Montreal Cognitive Assessment Scores In Patients Research Articles

Network meta-analysis of non-pharmacological interventions for cognitive impairment after an ischemic stroke.

This study aims to evaluate the effectiveness of non-pharmacological interventions in improving cognitive function in patients with ischemic stroke through network meta-analysis. We searched databases including the Cochrane Library, PubMed, EmBase, and Web of Science for randomized controlled trials (RCTs) on non-pharmacological treatments to improve cognitive impairment following ischemic stroke. The publication date was up to 15 March 2023. Due to the insufficiency of included studies, supplementary searches for high-quality Chinese literature were performed in databases such as CNKI, WanFang Data, and VIP Chinese Science Journals Database. Two reviewers independently went through the literature, extracted data, and assessed the risk of bias in the included studies using the risk of bias assessment tool recommended by the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. By utilizing R 4.2.3 RStudio software and the GeMTC package, a Bayesian network meta-analysis was conducted to assess the improvement in Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores under a variety of non-pharmacological interventions. A total of 22 RCTs involving 2,111 patients and 14 different non-pharmacological treatments were included. These interventions were transcranial direct current stimulation (tDCS), reminiscence therapy (RT), remote ischemic conditioning (RIC), physical fitness training (PFT), intensive patient care program (IPCP), moderate-intensity continuous training + high-intensity interval training (MICT + HIIT), medium intensity continuous training (MICT), grip training (GT), acupuncture, cognitive behavioral therapy (CBT), cognitive rehabilitation training (CRT), high pressure oxygen (HPO), moxibustion, and repetitive transcranial magnetic stimulation (rTMS). The results of the network meta-analysis indicated that rTMS had the highest likelihood of being the most effective intervention for improving MMSE and MoCA scores. The evidence from this study suggests that rTMS holds promise for improving MMSE and MoCA scores in patients with cognitive impairment following ischemic stroke. However, further high-quality research is needed to confirm and validate this finding.

Effective Factors in Cognitive Functions of Patients with Temporal Lobe Epilepsy

Background: Temporal lobe epilepsy (TLE) is the most common form of partial epilepsy and increases the risk of cognitive impairment, negatively impacting the quality of life of affected individuals. Objectives: This study aimed to investigate cognitive function in patients with low socioeconomic status affected by TLE and identify factors influencing such function. Methods: This case-control study, conducted between July 2021 and August 2022, compared the cognitive function of 40 patients affected by TLE to 92 healthy controls. The Montreal cognitive assessment (MoCA) was used for neurocognitive evaluation. Data analysis was performed using SPSS 25.0 for Windows. Results: The mean age of the patient group was 33.35 years, compared to 35.37 years in the control group. Moreover, 70% of patients affected by TLE displayed cognitive impairment and demonstrated lower performance in cognitive functions than the control group (P < 0.05). Significant correlations were identified between overall MoCA scores and several factors, including seizure frequency, educational level, polytherapy, disease duration, and self-esteem scores (P < 0.05). Multivariate analysis revealed that seizure control and higher educational level were statistically significant predictors of overall MoCA scores in patients affected by TLE. Conclusions: In low-income patients affected by TLE, seizure control and a higher educational level emerged as predictors of cognitive performance. These findings underscore the importance of identifying and managing comorbidities and the need for tailored cognitive rehabilitation programs for this population.

Abstract A030: The Montreal Cognitive Assessment (MoCA) administered virtually or via Duo APP in primary brain tumor patients: a preliminary analysis

Abstract Background: Primary brain tumor (PBT) patients experience cognitive dysfunction (CD) because of both their tumor and its treatment. Evaluating CD in PBT populations may inform patient outcomes and clinical management and allow exploration of biologic underpinnings associated with its occurrence. The Montreal Cognitive Assessment (MoCA) is a brief assessment of objective measures of cognition that evaluates 8 specific cognitive domains. Our group has previously reported the feasibility of MoCA, and this study includes using the newly developed MoCA Duo APP to evaluate and report the cognitive function of patients with PBT. Associations between total MoCA scores and clinical and demographic characteristics were explored. Methods: This cohort consisted of adult PBT patients (n=172) enrolled in the NCI-NOB Natural History Study (NCT02851706: PI T. Armstrong). Assessments were performed between February 2020 and July 2023 by MoCA certified assessors and administered in the clinic or via telehealth. MoCA scores range from 0 to 30 (normal cognition ≥ 26). Healthcare providers collected demographic and clinical characteristics, with Karnofsky performance status (KPS) scores categorized as poor (≤ 80) or good (≥ 90). Descriptive statistics, independent t-tests, one-way ANOVAs, and Pearson’s correlation were conducted using IBM SPSS Statistics software. Results: The majority of patients were male (58%), white (81%), had ≥12 years of education (87%), had high-grade (3/4) tumors (65%), and a good KPS score (68%). The mean MoCA score was 25 (median: 26; range: 6-30) with a mean completion time of 10.7 minutes (median: 10; range: 6.1-41.1). Forty-two percent (n=73) were classified as abnormal. The median scores were lowest in the visuospatial/executive (4/5; range: 0-5), abstraction (2/3; range: 0-3) and delayed recall (4/5; range: 0-5) domains. A univariate analysis identified lower MoCA scores in patients with high-grade tumors (p<0.001), poor KPS scores (p<0.001), who underwent two or more surgeries (p=0.004) or treatments (p=0.038), had recurrence (p=0.002), had progression on current imaging (p=0.017), and had current anticonvulsant (p=0.014) and corticosteroid use (p=0.036). Age at diagnosis (r=-0.157, p=0.021) and at visit (r=-0.193, p=0.005) had a weak negative correlation with MoCA scores. Conclusions: Our results indicate that patient age, tumor progression, treatment, and concomitant medications are associated with MoCA scores. Further analysis will evaluate tumor methylation status and blood-based biomarkers associated with occurrence to develop prediction models that can be evaluated in larger cohorts. Future investigations should compare MoCA scores to other forms of cognitive assessment, including patient-reported outcomes, incorporating multiple timepoints to monitor CD in patients throughout their treatment and survivorship care. Citation Format: McKenzie C. Kauss, Elizabeth Vera, Kimberly Reinhart, Hope Miller, Jaime Garcia, Morgan Johnson, Madhura V. Managoli, Maeve Pascoe, Kaitlynn Slattery, Alex R. Wollet, Mark R. Gilbert, Alvina Acquaye-Mallory, Terri S. Armstrong, Vivian A. Guedes. The Montreal Cognitive Assessment (MoCA) administered virtually or via Duo APP in primary brain tumor patients: a preliminary analysis [abstract]. In: Proceedings of the AACR Special Conference on Brain Cancer; 2023 Oct 19-22; Minneapolis, Minnesota. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_1):Abstract nr A030.

Mediation of Regional Cerebral Blood Flow in the Relationship between Specific Gut Microbiota and Cognition in Vascular Cognitive Impairment.

Gut microbiota could affect the onset and development of vascular cognitive impairment (VCI) through modulating metabolic and immune pathways. However, the vascular mechanisms involved remain unclear. To investigate the gut microbiota associated with VCI and examine the mediating effects of regional cerebral blood flow (CBF) to explore potential therapeutic targets for VCI. This prospective study enrolled patients with VCI (n = 16) and healthy controls (n = 18) from the Chinese Imaging, Biomarkers, and Lifestyle study between January 1 and June 30, 2022. The gut microbiota composition and diversity were determined by 16 S ribosomal RNA gene sequencing. The association between gut microbiota and Montreal Cognitive Assessment (MoCA) scores was determined using Spearman's correlation analysis. Regional CBF was calculated using pseudo-continuous arterial spin labeling. The mediating effects of regional CBF on the relationship between specific gut microbiota and cognition in VCI were investigated using mediation analysis. Compared to healthy controls, patients with VCI had significantly greater abundance of Bifidobacterium, Veillonella, R uminococcus gnavus , Fusobacterium, and Erysipelatoclostridium and smaller abundance of Collinsella. The abundance of Ruminococcus gnavus was negatively associated with MoCA scores in patients with VCI, with the CBF in the left hypothalamus, right hypothalamus, and left amygdala accounting for 63.96%, 48.22%, and 36.51%, respectively, of this association after adjusting for confounders. Ruminococcus gnavus is associated with cognition in VCI, which is strongly mediated by CBF in the bilateral hypothalamus and left amygdala. These findings highlight the potential regulatory roles of nutrition and metabolism-related areas of the brain in VCI.

Altered dynamic intrinsic brain activity of the default mode network in Alzheimer's disease: A resting-state fMRI study.

ObjectiveStatic regional homogeneity (ReHo) based on the resting-state functional magnetic resonance imaging (rs-fMRI) has been used to study intrinsic brain activity (IBA) in Alzheimer’s disease (AD). However, few studies have examined dynamic ReHo (dReHo) in AD. In this study, we used rs-fMRI and dReHo to investigate the alterations in dynamic IBA in patients with AD to uncover dynamic imaging markers of AD.MethodIn total, 111 patients with AD, 29 patients with mild cognitive impairment (MCI), and 73 healthy controls (HCs) were recruited for this study ultimately. After the rs-fMRI scan, we calculated the dReHo values using the sliding window method. ANOVA and post hoc two-sample t-tests were used to detect the differences among the three groups. We used the mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MoCA) to evaluate the cognitive function of the subjects. The associations between the MMSE score, MoCA score, and dReHo were assessed by the Pearson correlation analysis.ResultsSignificant dReHo variability in the right middle frontal gyrus (MFG) and right posterior cingulate gyrus (PCG) was detected in the three groups through ANOVA. In post hoc analysis, the AD group exhibited significantly greater dReHo variability in the right MFG than the MCI group. Compared with the HC group, the AD group exhibited significantly increased dReHo variability in the right PCG. Furthermore, dReHo variability in the right PCG was significantly negatively correlated with the MMSE and MoCA scores of patients with AD.ConclusionDisrupted dynamic IBA in the DMN might be an important characteristic of AD and could be a potential biomarker for the diagnosis or prognosis of AD.

Can residual kidney function affect quality of life and cognitive function in hemodialysis patients?

BackgroundResidual kidney function (RKF) may provide many benefits to patients on permanent renal replacement therapy that are reflected in better control of biochemical parameters. In hemodialysis patients, quality of life (QOL) and cognitive function are often impaired. This study aimed to assess the predictors of RKF and its impact on QOL and cognitive function in chronic hemodialysis patients.Patients and methodsThe study involved seventy-eight patients suffering from end-stage renal disease on regular hemodialysis. The patients were divided into two groups according to the presence or absence of RKF (24-hour urine volume ≥ 100 ml). Beside basic laboratory investigations, all patients were subjected to Kidney Disease Quality of Life-Short Form (KDQOL-SF) version 1.3 for assessing the quality of life and Montreal cognitive assessment (MoCA) score for assessing cognitive function.ResultsThere was a significantly higher score for KDQOL domains and MoCA score in patients with RKF compared to patients without RKF. There was a significant positive correlation between RKF and both of MoCA score and the physical composite score (PCS) of QOL. Moreover, there were statistically significant positive correlations between the MoCA score and both PCS and mental composite score (MCS). On multivariate analysis, hemodialysis duration was the only predictor for RKF; whereas age was a significant predictor for PCS; and MoCA score could be significantly predicted by the measured RKF and patients’ age.ConclusionHD patients with maintained RKF had better QOL and cognitive function. The duration of HD and the age of the patients were found to be related to RKF and PCS in this study. RKF was associated with the cognitive performance of hemodialysis patients.

Large-scale functional connectivity predicts cognitive impairment related to type 2 diabetes mellitus.

BACKGROUNDLarge-scale functional connectivity (LSFC) patterns in the brain have unique intrinsic characteristics. Abnormal LSFC patterns have been found in patients with dementia, as well as in those with mild cognitive impairment (MCI), and these patterns predicted their cognitive performance. It has been reported that patients with type 2 diabetes mellitus (T2DM) may develop MCI that could progress to dementia. We investigated whether we could adopt LSFC patterns as discriminative features to predict the cognitive function of patients with T2DM, using connectome-based predictive modeling (CPM) and a support vector machine.AIMTo investigate the utility of LSFC for predicting cognitive impairment related to T2DM more accurately and reliably.METHODSResting-state functional magnetic resonance images were derived from 42 patients with T2DM and 24 healthy controls. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Patients with T2DM were divided into two groups, according to the presence (T2DM-C; n = 16) or absence (T2DM-NC; n = 26) of MCI. Brain regions were marked using Harvard Oxford (HOA-112), automated anatomical labeling (AAL-116), and 264-region functional (Power-264) atlases. LSFC biomarkers for predicting MoCA scores were identified using a new CPM technique. Subsequently, we used a support vector machine based on LSFC patterns for among-group differentiation. The area under the receiver operating characteristic curve determined the appearance of the classification.RESULTSCPM could predict the MoCA scores in patients with T2DM (Pearson’s correlation coefficient between predicted and actual MoCA scores, r = 0.32, P=0.0066 [HOA-112 atlas]; r = 0.32, P=0.0078 [AAL-116 atlas]; r = 0.42, P=0.0038 [Power-264 atlas]), indicating that LSFC patterns represent cognition-level measures in these patients. Positive (anti-correlated) LSFC networks based on the Power-264 atlas showed the best predictive performance; moreover, we observed new brain regions of interest associated with T2DM-related cognition. The area under the receiver operating characteristic curve values (T2DM-NC group vs. T2DM-C group) were 0.65-0.70, with LSFC matrices based on HOA-112 and Power-264 atlases having the highest value (0.70). Most discriminative and attractive LSFCs were related to the default mode network, limbic system, and basal ganglia.CONCLUSIONLSFC provides neuroimaging-based information that may be useful in detecting MCI early and accurately in patients with T2DM.

Changes in the Shape and Volume of Subcortical Structures in Patients With End-Stage Renal Disease.

Introduction: End-stage renal disease (ESRD) typically causes changes in brain structure, and patients with ESRD often experience cognitive and sleep disorders. We aimed to assess the changes in the subcortical structure of patients with ESRD and how they are associated with cognitive and sleep disorders.Methods: We involved 36 adult patients for maintenance hemodialysis and 35 age- and gender-matched control individuals. All participants underwent neuropsychological examination and 3T magnetic resonance imaging (MRI) to acquire T1 anatomical images. The laboratory blood tests were performed in all patients with ESRD close to the time of the MR examination. We used volumetric and vertex-wise shape analysis approaches to investigate the volumes of 14 subcortical structural (e.g., bilateral accumbens, amygdala, hippocampus, caudate, globus pallidus, putamen, and thalamus) abnormalities in the two groups. Analyses of partial correlations and shape correlations were performed in order to identify the associations between subcortical structure, cognition, and sleep quality in patients with ESRD.Results: The volumetric analysis showed that compared with the healthy control group, patients with ESRD had less bilateral thalamus (left: p < 0.001; right: p < 0.001), bilateral accumbens (left: p < 0.001; right: p = 0.001), and right amygdala (p = 0.002) volumes. In the vertex-wise shape analysis, patients with ESRD had abnormal regional surface atrophy in the bilateral thalamus, right accumbens, left putamen, and bilateral caudate. Moreover, the Montreal Cognitive Assessment (MoCA) score was associated with volume reduction in the bilateral thalamus (left: Spearman ρ = 0.427, p = 0.009; right: ρ = 0.319, p = 0.018), and the Pittsburgh Sleep Quality Index (PSQI) score was associated with volume reduction in the bilateral accumbens (left: ρ = −0.546, p = 0.001; right: ρ = −0.544, p = 0.001). In vertex-wise shape correlation analysis, there was a positive significant correlation between regional shape deformations on the bilateral thalamus and MoCA score in patients with ESRD.Conclusion: Our study suggested that patients with ESRD have subcortical structural atrophy, which is related to impaired cognitive performance and sleep disturbances. These findings may help to further understand the underlying neural mechanisms of brain changes in patients with ESRD.

Comparison of the Effects of Epidural Anesthesia and General Anesthesia on Perioperative Cognitive Function and Deep Vein Thrombosis in Patients Undergoing Total Knee Arthroplasty.

Objective To explore the effects of epidural anesthesia and general anesthesia on perioperative cognitive function and deep vein thrombosis (DVT) in patients undergoing total knee arthroplasty (TKA). Methods Total of 68 patients undergoing TKA in our hospital from September 2019 to March 2021 were selected and divided into the control group under general anesthesia and the observation group under epidural anesthesia according to the different anesthesia methods, 34 patients in each group. TKA was selected in both groups and performed by the same group of physicians, anesthesiologists, and nursing staff. The mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation (SpO2) were observed immediately before anesthesia (T1), 30 min after anesthesia (T2), after surgery (T3), and 1 d after surgery (T4). The changes of platelet (PLC), fibrinogen (Fbg), prothrombin time (PT), activated partial thrombin time (APTT), and other coagulation indicators were recorded. The Montreal Cognitive Assessment (MoCA) scores before surgery and 1 d and 3 d after surgery were observed. The blood samples of the two groups were collected before surgery and 1 d and 3 d after surgery, and the levels of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) in the peripheral blood of the two groups were measured by ELISA. The number of postoperative mental disorders and DVT in the two groups was calculated. Results The MAP and HR of T4 were lower than those of T1, T2, and T3. The MAP of T2, T3, and T4 in the observation group was lower than that in the control group (P < 0.05), and the SpO2 of T1–T4 in the two groups did not change significantly, and there was no significant difference between the two groups (P > 0.05). Compared with T1, there was no significant difference in PLC, Fbg, and PT in the observation group T4 (P > 0.05), and APTT was lower than T1 (P < 0.05). The PLC, PT, and APTT of T4 in the control group were all lower than those of T1 (P < 0.05), and there was no significant difference between Fbg and T1 (P > 0.05). The PLC, Fbg, and PT of T4 in the observation group were higher than those in the control group, while APTT was lower than that in the control group (P < 0.05). The MoCA scores of patients in both groups on the 1st and 3rd day after operation were lower than those before operation, and the observation group was higher than that in the control group (P < 0.05). The BDNF and NGF of patients in both groups were lower than those before operation on the 1st day after operation, and the BDNF and NGF in the observation group were higher than those in the control group on the 1st and 3rd day after operation (P < 0.05). The mental disorder (2.94%) and DVT incidence (2.94%) in the observation group were lower than those in the control group (29.41%, 26.47%) (P < 0.05). Conclusion Epidural anesthesia for patients with TKA can obtain better clinical effects, maintain stable hemodynamic and coagulation states, reduce stress response of patients at the same time, and reduce perioperative cognitive dysfunction and the incidence of DVT in patients.

Cognitive Impairment in Patients with Atrial Fibrillation without Stroke

Background: Vascular dementia is the second leading cause of dementia worldwide; however, the causation is multifactorial and may be preventable. There is increasing evidence that atrial fibrillation (AF) is independently correlated with cognitive decline. Assessing cognition in an outpatient setting is challenging. Gait speed may be able to transcend language in assessing cognition. We aim to assess cognitive impairment in patients with AF without known history of stroke with gait speed. Methods: This was a prospective, observational study of patients attending cardiology outpatient department. Patients were screened for a history of valvular or nonvalvular AF. Controls were patients without AF. Patients underwent structured interview, Montreal cognitive assessment (MoCA), and gait velocity assessment. Gait velocity and MoCA scores were compared in control and cases using Student's t-test. Results: A total of 189 patients were consented; 88 cases with AF and 101 controls. Mean ± standard deviation age was 60 ± 12 years. The median (interquartile range) gait velocity in patients with AF and nonAF was similar (0.80 [0.65–0.93] m/s vs. 0.80 [0.65–0.93] m/s, P = 0.708). The mean MoCA scores in patients with AF and without AF were also similar (17.38 ± 5.66 vs. 18.36 ± 5.30, P = 0.229). A cutoff value of &lt;0.80 m/s had sensitivity of 66% and specificity of 61.4% to diagnose dementia. Conclusion: There is a high occurrence of cognitive deficits in patients with and without AF visiting a cardiology outpatient clinic. Future studies are needed to target this group of the patient to reduce the burden of vascular dementia.

Sex characteristics of cognitive functions assessed by the MMSE and MoCA scores in patients with coronary artery disease

Aim.To study the sex characteristics of cognitive functions in a cohort of patients undergoing coronary artery bypass grafting (CABG) by comparing the results of Mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores.Material and methods.The prospective cohort study included 272 people, including 74 women aged 41 to 82 years, who were admitted to the Research Institute of Complex Issues of Cardiovascular Diseases for CABG surgery. All patients underwent clinical, laboratory, electrophysiological and ultrasound examinations. The Charlson comorbidity index (CCI) was calculated. Assessment of cognitive functions was carried out using the MMSE and MoCA scores. All types of statistical analysis were performed using the STATISTICA 10 program (StatSoft Inc., USA).Results.It was found that women scheduled for CABG have an older age and a higher CCI score compared to men (p=0,008). According to the MMSE, the likelihood of moderate and severe cognitive impairment in men compared with women was 1,36 times higher (odds ratio (OR), 1,35; 95% confidence interval (CI), 0,79-2,32, Z=1,11, p=0,27). The MoCA scores showed that half of the male (49%) and female (50%) participants had severe cognitive impairment. The likelihood of moderateand severe cognitive impairment in men compared with women was 1,33 times higher (OR, 1,33; 95% CI, 0,68-2,59, Z=0,841, p=0,40). According to subtests of the MoCA, men were better in naming (p=0,002), abstraction (p=0,005), and women outperformed men in verbal fluency (p=0,04). Regression analysis revealed that the most significant negative predictors for cognitive status as measured by the MMSE and MoCA scores for men and women were age and CCI.Conclusion.Women scheduled for CABG, having the worst clinical and demographic indicators, are comparable with men in cognitive status using the MMSE score. The MoCA score shows sex differences in naming, abstraction, and verbal fluency domains and revealed a higher percentage of severe cognitive disorders (up to 50%) compared to the MMSE score (7-9%). In male and female candidates for CABG, age and comorbidities are negatively associated with cognitive status.

THE RELATIONSHIP BETWEEN DECREASED COGNITIVE FUNCTIONS AND THE LEVEL OF PROINFLAMMATORY CYTOKINES IN PATIENTS WITH ALZHEIMER’S DISEASE, VASCULAR DEMENTIA, AND MILD COGNITIVE DISORDER

Alzheimer's disease (AD) is a degenerative disease that leads to dementia symptoms [1, 2]. Histopathological signs of AD are amyloid plaques in the brain, mainly consisting of fibrillary forms of amyloid β-peptide-40 (Aβ-40) and amyloid β-peptide-42 (Aβ-42). Neutrophils are the main targets for IL-17 in the central nervous system (CNS) that promote inflammation and damage to CNS tissues, and may play an important role in the development of AD pathology. Interleukin 23 (IL‑23) synergizes with IL-6, IL-1 and is involved in the differentiation of Th17 cells in a pro-inflammatory context. The aim of the study was to analyze the relationship between interleukin levels of IL-17, IL-23 and neurocognitive scales in patients with AD, vascular dementia (VD) and mild cognitive disorder (MCD). The study involved 89 patients, of which 59 patients had cognitive impairment (32 men and 27 women, mean age 66.8±8.4 years); among them, 29 had major neurocognitive impairment (NCD), including 15 patients with AD, 14 – with VD, 30 patients – with MCD and 30 people in the control group had no cognitive deficit. All patients were tested with comprehensive neuropsychological examination using the following tests and scales: Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Alzheimer Disease Assessment Scale-cognitive (ADAScog). Serum levels of cytokines of IL-17 and IL-23 were assayed using sandwich ELISA on «Chem Well 2900» immunoanalyzer (Awareness Technology, USA). Test systems using Bender Medsystems, Australia (IL-17 and IL-23) were used in accordance with the manufactures instructions. Levels of detectable interleukins (IL-17 and IL-23) were significantly higher in patients with AD vs. patients with VD and MCD. The correlations between the two cytokines and the MMSE scales, MoCA, ADAS-cog and FAB were examined. Our results showed a significant positive correlation between the serum concentration of IL-23 and neurocognitive scales in all patients with AD. The most relevant correlations in the AD group were linked with the scales: ADAS-cog (r = 0.760; р = 0.001), namely with the sections «tasks for repeating words» (r = 0.775; p ˂ 0.001), «constructive praxis» (r = 0.651; p = 0.010), «orientation» (r = 0.684; p = 0.01), as well as «word recognition tasks» (r = 0.616; p = 0.020); and with MoCA scale (r = −0.592; p = 0.020), namely with the section «delayed recall» (r = −0.641; p = 0.010). A significant positive correlation was established between IL-23 and individual sections of the ADAS-cog scale in patients with MCD (r = 0.423; p = 0.020), namely with «word recognition tasks» (r = 0.466; p = 0.030), «understanding» (r = 0.306; p = 0.059) as well as «strike out numbers» (r = 0.301; p = 0.061). A weak positive correlation was found between the serum concentration of IL-23 and ADAS-cog scores in patients with VD (r = 0.497; p = 0.045). Moderate positive correlation was observed for IL-23 with «concentration and distraction» (r = 0.558; p = 0.040). An inverse correlation was established between the serum levels of IL-23 and MoCA scores in patients with VD (r = −0.510; р = 0.060), especially with «language» (r = −0.538; p = 0.047) and «executive functioning» (r = −0.485; p = 0.079). However, no other significant correlations were found between the serum concentration of IL-17 and neurocognitive domains in patients with MCD and VD. Correlation analysis confirmed the relationship between the severity of cognitive impairment and the level of proinflammatory markers, suggesting that inflammation can lead to cognitive decline in AD patients. The results of the study indicated that IL-23 may have a more complex relationship with the progression of this disease which gives reason to consider IL-23 as a marker of inflammatory activity. Levels of detectable proinflammatory cytokines (IL-17 and IL-23) were significantly higher in patients with AD vs. patients with VD and MCD. Such more pronounced changes in the production of interleukin 23 in patients with AD may indicate the activity of the inflammatory process. The level of IL-23 in all examined patients with Alzheimer's disease had high correlations with indicators of neurocognitive scales, which indicated its important role in the pathogenesis of this disease. There were no other significant correlations between the serum concentration of IL-17 and neurocognitive domains in patients with MCD and VD.

Incidence and risk factors of vascular dementia in Thai stroke patients

BackgroundBesides disability in stroke survivors, vascular cognitive impairment (VCI) can prevent these patients from living independently. The purpose of this study is to look for the incidence and risk factors of vascular dementia in Thai patients with stroke. MethodsAdults patients with ischemic stroke were prospectively included. Cognitive assessment was performed at 3–6 months after stroke onset. Montreal Cognitive Assessment (MOCA)- Thai version was used to evaluate cognitive function, with the cutoff point of 24/25 of MOCA to define cognitive impairment/normal cognition. Vascular mild cognitive impairment (VMCI) and vascular dementia (VAD) were diagnosed in those with cognitive impairment. Epidemiologic data, Apolipoprotein E (ApoE) status, and stroke characteristics were compared between patients with and without VAD. ResultsThere were 180 patients with the mean age of 65 years. Median time after stroke onset to have cognitive assessment was 6 months. Ninety patients (50%) had VMCI. VAD was diagnosed in 49 patients (27%). Mean Thai version of mental state examination (TMSE) and MOCA scores in patients with VAD were 20 and 12, respectively. Multivariate analysis showed that older age (OR 4.994, 95%CI 1.602–15.565, p-value = 0.006), lower education (OR 10.306, 95%CI 3.162–33.586, p-value < 0.001), history of stroke (OR 4.959, 95%CI 1.036–23.741, p-value = 0.045) and moderate to severe cerebral white matter lesions (OR 5.555, 95%CI 1.710–18.041, p-value = 0.004) were associated with VAD. ApoE 4 allele was found in 25% of the patients, but the presence did not show any association with the increased risk of VAD. ConclusionsVAD occurred in 27% of the stroke patients. Older age, low education level, history of stroke, and the presence of moderate to severe white matter lesions were associated with the increased risk of VAD.

Determination of MoCA Cutoff Score in Patients with Alcohol Use Disorders.

The Montreal Cognitive Assessment (MoCA) score is a convenient and promising tool for estimating alcoholic patients' global cognitive functioning, a major challenge for all specialized alcohol treatment centers. However, whether or not the score should be corrected for education level and whether the proposed cutoff is relevant in patients with alcohol use disorders (AUD) should be determined. We compared the MoCA scores in patients hospitalized for AUD with and without cognitive impairment assessed by a battery of neuropsychological (NP) tests. Sensitivity, specificity, and cutoff of the MoCA score were analyzed using receiver operating characteristic curve analysis. Thirty-one patients with and 25 without cognitive impairment were included in the study. There were 40 men and 16women, with a mean age of 49.5years. The mean uncorrected MoCA score was 23.1±3.3 in those with and 27.0±1.9 in those without cognitive impairment. NP tests were significantly correlated with the MoCA score. Uncorrected MoCA scores identified more than 80% of the patients with a cutoff score equal to 26, to obtain similar accuracy with the corrected score required using a cutoff score equal to 27. Our results confirm that the MoCA test is a convenient and reliable screening tool to measure cognition defects in alcoholic patients. As using the 1-point education adjustment increases the cutoff score by 1 point, it is suggested to use the noncorrected score and the usual cutoff, that is, 26. Being easy to administer and only moderately time-consuming, the MoCA score should be used extensively in addiction treatment centers.

Effects of donepezil on cognitive functions and the expression level of β-amyloid in peripheral blood of patients with Alzheimer's disease.

Alzheimer's disease is a degenerative disease affecting the central nervous system for which donepezil is usually prescribed. The aim of the present study was to examine the effects of donepezil on the cognitive functions and expression levels of β-amyloid (Aβ) in the peripheral blood of patients with Alzheimer's disease. In total, 76 patients with cognitive impairment, who visited the Department of Neurology of Binzhou City Center Hospital from June 2015 to September 2016, had memory decline for more than three consecutive months and underwent mini-mental state examination (MMSE) score screening, were selected for the study. All 76 patients were divided into the experimental (n=38) and control (n=38) groups by random number table. Patients in the control group were treated using conventional drugs combined with Nimotop, and patients in the experimental group received conventional drug therapy combined with donepezil, and the treatment outcomes in the two groups were compared. The MMSE scores and Montreal cognitive assessment (MoCA) scores after treatment in the two groups were significantly increased compared with those before treatment, and the differences were statistically significant (P<0.05). The activities of daily living scale (ADL) was decreased significantly (P<0.05). By comparing with the control group, the MMSE and MoCA scores in the experimental group were higher (P<0.05) while the ADL score was lower (P<0.05), and the adverse reaction rate during the treatment was lower (P<0.05). The Aβ levels in serum after medical treatment were obviously decreased in the two groups, and the difference was statistically significant (P<0.05). The serum Aβ level in the experimental group after treatment was lower than that in the control group (P<0.05). Drug therapy combined with donepezil has a certain degree of influence on the MMSE, ADL and MoCA scores of patients with Alzheimer's disease, which can decrease the Aβ level in peripheral blood and improve the cognitive functions of patients, thus having important clinical significance.

Impact of Rivastigmine on Cognitive Dysfunction and Falling in Parkinson's Disease Patients

Background: The purpose of this study was to observe the incidence of falls in Parkinson's disease (PD) patients with different cognitive levels and to investigate the effect of the cholinesterase inhibitor Rivastigmine on cognitive dysfunction and falling in PD patients. Subjects and Methods: Data from 176 PD patients participating in the collaborative PD study between June 2010 and June 2014 were collected; the Chinese edition of the Montreal Cognitive Assessment (MoCA) score was used to evaluate the cognitive function of patients, and falls were recorded. PD patients with cognitive dysfunction were randomly administered either a placebo or Rivastigmine. The cognitive function changes and difference in fall incidence were compared between the 2 groups. Results: The average number of falls per person in PD patients without cognitive impairment dysfunction was significantly lower than that in patients in the PD mild cognitive impairment (PD-MCI) group and that in the PD dementia (PDD) group (p < 0.01, p < 0.001, respectively), and the incidence of falls was significantly lower than that in patients in the PD-MCI and PDD groups (p < 0.01, p < 0.01, respectively). Compared to the PD-MCI group, the incidence of falls of patients in the PDD group (OR 2.45, 95% CI 0.97-6.20, p < 0.01) and the number of falls per person were significantly increased (p < 0.01). After taking the placebo or Rivastigmine for 12 months, the MoCA scores of patients in the Rivastigmine treatment group were significantly higher than those of the control group (p = 0.002). The number of falls per person and the incidence of falls of patients in Rivastigmine treatment group were significantly lower than those in the placebo group (p < 0.01). Conclusion: This study suggests that the degree of cognitive impairment is closely associated with the incidence of falls, and the cholinesterase inhibitor Rivastigmine can delay the deterioration of cognitive function and lower the incidence of falls in PD patients.

Relationship between cognitive impairment and cerebrovascular stenosis in patients with subcortical infarction

Objective To investigate the intracranial vascular lesions in patients with subcortical infarction-induced vascular cognitive impairment(VCI),and to investigate the etiology and mechanisms of VCI.Methods Inpatients with subcortical infarction in our hospital were enrolled in this study from Nov.2012 to Feb.2014,with those unable to complete the cognitive evaluation eliminated.According to the diagnostic criteria of VCI the patients were divided into two groups:49with cognitive impairment(VCI group)and 42 without cognitive impairment(NVCI group).The clinical data,physical examinations,laboratory tests,and the Montreal Cognitive Assessment(MoCA)scale scores were collected.Cerebral blood vessels were assessed by CT angiography or magnetic resonance angiography(MRA).Results The results showed that,according to TOAST classification,VCI group had 24(48.98%)patients with large artery atherosclerosis(LAA)and NVCI group had 22(52.38%),showing no significant difference between the two groups.CTA or MRA indicated that 37(75.51%)patients in VCI group had vascular stenosis,with 75.25% of the 37 patients having intracranial vascular stenosis and 28.71%with middle cerebral artery stenosis.Patients with single cerebral artery stenosis accounted for 18.37% and those with the multiple artery stenosis accounted for 57.14%.CTA or MRA indicated that 34(80.95%)patients in NVCI group had vascular stenosis,with 60% having intracranial vascular stenosis,including 32% with middle cerebral artery stenosis,26.19% with single cerebral artery stenosis,and 54.76% with the multiple artery stenosis,with the latter two data being significantly different from the VCI group(P0.05).In VCI group,the number of intracranial vascular stenosis branches ranged 0-6,with a mean of(1.51±1.67),and a negative relation was found between numbers of stenosis arteries and MoCA scores in patients of VCI group(rs=-0.283,P0.05).Conclusion Different from the common causes of small blood vessels,LAA is the most common etiology of subcortical VCI,which implied that exploring the LAA causes of small lesions is crucial for the prevention of VCI in Chinese patients.

Assessment of cognition and associated factors in patients with stable chronic obstructive pulmonary disease

To explore and analyze the cognitive function in patients with stable chronic obstructive pulmonary disease (COPD). The cognition differences between patients with COPD and healthy subjects were analyzed by Montreal Cognitive Assessment (MoCA). GOLD grade, PaO₂, PaCO₂, the education degree and the age were included as associated factors. The correlation between those factors with cognition were analyzed. The MoCA in patients with COPD was 20.6 ± 2.3, and that in healthy subjects was 25.3 ± 1.7; the difference between the 2 groups being significant (P < 0.01). The MoCA was 22.4 ± 0.8 in patients with GOLD grade I disease, 21.7 ± 1.0 in grade II, 20.2 ± 1.2 in grade III, and 19.1 ± 1.20 in grade IV diseases; the difference among the 4 subgroups being significant (F = 31.69, P < 0.05). The MoCA in GOLD grade I was higher than that in GOLD grade II, but the difference did not reach significance (P > 0.05). The MoCA of GOLD grade II was higher than that in GOLD grade III (P < 0.05) , and the MoCA of GOLD grade III was higher than that GOLD grade IV (P < 0.05). The MoCA in non-hypoxemia subgroup and hypoxemia subgroup was 22.2 ± 1.1 and 19.8 ± 1.1, respectively (P < 0.05) , while the MoCA in hypercapnia subgroup and non-hypercapnia subgroup was 20.0 ± 1.3 and 22.3 ± 1.0 respectively (P < 0.05). By regression analysis, the score of MoCA was correlated positively to education degree (Standard B1 = 0.134, P < 0.01), GOLD grade(Standard B2 = 0.351, P < 0.01) and PaO₂(Standard B3 = 0.305, P < 0.01), while the score of MoCA was correlated negatively to age(Standard B4 = -0.146, P < 0.01) and PaCO₂(Standard B5 = -0.145, P < 0.01). The MoCA score in patients with COPD was lower than that in healthy people. Lower MoCA score was found in patients with severe COPD. The MoCA scores in both hypoxemia subgroup and hypercapnia subgroup were lower. The cognitive dysfunction in patients with stable COPD was positively correlated with education degree, GOLD grade, and PaO₂, but negatively with age and PaCO₂.

Correlation between cognitive function and the association fibers in patients with Alzheimer’s disease using diffusion tensor imaging

White matter (WM) changes, along with well-characterized cortical abnormalities, occur in patients with Alzheimer’s disease (AD). We investigated the integrity of WM tracts within association fibers by the use of fractional anisotropy (FA), and the relationship between FA values and cognitive function in patients with AD. Neuropsychological examination and conventional MRI, as well as diffusion tensor imaging, (DTI) were conducted on 12 patients with mild to moderate AD and 18 cognitively healthy volunteers. DTI was performed to measure FA in the bilateral inferior fronto-occipital fasciculus (IFOF) and the superior longitudinal fasciculus (SLF). Mini-Mental State Examination (MMSE) scores and Montreal Cognitive Assessment (MoCA) values were used to evaluate cognitive function and the Clinical Dementia Rating (CDR) scale was used as a staging tool for dementia severity. FA measures were analyzed and correlated with neuropsychological data. No patient showed any WM tract abnormality on either T1-weighted or T2-weighted MRI. However, the FA values in the bilateral IFOF and SLF and the MoCA scores in patients with AD were significantly decreased (p<0.05) compared to the controls. Furthermore, the decreased FA values in the SLF were positively correlated with cognitive function (MMSE scores – right: r=0.672, p=0.033, left: r=0.919, p<0.01; MoCA values – right: r=0.747, p=0.013, left: r=0.679, p=0.031). Our findings confirmed that the loss of integrity of microstructural WM connectivity has a role in the cognitive decline of patients with AD. The data also suggest that the FA values of the SLF may be used as a clinical marker of cognitive function.