Montreal Cognitive Assessment Scores In Group Research Articles

Effect of Nitrendipine and Amlodipine on Cognitive Functions of Patients with Arterial Hypertension

Background: Arterial hypertension (AH) is one of the main factors causing a high risk of cardiovascular complications and mortality. The existence of a relationship between high blood pressure (BP) and the risk of developing central nervous system pathology, primarily stroke, and cognitive impairment, has been shown. The purpose of this study was a comparative assessment of the effect of 12-month antihypertensive therapy (AHT) with the inclusion of nitrendipine (NIT) or amlodipine (AML) on cognitive functions (CF) in hypertensive patients. Methods and Results: The study included 111 patients of both genders aged 30-75 years with AH Grades 1-3 (ESC/ESH, 2018). All patients underwent the following examinations: assessment of traditional risk factors, physical examination, clinical and biochemical laboratory methods, 12-lead ECG, echocardiography, pulse contour analysis, and 24-hour ambulatory blood pressure monitoring, neuropsychological tests (Mini-Cog test, Montreal Cognitive Assessment (MoCA) test, Hospital Anxiety and Depression Scale (HADS), and self-assessment questionnaire for memory, attention, thinking, ability to cope with one's affairs, and ability to make decisions). After the screening stage, all patients were discontinued from previous therapy and assigned to the 2 regimes of AHT. Group 1 included 58 AH patients who received NIT as monotherapy or as part of combination AHT; Group 2 included 53 patients who received AML as monotherapy or as part of combination AHT. Correlation analysis between the parameters of DBPP and the MoCA test revealed a weak but statistically significant negative correlation between the total MoCA score and the average 24-h SBP (rs=-0.33, P=0.015). In addition, there was a weak but statistically significant negative correlation between the total MoCA score and the daytime SBP variability and daytime DBP variability (rs=-0.40 and rs=-0.35, respectively, P=0.000 in both cases). A weak but statistically significant negative correlation was found between the total Mini-Cog score and PWV and PPc (rs=-0.24, P=0.01 and rs=-0.27, P=0.007, respectively). Analysis of the office BP indicators showed high antihypertensive efficacy of 12-month therapy in both groups, regardless of the therapy regimens. A comparative analysis of the effect of AHT with the inclusion of NIT or AML on CF in AH patients showed the advantages of combined AHT with the inclusion of NIT. Amlodipine treatment did not significantly affect any test score. Thus, in Group 1, after 12 months of therapy, there was an increase in the total Mini-Cog score from 3.8±1.08 points to 4.55±0.75 points (P<0.001), while in Group 2, there was a non-significant decrease in this score from 4.26±0.98 points to 3.92±0.95 points (P>0.05). There was also an increase in the total MoCA score in Group 1 from 23.3±2.8 points to 25.08±2.6 points (P<0.001), while in Group 2, there was a non-significant decrease in this score from 24.06±2.73 points to 23.07±2.7 points (P>0.05). It should be noted that only in Group 1 did we find a significant improvement in CF, such as abstraction, delayed recall, memory, and attention, as well as a significant improvement in work-coping and decision-making. In Group 1, the HADS Depression score decreased from 4.6±3.7 points to 3.32±2.95 points (P<0.05), HADS Anxiety score decreased from 7.01±5.37 points to 4.95±3.75 points (P<0.02). At the same time, in Group 2, in contrast, the HADS Depression score and the HADS Anxiety score did not significantly change. Conclusion: A weak but statistically significant negative correlation was found between the total MoCA score and the daytime SBP/DBP variability in AH patients. A weak but statistically significant negative correlation was found between the total Mini-Cog score and pulse wave velocity and central pulse pressure. A pronounced antihypertensive efficacy of 12-month combination therapy was noted, with the inclusion of both NIT and AML. The NIT-based treatment contributed to a significant increase in the total Mini-Cog score and the total MoCA score and a substantial improvement in CF. Abstraction, delayed recall, memory, attention, work-coping, and decision-making significantly improved, compared to AML-based treatment. The presented data allow a differentiated approach to tactics for treating AH patients with severe cognitive impairment.

Cognitive impairment in diabetic adults with and without hypertension

Background: Diabetes is a heterogeneous disease that is modified by many risk factors, most notably hypertension. Although its negative effects on the retinal, renal, cardiovascular, and peripheral nervous systems are well known, its impact on cognitive performance has received less attention. It has been shown that diabetes is linked to mild cognitive impairment, a transitional stage between normal aging and dementia. Methods: In this case–control study, 150 patients, which were further divided into three groups of 50 patients each with 50 patients who fulfilled the American Diabetes Association's (ADA) Guidelines 2018 for diabetes were in Group A, 50 patients who fulfilled both ADA Guidelines 2018 for diabetes and Joint National Committee 7 (JNC 7) Guidelines for hypertension in Group B while 50 healthy subjects in Group C, were included after applying the exclusion criteria and were subjected to cognitive assessment by Montreal cognitive assessment (MoCA) test. Results: In the diabetic arm of the study (n = 100), 65% (n = 65) of the patients had cognitive impairment as compared to the control group (n = 50), where only 12% (n = 6) of the patients had cognitive decline (P < 0.001). The mean MoCA scores were lowest in patients who had concomitant diabetes and hypertension (23.86 ± 1.78) as compared to patients having diabetes alone (24.76 ± 1.38) while the control group had the highest mean MoCA score (27.46 ± 1.69) (P < 0.001). Age correlated negatively with MoCA while no correlation was observed with gender distribution and area of residence. Duration of diabetes correlated negatively with MoCA scores in Group A (−0.874) (P < 0.001) and Group B (−0.801) (P < 0.001). Duration of hypertension also showed a negative correlation with MoCA scores in Group B (−0.745) (P < 0.001). A negative correlation was also observed between glycated hemoglobin and MoCA scores in Group A (−0.665) (P = 0.001) and Group B (−0.567) (P = 0.034). Conclusions: In conclusion, the incidence and severity of cognitive impairment was more in patients having concomitant diabetes and hypertension as compared to patients having diabetes alone, thus signifying the additional burden and contribution of hypertension to the cognitive decline.

Are Standard Follow-Up Parameters Sufficient to Protect Neurocognitive Functions in Patients with Diabetes Mellitus who Underwent Coronary Artery Bypass Grafting?

ObjectiveWe aimed to compare the effectiveness of cognitive function protection between the standard follow-up parameters and advanced neuromonitoring methods in diabetic patients who underwent coronary artery bypass grafting during cardiopulmonary bypass.MethodsStudy design was prospective and observational. Patients were separated into two groups, treated only with standard follow-up parameters (Group 1) and followed up with the change of regional cerebral tissue oxygenation (rSO2) by near-infrared spectroscopy (Group 2). Neurocognitive functions were evaluated preoperatively and postoperatively before discharge in all patients using the Montreal Cognitive Assessment (MoCA) test.ResultsCognitive functions of Group 2 patients in the postoperative period were significantly higher than Group 1 patients (P=0.001). The mean postoperative MoCA score of patients was significantly lower than the mean preoperative MoCA score in Group 1 (24.8±2.2 vs. 23.6±2.6, P=0.02). However, mild cognitive dysfunction was significantly lower in Group 2, compared to Group 1 (P=0.02).ConclusionIn patients followed up with standard parameters, a significant decrease in cognitive function was observed in the early period. However, the use of advanced neuromonitoring methods can significantly prevent this decrease in cognitive functions.

Effects of acute hypercapnia on cognitive function in patients undergoing bronchoscope intervention.

There are multiple studies that have revealed that hypercapnia possessed neuroprotection, the conclusive cognitive impacts of permissive hypercapnia in medicine is still unclear. A total of 102 patients registered for this research work had accomplished cognitive tests; with 64 patients possessing moderate hypercapnia all through bronchoscope intervention (BI). Thirty-six patients completed collection of blood specimens. Every patient underwent the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) a day before the surgery (T0), as well as at 7 days (T7). Serum specimens were used to measure levels of S100B, neuron-specific enolase (NSE), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA), superoxide dismutase (SOD) prior to the administration of anesthesia (T0), one day (T1) and seven days (T7) after surgery. In comparison with the preoperative MMSE scores, Group Hypercapnia (Group H) on 7 days after surgery, exhibited a significant increased score (P=0.00). In comparison with the preoperative MoCA scores, Group H on 7 days after surgery exhibited a significant increased score (P=0.00). Meanwhile, the MoCA scores in Group H exhibited considerably higher elevation as compared with that in the Group Control (Group C) (P=0.01). No substantial differences were observed in serum S100B and NSE levels between Group H and Group C (P=0.23, P=0.14). Serum IL-6, TNF-α, SOD and MDA levels shared similarity between two groups. Mild and moderate hypercapnia augmented cognitive activity with the help of MMSE tests and MoCA tests, whereby the latent reasons were not sure. As suggested by this study, hypercapnia up to 100 mmHg during BI was less likely to affect cognitive function adversely.

The Effect of Mydriatic Solutions on Cognitive Function

Introduction: Anticholinergic and sympathomimetic ophthalmic solutions are used for mydriasis. These solutions have well-documented systemic side effects despite their topical administration. However, no studies have been conducted regarding the effect of mydriatic drops on cognitive function. The purpose of this study is to determine the effect, if any, of mydriatic drops on cognitive function, including memory, concentration, and orientation. Methods: Participants were randomized into two groups using the technique of permuted block randomization, and randomization was stratified by gender, age, and education. Participants in Group 1 completed the Montreal Cognitive Assessment (MoCA) test with undilated pupils, while participants in Group 2 completed the MoCA test with dilated pupils. Administration time of the MoCA test was approximately 10 minutes, and each participant could receive a maximum of 30 points, with a score of 26 or greater being considered normal cognitive function. Dilation was achieved in both eyes with a combination of tropicamide 0.5% and phenylephrine 2.5%. Results: There was no statistical difference between the MoCA scores of Group 1 and Group 2 (p = 0.65). In addition, MoCA scores were not statistically different between the glaucoma and non-glaucoma subpopulations within each group. MoCA test scores were shown to correlate with education (p = 0.004), age (p = 0.0003), and race (p = 0.03). Patients with confirmed or suspected glaucoma whom eyes dilated required 10.8 minutes to complete the MoCA test, while patients with no confirmed or suspected glaucoma whom eyes dilated required 8.5 minutes to complete the test (p = 0.02). Discussion: Age, race, and education were found to be the most important factors affecting cognitive function in this study. There was no significant difference in the MoCA test scores of participants with confirmed or suspected glaucoma and participants without glaucoma. There was also no significant difference in the MoCA scores of dilated participants and non-dilated participants as a whole. However, dilation significantly increased the amount of time required to complete the MoCA test among the glaucoma and suspected-glaucoma population. The results of this study suggest that physicians should spend more time with dilated glaucoma patients while explaining medical conditions and treatment instructions in order to ensure that patients have adequate time to comprehend instructions for glaucoma management.