MoCA Score Research Articles

Evaluating the Clinical Impact of a Polyphenol-Rich Extract from Salicornia ramosissima on Patients with Transient Ischemic Attack and Minor Stroke

Transient ischemic attack (TIA) is a well-established risk factor for future strokes, making interventions that target recovery and vascular risk crucial. This study aimed to assess the safety and clinical effects of a polyphenol-rich Salicornia ramosissima extract in post-TIA patients. A randomized, triple-blind, placebo-controlled trial was conducted with participants who had a history of TIA or minor stroke and who received 1 g of Salicornia extract or placebo over 11 months. Biochemical analyses, neuropsychological assessments (MOCA test), and gait and aerobic performance tests were conducted at the beginning and the end of the study. A total of 118 individuals were screened, with 80 finally included. Importantly, no significant adverse events were reported throughout the study. A neurological analysis showed an improvement in MOCA scores in patients treated with the Salicornia extract for 11 months. The treatment did not affect spatiotemporal gait parameters, but it significantly reduced blood pressure at baseline and after the aerobic performance test. Biochemically, both groups exhibited mild hyperhomocysteinemia at baseline; however, Salicornia treatment significantly lowered homocysteine levels, bringing them within the normal range. These findings highlight the safety of the Salicornia extract in patients at a high cerebrovascular risk and suggest it as a potential therapeutic option for managing vascular risk factors, such as hyperhomocysteinemia and hypertension. However, further studies are required to confirm the underlying mechanisms and explore broader clinical applications.

Assessment of cognitive disorders in elderly type 2 diabetic patients with obesity

ABSTRACT Background Cognitive impairment is common in the elderly and can result from many chronic illnesses. The risk of CI is around one-third for older persons with diabetes. Diabetes increases the incidence of numerous common geriatric syndromes in older persons, including polypharmacy, CI, depression, urine incontinence, injurious falls, and chronic pain. Additionally, obesity raises the risk of high blood pressure, and DM and promotes arterial aging, which are known to be independent risk factors for CI. Objective The current study evaluated cognitive disorders in elderly type 2 diabetic patients with obesity. Material and Methods A sample of 120 elderly persons was divided into 3 groups: Group (1): 40 elderly non-obese non-diabetics (Control), Group (2): 40 elderly obese non-diabetic patients, and Group (3): 40 elderly obese type 2 diabetic patients. Fasting plasma glucose (FPG), 2 hPPPG (2 hour post prandial plasma glucose), glycosylated hemoglobin (HA1C) were measured. Obesity was assessed using height, weight, body mass index (BMI), and waist circumference (WC). Cognitive impairment in the elderly was detected using a questionnaire called the Montreal Cognitive Assessment (MoCA). Results There was statistical significance between the three investigated groups concerning HbA1c, FPG, and 2-hour PPG. Also, there was statistical significance between the three study groups in terms of total MOCA score. Weight, BMI, and WC showed statistical significance between the three study groups. Conclusion: Cognitive impairment is related to obesity and type 2 diabetes in elderly.

Altered spontaneous brain activity in patients with progressive-stage and end-stage chronic kidney disease: insights from dALFF analysis.

Chronic kidney disease (CKD) is a worldwide public health problem. Its association with cognitive impairment has attracted widespread attention in the world. However, the neuropathological mechanisms underlying kidney-brain interactions in CKD remain unclear. Using the dynamic amplitude of low-frequency fluctuations (dALFF) technique, 21 patients with progressive-stage CKD (CKD stages 3-4), 22 patients with end-stage CKD (CKD stage 5, ESKD), and 23 healthy volunteers (HCs) were enrolled to explore the brain regions with dALFF abnormalities in the progressive-stage and end-stage CKD. We used biased correlation analyses to explore the relationship between dALFF values and clinical indicators in patients with progressive-stage and end-stage CKD. Patients with both progressive-stage CKD (stages 3-4) and ESKD had abnormal dALFF values in the right parahippocampus, right inferior temporal gyrus, and left cuneus compared with HCs. In addition, abnormal dALFF were present in the left fusiform gyrus, insula and hippocampus in patients with progressive-stage CKD and in the left inferior temporal gyrus in patients with ESKD. Biased correlation analysis showed that dALFF values in the right parahippocampus, left fusiform gyrus and left insula were positively correlated with serum creatinine concentrations in patients with progressive-stage CKD and that dALFF values in the left inferior temporal gyrus were negatively correlated with MoCA scores in patients with ESKD. Our findings highlight the variability of neuroimaging changes between different stages of CKD and provide new insights and research directions for an in-depth exploration of the neuropathological mechanisms of renal-brain interactions.

Abnormal neurovascular coupling exists in patients with peritoneal dialysis and hemodialysis: evidence from a multi-mode MRI study

Abstract Background Neurovascular coupling (NVC), as indicated by a comprehensive analysis of the amplitude of low-frequency fluctuation (ALFF) and cerebral blood flow (CBF), provides mechanistic insights into neurological disorders. Patients undergoing peritoneal dialysis (PD) and hemodialysis (HD) often face cognitive impairment, the causes of which are not fully understood. Methods ALFF was derived from functional MRI, and CBF was quantified using arterial spin labeling in a cohort comprising 58 patients with PD, 60 patients with HD, and 62 healthy control. Voxel-based global analysis for both ALFF and CBF, alongside region-based analyses of ALFF-CBF coupling coefficients, were conducted. Additionally, the study explored the correlation between clinical laboratory indices and imaging metrics. Results Compared to HC, NVC was reduced in the bilateral medial superior frontal gyrus (SFGmed), insula, Posterior Cingulate Cortex (PCC), and Caudate (CAU) among dialysis patients. Furthermore, the PD group exhibited lower NVC in the bilateral SFGmed, bilateral PCC, and left CAU compared to the HD group. Within the PD group, sodium level was negatively correlated with the ALFF-CBF coupling coefficient in the right insula. Additionally, a positive correlation emerged between the ALFF-CBF coupling coefficient in bilateral SFGmed and the dialysis adequacy. Conclusion While MoCA scores did not significantly differ between patients with PD and HD, PD group demonstrated poorer NVC in the bilateral SFGmed, bilateral PCC and left CAU. Sodium level and dialysis adequacy may affect NVC in patients with PD.

Age-Related Differences in the Association between Life's Essential 8 and Cognition in Cognitively Normal Adults: The CABLE Study.

This study investigated the relationship between Life's Essential 8 (LE8), a recently updated lifestyle-related health factor, and cognition across multiple life stages. We enrolled 1098 cognitively normal participants from the Chinese Alzheimer's Biomarker and Lifestyle (CABLE) study. We investigated the interactions between age and LE8 on cognition. Multiple linear regression models were utilized to explore the relationship between the LE8 total scores and its two subscales scores with cognition in the total sample, as well as in the mid-age (≤65 years) and the late-age (>65 years) subgroups. In addition, mediation analyses were performed to explore the biologically plausible pathways between LE8 and cognition. There was a significant interaction effect between age and LE8 total scores on MOCA score (P = 0.030). The mid-age subgroup showed a positive correlation between LE8 total scores and CM-MMSE (β = 0.110, P = 0.005) and MOCA (β = 0.112, P = 0.005) scores. However, no significant associations were found in the late-age subgroup. In the mid-age subgroup, CSF p-tau partially mediated the relationship between LE8 total scores and its two subscales and cognition, with a mediation proportion ranging from 6% to 12%. Our findings revealed that the association of the LE8 total scores with MOCA and CM-MMSE scores were significant in mid-age adults rather than late-age adults, indicating that the association might be age-specific and emphasizing the importance of lifestyle interventions in mid-life.

Effect of systemic ozone therapy added to pharmacological treatment on brain-derived neurotrophic factor (BDNF) and cognitive status in post-COVID patients

BACKGROUND: Treatment is required for post-COVID cognitive impairment associated with functional limitations, reduced work capacity, and significant deterioration in quality of life. Pharmacological treatment is ineffective. In this context, physical therapy, especially systemic ozone therapy with potential neuroprotective effects, appears promising. AIM: The aim of the study was to evaluate the effect of systemic ozone therapy added to pharmacological treatment on plasma brain-derived neurotrophic factor (BDNF) levels and cognitive status in patients with post-COVID cognitive impairment. MATERIALS AND METHODS: A total of 140 patients aged 18-45 years with post-COVID asthenic syndrome were evaluated and treated. They were randomized into two groups: an experimental group with 70 subjects who received systemic ozone therapy in addition to pharmacological treatment and the comparator group with 70 subjects who received pharmacological treatment only. Pre- and post-treatment outcomes were assessed using plasma BDNF levels and the Montreal Cognitive Assessment (MoCa) score. RESULTS: Statistically significant differences in BDNF levels (р=0.034) and MoCa scores (р=0.002) were found between the compared groups at the end of therapy (day 30). In our study, adding systemic ozone therapy to pharmacological treatment in patients with post-COVID cognitive impairment normalized BDNF levels and completely improved clinical manifestations of cognitive impairment in 95% of subjects. CONCLUSION: Therefore, systemic ozone therapy can be considered as one of the effective and pathogenetically proven strategies for comprehensive treatment of patients with post-COVID cognitive impairment in the outpatient setting.

Abstract 4147647: Effects on Cognition, Sleep, Quality of life and Exercise Capacity of a 12-week Tele-yoga Intervention in Persons with Heart Failure - Results from 3 and 6 Months Follow-up

Background and Objectives: Yoga may be a promising form of mind-body rehabilitation for patients with long term illness. Digitally delivered yoga increases access to participation but has not previously been evaluated in the heart failure population. The aim of this study was to examine the effects of tele-yoga on cognition, sleep, health-related quality of life and exercise capacity in persons with heart failure. Methods: The Tele-yoga study (ClinicalTrials.gov, ID: NCT 03703609) was a parallel two-arm randomised controlled trial (RCT) with 1:1 distribution to an intervention and control group. Study participants were randomised to tele-yoga including live-streamed group-yoga for 60 minutes twice weekly during 12 weeks and yoga individually for 10 minutes/day using an app, or to a control group receiving individual exercise advice. Cognition (Montreal Cognitive Assessment: MoCA), sleep (minimal insomnia symptom scale; MISS), health-related quality of life (EQ-5D VAS) and sub-maximal exercise capacity (6 minute walk test; 6MWT) were assessed at baseline, after 3 and 6 months. Linear mixed model with random intercept for patients as the random effect and group-time interaction along with age was taken as the fixed effects to analyse outcomes. Results: A total of 311 participants were included (tele-yoga n=156 and active controls n=155), mean age 66 years, 70% men. Adherence to the group yoga was very good. The linear mixed models showed a significant change in cognition, health-related quality of life and exercise capacity favouring the tele-yoga group. No significant differences between the groups were seen regarding sleep. When analysing the fixed effects of all outcomes, age, group assignment and time-points interaction had significant effects on EQ-5D VAS score, 6MWT distance and MoCA scores. For EQ-5D VAS the tele-yoga group performed significantly better than the control group at 3 months, but not at 6 months. For the 6MWT distance, the tele-yoga group performed better than the control group at 3 months, but not at 6 months. The tele-yoga group had significantly higher MoCA scores than the control group at both 3 and 6 months. Conclusion: This adequately powered RCT showed that digitally delivered mind-body training in the format of group and individual yoga during 12 weeks lead to an improvement in cognition, quality of life and exercise capacity at the end of the intervention. The effect was sustained for cognition also after 6 months.

Videos to study Interactions in AGEing (VIntAGE)

The Videos to study Interactions in AGEing (VIntAGE) corpus aims to investigate the complex relationship between language, cognition, and aging, focusing on verbal and non-verbal pragmatic markers in older persons with mild cognitive impairment (MCI). This multimodal and longitudinal corpus incorporates an analysis of gestural and verbal markers in discourse, aligned with neurolinguistic models. It provides a rich dataset for analyzing how aging impacts communicative competence in individuals with MCI. The VIntAGE corpus comprises approximately 18 hours of video recordings from 36 face-to-face interviews conducted by a close acquaintance of each of the nine women, all over 75 years old. Five participants were selected for in-depth analysis due to significant changes in their cognitive status. The participants underwent a series of semi-structured interviews over 15 months. The data were processed using transcription tools (for verbal discourse) and annotation tools (for gestures) and then subjected to Principal Component Analyses to manage each individual's diverse dataset and discursive modalities. The corpus includes the annotation of 6,351 verbal pragmatic markers (VPMs) and 8,044 non-verbal pragmatic markers (NVPMs). The data reveal an average decrease in MoCA scores from 23/30 to 20/30 over one year, highlighting cognitive decline's effects on verbal and non-verbal communication.

NCOG-27. HIGHER LEVELS OF SERUM ICAM-1 AND IL-10 ARE ASSOCIATED WITH COGNITIVE DYSFUNCTION IN BOTH IDH-WILDTYPE AND IDH-MUTANT GLIOMA

Abstract BACKGROUND Cognitive dysfunction is common among glioma patients, but the contribution of specific mechanisms to the development of cognitive symptoms is unclear. Circulating levels of proteins linked to neurodegeneration, inflammation, and vascular damage have been associated with cognitive symptoms in neurological diseases and aging, but their prognostic value in glioma is unknown. Here, we examined associations between cognitive symptoms and serum levels of protein biomarkers in glioma patients. METHODS Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA, scores ≤ 25 = cognitive dysfunction). Cytokines (interleukin-1β [IL-1β], IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, interferon-γ [IFN-γ], tumor necrosis factor-α [TNF-α]), and neurodegeneration (neurofilament light chain [NfL], tau, glial fibrillary acidic protein [GFAP]), and vascular damage markers (Serum amyloid A [SAA], C-reactive protein [CRP], vascular cell adhesion molecule 1 [VCAM-1], and intercellular adhesion molecule 1 [ICAM-1]) were measured using ultrasensitive assays (Meso Scale Discovery). RESULTS Patients (n=73) were predominantly male (58%), white (74%), with a median age of 44 (range=24,74). Cognitive dysfunction was found in 53% of the patients. Levels of NfL (p=0.035), IL-6 (p=0.006), IL-10 (p=0.007), TNF-α (p=0.035), IFN-γ (p=0.011), CRP (p=0.016), VCAM-1 (p=0.012), and ICAM-1 (p<0.001) were higher in patients with cognitive dysfunction when compared to those with normal cognition. After adjusting for isocitrate dehydrogenase (IDH) tumor mutation status, age, tumor grade, and number of surgeries, higher levels of ICAM-1 and IL-10, but not other markers, remained associated with cognitive dysfunction. MoCA scores were negatively correlated with GFAP (r=-0.24, p=0.038), IFN-γ (r=-0.31, p=0.008), IL-6 (r=-0.29, p=0.014), IL-10 (r=-0.24, p=0.039), and ICAM-1 (r=-0.39, p<0.001). CONCLUSIONS ICAM-1 and IL-10 levels were higher in patients with MOCA determined cognitive dysfunction, suggesting an association between cognitive symptoms and inflammation and vascular impairment in glioma patients. Future analyses in larger longitudinal cohorts are warranted to assess the predictive value of protein biomarkers.

NCOG-04. MEMORY TRACT SPARING USING DIFFUSE TENSOR IMAGING IN RADIATION PLANNING OF PRIMARY BRAIN TUMORS

Abstract INTRODUCTION Radiation therapy (RT) is a critical treatment modality for both primary and metastatic brain tumors, yet approximately 30% of patients experience cognitive decline post-radiotherapy. This cognitive toxicity is linked to low radiation doses affecting neural stem cells in the hippocampal dentate gyrus. Hippocampal Avoidance (HA)-Whole Brain Radiotherapy (WBRT) combined with Memantine has shown promising outcomes in preserving cognitive function and quality of life (QOL) in patients with brain metastases, suggesting it should be the standard of care for those with good performance status and no hippocampal metastases. METHODS We conducted a prospective trial approved by the IRB (SMC0307-23), including patients aged 18 and above with primary brain tumors post-resection or biopsy. Exclusion criteria included multifocal glioma crossing to the other hemisphere. RT was delivered to a total dose of 60Gy in 30 fractions with concomitant TMZ. Diffusion tensor imaging (DTI) was performed to map hippocampal-associated white matter tracts. Memory fiber tracts and hippocampi were contoured and integrated into RT planning using Eclipse treatment planning software. Dosimetric analyses compared two plans: one with memory fiber constraints and one without. RESULTS Twelve patients with low-grade gliomas were included, with successful contouring of memory fibers and hippocampi. VMAT treatment plans met dose constraints for memory fibers, with an average mean dose of 10.1 Gy. The average MoCA score before RT was 27.1 and 26.4 at six months post-treatment, with a p-value of 0.07. Excluding one patient, the scores were 27.1 and 26.6, respectively (p=0.13). CONCLUSION MRI planning using DTI for memory fiber detection and incorporation into RT planning via VMAT techniques enables hippocampal and associated white fiber sparing, potentially preserving cognitive function. Preliminary cognitive data are promising, supporting the need for further validation in a larger cohort.

Convergent and predictive validity of the Mini MoCA and considerations for use among older adults

The Mini MoCA is a cognitive screening instrument designed for quick administration that can be completed via telephone. The Mini MoCA has not received the same level of research attention as the original MoCA, and no articles have explored its validity and feasibility of use with older adults using the officially published administration/scoring protocol. This study examined the convergent and predictive validity of the Mini MoCA among community-dwelling older adults (N = 68, M age=74.5 years) and identified considerations for use as a telephone cognitive screener. Correlations examined the Mini MoCA’s convergent validity with a measure of general cognitive functioning (RBANS). A significant positive correlation was found (r = .34), such that higher Mini MoCA scores were associated with higher overall scores on the RBANS. Additionally, the Mini MoCA was uncorrelated with measures of problem-solving ability and inhibition (M-WCST, D-KEFS Color-Word Interference Test) providing evidence for discriminant validity. Multiple regression analyses revealed total Mini MoCA scores predicted RBANS total scores when accounting for demographic variables. Overall, the current study provides preliminary support for the Mini MoCA as a valid screening measure of general cognitive functioning among older adults. However, several barriers to valid administration of the Mini MoCA arose that warrant attention.

REM sleep behavior disorder: Relation between aggressiveness and emotions expressed in dream enactment and cognitive and anxiety/depression status

Aggressiveness and negative emotions in dreams reports of patients with alfa-synucleinopathies have been associated with cognitive dysfunction. Observation of dream enactment episodes could be a more precise method to capture dream content in patients with REM sleep behavior disorder (RBD). Our objective was to assess the relation between aggressive and emotional dream enactment episodes in patients with RBD and cognition and depression/anxiety.Motor events (ME) during REM sleep were classified by visual inspection of video-PSG files. Cognition and anxiety/depression were assessed with MoCA and the Hospital Anxiety and Depression Scale (HADS), respectively. Multivariate regression analysis was performed, with MoCA or HADS scores as predictors, age and DED as co-variates and aggressive, negative and positive ME frequency (raw values, per total and per complex indexes) as the dependent variable.We included 15 patients with isolated RBD and 12 and 4 with RBD associated with Parkinson's disease and Dementia with Lewy Bodies, respectively. They presented a total of 873 ME. There was a significant positive association between HADS score and violent/complex and negative emotion/complex indexes. There was a significant positive association between MoCA score and violent/complex index.A significant correlation between depression/anxiety severity and negative emotion and aggression ME frequency agrees with the dream continuity hypothesis and suggests that REM sleep acts as a regulator of emotional experience. Patients with a higher prevalence of aggressive ME had higher scores in cognitive testing, suggesting that the elaboration of these complex movements could depend on the integrity of cognitive functions.

NEUROBICS: A VITAL ADJUNCT TO PHYSICAL THERAPY IN IMPROVING COGNITIVE AND PHYSICAL FUNCTIONS IN A PREGNANT WOMAN WITH WERNICKE'S ENCEPHALOPATHY - A CASE REPORT.

Background: Wernicke’s Encephalopathy (WE) is a neurological disorder caused by thiamine deficiency, leading to cognitive and physical impairments like confusion, ataxia, and ophthalmoplegia. Pregnant women with WE face additional challenges due to pregnancy demands. This case report examines the use of neurobics—cognitive exercises to stimulate brain function - as an adjunct to physical therapy in enhancing cognitive and physical recovery in a pregnant woman with WE. Objective: This report aims to demonstrate the benefits of combining neurobics with physical therapy to improve cognitive and physical outcomes in a pregnant woman with WE. Case Presentation: A 28-year-old pregnant woman in her second trimester, diagnosed with WE, presented with confusion, ataxia, and visual disturbances. After stabilization with intravenous thiamine, a rehabilitation program combining neurobics and physical therapy was initiated. Physical therapy targeted balance, coordination, and strength, while neurobics engaged the brain with unusual sensory stimuli and non-routine tasks to enhance cognitive function. Results: After four weeks, the patient’s cognitive function improved, with her MoCA score increasing from 4 to 17. Significant gains were seen in executive function, attention, language, visuospatial skills, and orientation, though memory remained unchanged. Ataxia symptoms also improved, with her SARA score reducing from 22 to 14. Conclusion: The integration of neurobics with physical therapy offered a comprehensive approach to rehabilitation in this pregnant woman with WE. Neurobics enhanced cognitive recovery alongside physical rehabilitation, suggesting its potential as a valuable adjunct in managing WE.

Oxygen supplementation and cognitive function in long-COVID.

Patients can experience persistent cognitive complaints and deficits in long-COVID. Inflammation and capillary damage may contribute to symptoms by interfering with tissue oxygenation. This was an exploratory pilot crossover study designed to describe the effects of supplemental oxygen (portable oxygen concentrator, POC) on cognitive performance and peripheral and cerebral oxygen saturation at rest and exercise. Participants with long-COVID (n = 21) were randomized 1:1 to: 1) POC (3h/day) for 2 weeks followed by standard of care (Control) for 2 weeks or 2) Control for 2 weeks then POC (3h/day) for 2 weeks, with a 1-week washout. Cognitive assessment (global cognition [Montreal Cognitive Assessment, MoCA], episodic memory [Hopkins], working memory [Digit Span], executive function [Verbal fluency]) was performed at baseline and after each treatment period. Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 were completed. Peripheral and cerebral oxygen saturation were measured at rest and exercise (treadmill) at baseline and after each treatment period. Statistical analyses were descriptive without formal testing. MoCA scores were similar under POC (26.45±2.31) and Control (26.37±2.85); overall POC-Control difference was -0.090 (95% CI [-1.031, 0.850]). Because of a learning effect, post-hoc analyses were performed for Period 1, where the MoCA score difference was 1.705 [0.140, 3.271]. MoCA subscores suggested better performance with POC for Visuospatial/executive (0.618 [-0.106, 1.342]) and Attention (0.975 [0.207, 1.743]). POC trended to have better scores on Digit Span backward (difference: 0.822 [-0.067, 1.711]) and self-reported depressive symptoms (difference: -1.335 [-3.166, 0.495]). For specific PHQ-9 items, POC tended to have lower (better) scores for Q1 (Little interest/pleasure) and Q7 (Trouble concentrating). Cerebral oxygen saturations at end of exercise showed no difference between POC and Control. Peripheral saturations during exercise were similar under POC and Control (difference: 0.519% [-1.675, 2.714]). An advantage of POC over Control was observed for global cognition, attention, visuospatial/executive performance and depressive symptoms. Results need to be validated in a larger study.

Transcutaneous auricular vagus nerve stimulation improves cognitive decline by alleviating intradialytic cerebral hypoxia in hemodialysis patients: A fNIRS pilot study

Cognitive impairment is common in hemodialysis patients, possibly due to inadequate cerebral blood flow during hemodialysis. No effective non-pharmacological interventions are available. This study investigates the impact of hemodialysis-induced cerebral hypoxia on cognitive decline in hemodialysis patients and the potential of transcutaneous auricular vagus nerve stimulation (taVNS) as a non-pharmacological intervention. A randomized controlled trial with 36 participants showed that cognitive performance and cerebral oxygenation in the dorsolateral prefrontal cortex (DLPFC) significantly declined in the sham group. In contrast, taVNS improved cognitive function by increasing cerebral oxygenation, with significant correlations to reaction times and MoCA scores. The study suggests that Hemodialysis-induced cerebral hypoxia may contribute to persistent cognitive decline in MHD patients. However, taVNS could be an effective intervention to prevent cognitive impairment in hemodialysis patients by alleviating cerebral hypoxia.

Association between silent cerebral embolism and cognitive alterations following transcatheter aortic valve replacement in bicuspid versus tricuspid aortic valve patients

Abstract Background Silent cerebral ischemic lesions (SCILs) is a common magnetic resonance imaging (MRI) finding in severe aortic stenosis patients post - transcatheter aortic valve replacement (TAVR). We evaluated the association between SCILs and cognitive alterations in patients with bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV) post-TAVR. Methods This study enrolled 100 consecutive TAVR (45 with BAV and 55 TAV). DW-MRI and neurocognitive evaluation (MoCA score) were performed at baseline, discharge, and 1- and 12-month post-discharge. Results Ninety-two out of the 100 patients (92%) exhibited cognitive dysfunction at baseline. Post-TAVR, overall cognitive function significantly improved, the average MOCA score increased from 18.69±6.74 to 22.18±6.30. During the 1-year follow-up, 54 patients demonstrated improved cognitive function, and the number of patients with moderate-to-severe cognitive dysfunction (MoCA score < 18) significantly decreased from 32 to 16. Prevalence of SCILs was 14% and 72% at baseline and discharge, respectively. New SCILs were observed in 60 patients at discharge, distributed across all vascular territories, averaging 4 lesions with a total volume of 215.4±195.4mm3. Although no significant correlation existed between total volume of new SCILs and cognitive changes post-TAVR (R=-0.133, p=0.206), patients with SCILs still displayed significant cognitive improvement (MoCA score from 18.4±6.6 to 22.0±7.1), whereas patients who developed large SCILs (lesion diameter >9) showed less improvement compared to those with small or median SCILs (number of patients who had cognitive improvement: 32 vs. 52, p<0.05). Cognitive function improvement post-TAVR did not significantly differ between BAV and TAV patients, MoCA scores were comparable (BAV group, n=45, from 18.63±6.68 to 21.88±6.80 vs. TAV group, n=55, from 18.73±6.81 to 22.42±5.80; p>0.05). DW-MRI revealed more new SCILs in BAV patients post-TAVR compare to TAV patients (235 lesions vs. 150 lesions, respectively). In BAV patients, SCILs primarily manifested in small and medium sizes (224 lesions), despite more severe calcification (valvular calcium volume 956.5±644.0 mm vs. 634.4±508.0 mm3; p=0.028). The number of large lesions was similar in the two groups (11 in BAV group and 10 in TAV group). Conclusion TAVR demonstrates positive effects on improving cognitive function in aortic stenosis patients, despite common occurrence of SCILs in both BAV and TAV patients. Cognitive function post-TAVR was comparable between BAV and TAV patients. The cognitive improvement from TAVR may be less impacted by small- and medium-sized SCILs, while severe SCILs might impede or diminish the cognitive benefits of TAVR.table

Red-cell omega-3 fatty acids associate with increased hippocampal volume and superior longitudinal cognition in atrial fibrillation

Abstract Background Atrial fibrillation (AF) is associated with cognitive impairment and dementia. Omega-3 Fatty Acids (n-3 FAs) have anti-thrombotic, anti-inflammatory and anti-oxidative properties; however, their neuroprotective effects remain controversial. Here, we report the association of n-3 FAs with both structural (hippocampal volume) and functional (cognition) readouts in a large cohort of AF pts. Purpose a) To determine the association of n-3 FAs and left and right hippocampal volume at baseline in AF pts. b) To assess the predictive value of HV and n-3 FAs for the risk of cognitive impairment after a 7-year follow-up period. Methods This prospective ongoing multicenter Swiss Atrial Fibrillation study (Swiss-AF) included 2,359 pts with documented AF and baseline red-cell n-3 FAs levels, measured by gas chromatography and mass spectrometry. Hippocampal volume (HV) and segmentation based intracranial volume (ICV) were analyzed by FreeSurfer's (v 7.4.0) subregion segmentation module and Sequence Adaptive Multimodal SEGmentation from brain MRI in 1,736 pts. Detailed neurocognitive assessments in pts at baseline and follow up periods were performed. We used mixed-effect linear regression models to determine the association of n-3 FAs and HV. For conversion to cognitive impairment (defined as MoCA score < 26), we performed cox-proportional hazards regression model. Two adjustment models were applied as described in the figures. Results Patients with AF (mean age, 73 years old [±8.5 SD]; 157 women [27%]) with 9569 cognitive evaluations (mean follow-up, 3.6 years [±2.3 SD]) were assessed. At baseline, we observed statistically significant associations between total n-3 FAs levels (EPA + DHA + ALA + DPA) and individual n-3 FAs (EPA, DHA, DPA) with increased HV after adjustment for ICV and other covariates (Fig1A, 1B). After all adjustments, EPA remained associated with both bilateral HV and right HV. Furthermore, we observed a significant association between HV and neurocognitive assessments, as measured both in global (MoCA, CoCo) and specific tests (TMT-A, TMT-B, DSST, SF) (Fig1C). Over time, quartile 4 (Q4, highest n-3) compared to quartile 1 (Q1, lowest), had a 16% lower risk of cognitive impairment (HR, 0.84 [CI 0.75-0.93]; P=0.001) for total n-3 FAs and even 30% lower specifically for EPA (HR, 0.7 [CI 0.63-0.78]; P<0.001). The risk of cognitive impairment was 47% lower (HR, 0.53 [CI 0.45-0.63]; P<0.001) when the highest HV Q4 was compared to lowest HV Q1 (Fig2A). In combination, the highest quartile of bilateral HV and EPA demonstrated an increased probability of being cognitive impairment-free and they had a 72% lower (HR, 0.28 [0.18-0.43]; P<0.001) risk of cognitive impairment (Fig2B). Conclusions 1. Red cell n-3 FAs levels are associated with higher HV in AF pts. 2. Higher baseline levels of n-3 FAs, particularly of EPA, are associated with both an increased HV and a decreased risk of cognitive impairment after 7 years follow up.

Peripheral biomarkers of Parkinson’s disease and its correlation with clinical symptoms: a case-control study

BackgroundInflammation significantly impacts Parkinson’s disease (PD), yet the intricate relationship between inflammatory markers and PD remains elusive.ObjectiveTo identify the peripheral biomarkers of PD and its correlation with the motor and non-motor symptoms of PD.Methods79 PD patients and 65 controls were included in this study. Clinical information and the serum levels of IL-8, IL-27, IL-33, β-NGF, AgRP, and TRAILR2 in the participants were collected. Appropriate scales were used to assess the symptoms of PD. For the factors with significant differences in the two groups, multivariable logistic regression was used to determine its relationship with PD. Moreover, spearman correlation was conducted to explore the correlation between the factors and PD related symptoms. The IL-27 level was compared between the cognitively healthy PD group and the mild cognitive impairment in PD (PD-MCI). The serum level of TRAILR2 was positively correlated with age and was not associated with other clinical characteristics related to PD.ResultsCompared to controls, the serum levels of IL-27(P = 0.013) were increased whereas the levels of TRAILR2(P = 0.008) were decreased in PD patients. IL-8, IL-33, β-NGF, and AgRP showed no significant differences between the two groups. After controlling for the other variables, IL-27 was considered as an independent risk factor for PD in the multivariable logistic regression model. The receiver operating characteristic (ROC) curve for diagnosing PD with IL-27 yielded an area under the curve (AUC) of 0.621. Additionally, IL-27 level in PD patients was positively correlated with age, the disease duration, LEDD and negatively correlated with the MoCA scores. However, no significant difference was found in IL-27 levels between cognitively healthy PD and PD-MCI groups.ConclusionElevated serum IL-27 was a risk factor for PD and positively correlated with the cognitive decline in PD.

Multidomain cognitive improvement in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation

Abstract Background Cognitive impairment is prevalent in one third of patients with symptomatic severe aortic valve stenosis scheduled for transcatheter aortic valve implantation (TAVI). How TAVI affects cognitive functioning in these patients remains unknown. Purpose The CAPITA study (CArdiac outPut, cerebral blood flow and cognition In patients with severe aortic valve stenosis undergoing Transcatheter Aortic valve implantation) assessed the effects of TAVI on cerebral lesions and cognitive functioning. Methods CAPITA is a prospective study of cerebral and cognitive outcomes in 148 patients undergoing TAVI. One day before and three months after TAVI, patients underwent a standardized multidomain neuropsychological assessment, and simultaneous brain magnetic resonance imaging. The primary outcome was change in global cognitive functioning as measured with z-scores. Also, we assessed the cognitive subdomains of attention/psychomotor speed, memory, language, and executive functioning. Z-scores for each cognitive domain were constructed as: (test score - mean baseline score) / standard deviation. Global cognitive function was calculated as the mean from the four domain scores. Results Mean age was 80.5±5.7 years, 43% was female and median STS-PROM (Society for Thoracic Surgeons Predicted Risk for 30-day Mortality) was 2.0% (IQR 1.4%-2.9%). MoCA scores improved from 23.3±3.7 to 24.4±3.3, (p<0.001) and MMSE scores from 26.4±2.6 to 26.9±2.4 (p=0.01). There was an overall increase in global cognitive z-scores (0.02±0.52 to 0.15±0.48, p<0.001). Cognitive domains of memory (0.03±0.77 to 0.18±0.80, p=0.003) and language (-0.07±1.07 to 0.20±0.80, p=0.02) significantly improved, whereas executive function (0.01±0.70 to 0.06±0.76, p=0.42) and attention (0.10±0.69 to 0.17±0.69, p=0.06) did not significantly change. Quality of life on the visual analogue scale improved from 66.4±15.9 to 72.9±12.8, (p<0.001). Patients in the lowest tertile of baseline cognitive functioning (i.e., those with worst baseline cognitive functioning), had the largest increase in cognitive functioning, compared with patients in the intermediate or highest tertile of baseline cognitive functioning (0.30±0.55 vs 0.09±0.27 vs 0.01±0.16, p=0.002). Patients with >0.5 SD decline in cognitive functioning (12%), had a higher volume of new white matter hyperintensities on follow-up MRI than patients with stable or improved cognitive functioning (1.26±2.96, vs 0.29±0.45 vs 0.31±0.91 mL, p=0.06). Conclusions In 148 patients who underwent TAVI, there was an overall improvement in cognitive functioning at three months follow-up. This improvement was consistent through different cognitive domains and most prominent in patient with lowest baseline cognitive functioning.Change in cognitive functionin

Cognitive function characteristics and influencing factors in patients with depressive disorders: a 5-year follow-up report based on the epidemiological survey of mental disorders in Shandong Province, China.

Cognitive impairment represents a notable feature of depressive disorders. Comprehending its characteristics and influencing factors is vital for patient rehabilitation. This study is based on the 2015 Shandong Province epidemiological survey of mental disorders, from which 871 individuals meeting DSM-IV criteria for depressive disorders were selected as the research group. Using 1:1:1 matching by sex, age, and residence, we randomly selected 825 individuals with no DSM-IV diagnosis but positive on GHQ-12 and additional risk assessments as the elevated risk control group, and 825 with negative screenings as the minimal risk control group. In 2020, a follow-up survey was conducted, resulting in a final analysis of 1,855 cases. The survey included demographic data, various clinical information, and a series of screening and questionnaire assessments. The current depressive group scored lower on the MoCA than the non-depressive group (t=8.86, P<0.01). The research group scored lower on the MoCA than the elevated and minimal risk group (F=11.98, P<0.01). The depression-unremitted group scored lower than the depression-remitted group (t=6.44, P<0.01). The Analysis indicated that males, with better life quality, poor early psychological status and, and longer education were associated with higher MoCA scores. Conversely, older age, rural residency, employment, current depression, and poor marital were associated with lower MoCA scores. Individuals with depression commonly suffer cognitive impairment, which tends to partially improve as depression remits. Individual cognitive function is influenced by early psychological health, depressive status, quality of life, age, sex, educational level, residence, occupational, and marital status.