Montreal Cognitive Assessment Questionnaire Research Articles

Effects of Conventional versus Virtual Reality-simulated Treadmill Exercise on Fatigue, Cognitive Function, and Participant Satisfaction in Post-COVID-19 Subjects. A Randomized Trial

Background/ObjectivePost-COVID-19 subjects typically experience symptoms of fatigue, cognitive impairment, and sleep difficulty, which can be relieved by conventional aerobic exercise. Virtual Reality (VR) technology to support conventional exercise has recently gained much attention. Therefore, this study aimed to assess the effects of traditional treadmill exercise compared to virtual reality-simulated treadmill exercise on fatigue, cognitive function, sleep quality, and participant satisfaction with the exercise program in post-COVID-19 subjects. MethodsThis single-centered, randomized, parallel-group intervention study was conducted between December 2021 and March 2022. Sixteen of twenty post-COVID-19 subjects completed this study (n1=8, n2=8). Inclusion criteria were persistent dyspnea/fatigue, mild cognitive problems, and age 30–60 years. Exclusion criteria were previous severe COVID-19 infection and ICU admission, concomitant respiratory or cardiovascular disease, and musculoskeletal or neurological disease. Eligible subjects were assigned randomly to two groups: a non-VR group that received traditional treadmill aerobic exercise only and a VR group that received treadmill exercise with non-immersive VR. Both groups received moderate-intensity exercise on a treadmill at [50–60% (peak HR－resting HR) + resting HR] for 30–45 min, three times per week, and for four weeks. The outcome measures were the Chalder Fatigue Scale, Montreal Cognitive Assessment (MoCA) questionnaire, Pittsburgh Sleep Quality Index (PSQI), and participant satisfaction with the exercise program rated on a 5-point Likert scale. ResultsBoth groups showed significant improvements in the Chalder Fatigue Scale, the MoCA questionnaire, and the PSQI scores after training compared to baseline (p<0.05), without significant differences between them (p>0.05). However, participant satisfaction with the exercise program was significantly higher in the VR group than in the non-VR group (p=0.037). ConclusionA moderate-intensity 4-week treadmill exercise program with and without non-immersive VR may improve fatigue, cognitive function, and sleep quality to the same extent in COVID-19 survivors. However, participant satisfaction with the exercise program could be greater after conventional treadmill training assisted by non-immersive VR than after conventional treadmill training alone in this cohort. Trial registrationPan African Clinical Trials Registry, PACTR202311561948428, retrospectively registered

Attenuated adiponectin, omentin, increased interleukin-6 and tumor necrosis factor-alpha levels with altered cognition and depression in non-Hodgkin lymphoma patients: A case-control study

Background and purposeImmune dysfunction is one of the risk factors which plays an important role in the development of non-Hodgkin lymphoma (NHL), and inflammation may be involved in its etiology. Minimal data is available on the effect of cytokine levels on neurobehavioral function in lymphoma before the initiation of chemotherapy. Therefore, we aimed to explore the risk of NHL by assessment of cytokine and adipokine levels and their correlation with neurobehavioral changes. MethodsThis case-control study enrolled 62 subjects (age-sex matched: 31 cases and 31 controls). Neurobehavioral assessment was done using Montreal Cognitive Assessment questionnaire (MoCA) and Patient Health Questionnaire (PHQ-9). EORTC Core Quality of Life questionnaire (EORTC QLQ-C30) was used to assess quality of life. Questionnaire assessment and sample collection were done after the patient enrolment and before first cycle of chemotherapy. ResultsMean age of NHL patients and healthy controls was 51.9 ± 11.8 and 50 ± 10.9 years, respectively. NHL patients showed significantly higher levels of IL-6 (0.77 ± 0.11) and TNF- α (1.47 ± 1.31) than controls (0.55 ± 0.4 and 0.66 ± 0.89, respectively) with p-value<0.005. Also, NHL patients showed significantly lower levels of adiponectin (0.31 ± 0.24) and omentin (0.46 ± 0.1) than controls (0.42 ± 0.13 and 0.53 ± 0.11, respectively) with p-value<0.005. Lower MoCA and EORTC QLQ C-30 scores and higher PHQ-9 scores were observed in NHL patients in comparison to healthy control. ConclusionOur results showed that adiponectin, omentin IL-6 and TNF-α may be used as pre-diagnostic markers of NHL risk. Neurobehavioral changes observed in NHL patients may alter the quality of life.

Anti-CGRP monoclonal antibodies improve cognitive function in patients affected by chronic migraine complicated with medication overuse-headache

Background: Migraine represents one of the most disabling neurological diseases in the world. This burden is primarily due to recurrent pain episodes, alongside cognitive function impairments that patients may experience. This paper aims to explore the effect of three anti-calcitonin Gene-Related Peptide (CGRP) monoclonal antibodies (mAbs) – erenumab, fremanezumab, and galcanezumab – on the cognitive performance of a sample of patients suffering from migraine using the Montreal Cognitive Assessment (MoCA) questionnaire.Methods: A total of 215 patients suffering from migraine who visited the Modena Headache Center were enrolled. The MoCA questionnaire was filled in by the patients at the baseline and subsequent assessments were conducted at 6 and 12 months thereafter. Additionally, patients were requested to complete the 6-item Headache Impact Test, Migraine Disability Assessment Score, and Hospital Anxiety and Depression Scale every three months.Results: The sample was composed of 82% of female participants and 87% of the enrolled patients were diagnosed with chronic migraine. Following one year of treatment, there was a significant enhancement observed in MoCA scores compared to baseline measurements. Moreover, higher consumption of analgesics, elevated body mass index (BMI), and prolonged chronic migraine history exhibited an inverse correlation with MoCA score improvements after 12 months.Conclusions: Erenumab, fremanezumab, and galcanezumab have proven to be effective in relieving the cognitive impairment associated with migraine after 1 year of treatment. These findings underscore the reversibility of cognitive impairment among migraine sufferers, even among those suffering from chronic migraine, as delineated by the majority of the patients under study. This study revealed that prolonged chronic migraine history, higher baseline analgesic intake, and elevated BMI were all predictive of diminished cognitive enhancements following treatment.

Validity and reliability of a digital solution for cognitive assessment: The Brain on Track®.

Cognitive assessment and the early detection of cognitive impairments have been enhanced by the use of remote digital solutions. The Brain on Track® is one of these digital solutions used in clinical practice for online screening and monitoring of cognitive functioning. This study aimed to explore the validity and reliability of the Brain on Track® computerized test on a tablet device in adults. A community sample of 54 young adults, 51 middle-aged adults, and 50 older adults were invited to attend in two assessment sessions. The first session included data collection on sociodemographic data, user digital literacy, Brain on Track® on the computer and on the tablet device, and usability from the user and moderator perspective. The second session included the Montreal Cognitive Assessment Questionnaire (MoCA) and a second completion of the Brain on Track® on tablet to assess the criterion validity and test-retest reliability. Hypothesis testing was used to assess construct validity. A weak to moderate correlation was found between the Brain on Track® tablet score and the MoCA. The ICC was 0.72, 0.84, and 0.79, and Cronbach's alpha was 0.84, 0.83, and 0.89 in young adults, middle-aged adults, and older adults, respectively. This study suggested that the Brain on Track® administered using a tablet device has criterion validity, particularly in middle-aged and older adults, and internal consistency and test-retest reliability in adults of any age group.

Vitamin D Deficiency as a Factor Associated with Cognitive Impairment in Patients with Type 2 Diabetes Mellitus

Objective: Vitamin D as an essential nutrient is increasingly being studied and reported to have roles in diabetes and cognitive function through its antioxidant, anti-inflammatory, and neuroprotective functions. This study aimed to investigate vitamin D deficiency as a factor associated with cognitive impairment in Type 2 Diabetes Mellitus patients. Materials and Methods: This case-control study was conducted at the diabetic center and neurology outpatient clinic at Prof. Dr. I.G.N.G Ngoerah Hospital in Denpasar, Indonesia between September and December 2022. Cases had a score of &lt; 26 on the Montreal Cognitive Assessment questionnaire (Indonesian version) controls had a score ≥26. Vitamin D levels were assessed using serum 25-hydroxyvitamin D levels. The cut-off for vitamin D deficiency was obtained through the receiver operating curve characteristic. Results: In total 31 cases and 31 controls were included. The cut-off for vitamin D deficiency was &lt;24.6 ng/ml. Patients with T2DM and vitamin D deficiency had an increased association with cognitive impairment (OR 3.8; 95% CI [1.1 to 13.4]) compared to patients without vitamin D deficiency. Other independent factors associated with cognitive impairment in T2DM were low education levels (OR 5.4; 95% CI [1.3 to 22.2]) and diabetes duration of more than 5 years (OR 4.1; 95% CI [1.1 to 14.4]). Conclusion: Vitamin D deficiency is one of the factors associated with cognitive impairment in T2DM patients.

The effects of Brazilian dance, deep-water exercise and nordic walking, pre- and post-12 weeks, on functional-motor and non-motor symptoms in trained PwPD

BackgroundMotor and non-motor symptoms affect functional autonomy, mobility and daily life activities in People with Parkinson's Disease (PwPD). Brazilian Dance (BD), Deep-water exercise (DWE), and Nordic Walking (NW) are well-accepted, low-cost, and safe non-pharmacological strategies for untrained PwPD. However, no previous studies have investigated and compared the effects of these interventions on trained PwPD. ObjectiveTo describe and compare the effects of BD, DWE and NW, pre- and post-12 weeks, on functional-motor and non-motor symptoms in trained PwPD. MethodsEighty-three trained PwPD were randomly assigned into three groups: BD (n = 31), DWE (n = 21) and NW (n = 31), that participated in one of the interventions for 12 weeks. We applied Timed up and go at two speeds (self-selected and fast); 6-min and 10-meter walk test; Sit-to-Stand and handgrip test; Unified Parkinson Disease Rating Scale - III; Falls Efficacy Scale; Montreal Cognitive Assessment questionnaire; and Parkinson's Disease Questionnaire-39. The main (group and time) and interaction effects were analyzed using GEE analysis (p<0.05). ResultsStatistical differences were found between groups in the handgrip test (p<0.01), the time (p = 0.04), and interaction group*time (p< 0.01) in the Sit-to-stand test. While BD improved the Sit-to-stand test performance (ES=1.00; large effect size), DWE and NW remained unchanged (ES=0.16 and ES=0.14; low effect size). ConclusionBD, DWE, and NW maintained most of the functional-motor and non-motor symptoms in trained PwPD. BD was shown to be more effective at improving strength in the lower limbs, when compared to NW and DWE.

Medication Use Status and Its Related Factors among Older Adults in Kerman, Iran

Introduction: Older adults are the largest group of medication users in each society. Since medications act differently in seniors compared with younger patients, great considerations are required regarding the effects and side effects of medications in the older adults. The present study aimed to determine the status of medication use and its related factors among older adults in Kerman city, Iran.&#x0D; &#x0D; Methods: In the cross-sectional study, 388 seniors were selected using multistage cluster sampling from the population covered by comprehensive health centers in Kerman in 2021. Demographic information questions (age, gender, education level, marital status, life status, substance abuse, income, and health insurance status), a question regarding medication usage status and a question regarding disease that the elderly are currently suffering from, Montreal Cognitive Assessment Questionnaire, Geriatric Depression Scale, and Sleep Disorder Questionnaire were used for data collection. The data were analyzed using SPSS software by running Chi-square and multiple logistic regression tests.&#x0D; &#x0D; Results: The average number of medications used per day was 4.59 and 53.5% of the participants used five or more medications concomitantly. Antihypertensive medications had the highest prevalence (64.3%) followed by anti-hyperlipidemic (43.6%) and Supplements (41.3%). A significant correlation was found between the participants' frequency of medication use and their gender, income, primary insomnia, and cognitive impairment (p &lt; 0.001). However, medication use had no significant association with the senior's age, marital status, education level, living status, substance abuse, and health insurance (p &lt; 0.05). The risk of polypharmacy was 2.15 times higher in the elderly women than men (p = 0.001) and 0.45 times higher in participants with depression than non-depressed seniors (p = 0.011).&#x0D; &#x0D; Conclusion: The high prevalence of polypharmacy indicates an unfavorable status of medication use among older adults in Kerman. So, authorities are required to provide educational information about polypharmacy to aged groups.

Effect of antiparkinsonian medication on spatiotemporal gait parameters of individuals with Parkinson’s disease: comparison between individuals with and without freezing of gait

BACKGROUND: The gait of individuals with Parkinson’s disease (PD) tends to be slower, characterized by narrow and short steps. During the medication, the self-selected gait speed of individuals with PD increases. However, when looking individually at the spatiotemporal parameters of gait, the medication induces different and not always consistent effects. However, the effects of medication and freezing of gait during walking in individuals with PD are unknown. AIM: To analyze the effect of antiparkinsonian medication and freezing of gait (FoG) on spatiotemporal gait parameters in individuals with PD. METHOD: For this purpose, we compared gait parameters in individuals with FoG (freezers, n=11) and without FoG (non-freezers, n=11). Spatiotemporal gait parameters (speed, cadence, step length, step time, step width, stride length, stride time, swing phase, and double support) and clinical scales (parts II and III of the Unified Parkinson’s Disease Rating Scale, Hoehn and Yahr, Montreal Cognitive Assessment questionnaire and Mini-Test scale of Balance Assessment System) were analyzed in two experimental sessions, counterbalanced between individuals: one in the ON medication state (1h after ingestion), and another in the OFF medication state (~12h after the last ingestion). Linear mixed effects models 2-groups X 2-conditions were used. RESULTS: We found that gait speed, stride, and step length were significantly higher in the ON than in the OFF condition for both freezers and non-freezers, and significantly lower in the freezers than in the non-freezers, regardless of the medication state. CONCLUSION: These results indicate that medication improved gait performance equivalently in both freezers and non-freezers.

Assessment of Preoperative and Postoperative Cognitive Performance in Asymptomatic Patients Undergoing Carotid Endarterectomy: A Pilot Study

The association between vascular cognitive impairment and carotid stenosis and the possible improvements in vascular cognitive impairment favored by the intervention of carotid endarterectomy (CEA) have not yet been clearly defined. The aim of this pilot study was to prospectively evaluate whether cognitive functions can be influenced by carotid endarterectomy performed in patients with asymptomatic severe carotid stenosis. From January to August 2022, 105 consecutive CEAs were performed in patients with severe asymptomatic carotid stenosis at our institution. Of these, 28 provided informed consent for inclusion in the study and were therefore enrolled, representing our study group. The evaluation of the cognitive functions was made by using the Montreal Cognitive Assessment (MoCA), which was administered to the participants at the moment of the preoperative anesthesiologic assessment, usually between 1 and 7 days prior to surgery. Following the intervention and within the third postoperative month, a clinical and instrumental control visit was performed and during that visit the MoCA questionnaire was again administered to the patients. A comparison between the mean corrected pre- and postoperative values of the MoCA questionnaire was performed using Student t test. Multivariate analysis for the factors affecting the lack of postoperative improvement was performed. Patients were more frequently male (18 patients, 64%) with a mean age of 74.4 ± 7.9 years. The mean MoCA test value in the preoperative was 22.68 ± 3.34, thus slightly below the threshold value for identifying the presence of cognitive impairment. The distribution of the values followed a normal pattern. There were nor perioperative deaths neither neurological events. All the patients had their 3-month reevaluation; no neurological events were detected in this period. At the three-month follow-up, the mean MoCA test score was 23.4 ± 3.4, with a statistical trend toward significant improvement (P = .08; 95% confidence interval, −1.8 to 0.34). The most noticeable improvements were found in the visuospatial, language and abstraction domains, while they were less marked in the domains of attention and memory. Multivariate analysis for the factors affecting the lack of postoperative improvement showed a trend toward worse results in diabetic patients, in those with silent ipsilateral brain lesions and in those on neuropsychiatric drug therapy. Our pilot study, consistently with the literature, confirmed a mild cognitive improvement after CEA performed in asymptomatic patients; however, larger studies with a higher number of patients and a longer follow-up are necessary before considering the possibility of suggesting CEA in order to prevent or reverse cognitive decline.

Impact of CPAP Therapy Adherence on Global Cognition in Patients with Moderate to Severe Obstructive Sleep Apnea: A One-Year Follow-Up.

Background: Obstructive sleep apnea increases (OSA) cognitive impairment risk. The objective of this study was to determine the impact of continuous positive airway pressure (CPAP) adherence on global cognition using the Montreal Cognitive Assessment questionnaire (MoCA). Materials and Methods: Thirty-four new patients diagnosed with moderate or severe OSA (apnea-hypopnea index AHI ≥ 15 events/h) from the CPAP group were compared with thirty-one moderate to severe OSA patients from the no-CPAP group. In addition, all patients completed the MoCA test, a patient health questionnaire (PHQ-9) for depressive symptoms, and a generalized anxiety questionnaire (GAD-7) for anxiety symptoms, at baseline, after 6 months, and after 1 year. Results: At baseline, there were no significant differences between the two groups regarding total MoCA scores, 20.9 ± 3.5 CPAP group to 19.7 ± 2.9 no-CPAP group (p = 0.159), PHQ-9 (p = 0.651), and GAD-7 (p = 0.691). After one year, improvement was observed for a total MoCA score of 22.7 ± 3.5 (p < 0.001) for the CPAP group, and significant variance of score between groups was more accentuated for delayed recall and attention (p < 0.001) sub-topic. Moreover, PHQ-9, GAD-7 scores, and the Epworth Sleepiness Scale (ESS) decreased significantly (p < 0.001) after CPAP therapy. The MoCA score was significantly correlated with years of education (r = 0.74, p < 0.001) and had a negative correlation with body mass index (BMI) (r = -0.34), ESS (r = -0.30) and PHQ-9 (r = -0.34). Conclusions: One year of CPAP adherence improved global cognition associated with OSA.

HEART RATE VARIABILITY AND BRAIN FUNCTIONING IN HYPERTENSIVE PATIENTS

Objective: Decreased heart rate variability (HRV) reflecting autonomic nervous dysfunction has been associated with increased mortality in cardiovascular diseases. Less is known about the relationship between HRV and hypertension associated cognitive impairment. The study aimed to compare HRV parameters in well-controlled hypertensive patients with and without cognitive dysfunction, as marker of functional brain damage caused by hypertension. Design and method: Data about 226 hypertensive patients were obtained, 53% males, between 37 and 98 years (mean age 66 years ± 10). The mean blood pressure was 135/81 mmHg (±19/11 mmHg) (under hypertensive medication). Cognitive abilities were measured with the multi-domain Montreal Cognitive Assessment questionnaire (MoCA) defining cognitive decline below 24 points. All patients had 24- hour Holter monitoring. Time domain [pNN(50), NN(50) SDNN, rMSSD] and the LF/HF frequency domain HRV parameters were analyzed in patients with normal and impaired cognition, and in different cognitive domains with the IBM SPSS v20 software. Results: Cognitive dysfunction was present in 63.73% of the studied group. Time domain parameters pNN(50), NN(50) and r MSSD were significantly higher in patients with altered cognition (p = 0.002, p = 0.001, p = 0.02). Frequency domain HF was also significantly higher in this group (p = 0.03). Male individuals had significantly higher LF/HF ratio (men 1.08% vs. women 0.97%, p = 0.006). Patients with hypertension grade II had higher LF/HF ratio compared to grade III (1.069 vs. 0.98%, p = 0.01). Analyzes of cognitive domains in the total study group revealed low SDNN, rMSSD values in language, abstraction domains, with statistical significance in the domains of visuospatial-executive (SDNN p = 0.013, rMSSD p = 0.001) and attention (SDNN p = 0.044). Higher LF/HF ratio was found in all cognitive domains, excepting attention, with statistical difference in delayed recall (p = 0.015). Conclusions: Our data suggest a gender difference regarding sympathovagal balance in hypertensive patients with enhanced sympathetic activity in males. Although higher HRV was observed in cognitively impaired well-controlled hypertensive patients, time domain HRV parameters reflecting impaired autonomic nervous function were related to some specific cognitive domains. Future studies are needed to better understand these findings.

Differences in Health Literacy of Older Adults According to Sociodemographic Characteristics

BACKGROUND: The research is based on the concept of health literacy. This is the “sixth vital sign” to navigating the healthcare system and raising self-efficacy in the field of healthcare.&#x0D; AIM: The study aim was to present the health literacy of the elderly in the Savinja statistical region in Slovenia.&#x0D; METHODS: The study was based on a non-experimental quantitative research approach. The study included 199 elderly people aged 65 and more, without the presence of dementia. The data were collected using the Health Literacy and Montreal Cognitive Assessment questionnaire. We used a non-random, convenience sampling.&#x0D; RESULTS: We established that in the study population, 64.8 % of the population was below the level of acceptable general health literacy, whereas only 3.5 % of this population had an excellent level of health literacy. Statistically significant differences in the level of health literacy are shown in the field of healthcare treatment in older adults living with their families (F = 5,198; p ˂ 0,001). Respondents who engaged in activities in day care centres also had a higher level of health literacy (t = 3,738; p &lt; 0,001). People with low health literacy, who use health services more frequently, should be given access to health education, based on individual presentation of contents, supported by andragogical knowledge.&#x0D; CONCLUSION: The health literacy of older adults is the basis for their greater care for their own health and a better quality of life.

Psychiatric and cognitive comorbidities of persistent post-traumatic headache attributed to mild traumatic brain injury

ObjectiveTo investigate the association of psychiatric and cognitive comorbidities with persistent post-traumatic headache (PTH) attributed to mild traumatic brain injury (TBI).MethodsA total of 100 patients with persistent PTH attributed to mild TBI and 100 age- and gender-matched healthy controls free of mild TBI were enrolled between July 2018 and June 2019. Quality of sleep was evaluated using the Pittsburgh Sleep Quality Index, while symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Cognitive impairment was evaluated using the Montreal Cognitive Assessment questionnaire, while post-traumatic stress disorder (PTSD) was assessed using the Harvard Trauma Questionnaire.ResultsIn 100 patients with persistent PTH, 85% reported poor quality sleep, compared with 42% of healthy controls (P < 0.01). The relative frequency of probable to high risk of anxiety was 52% in the persistent PTH group vs. 8% in healthy controls (P < 0.01), while the relative frequency of probable to high risk of depression was 42% in the persistent PTH group vs. 2% in healthy controls (P < 0.01). Furthermore, 27% of the patients with persistent PTH had mild cognitive impairment while 10% had probable PTSD.ConclusionsPoor quality of sleep as well as symptoms suggestive of anxiety and depression were more common in patients with persistent PTH than healthy controls. Clinicians should screen patients with persistent PTH for these comorbidities and develop treatment plans that account for their presence.

Cognitive function in methadone maintenance patients compared with abstinent opioid users

Background Opioid is the second most prevalent illicit drug worldwide, whose consumption is very high in Iran, due to Iran’s geographical proximity to producing countries. Methadone maintenance therapy is one of the most prevalent and accepted methods of substance abuse treatment. Nevertheless, cognitive disorders have been reported as one of its complications. Aim This study was conducted to evaluate cognitive impairment in methadone maintenance patients (MMPs) and to compare it with abstinent opioid users (AOUs). Materials and Methods This cross-sectional analytical study was performed on 25 MMPs and 25 AOUs. Samples were selected through convenience sampling method whereby a self-made questionnaire was distributed among them to assess demographic information, clinical variables such as methadone and opioid use history, underlying disease and medication history, as well as 13-item Beck depression inventory. Then, they were interviewed using the Montreal Cognitive Assessment (MoCA) questionnaire. Results Significant differences were found in MoCA questionnaire total scores (p = 0.018) and orientation to time and place dimension (p = 0.008) between the two groups, with the mean scores being higher in AOU group. Duration of opioid use was the only factor influencing cognitive assessment score in both Groups. (p = 0.029) Conclusion We suggest monitoring and assessing cognition function in patients receiving methadone especially for those with a long history of opioid use.

Neuro-Cognitive Profile of Morning and Evening Chronotypes at Different Times of Day.

Background:Chronotype is the circadian time preference for sleep–wake timings. However, its impact on cognitive performance is least explored.Objective:The present study investigated the effect of chronotype (morning “M” vs. evening “E”) on cognitive measures as a function of time of the day. In addition, the correlation between electroencephalogram (EEG) waves and subjective/objective cognitive measures were investigated.Method:Cognitive status of 28 adult male subjects (15 “M” and 13 “E”) was assessed objectively through event-related potential (ERP) by administering visual odd ball paradigm test and subjectively through Montreal Cognitive Assessment questionnaire. In addition, 20 to 30 min of resting EEG was recorded. Recordings were done from 8 to 10 am and from 4 to 6 pm on a single day. Power spectral analysis of EEG for alpha and beta waves at PZ and FZ cortical sites was done after subjecting selected epochs to fast Fourier transformation. Also, latency and amplitude of P300 potential from event-related potential record were measured. Appropriate statistical tests were applied for analysis.Results:Higher alpha and beta power was observed in “E” at PZ in the evening. “M” showed increased P300 latency and amplitude during evening session for frequent and rare stimuli and vice versa in “E.”’ Significant negative correlation was seen between latency of rare stimuli and alpha and beta power at FZ site during evening in “E” chronotype only.Conclusion:Result indicates better attention and alertness during evening hours in evening chronotypes and vice versa in morning chronotypes. The findings could be implemented to schedule the mental performance/cognitive load according to individual chronotype.

Vitamin D, Oxidative Stress and Cognition in Diabetes Mellitus

Introduction: Diabetes is a very common disease that affects almost all body systems. Of late recent studies have determined that vitamin D deficiency can cause several diseases such as diabetes, cardiovascular complications etc. Oxidative stress is an imbalance between free radicals and antioxidants in the body. Vitamin D is an antioxidant and its deficiency can cause oxidative stress .Thus vitamin D deficiency by itself and by causing oxidative stress can increase risk of developing diabetes Hyperglycemia can affect cognition. Oxidative stress too can affect cognition. Studies done studying the role of vitamin D affecting cognition especially in diabetics are very few. Aim: To determine the role of vitamin D in affecting cognition in Diabetic patients. To determine the correlation between vitamin D, oxidative stress and cognition in diabetes . Materials and Method: Comparative cross sectional study 100 Diabetes patients were studied. Exclusion Criteria: Hypertensives, alzheimers disease, dementia, bone diseases, epileptics, taking calcium or vitamin d supplements, hypo or hyperparathyroidism, thyroid disorders. After obtaining ethical approval from the institution a structured questionnaire was given to all. Fasting blood glucose levels was determined by GOD-POD Method. Hba1c was determined by Immunoturbidometry. Vitamin D was determined by ELISA method. Oxidative stress (malonylaldehyde) was measured by manual TBARS(Thiobarbituricacid reactive substances method) Cognition was assessed using Montreal cognitive assessment questionnaire. All tests were carried out at the central lab of Sree Balaji Medical College and Hospital,Chennai. Results were analysed using Microsoft excel. Results: A negative correlation was seen between vitamin D and MOCA scores. A positive correlation was seen between MDA and MOCA scores. Conclusion: Vitamin D deficiency causes oxidative stress and affects cognition in diabetics. Vitamin D supplementation can be considered to reduce oxidative stress and thus improve cognition in diabetes mellitus patients.

Prevalence of cognitive impairment using the Montreal Cognitive Assessment questionnaire among patients with systemic lupus erythematosus: a cross-sectional study at two tertiary centres in Malaysia.

Cognitive impairment is a common neuropsychiatric manifestation of systemic lupus erythematosus (SLE). However, it is not routinely assessed for despite its high prevalence and significant disease burden. This study aimed to determine the prevalence of mild cognitive impairment (MCI) using the Montreal Cognitive Assessment (MoCA) and its associated factors among patients diagnosed with SLE in Malaysia. A total of 200 SLE patients were recruited prospectively from the outpatient clinics of two tertiary hospitals in Malaysia. Standardized clinical interview was utilized to obtain information on socio-demographic characteristics. All patients were then assessed using the MoCA questionnaire for presence of cognitive impairment; the Patient Health Questionnaire 9 (PHQ-9) for presence of depressive symptoms; and the Wong-Baker Faces Pain Scale (WBFPS) for severity of pain. The evaluation of disease activity and severity were performed by the treating rheumatologists and nephrologists using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics Damage Index (SLICC DI). The prevalence of MCI was 35%. The significant associated factors from the bivariate analysis were male gender (p = 0.04), educational level (p = 0.00), WBFPS score (p = 0.035) and anticardiolipin IgM (p = 0.01). Further analysis using logistic regression model found that male gender (OR = 7.43, 95% confidence interval 1.06-52.06, p = 0.04), lower educational level (OR = 4.4, 95% confidence interval 1.47-13.21, p = 0.01) and presence of anticardiolipin IgM (OR = 6.81, 95% confidence interval 1.45-32.01, p = 0.031) were associated with impaired MoCA scores. Also, increasing pain scores increased the risk of patients being affected by cognitive impairment. Over one-third of patients with SLE in our cohort were found to have MCI. Risk factors included male gender, lower educational level, higher pain score and presence of anticardiolipin IgM. Physicians are encouraged to perform routine screening to detect cognitive dysfunction in patients with SLE in their clinical practice as part of a more comprehensive management.

The Validity of the Montreal Cognitive Assessment for Moderate to Severe Traumatic Brain Injury Patients: A Pilot Study.

The aim of the study was to pilot the use of Montreal Cognitive Assessment as a quick clinical screen for cognitive assessment in traumatic brain injury patients. The study recruited 61 participants with moderate to severe traumatic brain injury presenting to a tertiary rehabilitation center under the Brain Injury Program. A Montreal Cognitive Assessment questionnaire and neuropsychological battery (Repeatable Battery for the Assessment of Neuropsychological Status and Color Trails Test) were administered to participants who had completed inpatient rehabilitation. Receiver operating characteristic analysis for the Montreal Cognitive Assessment revealed an optimal balance of sensitivity and specificity at 24/25 to discriminate participants who were classified as less than 5th centile on the Total Scale Index on the Repeatable Battery for the Assessment of Neuropsychological Status. This achieved a sensitivity, specificity, PPV, and NPV of 73.9%, 86.5%, 77.3%, and 84.2%, respectively. Receiver operating characteristic analysis for the trail making subtest of the Montreal Cognitive Assessment achieved a sensitivity, specificity, PPV, and NPV of 79.4%, 74.1%, 79.4%, and 74.1% in identifying patients classified as less than 5th centile on Color Trail Test part 2. The use of Montreal Cognitive Assessment displayed good validity in identifying patients with clinically significant impairment on a standard neuropsychological assessment battery in the study population. However, it may lack sensitivity for estimating mild levels of impairment.

Neuro-cognition in patients of Obstructive Sleep Apnoea Syndrome

Background: Obstructive Sleep Apnoea Hypoapnoea Syndrome (OSAHS) is known to be associated with impairment in neuro-cognitive functions. This impairment in cognition is associated with daytime sleepiness that results in occupational deficits and an increased risk of automobile accidents. Objectives: The aim of the study was to assess Neuro-cognition in patients of Obstructive Sleep Apnoea Hypoapnoea Syndrome (OSAHS) Material and methods: Our study was an observational cross-sectional study. Eligible patients (n=205) undergoing polysomnography were categorized into Snoring (n=105), Mild OSA (n=70), Moderate OSA (n=17) and Severe OSA (n=13) groups, based on Apnoea Hypoapnoea Index (AHI). The Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) Questionnaires were administered to assess their cognitive functions and the correlation between Questionnaire scores and severity of OSAS was determined. Results: MMSE Questionnaire detected overall cognitive impairment in 22% of OSA patients while as MoCA Questionnaire detected overall cognitive impairment in 33% of the same OSA patients. The frequency of mild neurocognitive impairment as detected by MMSE Questionnaire increased progressively as the severity of OSA increased from Snoring(6.7%) to Mild OSA(17.1%), Moderate OSA(29.4%) and severe OSA(38.4%). MoCA Questionnaire demonstrated the same pattern except that it was more sensitive. It detected cognitive impairment of 12.4% in Snoring group, 27.1% in Mild OSA group, 41.2% in Moderate OSA group and 53.9% in Severe OSA group. Conclusion: Neurocognitive impairment is common in patients with OSAHS. The MoCA is a more sensitive tool than MMSE for the assessment of mild cognitive impairment in OSAHS patients, whose performance on the MMSE is in the normal range.

Cognitive functions and white matter lesions on magnetic resonance images in a sample of normal Iranian population with cardiovascular risk factors

Due to a suggestive three-way relationship between brain structural disorders, microvascular lesions, and cognitive impairments, we aimed to examine the association of the volume and number of white matter hyperintensity lesions and lacunar infarcts with cognitive impairment among patients with cardiovascular risk factors in a sample of the Iranian population. This study was conducted on a total number of 156 normal subjects aged 30-74 years with cardiovascular risk factors. We used the Framingham general cardiovascular risk factors prediction model to calculate the likelihood of each risk factor. The total number of lacunar infarcts and the volume of white matter hyperintensity lesion were calculated in brain magnetic resonance imaging. Cognition status was assessed using the Montreal Cognitive Assessment questionnaire. An adverse association was revealed between Montreal Cognitive Assessment score and different cardiovascular risk profiles including the Framingham body mass index score ( p < 0.001) and the Framingham lipid score ( p < 0.001). The total volume of white matter hyperintensity was negatively associated with total Montreal Cognitive Assessment cognition score ( p < 0.001). Our study also showed an adverse association between total number of lacunar infarcts and total Montreal Cognitive Assessment cognition score ( p = 0.038) and with some cognition components including memory ( p = 0.013), attention ( p = 0.037), abstraction ( p = 0.046), and orientation ( p = 0.002). Periventricular lesions are associated with impaired memory, language, and visuoconstruction while subcortical lesions are associated with impairment in naming, attention, language, and abstraction functions in normal subjects with cardiovascular risk factors but without cardiovascular or cerebrovascular disorders.