Montreal Cognitive Assessment Test Scores Research Articles

Cognitive decline and diabetes in the clinical setting

Objective. The aim of our study was to evaluate the prevalence of cognitive decline in patients with diabetes in the clinical setting and to identify patient characteristics directly associated with this condition. patients with diabetes in the clinical setting and to identify patient characteristics directly associated with this condition.
 Methods. In our cross-sectional study, we applied the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to determine cognitive function in 172 diabetic patients, in the clinical setting. We included 120 patients with type 2 diabetes (T2DM), 42 cases with type 1 diabetes (T1DM) and 10 patients with confirmed secondary diabetes (SDM). The mean age of the participants was 62.4 years (±1.01, min: 26 years, Max: 87 years), with median diabetes duration of 15±11.8 years.
 Results. More than half (55.23%) of the subjects presented cognitive deterioration, which was diabetes type-specific (p<0.05). Mild forms affected mostly T1DM and SDM cases (31.5% and 30% vs. T2DM: 14.5%, p=0.00), whereas moderate cognitive decline was more predominant in T2DM (21.9% vs. T1DM: 7.1%, p=0.1). A higher prevalence of severe cognitive impairment was present in T1DM (14.5% vs. T2DM: 8.7%, p=0.1).
 The middle-aged category (40-64 years) was characterized by a more significant reduction of cognitive function in comparison with other age groups (p=0.02).
 No gender-related difference in the prevalence of cognitive decline was found (female: 45.83% vs male: 45.71%, p=0.98), although severe forms were significantly more suggestive for men (15.27% vs. 4.18%, p=0.04).
 Diabetic ketoacidosis (DKA) at admission was more frequently associated with cognitive deterioration, in comparison with hypoglycemic events (p=0.03).
 In T2DM, cognitive decline (p=0.006, r=-0.342) was associated with the presence of anemia.
 In T2DM women, treatment with calcium-channel blockers facilitated cognitive decrement (p=0.01, r=-0.339), whereas in men, therapy for distal symmetric polyneuropathy resulted in higher MMSE/ MoCA test scores (p=0.00, r=0.72).
 In T1DM, a higher glycemic burden evidenced by increased HbA1c (p=0.03, r=- 0.364) and glycemia at admission (p=0.01, r=-0.389) was suggestive to a more severe form of cognitive impairment. Distal symmetrical polyneuropathy (p=0.05, r=-0.305) and diabetic retinopathy (p=0.03, r=-0.102) was often co-occurring with cognitive decline.
 Cognitive deterioration was associated with insulin therapy (p=0.05, r=-0.232).
 Conclusion. The prevalence of cognitive decline is high in the diabetic population. Risk stratification must start at diagnosis and physicians should follow disease progression periodically, with special attention attributed to T1DM and the middle-aged population.

Levodopa-Carbidopa-Entacapone Intestinal Gel in Advanced Parkinson Disease: A Multicenter Real-Life Experience.

For Parkinson disease (PD) patients who have been diagnosed with advanced disease that can no longer be effectively controlled with optimized oral or transdermal medications, a range of device-aided therapies (DAT) are available, comprising either deep brain stimulation or infusion therapies providing continuous dopaminergic stimulation. Levodopa-entacapone-carbidopa intestinal gel (LECIG) infusion is the latest DAT for advanced PD (APD) that was approved in Romania in 2021. What is the experience to date in real-world clinical practice in Romania regarding the efficacy and tolerability of LECIG in APD? A retrospective evaluation of 74 APD patients treated with LECIG at 12 specialized APD centers in Romania. Demographic data and various clinical parameters were recorded, including Mini Mental State Evaluation score or Montreal Cognitive Assessment Test score. Levodopa-equivalent daily dose and the administered doses of levodopa and other PD medications were evaluated at baseline and after starting LECIG treatment. The efficacy of LECIG in reducing daily hours of off time, motor fluctuations, and dyskinesias were assessed. Any percutaneous endoscopic gastrojejunostomy system or device complications after starting LECIG treatment were noted. At baseline, patients were taking oral levodopa for a mean of 5.3 times per day, with a high proportion also taking concomitant add-on therapies (dopamine agonists, 86%, monoamine oxidase type-B inhibitors, 53%; catechol-O-methyltransferase inhibitors, 64%). LECIG treatment significantly reduced daily off time versus baseline from 5.7 h/d to 1.7 hours per day ( P < 0.01). Duration and severity of dyskinesias was also significantly reduced versus baseline, and improvements were observed in Hoehn and Yahr Scale scores. LECIG treatment also allowed a significant reduction in the use of concomitant oral medications. These findings suggest that LECIG treatment is an effective DAT option in APD that can simplify the treatment regimen.

Zinc as a Mediator Through the ROCK1 Pathway of Cognitive Impairment in Aluminum-Exposed Workers: A Clinical and Animal Study.

Aluminum (Al) exposure was implicated in neurodegenerative diseases and cognitive impairment, yet the involvement of zinc (Zn) and its mechanism in Al-induced mild cognitive impairment (MCI) remains poorly understood. The objective is to explore the role of Zn in Al-induced cognitive impairment and its potential mechanisms. Montreal cognitive assessment (MoCA) test scores and serum Al, Zn from Al industry workers were collected. A mediation analysis was performed to evaluate the role of serum Zn among serum Al and MoCA test scores. Subsequently, an Al-exposure study was conducted on a rat model categorized into control, low-, medium-, and high-dose groups. After a Morris Water Maze test and detection of Al, Zn content in the hippocampus, integrated transcriptomic and proteomic analyses between the control group and the high-dose group were performed to identify the differentially expressed genes (DEPs), proteins (DEPs), and pathways. To corroborate these findings, quantitative real-time polymerase chain reaction (qRT-PCR) and western blotting (WB) were selected to identify the gene and protein results. Zn overall mediates the relationship between serum Al and cognitive function (mediation effect 17.82%, effect value = - 0.0351). In the Al-exposed rat model, 734 DEGs, 18 miRNAs, 35 lncRNAs, 64 circRNAs, and 113 DEPs were identified between the high-dose group and the control group. Among them, ROCK1, DMD, and other four DEPs were identified as related to zinc finger proteins (ZNF). Co-enrichment analyses of the Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) linked these changes to the RHOA/ROCK1 signaling axis. ZNF-related proteins Rock1, DMD, and DHX57 in the high-dose group were downregulated (p = 0.006, 0.003, 0.04), and the expression of Myl9, Rhoa, miR431, and miR182 was also downregulated (p = 0.003, 0.032, 0.032, and 0.046). These findings also show correlations between Al, Zn levels in the hippocampus, water maze performance, and expressions of Myl9, Rhoa, miR431, miR182, DMD, ROCK1, and DHX57, with both negative and positive associations. Based on the results, we determined that Zn was involved in Al-induced MCI in Al workers and Al-exposed rat models. Al exposure and interaction with Zn could trigger the downregulation of ZNF of ROCK1, DMD, and DHX57. miR431, miR182 regulate RHOA/ROCK1 was one of the Zn-involved pathways in Al-induced cognitive impairment.

Associations between Informant-Reported Cognitive Complaint and Longitudinal Cognitive Decline in Subjective Cognitive Decline A 7-Year Longitudinal Study.

This study aimed to determine the predictive values of informant-reported memory decline (IMD) among subjective cognitive decline (SCD) older adults from a 7-year community-based cohort study. Ninety SCD participants were included. Demographic data and neuropsychological test scores at both baseline and 7-year follow-up were collected. Differences between SCD with IMD (+IMD) and SCD without IMD (-IMD) were compared. Logistic regression models were used to determine whether baseline IMD could predict diagnostic outcomes at 7-year follow-up. Forty-one percent of SCD adults had IMD. At baseline, the +IMD group showed more depressive symptoms (p = 0.016) than the -IMD group. Furthermore, the Beijing-version Montreal Cognitive Assessment (MoCA), Digit Span Test-Forward, Visual Matching and Reasoning, and Wechsler Adult Intelligence Scale-RC Picture Completion (WAIS-PC) scores in the +IMD group were significantly lower than those in the -IMD group. Fifty-four percent of +IMD participants converted to mild cognitive impairment (MCI) or dementia at follow-up, and 22.6% of the -IMD participants converted to MCI. Follow-up Mini-Mental State Examination, MoCA, and Verbal Fluency Test scores of the +IMD group were significantly lower than those in the -IMD group. The +IMD group was more likely to progress to cognitive impairment at 7-year follow-up (OR = 3.361, p = 0.028). SCD participants with +IMD may have poorer cognition and are more likely to convert to cognitive impairment over time. Our long-term follow-up study confirmed the importance of informants' perceptions of SCD, which can help clinicians identify individuals at risk of cognitive decline.

CLINICAL CORRELATION OF MOCA AND TAU IMAGING

Abstract Background Tau-PET Scan measures brain tau deposition. Montreal Cognitive Assessment (MOCA) is used for cognitive impairment in (MCI) and Alzheimer Disease (AD). We analyzed the correlation of MOCA to tau-PET imaging in a memory clinic. Hypothesis Tau-PET positivity correlates with lower MOCA scores in memory clinic patients Objectives To assess the correlation of tau-PET positivity to MOCA test scores in memory clinic patients To evaluate an MOCA score cut-off that translates optimally to tau-PET positivity Method Retrospective observational chart review study of 34 patients attending a memory clinic in Boston, MA, with MOCA score and tau-PET scan included for analysis No stratification based on initial or final diagnosis, severity of cognitive impairment, or tracer used. Baseline MOCA and a binary PET scan result were analyzed with covariates age, sex and race. Analysis done on ‘R’ v. 2.4.0. Pearson correlation estimated MOCA score to tau-PET status. Kruskal Wallis/Chi square tests for relationship of age, sex, gender and education with MOCA score and tau-PET status. ROC analyses and sensitivity/specificity were obtained. Results Tau PET positivity did not correlate significantly with MOCA score (r= -0.24, 95%CI –0.54 to -0.12, p=0.19). A cut point of 22 on the MOCA estimated tau deposition in the brain by PET scan, with an AUC of 80%, 95% CI –0.6 to –0.99, possibly indicating a ceiling effect on the MOCA. Conclusion Tau PET does not correlate with MOCA scores, possibly due to a ceiling effect in the mild impairment subjects.

7 The MOCA Versus Neuropsychological Testing in Assessing Presence of Memory Impairment and MCI

Objective:The Montreal Cognitive Assessment (MOCA) is a brief cognitive screener, widely used by providers to detect mild cognitive impairment (MCI). It encompasses 30 questions, assessing executive functioning, visuospatial skills, language, memory, attention, and orientation. Although the MOCA has been shown to have high sensitivity (90%) and specificity (87%) for detecting MCI, existing studies have primarily included participants who were already diagnosed with amnestic MCI via neuropsychological testing. Since several factors beyond the presence of MCI can contribute to low performance on the MOCA (e.g., premorbid IQ, fatigue, mood symptoms), over-reliance on the MOCA runs the risk of falsely identifying individuals as having cognitive impairment. The MOCA’s memory subtest raises particular concern as there are several language-based tasks between the learning and delay trials, introducing the potential for interference effects. Thus, the MOCA’s ability to accurately identify those at risk for MCI in the community remains unclear. The objective of the present study was to evaluate: (1) the MOCA’s association with neuropsychological memory measures; and (2) its ability to distinguish between neurocognitive groups (intact vs. MCI vs. dementia).Participants and Methods:This study involved a retrospective analysis of fifty-one patients (M age=72.58 [7.90]; M education= 16.37 [16.37]) who underwent neuropsychological evaluation. Standardized scores for total list-learning (HVLT; CVLT-bf) were used to capture memory encoding; retention % scores were used to capture memory storage. MOCA scores included Total MOCA, MOCA-Orientation, and the MOCA Memory Index (MOCA-MEM). MOCA-MEM was calculated based on Julayanont et al., 2014— (Free-Delayed Recall*3) + (Category-Cued Recall*2) + Multiple Choice-Cued Recall. Bivariate correlations were conducted for the MOCA and neuropsychological test scores. Participants were divided into three diagnostic groups, classified by the neuropsychologist: (1) Cognitive Intact (CI; n=13); (2) MCI (n=26); and (3) Major Neurocognitive Disorder/Dementia (MNCD; n=11). Analysis of covariance was used to analyze differences between the cognitive groups on Total MOCA, MOCA-Orientation, and MOCA-MEM.Results:Total MOCA correlated with word-list learning (r=.434, p=.004) and retention% (r=.306, p=.049). MOCA-MEM was correlated with word-list learning (r=.367, p=.042); it did not significantly correlate with retention%. MOCA-Orientation had the strongest correlation with retention0/) (r=.406, p=.009). Means of Total MOCA significantly differed between CI (25.31[2.56]), MCI (22.04[4.14]), and MNCD (15.44[4.13]). MOCA-MEM only differentiated CI (10[3.66]) and MNCD (5.71[2.14]); it did not differentiate MCI (6.94[3.13]) from either CI or MNCD.Conclusions:Our findings suggest that the MOCA has limitations in accurately classifying memory deficits in older adults. First, our study suggests that the MOCA-MEM reflects encoding rather than memory storage. Given that deficiency in encoding may be secondary to other cognitive deficits, such as attention and executive dysfunction, performance on MOCA-MEM cannot readily delineate the presence of an amnestic process. Second, the findings show that MOCA-MEM does not differentiate between patient groups with intact cognition versus MCI, nor those with MCI versus MNCD. These findings argue the importance of neuropsychological evaluation in deciphering patterns of memory performance and the presence of an amnestic process.

Changes in gut microbiota and cytokines following laparoscopic sleeve gastrectomy are associated with cognitive function improvement

PurposeVariations of cytokines and gut microbiota diversity with improved cognitive function in patients with obesity following bariatric surgery were poorly understood. The aim of this study was to testify the relationship among gut microbiota, cytokines and cognitive function in patients with obesity before and after laparoscopic sleeve gastrectomy (LSG). MethodsForty patients were enrolled in this study. Demographics, and serum and stool specimens were collected from all patients before and 3 months after LSG. The Montreal Cognitive Assessment (MoCA) scale, as well as assessment of immediate and delayed memory were used to evaluate self-perceived cognitive improvement after LSG. ResultsLSG resulted in significant weight loss and improvement in cognitive functions, as measured by questionnaires. Bariatric surgery tended to increase gut microbiota relative abundance and diversity. The intestinal flora increased in the proportion of Bacteroidetes and Fusobacteria phyla, and decreased in the proportion of Firmicutes, Proteobacteria, and Actinobacteria phyla after LSG. Plasma IL-1β and TNF-α levels were significantly decreased following LSG, while IL-4 was significantly increased. MoCA test scores were significant correlated with IL-4, TNF-α and IL-1β. In addition, Firmicutes had a positive correlation with TNF-α, while Fuscobacteria had a negative correlation with IL-1β. Bacteroidetes was negatively correlated with IL-4. ConclusionChanges in gut microbiota were positive relationship with cognitive function improvement following LSG. Inflammation cytokines maybe played as a mediator between gut microbiota and cognitive function through gut-microbiota-brain axis.

#5200 IMPACT OF MINERAL BONE PARAMETERS IN COGNITIVE IMPAIRMENT IN DIALYSIS PATIENTS

Abstract Background and Aims Mineral bone disease and cognitive impairment are related diseases in the CKD population. Vascular calcification, a marker of MBD, may play a role in the early detection of cognitive decline. This study aims to identify a relationship between MBD biomarkers and cognitive function and to identify dialysis patients with a high risk of dementia. Method A total of 98 patients participated in this cross-sectional study, with 63 on hemodialysis and 35 on peritoneal dialysis. They underwent the Montreal Cognitive Assessment (MoCA) questionnaire, which categorized mild, moderate, severe, and severe based on scoring. PTH, P, Ca, ALP, and Mg serum concentrations and vascular calcification were measured as MBD biomarkers. The Adragaos score was applied to graphs of the hands and pelvis to evaluate vascular calcification. Results The mean MoCA score was 20,28±5.8. Based on the responses, it was concluded that 70% of HD patients had mild cognitive impairment, compared to 63% of PD patients. According to the descriptive data, patients whose underlying CKD was caused by nephroangisclerosis had the lowest MOCA test results compared to other groups (p&amp;lt;0.001). The degree of calcification was observed to have an adverse effect on cognitive performance in both groups (p&amp;lt;0.012); the high Adragaos score contributed to the decline in the MoCA test score. In multivariate logistic regression analysis, hypercalcemia and hypomagnesemia were independent variables for cognitive function impairment (p = 0.006 and p = 0.04, respectively). The serum concentration of PTH (p = 0.008) and ALP (p = 0.001) were found to be risk factors for HD patients during the evaluation of the MoCA test in each of the groups. Conclusion Vascular calcifications are considered a risk factor for cognitive impairment. In our study, vascular calcification risk is positively impacted by indicators such as hyperparathyroidism, hypercalcemia, high levels of ALP, and hypomagnesemia. Recently research has demonstrated the effectiveness of magnesium as a vascular calcification inhibitor. So, nephrologists should be more careful in monitoring levels of MBD biomarkers.

#6287 EFFECT OF REMOTE ISCHEMIC PRECONDITIONING ON NUTRITIONAL STATUS, COGNITIVE FUNCTION, AND BONE IN HEMODIALYSIS PATIENTS: A RANDOMIZED CONTROLLED TRIAL

Abstract Background and Aims Remote ischemic preconditioning (RIPC) is a process in which a brief period of ischemia is induced in one part of the body to protect another part from damage due to subsequent periods of more severe ischemia. Hemodialysis sessions are considered an ischemic process because it involves reducing blood flow to certain parts of the body, which can lead to tissue damage .Malnutrition, deterioration of cognitive function, bone disorders, cardiovascular disease, and hemodynamic instability can result from ischemia induced by hemodialysis sessions. These adverse effects increase mortality in HD patients. RIPC has been studied as a potential therapeutic strategy to reduce the risk of cardiovascular events in hemodialysis patients; however, the effect of RIPC on cognitive function, nutritional status, and bone disorder among hemodialysis patients has not been enough studied. Aim: to assess the effect of remote ischemic preconditioning on nutritional status, bone disorders, and cognitive function in hemodialysis patients at the urology and nephrology center, Mansoura University. Method Fifty patients who received regular hemodialysis for more than one year in our dialysis unit were included. The patients were randomized (single-blind) into two groups a control group (20 patients) and an intervention group (30 patients). Before each HD session, sphygmomanometer cuffs was placed around the non-vascular access arm. Three cycles of ischemia for five minutes were performed followed by reperfusion for five minutes. Ischemia was induced by inflating the sphygmomanometer cuffs to 200 mmHg. This maneuver was done before each HD session for 12 weeks. The Montreal Cognitive Assessment (MOCA) was used to assess cognitive function. The nutritional state was assessed by anthropometric measurement (body weight, BMI), laboratory (serum albumin and serum cholesterol), and Subjective Global Assessment Form (SGA). Serum calcium (s.Ca) and serum phosphorus (s.po), serum alkaline phosphate (s. ALP) and intact parathyroid hormone (iPTH) were used as indices for bone profile. Results The intervention group include 30 patient with mean age (36+/-10), 19 male (63.3%) and 11 females (36.7%). The control group include 20 patient with mean age (46+/-9), 12 male (60%) and eight female (40%). None of these patients’ demographic data (age, sex, original kidney disease, and duration of dialysis) were significantly different between the study groups (P&amp;gt;0.05). MOCA test score at baseline was (24.5 +/-2.6) at intervention group and (24.4+/-3.2) at control group, and after 12 weeks intervention was (24.8 +/-2.2) at intervention group and (24.4+/-2.8) at control group. there were no statistical significance regarding cognitive function between the two group over time (p = 0.4). NO significant Statistical changes in anthropometric measurements (Body weight (p = 0.3) and BMI (P = 0.6) were found between the two groups. Additionally, no significant changes (serum albumin and cholesterol) were detected. SGA score at baseline was at intervention group (1.2+/-0.4) and control group (1.1 +/- 0.3), and after 12 week was at the intervention group (1.4 +/-0.5) and control group (1.6 +/-0.5). SGA showed no statistical significance between the two groups over time (p = 0.2). No significant statistical changes regarding bone profile (s.ca (p = 0.5), s.PO (p = 0.2), s.ALP (p = 0.7) and iPTH (p = 0.5)). Conclusion Although some studies showed a beneficial effect of RIBC on reduction of cardiovascular risk, our study found no significant effect on cognitive function, nutritional status, and bone disorders among hemodialysis patients.

Associates of cognitive functions in aged Turkish adults: Insights from a psychiatry outpatient clinic

Introduction: The aim of this study was to determine the cognitive function and its influential factors in elderly adults in Turkey. Materials and Methods: 127 patients aged over 65 years referred to a psychiatry outpatient clinic for the first time were included to cross-sectional and descriptive study. Patients were assessed by Carlson Comorbidity index, Montreal Cognitive Assessment Test, Geriatric Depression Scale, Beck Anxiety Inventory, Nottingham Health Profile and Lawton Instrumental Activities of Daily Living Scale. Results: The mean age of the patients was 69.7±4.2 years and 55.1% (n=70) of the participants were female. The primary diagnosis was Generalized Anxiety Disorder in 48.8% and Major depressive disorder in 51.2% of the patients. In multivariate analysis, age (OR:0.759, 95% CI:0.630-0.914, p=0.004), income &lt;3800 TL (OR:14.72, 95% CI:1.78-121.51, p=0.013), medication usage (OR:0.171, 95% CI:0.035-0.845, p=0.030) and Geriatric Depression Scale score (OR:0.876, 95% CI:0.785-0.977, p=0.017) remained as independent predictors of Montreal Cognitive Assessment Test score. Conclusion: In Turkish adults with Generalized Anxiety Disorder or Major depressive disorder who admit to a psychiatry outpatient clinic for the first time, various parameters including age, education, income, leisure activity, medication usage, depression, Lawton Instrumental Activities of Daily Living Scale score and Nottingham Health Profile score are linked with cognitive impairment. However, only age, income, medication usage and depression independently associate with cognitive impairment in this highly specific patient population. Keywords: Cognitive Dysfunction; Geriatric Psychiatry; Depression; Quality of Life.

Comparison of DBFS with MoCA and MMSE tools for MCI screening.

Mild cognitive impairment (MCI) has been associated with many diseases. The MCI could be a marker for the early diagnosis of certain diseases. Early detection of MCI could be beneficial for restoration of cognitive reserves. One hundred and five subjects were included in the study, underwent the Digital Brain Function Screen (DBFS) test as well as the Montreal Cognitive Assessment (MoCA) test and 73 subjects took the Mini-Mental State Examination (MMSE) test. DBFS test and retest was taken by 16 subjects. The test scores of DBFS tool showed significant positive correlation with MoCA and MMSE test scores. In conclusion, the DBFS tool could be an effective digital tool which can overcome the disadvantages of traditional tools of screening MCI like MoCA and MMSE.

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.

Vascular Factors in Patients with Midlife Sensorineural Hearing Loss and the Progression to Mild Cognitive Impairment.

Background and Objectives: Midlife hearing loss (HL) has been considered as a major modifiable risk factor for a later-life progression to dementia. Our aim was to detect a link between precocious sensorineural hearing loss (SNHL) and mild cognitive impairment (MCI) and their association to putative risk factors for a common pathology. Materials and methods: In this study, a retrospective case-control study was carried out. A total of 112 patients were enrolled as following: 81 patients with bilateral SNHL and 31 subjects with normal hearing, whose ages ranged from 50 to 65 years. Both groups performed pure tone audiometry, a tinnitus handicap inventory (THI), Mini-Mental State examination (MMSE), and the Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS-A and HADS-D). Results: The mean age was 58 ± 5.2 in SNHL patients and 53.2 ± 4.8 in the control group. The mean pure tone average in the SNHL group was 40.2 ± 18.7 dB HL on the right side and 41.2 ± 17.2 dB HL on the left side, while in the control group it was 12.5 ± 2.8 dB HL on right side and 12.4 ± 3.1 dB HL on left side. About 64% of patients with SNHL exhibited comorbidities, and the most common condition was hypertension. Altered MoCA test scores were significantly related to the pure tone averages in patients with SNHL compared to the control group (p = 0.0004), while the differences in the HADS-A and HADS-D were not significant. Furthermore, a significant correlation was observed in SNHL patients between an altered MoCA test and hypercholesterolemia (p = 0.043). Conclusions: Hearing impairment and screening tests to detect MCI should be considered in the midlife in order to carry out strategies to prevent the progression to dementia. Hypertension and hypercholesterolemia are two risk factors in the development of endothelial dysfunction, oxidative stress, and vascular inflammation, and may represent the common pathology linking the inner ear and brain damage.

The neural correlates of emotional conflict monitoring as an early manifestation of affective and cognitive declines in persons with Type 2 diabetes.

Patients with Type 2 diabetes are known to be more susceptible to experience dementia and depression/anxiety. The neural circuits of emotional conflict monitoring, as indicated by a Stroop task, might become altered in terms of cognitive and affective impairments in diabetes. This study investigated alterations in the emotional conflict monitoring and associations of corresponding brain activities with metabolic parameters in persons with Type 2 diabetes. Participants with normal cognitive and affective functioning, including 40 persons with Type 2 diabetes and 30 non-diabetes control subjects, underwent a functional MRI paradigm with the face-word emotional Stroop task and detailed cognitive and affective assessments, including the Montreal Cognitive Assessment and Beck Anxiety Inventory. Compared with the controls, people with diabetes exhibited stronger emotional interference, as indicated by differential reaction times between congruent and incongruent trials (Δcon). Δcon was correlated with Montreal Cognitive Assessment test scores and fasting glucose levels. People with diabetes demonstrated altered brain activation and functional connectivity in the neural network for emotional conflict monitoring. The neural network for emotional conflict monitoring mediated the association of pancreatic function with anxiety scores as well as the relationship between Δcon and Montreal Cognitive Assessment scores. Results suggested that alterations in the neural network underlying emotional conflict monitoring might present before clinically measurable cognitive and affective decrements were apparent, thereby bridging the gap between dementia and anxiety/depression in persons with diabetes.

Concordance and discordance in disease severity classification between clinician judgments and cognitive testing scores for Alzheimer’s disease in the United States Veterans Affairs Healthcare System

AbstractBackgroundThe current standard of practice for assessment of Alzheimer’s disease (AD) severity in the Department of Veterans Affairs (VA) Healthcare System is primarily based on clinical examination and cognitive testing. We aimed to assess the consistency between clinician judgements of AD severity compared with that classified by cognitive test scores in the VA system.MethodWe identified medical notes for patients with mild, moderate, or severe AD from the VA electronic healthcare records (EHR) database between March 2008 and October 2021, using the natural language processing technology. Mini‐Mental Status Exam (MMSE) and Montreal Cognitive Assessment (MoCA) scores from the corresponding medical notes with physician judgments were classified and used for comparisons of severity levels. A binary variable was coded to indicate concordance or discordance for each paired comparison.ResultWe screened clinical notes from 51,809 AD patients and analyzed 8,888 clinical notes that had either an MMSE or MoCA test score from 5,150 AD patients (3.5% female; average age at 78.1±9.4 years). Clinician judgements and test‐score‐based classification of AD severity were concordant in 53.2% of comparisons (weighted Kappa = 0.39, 95% CI:0.38‐0.41, p = 0.009); whereas clinician judgments were less severe in 25.7% and more severe in 21.1% comparisons, relative to the test‐score‐based severity level. Clinician judgments were concordant with 54.1%, 51.8%, and 53.0% cognitive test‐score‐based classifications, of mild, moderate, and severe AD, respectively. Concordance was observed in 55.9% clinician judgments involving internist, 53.0% involving psychiatrist or neurologist, and 51.7% involving psychologist specialties, and in 50.4% involving nurse practitioners. Among discordant severity classifications, clinician judgments tended to be less severe than test scores (Figure).ConclusionExamination of VA EHR reveals that nearly one half of clinician judgments of AD severity are discordant with severity classification based on the MMSE or MoCA test scores. Discordance is more pronounced in the moderate relative to mild and severe AD categories but does not vary substantially over clinicians’ specialty background. Research will aim to find plausible explanations for the variation of concordance vs discordance by further examining the relative contributions of patient, clinician, and system characteristics in the process of AD clinical assessments.

The association between total cholesterol and cognitive impairment in chronic obstructive pulmonary disease patients

AimChronic obstructive pulmonary disease (COPD) is primarily a respiratory system disorder associated with extrapulmonary conditions. Cognitive impairment (CoI) is very common among COPD patients This study sought to investigate the association between CoI and clinical parameters, inflammatory markers and lipid profiles in a COPD patient population. MethodsThe study population included 111 stable COPD patients. COPD was diagnosed according to Global Initiative for Chronic Obstructive Lung Disease guideline. Total complete blood count test and biochemical measurements including lipid profile were performed. Afterwards, all patients underwent neuropsychological assessment including Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index and Montreal Cognitive Assessment (MoCA) tests. ResultsThe patients were categorized into two groups according to their MoCA test score: MoCA score ≤ 21 (CoI) (n = 69) and MoCA score > 21 (normal cognition) (n = 42). Total cholesterol (TC) levels were significantly lower in patients with CoI compared to patients with normal cognition. Inflammation related parameters including C-reactive protein were similar among groups. Multivariate logistic regression analysis yielded education, HADS score and TC (OR:1.02, 95% CI:1.00–1.04, p = 0.025) as independent predictors of MoCA score. ConclusionTC independently associates with CoI in COPD patients. There is comparable inflammatory status in COPD patients with CoI compared to COPD patients with normal cognition.

Association of Anxiety and Depression with Objective and Subjective Cognitive Decline in Outpatient Healthcare Consumers with COVID-19: А Cross-Sectional Study

BACKGROUND: In addition to the neurological complications affecting people infected with COVID-19, cognitive impairment symptoms and symptoms of anxiety and depression remain a frequent cause of complaints. The specificity of cognitive impairment in patients with COVID-19 is still poorly understood.&#x0D; AIM: An exploratory study of factors that may be associated with cognitive decline during the COVID-19 pandemic.&#x0D; METHODS: The cross-sectional multicentre observational study was conducted in a polyclinic unit in Saint Petersburg and in the regions of the North-Western Federal Region. During the study, socio-demographic parameters and information about the somatic condition of patients who applied for primary health care was collected. Emotional and cognitive state were investigated using the Hospital Anxiety and Depression Scale (HADS) and Montreal Cognitive Assessment (MoCA). Mathematical and statistical data processing was carried out using SPSS and RStudio statistical programs.&#x0D; RESULTS: The study included 515 participants, 60% (n=310) of which were women. The sample was divided into those who did (28.5%, n=147) and did not (71.4%, n=368) complain of cognitive decline. Patients with complaints of cognitive decline were significantly older, had lower levels of education and higher levels of depression and anxiety according to HADS (p 0.05). Patients with complaints of cognitive decline underwent the MoCA test (24.3%, n=125). The median MoCA test scores were within the normal range (Median=27, Q1=25, Q3=28), and cognitive decline (MoCA less than 26 points) was detected in 40% (n=50) of patients with complaints of cognitive decline. No significant correlations were found between the MoCA scores and the levels of anxiety and depression according to the HADS (p 0.05). Patients with mild severity of the COVID-19 course were more successful with MoCA subtests than patients with moderate and severe courses.&#x0D; CONCLUSION: We found no linear association between objective cognitive deficit and the affective state of respondents. Patients subjective complaints about cognitive dysfunction were mostly caused by their emotional state than an objective decrease of their cognitive functions. Therefore, in case of subjective complaints on cognitive decline, it is necessary to assess not only the cognitive but also the affective state of the patient. The severity of the COVID-19 course affects the functions of the cognitive sphere, including attention, regulatory functions and speech fluency. Mild and moderate severity of the COVID-19 correlates with clinically determined depression. The absence of this relationship with the severe course of the disease is probably explained by the significant somatic decompensation of patients.

Evaluation of the Montreal Cognitive Assessment as a screening tool for cognitive dysfunction in SLE

ObjectivesCognitive dysfunction in SLE is common and associated with significant morbidity but is currently underdetected. Early detection requires the use of screening tests, as formal diagnostic cognitive testing is time-consuming....

Gingival Crevicular Fluid as Biomarker’s Source for Alzheimer’s Disease

Periodontitis is a low-grade inflammatory disease caused by a subgingival dysbiotic microbiota. Multiple studies have determined the higher prevalence of tooth loss and poor oral hygiene in patients with Alzheimer’s disease (AD). However, the periodontal diagnosis, periodontal bacteria or mediators has not been measured to date. Aim: To determine the periodontal status, the pro-inflammatory mediators, Porphyromonas gingivalis load, and Apoliporpotein E (ApoE) in patients with AD. A complete dental examination was performed on 30 patients, and cognitive status was determined by the Montreal Cognitive Assessment (MoCA). Subgingival microbiota and GCF samples were then taken from all patients from the deepest sites. Total DNA was isolated from the microbiota samples for the quantification of the 16S ribosomal subunit. Pro-inflammatory mediators and ApoE were quantified from the gingival crevicular fluid (GCF). Patients with AD had periodontitis stage III-IV in 80%, a higher concentration of pro-inflammatory and ApoE mediators, and a higher P. gingivalis load compared to healthy subjects. The pro-inflammatory mediators, P. gingivalis load had a negative correlation with the MoCA test scores. Finally, a ROC curve was performed to assess the specificity and sensitivity of ApoE levels, detecting an area of 84.9%. In AD patients, we found a more severe periodontitis, a higher levels of pro-inflammatory mediators, and higher bacterial load. In addition, there is an increase in ApoE that allows to clearly determine patients with health, periodontitis and periodontitis and AD.

Validation of the Spanish-language version of the Montreal Cognitive Assessment as a screening test for cognitive impairment in multiple sclerosis

BackgroundThe neuropsychological batteries traditionally used for the assessment of cognitive impairment (CI) in patients with multiple sclerosis are complex tests requiring a long time to administer. Simpler tests are needed to detect cognitive impairment in daily clinical practice. ObjectiveWe aimed to evaluate the diagnostic validity and reliability of the Montreal Cognitive Assessment (MoCA) test as a screening tool for CI in patients with multiple sclerosis, as compared against the Brief Neuropsychological Battery. Material and methodsWe recruited 52 patients with multiple sclerosis (61.5% women; mean age [standard deviation]: 41.7 [11.5] years). We analysed the reliability (internal consistency, interobserver reliability, and test-retest reliability), construct validity (factor analysis, Pearson correlation coefficient, and coefficient of determination), and criterion validity (ROC curve, sensitivity, specificity, total agreement, positive and negative predictive values, positive and negative likelihood ratios, and Fagan nomogram) of the MoCA test in this population. ResultsThe prevalence of CI was 21.2% according to findings from the Brief Neuropsychological Battery, and 25% according to the MoCA test. The MoCA test showed good internal consistency (Cronbach alpha, 0.822) and interobserver and test-retest reliability (intraclass correlation coefficient 0.80 and 0.96, respectively). The correlation coefficient between total Brief Neuropsychological Battery and MoCA test scores was 0.82. The optimal cut-off point on the ROC curve was 25-26, yielding 91% sensitivity and 93% specificity. ConclusionThe MoCA test is a valid and reliable tool for screening for CI in patients with multiple sclerosis.