MoCA Total Score Research Articles

A - 113 Assessing the Feasibility of Machine Learning to Predict Frontotemporal Dementia Severity from Neuropsychological Assessments

Abstract Objective To assess the feasibility of utilizing machine learning (ML) of neuropsychological assessment data in determining the severity of frontotemporal dementia (FTD) as classified by the Clinical Dementia Rating (CDR). Method A Random Forest classification model was employed using a deidentified FTD dataset. Participants’ (N = 3023) were stratified based on CDR scores for severity: Normal (n = 1646, Mage = 46.95, 59.66% female), Mild (n = 855, Mage = 63.06, 57.08% female), Moderate–Severe (n = 522, Mage = 64.57, 62.45% female). Participants were than randomly stratified into a training set (80%) and a testing set (20%) for model evaluation. The model was then trained on the training set using participant data including age, gender, verbal fluency, digit span forward, digit span backward, trails A, trails B, and the MOCA total score. The model was then evaluated on the testing set. Results The model achieved an accuracy of 74.55% on the testing set. Detailed performance metrics revealed a precision of 86%, recall of 91%, and F1-score of 89% for the normal category, 56% precision, 56% recall, and 56% F1-score for mild, and 65% precision, 52% recall, and 58% F1-score for moderate–severe. The most salient features were verbal fluency and age, with assigned importance scores of 0.174 and 0.150, respectively. Conclusions Although the Random Forest model demonstrated potential in predicting FTD severity from neuropsychological data, its moderate performance for mild and severe categories indicates it’s not yet clinically viable. This study offers a foundational framework, suggesting further model refinement and larger datasets are necessary to enhance accuracy and clinical utility. Future research should focus on including diverse variables and populations.

A - 7 An Examination of the Predictive Roles of Healthy Literacy and Age in Online and Print Health Information Search Performance among Older Adults

Abstract Objective As older adults increasingly seek health information online, evaluating complex technology-based everyday behaviors is important. This study examined the predictive roles of health literacy and age in health information search accuracy across online and print sources. Methods Participants were 96 community-dwelling older adults (age: M = 70.09, SD = 8.69; education: M = 16.57, SD = 2.14; 75% female; 96.88% White). Participants completed the Newest Vital Sign, a health literacy measure that required participants to interpret verbal and numerical information on a nutrition label, and a health search task (HST), which examined the ability to navigate web and print sources to search for health information. Results A multiple regression was conducted in which HST accuracy was regressed onto health literacy and age for web and print subtasks separately. Cognitive status (MoCA total score) was a covariate. Although health literacy was not a significant predictor of HST accuracy, age was a significant predictor for the web-based subtask, β = −0.29, b = −0.05, SEb = 0.02, 95% CI [−0.08, −0.02], t(92) = −2.94, p = 0.004, and cognitive status for the print-based subtask, β = 0.36, b = 0.18, SEb = 0.05, 95% CI [0.08, −0.28], t(92) = 3.50, p = 0.001. Conclusions Compared to health literacy, age and cognitive status were stronger predictors of health information search performance across online and print sources in community-dwelling older adults. Future studies should consider the impact of age and comfort with technology in examining older adults’ ability to successfully navigate online health sources.

The study of the relationship between moderate to severe sleep obstructive apnea and cognitive impairment, anxiety, and depression.

The present study endeavored to investigate the interconnection between obstructive sleep apnea (OSA) and cognitive function, alongside the manifestations of depression and anxiety. Simultaneously, an analysis was conducted to discern the factors exerting influence upon cognitive function. A cohort of 102 patients, who had undergone polysomnography (PSG) at Binhu Hospital, Anhui Medical University, between January 2022 and June 2023, was encompassed in the study. Employing the PSG findings, these individuals were classified into two distinct categories: the grouping consisted of those with either negligible or mild OSA, and the other comprised individuals with moderate to severe OSA. Utilizing the Montreal Cognitive Assessment (MoCA-Beijing), Stroop Color and Word Test (SCWT), Digit Span Test (DST), Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS), scores were recorded and analysed for each of the respective assessments. Additionally, discrepancies and associations between these groups were also scrutinized. The group exhibiting moderate to severe OSA demonstrated significantly elevated measurements in parameters such as neck circumference, BMI, completion times for SCWT-A, B, C, Sleep Inefficiency Index (SIE), SAS, and SDS, in comparison to the No or Mild OSA group. Furthermore, the moderate-severe OSA group manifested notably diminished MoCA scores in areas of visual-spatial and executive function, memory, language, abstraction, delayed recall, orientation, total MoCA score, lowest oxygen saturation (LSaO2), average oxygen saturation, Digit Span Test-backward(DST-b), and Digit Span Test-forward(DST-f), as contrasted with the no-mild OSA group. These inter-group disparities exhibited statistical significance (p < 0.05). The MoCA total score portrayed inverse correlations with age, Apnea-Hypopnea Index (AHI), BMI, SIE, SAS, SDS, CT90%, AHT90%, and Hypoxic Apnea Duration (HAD) (ranging from -0.380 to -0.481, p < 0.05). Conversely, it displayed positive correlations with DST-f, DST-b, LSaO2, and average oxygen saturation (ranging from 0.414 to 0.744, p < 0.05). Neck circumference, AHI, and SAS were autonomously linked to MoCA scores (OR = 1.401, 1.028, 1.070, p < 0.05), while AHI exhibited an independent correlation with SDS and SAS scores (OR = 1.001, p = 0.003). Patients grappling with moderate to severe OSA frequently reveal cognitive impairment and concomitant emotional predicaments encompassing depression and anxiety. These manifestations share an intimate association with AHI, LSaO2, and average oxygen saturation. Notably, anxiety, when coupled with OSA, emerges as an autonomous influential element impinging upon cognitive impairment.

Evaluation of a multimodal diagnostic algorithm for prediction of cognitive impairment in elderly patients with dizziness

BackgroundThe current diagnostic workup for chronic dizziness in elderly patients often neglects neuropsychological assessment, thus missing a relevant proportion of patients, who perceive dizziness as a subjective chief complaint of a concomitant cognitive impairment. This study aimed to establish risk prediction models for cognitive impairment in chronic dizzy patients based on data sources routinely collected in a dizziness center.MethodsOne hundred patients (age: 74.7 ±\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\pm$$\\end{document} 7.1 years, 41.0% women) with chronic dizziness were prospectively characterized by (1) neuro-otological testing, (2) quantitative gait assessment, (3) graduation of focal brain atrophy and white matter lesion load, and (4) cognitive screening (MoCA). A linear regression model was trained to predict patients’ total MoCA score based on 16 clinical features derived from demographics, vestibular testing, gait analysis, and imaging scales. Additionally, we trained a binary logistic regression model on the same data sources to identify those patients with a cognitive impairment (i.e., MoCA < 25).ResultsThe linear regression model explained almost half of the variance of patients’ total MoCA score (R2 = 0.49; mean absolute error: 1.7). The most important risk-predictors of cognitive impairment were age (β = − 0.75), pathological Romberg’s sign (β = − 1.05), normal caloric test results (β = − 0.8), slower timed-up-and-go test (β = − 0.67), frontal (β = − 0.6) and temporal (β = − 0.54) brain atrophy. The binary classification yielded an area under the curve of 0.84 (95% CI 0.70–0.98) in distinguishing between cognitively normal and impaired patients.ConclusionsThe need for cognitive testing in patients with chronic dizziness can be efficiently approximated by available data sources from routine diagnostic workup in a dizziness center.

Cognitive Outcome after Acute Spontaneous Intracerebral Hemorrhage: Analysis of the iDEF Randomized Trial

Introduction: The impact of intracerebral hemorrhage (ICH) on cognition and the determinants of cognitive recovery early after ICH remain elusive. In this post hoc analysis of the intracerebral hemorrhage deferoxamine (iDEF) trial, we examined the trajectories of cognitive impairment and the determinants of early cognitive recovery after ICH. Methods: We examined baseline factors associated with a 90-day cognitive outcome and constructed generalized linear mixed models to examine the trajectory of cognitive function over time among iDEF participants. Cognition was measured by the Montreal Cognitive Assessment (MoCA) scores on days 7, 30, and 90. Results: 291 were available for analysis under the trial’s modified intention-to-treat definition (38% female, mean age 60.3 ± 12.0 years, median NIHSS 13, IQR 8–18). The median baseline ICH volume was 12.9 IQR (6.4–26.0) mL; 59 (20%) of the ICH cases were lobar, 120 (41%) had intraventricular extension. There was an overall significant increase in total MOCA score with time (p < 0.0001). Total MOCA score increased by an estimated 3.9 points (95% CI: 3.1, 4.7) between the day 7 and day 30 assessments and by an additional 2.9 points (95% CI: 2.2, 3.6) between the day 30 and day 90 assessments. Despite the overall improvement, 134 of 205 (65%) patients with an available 90-day MoCA score remained cognitively impaired with a score <26 on day 90. Older age, higher NIHSS score, baseline ICH volume, intraventricular hemorrhage, and perihematoma edema had an adjusted negative impact on cognitive recovery. Conclusions: Although ICH survivors exhibit significant improvement of cognitive status over the first 3 months, cognitive performance remains impaired in the majority of patients. Among factors independently associated with worse cognitive recovery, higher baseline ICH, intraventricular blood and perihematomal edema volumes, are potential therapeutic targets that merit further exploration.

Neurocognitive Changes in Patients with Post-COVID Depression.

Background: Depression and cognitive impairment are recognized complications of COVID-19. This study aimed to assess cognitive performance in clinically diagnosed post-COVID depression (PCD, n = 25) patients using neuropsychological testing. Methods: The study involved 71 post-COVID patients with matched control groups: recovered COVID-19 individuals without complications (n = 18) and individuals without prior COVID-19 history (n = 19). A post-COVID depression group (PCD, n = 25) was identified based on psychiatric diagnosis, and a comparison group (noPCD, n = 46) included participants with neurological COVID-19 complications, excluding clinical depression. Results: The PCD patients showed gender-dependent significant cognitive impairment in the MoCA, Word Memory Test (WMT), Stroop task (SCWT), and Trail Making Test (TMT) compared to the controls and noPCD patients. Men with PCD showed worse performances on the SCWT, in MoCA attention score, and on the WMT (immediate and delayed word recall), while women with PCD showed a decline in MoCA total score, an increased processing time with less errors on the TMT, and worse immediate recall. No differences between groups in Sniffin's stick test were found. Conclusions: COVID-related direct (post-COVID symptoms) and depression-mediated (depression itself, male sex, and severity of COVID-19) predictors of decline in memory and information processing speed were identified. Our findings may help to personalize the treatment of depression, taking a patient's gender and severity of previous COVID-19 disease into account.

Is Montreal Cognitive Assessment a valuable test for the differentiation of Alzheimer's disease, frontotemporal dementia, dementia with Lewy body, and vascular dementia?

This study examined the diagnostic value of the total MoCA score and its subscores in differentiating Alzheimer's disease (AD), frontotemporal dementia (FTD), dementia with Lewy body (DLB), and vascular dementia (VaD). A total of 241 patients (AD=110, FTD=90, DLB=28, and VaD=13) and 59 healthy persons, who were referred to a dementia clinic with memory impairment in Firoozgar Hospital, were included in this study. MoCA tests were performed in all patients and normal persons. By using the receiver operating characteristic (ROC) curve and measuring the area under the curve (AUC) for the total MoCA score in each group, AUC was 0.616, 0.681, 0.6117, and 0.583 for differentiating AD, FTD, DLB, and VaD patients, respectively. Among the groups, just the VaD group showed no significant usefulness in using the total MoCA score to differentiate it. To compare MoCA subscores, AD patients had higher scores in digit span, literal fluency, and abstraction but lower delayed recall scores compared with FTD patients. The total MoCA score and its subscores could not differentiate people with different types of dementia in the setting of screening.

UNDERSTANDING THE INTERPLAY OF BRAIN HEALTH, COGNITION, AND AUTONOMIC FUNCTION

Abstract Research in clinical populations focused on various age-related diseases report multi-system difficulties in autonomic regulation, motor performance, cognition, and brain health. My research investigated the relationship between brain health, chronological age, and cognition. To assess these domains, I cross analyzed Compass 31, MoCA, and Brain Age Technology. The study population included 158 participants, both healthy and unhealthy. The collected data evaluated the relationship between brain age disparity, chronological age, and autonomic function. Correlation analysis, regression modeling, and subgroup comparisons were employed to explore potential associations, age-related patterns, and autonomic function variations. The findings from this research study contributes to a deeper understanding of the complex interplay between brain health, chronological age, and autonomic function. Age, White Matter Hyperintensities, Brain Age Gap, and Brain Age Variance demonstrate high significance when correlated with the MoCA total score. MoCA and all Compass 31 domains were found to be predictive of total white matter hyperintensity volume. This finding highlights a strong relationship between all three domains and suggests that when participants score high on both assessments, they should follow up with neuroimaging to discover potential brain damage. Future studies should identify risk factors for cognitive impairment and brain health that are also symptoms for autonomic dysregulation.

ONLINE COGNITIVE MONITORING IN A SIMULATED ANTI-AMYLOID TRIAL: ADHERENCE AND COGNITIVE CHANGE

Abstract Remote assessment of cognitive function is increasingly of interest for monitoring cognitive decline. Additional advantages of remote monitoring are more frequent assessments and the examination of change over time, which may yield more sensitive indicators of cognitive status. This concept was tested in DETECT-AD (Digital Evaluations and Technologies Enabling Clinical Translation for Alzheimer’s Disease), an ongoing simulated anti-amyloid trial using digital biomarkers as outcome measures. Adherence to testing, relationships to age, global cognition, and SUVR, and trajectories of change were analyzed in the SMART (Survey for Memory, Attention and Reaction Time) test, a brief measure of visual-grid memory and executive function (Trails A/B, Stroop Color-Word), self-administered online every four weeks. To date (02/28/2023), 46/100 have been enrolled with mean(SD): follow-up=31.0(7.9) weeks (no dropout); age=78(6.6); 63% women; MoCABaseline=25.5(2.3); PET SUVR=1.09 (0.20; range=0.850-2.07). SMART surveys (n=184) completed online used a desktop (26%), laptop (48%), tablet (20%), or smartphone (7%). A mean of 4(2.0; range=1-8) SMART surveys/participant were completed with 96% completed tests. Older age significantly correlated with longer overall completion times (p=0.02), Trails-B (p&amp;lt; 0.01) and Stroop (p=0.02) times, and more click counts on Trails-B (p=0.03). MoCA total score significantly correlated with shorter completion times on overall SMART (p=0.02), Trails-A (p&amp;lt; 0.01), and Trails-B (p=0.03). There were no relationships between SUVR and SMART. Total SMART completion time decreased over multiple administrations (p=0.03), driven by shorter Trails-B time (p=0.01). Monthly online screening of cognitive function in a clinical trial setting is well maintained yielding novel information over time.

Results of Phase III Clinical Trial: a Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel Group Study of the Efficacy and Safety of Direkord in Ischemic Stroke Patients in Early Recovery Period

Direkord is an original drug containing the active substance of dicholine succinate, which improves the sensitivity of insulin receptors in neurons to insulin. The aim of this work was to evaluate the efficacy and safety of the drug in ischemic stroke patients in the early recovery period. In total, 160 patients after the first ischemic stroke in the carotid system, confirmed by computed or magnetic resonance imaging, with a stroke duration from 3 weeks to 2 months, mean age 63.2±8.4 years, were randomized into two treatment groups. The first group (n=80) received Direkord intramuscularly at a dose of 600 mg/day for two weeks; the second group (n=80) received a placebo. Treatment response was defined as an improvement in neurological status, functional status, and cognitive function of the patients: at least a two-fold decrease in the total NIHSS score, the total Barthel score ≥ 95, and the total MoCA score ≥ 26. The analysis of the primary endpoint of the study using exact Fisher’s test showed that Direkord was statistically significantly superior to the placebo (p=0.017) in the number of patients who responded to the therapy — 23.7 and 8.7% of patients in groups, respectively. The secondary end point analysis revealed a statistically significant superiority of Direkord over the placebo in reducing neurological deficits on the NIHSS scale (p=0.004), on the Rankin scale (p=0.0357), and on the CGI-I (p&lt;0.001) and PGI-I (p&lt;0.001) global clinical impression scales. Direkord has a good safety profile; thus, no statistically significant differences were found with the placebo in any of the safety parameters, including the number of adverse events, vital signs, laboratory parameters, and ECG. Overall, Direkord is statistically significantly more effective than placebo in recovering function and daily activities after ischemic stroke.

Clinical Manifestations.

Digital cognitive assessment solutions can overcome some barriers to cognitive screening in primary care by providing rapidly-obtained objective insights without requiring specialty-trained examiners. The Linus Health Digital Clock and Recall (DCR™) is a three-part test consisting of three-word immediate verbal acquisition, the Digital Clock Test (DCTclock™), and delayed recall of the three words. Our objective was to compare performance on the DCR to the Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) and the Saint Louis University Mental Status (SLUMS; Tariq et al., 2006), two commonly used screening tests in primary care. Comparative analyses of DCR, MoCA (Total Score and Memory Index Score [MIS]), and SLUMS results were conducted among 80 primary care patients - 65 years and older presenting for any reason - whose DCR performance was indicative of cognitive impairment. Of the 80 patients (mean age 74.0 [±7.8]; 60% female) performing as impaired or borderline impaired on the DCR, 67 completed the MoCA and 13 completed the SLUMS. Comparison between the DCR and MoCA Total Score included 78% (52/67) concordance for identifying impairment (cutoff <26). While the remaining 15 of 67 patients (22%) had normal MoCA Total Scores (≥26), 13 (87%) missed points in at least one MoCA cognitive domain and 8 (53%) missed points in multiple MoCA domains (often language and delayed recall). Comparison between DCR and SLUMS revealed that all 13 patients receiving SLUMS assessment had DCR scores 0-1 and SLUMS scores <27 (indicating cognitive impairment). See Tables 1 and 2 for breakdown of MoCA, MIS, and SLUMS stratified by DCR performance. Logistic regression found that DCTclock metrics of information processing (z = 2.00, p = .045) and spatial reasoning (z = 2.82 p = .005) discriminated cognitive impairment on MoCA Total Score (cutoff <26). Overall, ROC analysis revealed good accuracy of DCR to identify MoCA performance (AUC = .84; Figure 1). Screening in primary care using the DCR is feasible, takes less time to administer than MoCA or SLUMS, and shows concordant results with these more established screening tools in detecting cognitive impairment. Future research aims to investigate the criterion validity of the DCR among biomarkers for neurodegenerative disease.

Measurement Invariance of the NIH Toolbox‐Cognition Battery Across Demographic Characteristics

AbstractBackgroundThe tablet‐based NIH Toolbox‐Cognition Battery (NIHTB‐CB) was compared against the established NACC Uniform Data Set 3.0 (UDS 3.0) neuropsychological battery (used across Alzheimer’s Disease Research Centers). NIHTB‐CB factor invariance is critical for drawing appropriate cross‐demographic conclusions. Invariance was assessed across both batteries for consensus‐driven clinical diagnosis, sex, and age in a large sample of participants from the Advancing Reliable Measurement in Alzheimer’s Disease and Cognitive Aging (ARMADA) study. Goals of this project were to establish the factor relationship of these two batteries and examine their invariance across the aforementioned demographic characteristics.MethodNIHTB‐CB tasks measure Crystalized and Fluid ability. Tests were administered to 571 participants aged 65 to 99 years (mean age 77.2±7.8, 41% female) with normal cognition or amnestic mild cognitive impairment. Groups were classified for age (&lt; = 85 and &gt; 85), gender, and diagnosis. Exploratory Factor Analysis (EFA) was tested for each group with confirmatory factor analysis. If the model fit sufficiently between groups for the configural model, then metric, scalar, and strict invariance models were also examined. Uncorrected standard scores were used for analyses.ResultA four‐factor model emerged as the best fitting model and was invariant across all demographic groups through adjustments. Factor 1: Language (MINT Total, Oral Reading, Picture Vocabulary); Factor 2: Auditory retention (Digits Forward Total and Digits Backward Total); Factor 3: Learning/Memory (List Sorting Working Memory, Picture Sequence Memory, Craft Story 21 Immediate Recall, Craft Story 21 Delayed Recall, Benson Delayed Recall, Animals Category, Vegetables Category, and MoCA Total Score); Factor 4: Attention/Executive Functioning (Dimensional Card Sort, Flanker, Trails A, Trails B, Pattern Comparison Processing Speed, and Benson Recall). We found strong support for strict invariance across the assessed demographic characteristics.ConclusionA four‐factor structure comprised of NIHTB‐CB and UDS 3.0 tests supports the validity of the NIHTB‐CB by matching both UDS 3.0 and NIHTB‐CB measures as expected. Strong support for strict invariance reflects the psychometric equivalence of the NIHTB‐CB construct across the groups. The psychometric properties of the NIHTB‐CB subtests therefore are generalizable across samples. By satisfying the assumption of measurement invariance, inferences made using the NIHTB‐CB about between‐group differences are presumed valid.

Examining the measurement equivalence of Alzheimer’s Disease Centre Neuropsychological Test Battery (Version 3) across two distinct cultures

AbstractBackgroundNeuropsychological assessments are important in clinical diagnostic process for dementia as it help early detection of cognitive difficulties. Prior to using neuropsychological test batteries across different populations, it is critical to standardize the battery to ensure consistency in the assessment process, as well as valid and comparable results across different settings. The Alzheimer’s Disease Centre Neuropsychological Test Battery (Version 3) (ADCNTB3) is a widely used battery that had shown sensitivity in detecting cognitive decline in MCI and early dementia, with minimal test repetition effects (Boccardi et. al., 2022). While norms are available in America, harmonization efforts are currently in place to adapt ADCNTB3 for European populations.MethodThis study examined whether ADCNTB3 could be adapted to Singapore (multi‐ethic Asian population), a culture distinctly different from America, and whether ADCNTB3 demonstrates measurement equivalence when adapted to the Singapore population. Following the qualitative process of cultural adaptation, the ADCNTB3 was administered to 266 community‐dwelling older persons with normal cognition in Singapore. Scores from these participants were then compared with 1064 random samples with normal cognition from National Alzheimer’s Coordinating Centre (NACC) to evaluate whether the ADCNTB3 has equivalent scores across the two distinct populations. Score‐difference between the 2 populations was computed using multiple linear regression (adjusted for age, education, gender, family history of dementia, cardiovascular conditions, psychiatric and neurological history, smoking, untreated hearing loss, obesity, MoCA total score, CDR sum of boxes, NPI‐Q total score) and equivalence scores are considered to be present if the 90% confidence interval of the adjusted score‐difference fall within the equivalence margin. A priori, we defined the equivalence margin as 0.5 Standard Deviation of tests from ADCNTB3, as this often defines the minimally important clinical significance (Sloan et al., 2005).ResultOther than working and delayed memory tasks, all other tests from the ADCNTB3 are not directly equivalent. Notably, Asians performed better in visuospatial task, but consistently performed poorer in most other tasks.ConclusionOther than working and delayed memory tasks, all other tests from the ADCNTB3 are not directly equivalent. Notably, Asians performed better in visuospatial task, but consistently performed poorer in most other tasks.

Affordable, accessible, community‐delivered hearing care among individuals with cognitive impairment: Lessons from the HEARS RCT

AbstractBackgroundHearing loss is highly prevalent and associated with adverse health outcomes but undertreated among individuals with cognitive impairment, particularly African Americans. The incorporation of community health worker (CHW)‐partnered models may increase access and reduce disparities.The HEARS intervention is a hearing care program delivered by CHWs that provides a low‐cost amplification device. To assess the efficacy of CHW‐delivered hearing care provided to community‐dwelling older adults, including those with cognitive impairment, a randomized clinical trial was conducted.MethodAn open label randomized clinical trial took place in 13 community sites in Baltimore, Maryland. 348 older adults were screened and 151 participants with hearing loss were randomized to receive a CHW‐delivered hearing care intervention versus 3‐month waitlist control.The primary outcome was change in communication function (Hearing Handicap Inventory for the Elderly‐Screening [HHIE‐S]) from baseline to 3‐months post‐randomization. The average treatment effect was estimated using the doubly‐robust weighted least squares estimator. This pre‐specified subgroup analysis was stratified by cognitive status using the total MoCA score (≤25: cognitive impairment; post hoc sensitivity analysis using ≤22).ResultAmong 149 randomized participants with MoCA data, 100 individuals were cognitively impaired (Mean adjusted MoCA: 21(SD 3.5); 52% African American; 70% low‐income). At 3‐months post‐intervention, 66% with cognitive impairment reported daily device use versus 76% for those without cognitive impairment. Communication function significantly improved among individuals with cognitive impairment compared with the control, with an estimated average treatment effect of ‐13.92 HHIE‐S change (95% CI:‐16.84,‐10.86), comparable to those without cognitive impairment (‐11.47; 95% CI:‐18.04,‐4.17). Post hoc sensitivity analysis using a ≤22 MoCA cut‐off for cognitive impairment yielded similar findings.ConclusionAmong individuals with cognitive impairment, a CHW‐delivered low‐cost amplification device intervention, compared with a waitlist control, significantly improved communication function. The improvements were comparable to participants without cognitive impairment and similar in magnitude to improvements documented for older adults who received conventional clinic‐based hearing care with hearing aids fit by audiologists. To the authors’ knowledge, this trial was the largest trial to date of a hearing care intervention in the U.S. of African American older adults and low‐income older adults with hearing loss and cognitive impairment.

Montreal Cognitive Assessment MoCA‐XpressO: Validation of a Digital Self‐administered Cognitive Pre‐screening Tool for the General Adult Population

AbstractBackgroundThe population is aging worldwide, and the prevalence of Alzheimer’s dementia is expected to increase, adding demand for cognitive screening. A brief pre‐screening tool may allow self‐tracking of cognitive function and identify the “worried well” population, whom if pre‐screened will show no objective cognitive impairment, consequently reduce demand for cognitive screening. Therefore, we developed the MoCA‐XpressO, a brief home‐based cognitive pre‐screening tool. The purpose of this tool is to establish if further cognitive testing is necessary.MethodWe conducted a validation study for MoCA‐XpressO compared to MoCA test (version 8.1) as gold standard. Participants were recruited from MoCA clinic and a family practice. Ethics approval was received, and all participants provided informed consent. A crossover study design was applied to the MoCA‐XpressO and standard MoCA test; participants were randomized for the order of administration. Inclusion criteria included age ≥50, fluency in English and/or French, and minimum 6 years of education. Exclusion criteria included MoCA total score&lt;11, and completion of MoCA during recent 3 months. Logistic regression model was built, and the accuracy of the model was evaluated by the sensitivity, specificity, and area under the Receiver Operating Characteristic (ROC) curve.ResultThe MoCA‐XpressO evaluates 3 cognitive domains: processing speed, executive functions, and memory. Preliminary analysis (n = 44) showed a strong association between (1) MoCA Memory Index Score (MIS) and MoCA‐XpressO memory task score (p‐values&lt;.001); (2) MoCA Executive Index Score and MoCA‐XpressO logical task score (p‐values&lt;.03); and (3) total scores of MoCA test and MoCA‐XpressO (p‐values&lt;.005). The ROC curve of the logistic model has an Area Under the Curve (AUC) around 0.85. With a cutoff probability of 0.45, the sensitivity was 89.2% and the specificity was 62.5%; with a cutoff probability of 0.6, the sensitivity was 71.4% and specificity was 87.5%. Full analysis (n≥80) will be available in July 2023.ConclusionThe high values of AUC (0.85), indicate that MoCA‐XpressO may be strongly predictive of the standard MoCA. This suggests MoCA‐XpressO is a valid home‐based cognitive pre‐screening tool, also allowing self‐tracking of cognition over time. MoCA‐XpressO may differentiate the “worried‐well” from cognitively impaired population, consequently, reduce the high demand for cognitive screening in healthcare systems.

5 Antihypertensive Medication Use and Cognition in Older Adults

Objective:Hypertension is a common disorder that has been inconsistently associated with worse cognition in older adults. Antihypertensive medications offer treatment for high blood pressure but previous studies on the association between blood pressure, antihypertensive use, and cognitive performance in older adults have yielded inconsistent findings. Individuals without high blood pressure may also take antihypertensive medications for other medical conditions, including migraines. It is unclear whether antihypertensive medications have any effect on cognitive performance in older adults, and whether the differences, if any, are similar in hypertensives and normotensives.Participants and Methods:4,969 participants from the National Alzheimer Coordinating Center (NACC) database were included in this study (Mage=72.4 years, SD=7.3 years). Cognitive assessment included Letter Fluency, Category Fluency (animals and vegetables), Trail Making Test A &amp; B, Digit Ordering (forward and backward), and MoCA total score. Participants were included if they had a clinician diagnosis of hypertension or normotension and recorded history of whether they take any antihypertensive medication. Participants with a history of stroke were excluded. Cognitive differences between medication groups were investigated in hypertensive participants and normotensive participants using Bayesian Mann-Whitney tests.Results:Bayesian Mann-Whitney tests in hypertensive individuals showed no cognitive differences between those taking antihypertensive medications and those not taking antihypertensives (all BF10s &lt; 3). Bayesian Mann-Whitney tests in normotensive individuals showed individuals taking antihypertensive medications performed worse on Trail Making Test B compared to individuals not taking antihypertensives (123.6 seconds vs 108.8 seconds; BF10 = 35.1), with a small effect size (d=-.156).Conclusions:These results suggest that antihypertensive use in older adults with normal blood pressure may be associated with worse executive functioning. Antihypertensive use in normotensive older adults may lower blood pressure and reduce cerebral perfusion, resulting in worse cognitive functioning. Future studies should investigate long-term antihypertensive use and associated cognitive changes in both hypertensive and normotensive individuals.

36 Disparities in General Mental Status Between Lower and Higher SES Ethnically Diverse Older Adults

Objective:To investigate differences in performance on a widely used cognitive screener between community-dwelling older adults from two disparate socioeconomic groups.Participants and Methods:Participants were part of a larger study of cognitive screening in healthy older adults. The total sample (N=79, 69.6% female, 19% White/Caucasian, 12.7% Asian, 43% Latino/a, 25.3% Black/African-American) consisted of community-dwelling adults (Mage=73.1 years [SD=7.2] and Meducation=14.3 years [SD=2.6]) who were initially recruited via social media, flyers, and general community announcements. A lack of ethnic minority participants resulted in a two-year commitment to reach communities of color via visits and provision of health literacy to local religious and community programs. Continuous contact with leaders/gatekeepers helped establish research study credibility and forge a stronger sense of trust among ethnically diverse participants in the greater Houston, TX, area. Testing was initially conducted at the clinical study site. Due to low participation rates among people of color, greater effort was placed on tailored strategies to overcome economic and time constraints (i.e., schedule/time conflicts, lack of transportation, inability to pay for parking). To fit the priorities and needs of the participants, testing was also conducted at their homes (25.3%) and nearby religious and community centers (22.8%). Participants identifying as Latino/a or Black were predominantly recruited and tested at their local community center (as requested by gatekeepers/participants) to increase access to the study, in contrast to Caucasian participants. Median income estimates were used to stratify participants by socioeconomic status (SES) based on zip codes into low SES (L-SES) or high SES (H-SES) groups.Results:Participants from the L-SES group had significantly lower total scores on the MoCA than their H-SES counterparts, t(77J=2.837, p=0.003, g=0.696. The average MoCA total score for participants from the L-SES group was 2.64 points lower. The observed differences in MoCA total score when stratifying by ethnicity may be attributable to differences in education level and SES, which are known risk factors for cognitive impairment and will be further examined upon recruitment completion.Conclusions:Studies have found that ethnically diverse older adults not only encounter more barriers to accessing quality health care but also experience disparities in brain health research. Communities of color comprise a sizeable portion of our older adults but have been traditionally underrepresented in clinical research, limiting the generalizability of research findings to clinical treatment. Socioeconomic deprivation has been identified as one of several barriers to research engagement for people of color, placing ethnic communities at increased risk for under- or misdiagnosis and limited access to medical intervention. Preliminary findings have implications for the recruitment of ethnically diverse groups in clinical research. Given the growing racial and ethnic diversity among the United States population, we must do our due diligence to increase understanding of participation and recruitment barriers for racial/ethnic individuals. Tailored community outreach and engagement strategies may be effective in improving the inclusion of ethnically diverse populations and facilitating recruitment and retention in clinical research studies.

Evaluation of non-motor symptoms in cervical dystonia, hemifacial spasm, and blepharospasm patients and their correlation with motor symptoms.

Awareness of non-motor symptoms has been increasing in recent years, but there are still few studies on this topic. Our aim was to evaluate various non-motor symptoms, especially psychiatric disorders, cognitive status, and sleep, in cervical dystonia (CD), hemifacial spasm (HFS), and blepharospasm (BPS) patients and to investigate whether these symptoms are related to the severity of motor symptoms. This was a single-center cross-sectional, observational, case-control study. Motor severity scales were used to determine disease severity. We evaluated non-motor symptoms with commonly used scales. A total of 73 patients and 73 control groups participated. In CD patients, the MoCA total score, 'language', 'abstraction', and 'orientation' scores were statistically significantly lower; PSQI, ESS, and NMSQ scores were statistically significantly higher than controls. In the BPS group, the MoCA total score and the 'language' score were significantly lower, and the NMSQ score was statistically significantly higher than the controls. In the HFS group, MoCA total score, 'executive functions', 'language', and 'abstraction' scores were statistically significantly lower; PSQI scores are statistically significantly higher than controls. There was a positive correlation between the severity score and the PSQI score in the CD group and between the severity score and the NMSQ score in the BPS group. All three groups had significant cognitive impairments. In CD, BPS, and HFS, non-motor symptoms are apparent with undeniable frequency in addition to common motor symptoms. Importantly, these NMS may cause significant deterioration in the quality of life of the patients.

Cognitive Impairment and Risk Factors in Post-COVID-19 Hospitalized Patients

Introduction: Numerous reports regarding cognitive deficits after the coronavirus disease 2019 (COVID-19), described as “brain fog,” have been published. However, the clinical presentations and risk factors of post-COVID-19 cognitive impairment are controversial. This study aimed to assess (a) the prevalence of cognitive impairment after COVID-19 hospitalization, (b) characteristics of the cognitive deficits, (c) risk factors of post-COVID-19 cognitive impairment, and (d) comparison of cognitive function between post-COVID-19 patients and healthy people. Methods: The study comprised 34 SARS-CoV-2-infected patients, admitted to the Neurological Institute of Thailand during the peak of COVID-19 pandemic in 2021–2022. These patients came for neuropsychological and clinical evaluations at 2-week follow-up visit. The cognitive impairment and characteristics were measured by TMSE and MoCA. Clinical risk factors and post-COVID-19 cognitive impairment were assessed. The comparison of cognitive function in post-acute COVID-19 patients and 22 healthy controls was also performed. Results: The prevalence of post-COVID-19 cognitive impairment defined by a total MoCA score below 25 points was 61.76%. Years of education were the only predictive factors related to cognitive impairment. Our multivariate analysis revealed no statistical difference in cognitive outcomes between post-acute COVID-19 patients and healthy controls. Conclusion: This study showed a moderate prevalence of cognitive dysfunction after COVID-19 hospitalization similar to previous reports. However, there was no significant difference in cognitive measurements between these patients and healthy people. Whether SARS-CoV-2 infection causes cognitive dysfunction is a myth or fact that still has a long way to prove via further longitudinal study.

Improvements in Montreal Cognitive Assessment scores after neurobehavioral therapy in adults with functional (nonepileptic) seizures and traumatic brain injury

Cognitive functioning impacts clinical symptoms, treatment response, and quality of life in adults with functional/nonepileptic seizures (FS/NES), but no study to date examines effects of behavioral FS/NES treatment on cognition in these patients. We hypothesized that there would be a reduction in cognitive symptoms in participants with FS/NES and traumatic brain injury (TBI) following neurobehavioral therapy (NBT). We also hypothesized that select seizure-related, medication, subjective cognitive, and mental health symptoms would be negatively correlated with improvements in cognitive performance after NBT. Participants were 37 adults with TBI + FS/NES and 35 adults with TBI only, recruited from medical centers in the northeastern or southeastern U.S. TBI + FS/NES participants completed a 12 session NBT intervention, and TBI without seizures participants were not treated. All participants completed pre-post assessments of cognition (Montreal Cognitive Assessment [MoCA]) and baseline sociodemographic factors and mental health symptoms. Pre-post MoCA scores increased significantly in TBI + FS/NES participants (28/37 [75.7%] improved) but not in TBI comparisons (10/35 [28.6%] improved). Language, memory, and visuospatial/executive functions, but not attention, improved over time in the TBI + FS/NES group. Gains in cognition were concentrated in those TBI + FS/NES participants with likely baseline cognitive impairments (MoCA total score <26), and 9/17 of these participants moved from the “impaired” range at baseline (<26) to the “intact” range at endpoint (≥26). Lastly, participants taking fewer medications and reporting lower subjective cognitive difficulties at baseline showed larger pre-post MoCA total score improvements. Overall, results from this study suggest the potential for positive change in cognition in FS/NES and co-occurring TBI using evidence-based psychotherapy.