low-density lipoprotein cholesterol but did not significantly altered plasma concentrations of glucose and glycated hemoglobin. We found a significant increase in serum insulin-like growth factor 1 levels (32.6%; P < 0.001) in the rhGH-treated group compared with that in the controls. After 6 months of rhGH treatment, mean Montreal Cognitive Assessment score improved from 16.31 (5.32) to 21.19 (6.54) (P < 0.001). The rhGH group showed significant increased area of activation with increased ALFF values in the regions of the frontal lobe, putamen, temporal lobe, and thalamus (P < 0.05), relative to the baseline conditions. The correlation analysis revealed that the ALFF and functional connectivity of default mode network was positively correlated with the ΔMoCA score and ΔIGF-1 levels; that is, the more the scale score increased, the higher the functional connection strength. No undesirable adverse effects were observed. The rhGH replacement has a significant impact on global and domain cognitive functions in poststroke cognitive impairment.

Abstract 68: Impaired Perfusion in Intracranial Atherosclerotic Disease Predicts Cognitive Outcomes

Background: Poor collateral circulation and hypoperfusion may lead to recurrent stroke in intracranial atherosclerotic disease (ICAD). The role of perfusion in silent strokes and potentially insidious cognitive impairment in ICAD is unknown. We used evidence of impaired perfusion at angiography in SAMMPRIS to predict subsequent cognitive changes. Methods: Angiography at enrollment in the SAMMPRIS trial was independently evaluated, blind to clinical data and cognitive testing. Antegrade flow in the symptomatic arterial territory and corresponding collateral flow were scored. Impaired perfusion was defined by poor antegrade and poor collateral flow. Serial testing with the Montreal Cognitive Assessment (MoCA) was done in subjects without aphasia or neglect at baseline, 4 mo, 12 mo and closeout, or until subjects had a clinical stroke endpoint. Results: 207 subjects (median age 61, range 33-81 years; 37% women) had baseline MoCA scores with angiography data on territorial perfusion. Baseline MoCA scores (mean 24.2±4.1) were similar between categories of antegrade flow and collateral circulation. Impaired perfusion was noted in 33/207 (16%). Serial MoCA revealed that changes in cognition over time were different at 4 mo, 12 mo and closeout based on the presence of impaired perfusion at baseline (p&lt;0.001). After more modest (mean MoCA change = 0.5 increase from baseline, p=0.80) early improved cognitive function at 4 mo, those with impaired perfusion had cognitive decline at 12 mo (mean MoCA change, p&lt;0.01) unlike the continued improvement in other subjects. Cognitive changes in those with impaired perfusion were associated with a higher frequency of subsequent stroke in the territory. Conclusions: Impaired perfusion in the symptomatic arterial territory of ICAD predicts cognitive outcomes that may precede recurrent ischemia. Future studies may define the role of noninvasive perfusion imaging in ICAD to predict cognitive trajectories and recurrent stroke.

Neurocognitive function and quality of life after proton beam therapy for brain tumour patients

BackgroundNeurocognitive function of adult patients with brain tumours may deteriorate after radiotherapy. Proton beam therapy (PBT) reduces the volume of irradiated healthy brain tissue and could potentially preserve neurocognition and quality of life (QoL). As present data are still limited, the impact of clinical factors and dosimetric parameters on neurocognitive function and QoL during recurrence-free follow-up after PBT is investigated. MethodsThe current study includes 62 brain tumour patients treated with PBT between 2015 and 2017. Neurocognition and QoL were assessed at baseline and every 3 months after PBT using the Montreal Cognitive Assessment (MoCA) test together with EORTC-QLQ-C30 and BN20 questionnaires, respectively. Objective and self-reported measures of neurocognitive functions were correlated. During two years of follow-up, the impact of clinical co-factors as well as dosimetric parameters of several brain structures were analysed using a mixed-model approach. ResultsAt baseline, mean MoCA total score was 24.8/30 and self-reported cognitive function was 68.9/100. Both remained stable over time. Patients with impaired neurocognition on the MoCA test reported significantly lower global health status, cognitive, physical and role function as well as more fatigue, pain, headache and communication deficits compared to normal performing patients. For most follow-up time points, the majority of MoCA subitems correlated significantly to QoL items regarding neurocognition. Slight deterioration of the MoCA score was associated with tumours located in the left hemisphere and with an increase in relative volume of the anterior cerebellum that received doses of 30–40 Gy(RBE). ConclusionSelf-reported and objectively measured neurocognition and most other QoL domains remained largely stable over time during recurrence-free follow-up for brain tumour patients treated with PBT.The association between reduced cognitive function and irradiated volume of the anterior cerebellum requires validation in larger studies and comparison to patients treated with photon therapy.

Normative Data for the Montreal Cognitive Assessment in a Lebanese Older Adult Population

IntroductionThe Montreal Cognitive Assessment (MoCA), a neuropsychological tool for cognitive decline screening is widely used. In the absence of normative data in Lebanon, this study offers normative data for the MoCA in Lebanese community-dwelling older people and compare scores to those of other countries. Methods: 164 literate subjects aged 60 and above were recruited to complete the MoCA. Results: The mean MoCA score observed (24.20 points) was lower than that for normal controls (27.4 points) in the original validation study of the MoCA. Regression analysis showed that fewer years of education were associated with lower MoCA scores (p < .000). Conclusions: This study presents normative data and the findings suggest that cultural differences are evident in cognitive testing.

Sleep disturbance and cognitive dysfunction in patients with persistent postural and perceptual dizziness

To study sleep quality and cognitive status and their correlation in patients with persistent postural and perceptual dizziness (PPPD). We assessed sleep quality and cognitive function among 70 patients with PPPD and 70 age-matched heathy volunteers using Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Pittsburgh Sleep Quality Index and polysomnography (PSG). The patients had a mean MMSE score of 25.10±3.87 and a mean MoCA score of 23.10±6.11, both suggesting mild cognitive impairment of the patients. The mean PSQI score of the patients was 14.60 ± 2.06, suggesting moderate insomnia among the patients. The MMSE scores in 3 dimensions (attention, memory and recall ability) and the dimension scores of MoCA for visual space and executive ability, attention and delayed recall all showed significant positive correlations with PSQI scores for sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disorders and daytime dysfunction. Moderate sleep disorder and mild cognitive dysfunction are common in PPPD patients. Sleep quality is correlated with cognitive function among these patients, suggesting that improving sleep quality of the patients helps to improve their cognitive function.

Cognitive Impairment in Patients with Ankylosing Spondylitis.

Little is known about the potential systemic effects of ankylosing spondylitis (AS) on the nervous system. We designed a study aiming to assess the frequency and clinical predictors of cognitive impairment in AS patients. We carried out a cross-sectional case-control study composed of consecutive patients with AS. Trained and blinded interviewers registered clinical-epidemiological data and applied a standardized neurological assessment for each subject of the study. At baseline, functional limitations were characterized using the Health Assessment Questionnaire. Cognitive impairment was evaluated with the Brief Cognitive Screening Battery, the Montreal Cognitive Assessment, and the Clinical Dementia Rating, while neuropsychiatric symptoms were investigated with the Hospital Anxiety and Depression Scale. Healthy controls were matched for age, educational attainment, sex, and comorbidities. We compared the neurological outcomes between case and controls, and we determined the clinical predictors of cognitive decline. We included 40 patients (mean: 49.3 years) with AS and 40 healthy controls (mean: 48.8 years) in our study. In Brief Cognitive Screening Battery, patients with AS presented a statistically significant poor performance in the clock drawing test and in the verbal fluency. The mean Montreal Cognitive Assessment (MoCA) scores were significantly lower in AS subjects compared to the control group. Also, the prevalence of subjects classified as cognitively impaired according to MoCA was significantly higher in the AS group (90.0% vs. 57.5%, p = 0.02). Moreover, neuropsychiatric symptoms were more prevalent in AS patients. Worse functional limitations were associated with poor cognitive performance as well. Patients with AS might be more vulnerable to cognitive decline.

Validation of Brain Health Test-7 for Detecting Patients with Mild Cognitive Impairment and Early Dementia

Objectives: We intended to develop a simple dementia screening tool to help primary care physicians identify patients with mild cognitive impairment (MCI) and early dementia. Methods: The brain health test-7 (BHT-7) was developed based on the original BHT study. Study patients aged 50 years and above with normal cognition, MCI, and dementia were recruited. All patients received evaluation with the BHT-7, mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), and clinical dementia rating (CDR) for cognitive function. The performance of BHT-7 in identifying cognitive impairment was compared with that of MMSE and MoCA. Results: We enrolled 376 study participants. The mean BHT-7, MMSE, and MoCA scores showed significant differences among the three groups. Compared to MMSE and MoCA, the BHT-7 (sensitivity = 86%, specificity = 76%, area under curve = 88%) showed better sensitivity in differentiating MCI from the normal group, with a cutoff value of 17/18. The scores of the three tests were all affected by educational level. Conclusion: The BHT-7 is a simple and easy-to-use cognitive screening tool that may be useful in primary care settings to identify patients with MCI or early dementia.

Cognitive Dysfunction in Patients with Chronic Kidney Disease.

Cognitive impairment is a common entity in patients with chronic kidney disease (CKD), which plays an important role in increasing the morbidity in these patients. This study was performed to evaluate cognitive dysfunction and its severity in different stages of CKD and identify the correlation with factors affecting this dysfunction. A cross-sectional design study was conducted on 100 patients with CKD Stage III to V-D fulfilling the eligibility criteria. Cognitive status was assessed using the mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) tests. The patients were divided into four groups according to their estimated glomerular filtration rate (eGFR); Group A with eGFR ranging between 30 and 59 mL/min/1.73 m2, Group B with eGFR between 15 and 29 mL/min/1.73 m2, Group C with eGFR <15 mL/min/1.73 m2 not on hemodialysis (HD), and Group D with eGFR <15 mL/min/1.73 m2 and on HD for the past six months. Factors affecting MMSE and MoCA scores were assessed using univariate and multivariate linear regression analysis. Mean MMSE score was 28.72 ± 1.37 in Group A, 26.00 ± 3.67 in Group B, 20.76 ± 4.84 in Group C, and 17.28 ± 3.32 in Group D, which showed a statistically significant difference. The mean MoCA score also showed a statistically significant decline from Group A to Group D with values being 26.36 ± 1.91, 24.56 ± 1.94, 22.08 ± 2.12 and 20.12 ± 1.81, respectively (P < 0.05). The MMSE and MoCA scores were found to have a statistically significant positive correlation with hemoglobin; serum corrected calcium and eGFR (P < 0.01) and statistically significant negative correlation with blood urea, serum creatinine, serum uric acid, serum phosphate, serum potassium and stage of CKD (P < 0.01). By raising the clinician's awareness about cognitive dysfunction in CKD patients and its potential effects on medication, fluid and, dietary compliance improved quality of care is expected. Early intervention will improve the patient's quality of life.