Montreal Cognitive Assessment Test Scores Research Articles

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.

Altered cerebral perfusion and microstructure in advanced Parkinson’s disease and their associations with clinical features

ABSTRACT Objective To explore the whole cerebral perfusion and microstructure alteration patterns in Parkinson’s disease (PD) and the associations of these patterns with clinical features. Methods Forty-one subjects [20 PD patients and 21 healthy controls (HCs)] underwent arterial spin labeling (ASL), diffusion tensor imaging (DTI) and 3D T1-weighted imaging (T1WI) MRI. The cerebral blood flow (CBF) of the whole brain and the fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD) of subcortical and cerebellar regions were measured and compared between groups. Pearson’s correlation was calculated between MRI measurements and clinical features [Unified Parkinson’s Disease Rating Scale (UPDRS), UPDRS III, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and olfactory test scores]. Results Compared to HCs, PD patients showed lower CBF in the frontal, parietal and temporal lobes but higher CBF in bilateral hippocampi, red nuclei, right substantia nigra, thalamus and most cerebellar regions. The MD in the right thalamus and several regions in the cerebellum increased in PD compared to HCs. In PD patients, the total UPDRS, UPDRS III, MoCA, MMSE and olfactory test scores were related to FA or CBF in cerebellum. (all p < 0.05) Conclusion Hypoperfusion in cortical regions, together with hyperperfusion in subcortical and cerebellar regions may be the characteristic perfusion pattern in advanced PD patients. The microstructures of the right thalamus and cerebellum were changed in PD patients. The cognitive, motor and olfactory performance of PD patients is closely related to the perfusion and microstructure of the brain, especially the cerebellum.

Examining the test-retest reliability and construct validity of the Six-Spot Step Test in older adults with self-reported balance problems

Objective: To evaluate the test-retest reliability and construct validity of the Six-Spot Step Test in older adults. Design: Cross-sectional study. Setting: Outpatient clinics. Subjects: Sixty-six adults aged ⩾65 years with self-reported balance problems. Main measure: The Six-Spot Step Test was completed twice on day 1. Three days later, the Six-Spot Step Test, the Timed “Up and Go” test, Dynamic Gait Index, the Mini-BESTest, and standing balance test were conducted. Reliability and validity were estimated using Bland-Altman statistics, minimal detectable change, Intraclass Correlation Coefficient (ICC), and Spearman’s rank correlation coefficient (ρ). Results: Participants had a mean (SD) age of 75.5 (6.6) years, a median (Q1–Q3) Montreal Cognitive Assessment test score of 26 (24–27), and a median (Q1–Q3) Falls Efficacy Scale International score of 22 (20–26). The study found within-day and between-day limits of agreements of ±15.7% and ±18.1%, respectively. The minimal detectable changes at the 95% level of confidence for within-day and between-day were 17.5% and 21.6%, and the ICCs were 0.96 (CI: 0.92–0.98) and 0.94 (CI: 0.86–0.97), respectively. A learning effect was observed between the first and second Six-Spot Step Test. Moderate to strong correlations were found between the Six-Spot Step Test and Mini-BESTest (ρ = −0.62), Dynamic Gait Index (ρ = −0.55), and the Timed “Up and Go” test (ρ = 0.79). Weak correlations were identified between the Six-Spot Step Test and static standing balance test (ρ < 0.38). Conclusion: The Six-Spot Step Test shows excellent relative consistency and moderate to high construct validity in older adults. A change of 21.6% is a true change in outcome.

Increased Carotid Intima-Media Thickness was not Associated With Cognitive Dysfunction After Off-Pump Coronary Surgery in Older Adult Patients Without Carotid Stenosis

Increased carotid intima-media thickness (C-IMT), a marker of atherosclerosis, is known to be associated with cerebrovascular and cortical abnormalities and cognitive impairment. This prospective observational study investigated the association between increased C-IMT and postoperative cognitive dysfunction (POCD) in older adult patients undergoing off-pump coronary artery bypass surgery. A total of 201 patients (57 females, 144 males; >60 years) were classified into increased (n = 105) or normal (n = 96) C-IMT groups by a cut-off value of 0.9 mm (bilateral C-IMT mean). Cognitive function was serially assessed with the Korean Mini-Mental State Examination, and Korean Montreal Cognitive Assessment scores preoperatively and at 7 days and 3 months postoperatively. POCD was defined as the deterioration of 1 standard deviation in at least one of the postoperative tests compared with their corresponding baseline scores. Independent risk factors for POCD were evaluated using multivariable analysis. Overall, POCD occurred in 46 patients (23%) over the 3 months. The incidences of POCD at 7 days and 3 months after surgery were similar, and there was no difference in both Korean Mini-Mental State Examination and Korean Montreal Cognitive Assessment test scores before and after surgery between groups. Chronic obstructive lung disease and intraoperative hyperglycemia episodes (>180 mg/dL), but not increased C-IMT, were independent risk factors for POCD. Unlike in nonsurgical cohorts, increased C-IMT was not significantly associated with the occurrence of POCD in older adult patients undergoing off-pump coronary artery bypass surgery.

External carotid artery stenting in patients with ipsilateral internal carotid artery occlusion: Peri-operative and 12-month follow-up.

This study aimed to evaluate the safety and clinical efficacy of external carotid artery (ECA) stenting in patients with ipsilateral internal carotid artery (ICA) occlusion. In patients with ICA occlusion, severe ipsilateral ECA stenosis may exacerbate pre-existing cerebral ischemia and cognitive impairment. It remains unclear whether ECA stenting to normalize ECA collaterals to the cerebralis alleviates cerebral ischemia and improves cognitive function. From January 2008 to June 2019, we retrospectively collected clinical data of 36 consecutive patients with ipsilateral ICA occlusion who had undergone ECA stenting (mean age, 66.7 ± 8.3 years; males, n = 26 [72.2%]). Neurocognitive test results, including Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA) tests, symptom assessment, and adverse events were recorded. ECA stenting was successful in all 36 patients. Intra-operatively, six (16.7%) patients experienced hemodynamic depression during balloon dilation and recovered completely within 2 days. Within a 12-month follow-up period, two patients experienced a transient ischemic attack, one patient had a contralateral minor stroke, and 33 patients remained asymptomatic. No other adverse events occurred in the peri-operative or follow-up periods. Compared with baseline, significant MMSE (25.3 ± 1.3 vs. 23.6 ± 1.7; p < .05) and MOCA (24.1 ± 1.3 vs. 22.8 ± 1.7; p < .05) test score improvements were observed 3 months post-operatively and were maintained throughout follow-up. ECA stenting may improve cerebral ischemia and cognitive function in patients with severe ECA stenosis and ipsilateral ICA occlusion; however, further research is required to support our findings.

Structural Analysis of Brain Hub Region Volume and Cortical Thickness in Patients with Mild Cognitive Impairment and Dementia.

Background and Objectives: A complex network of axonal pathways interlinks the human brain cortex. Brain networks are not distributed evenly, and brain regions making more connections with other parts are defined as brain hubs. Our objective was to analyze brain hub region volume and cortical thickness and determine the association with cognitive assessment scores in patients with mild cognitive impairment (MCI) and dementia. Materials and Methods: In this cross-sectional study, we included 11 patients (5 mild cognitive impairment; 6 dementia). All patients underwent neurological examination, and Montreal Cognitive Assessment (MoCA) test scores were recorded. Scans with a 3T MRI scanner were done, and cortical thickness and volumetric data were acquired using Freesurfer 7.1.0 software. Results: By analyzing differences between the MCI and dementia groups, MCI patients had higher hippocampal volumes (p < 0.05) and left entorhinal cortex thickness (p < 0.05). There was a significant positive correlation between MoCA test scores and left hippocampus volume (r = 0.767, p < 0.01), right hippocampus volume (r = 0.785, p < 0.01), right precuneus cortical thickness (r = 0.648, p < 0.05), left entorhinal cortex thickness (r = 0.767, p < 0.01), and right entorhinal cortex thickness (r = 0.612, p < 0.05). Conclusions: In our study, hippocampal volume and entorhinal cortex showed significant differences in the MCI and dementia patient groups. Additionally, we found a statistically significant positive correlation between MoCA scores, hippocampal volume, entorhinal cortex thickness, and right precuneus. Although other brain hub regions did not show statistically significant differences, there should be additional research to evaluate the brain hub region association with MCI and dementia.

Dysfunction in Automatic Processing of Emotional Facial Expressions in Patients with Obstructive Sleep Apnea Syndrome: An Event-Related Potential Study.

AimObstructive sleep apnea syndrome (OSAS) is a prevalent chronic disease characterized by sleep fragmentation and intermittent hypoxemia. Several studies suggested that electrophysiological changes and neurocognitive abnormalities occurred in OSAS patients. In this study, we compared automatic processing of emotional facial expressions schematic in OSAS patients and matched healthy controls via assessing expression-related mismatch negativity (EMMN).MethodsTwenty-two OSAS patients (mean age 44.59 years) and twenty-one healthy controls (mean age 42.71 years) were enrolled in this study. All participants underwent Montreal Cognitive Assessment (MoCA) scale test and polysomnographic recording. An expression-related oddball paradigm was used to elicit EMMN and the electroencephalogram was recorded and analyzed. Furthermore, Pearson’s correlations were calculated to discuss the correlation between neuropsychological test scores, clinical variables and electrophysiological data.ResultsCompared with healthy controls, OSAS sufferers demonstrated significantly reduced EMMN mean amplitudes within corresponding time intervals, regardless of happy or sad conditions. Meanwhile, we observed that amplitude of sad EMMN was larger (more negative) than happy EMNN in healthy controls, while not in patients. Moderate correlations were found between MoCA test scores, sleep parameters and EMMN amplitudes.ConclusionOur findings suggested pre-attentive dysfunction of processing emotional facial expressions in patients with OSAS, without the existence of negative bias effect. Moreover, correlation analysis showed that clinical characteristics of OSAS patients could affect EMMN amplitudes. Further studies on the advantages of EMMN as clinical and electrophysiological indicators of OSAS are warranted.

Validación de la versión española de la Escala Cognitiva de Montreal (MoCA) como herramienta de cribado de deterioro cognitivo asociado a la esclerosis múltiple

IntroductionThe 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.

The relation between teeth loss and cognitive decline among Saudi population in the city of Riyadh: A pilot study

BackgroundTeeth are necessary for sensory input to the brain during the chewing process, but how the decrease in this sensory input, due to loss of teeth, may cause weak memory and lead to cognitive decline is not well understood. This pilot public survey aiming to assess the correlation between the number of missing teeth, periodontal disease, and cognitive skill in the city of Riyadh. Material& MethodsA multicenter cross-sectional survey, targeting geriatric population aged ≥60 years, was performed in Riyadh City, Saudi Arabia. The Montreal Cognitive Assessment (MoCA) was conducted to all participants to assess their cognitive function. Assessment of oral health status was carried out, including the number of present dentation and their periodontal status. Community periodontal-index (CPI) was used to assess the periodontal condition. The primary variables were number of missing teeth, periodontal disease and MoCA test scores. Chi-square test and Pearson’s correlation coefficients were computed and the significant P- value was set at <0.05. ResultsOf 95 participants, overall, 57 (60%) and 38 (40%) were male and female, respectively, with a mean age of 65.67 ± 6.32 years. Females showed more significant cognitive decline than males (P < 0.001). Cognitive decline was significantly high in participants with low educational level 19 (95%), unemployment 41 (79%), and lower income people 26 (79%), while being cognitive intact was significantly higher in highly educated 13 (87%), retired 21 (62%), and higher income people 28 (74%) at (P < 0.001). An advanced age and greater number of missing teeth are associated with lower MoCA test scores. No statistical significant correlation with regard to periodontal disease and MoCA test scores. ConclusionBased on the preliminary data, positive correlation was confirmed when the number of missing teeth and cognitive skill were assessed. Therefore, larger, multi-center regional surveys are needed to investigate further this relationship.

Identifying an Optimal Cutoff of the Montreal Cognitive Assessment to Predict Amyloid-PET Positivity in a Referral Memory Clinic.

Brain amyloid- positron emission tomography (PET) imaging is highly sensitive for identifying Alzheimer disease. Currently, there is a lack of insight on the association between amyloid-PET status and the widely used Montreal cognitive assessment (MoCA). Studying this relationship may optimize the clinical use of amyloid-PET imaging. To evaluate the relationship between amyloid-PET status and MoCA scores and to identify a MoCA score cutoff that translates to amyloid-PET positivity. Using retrospective chart review, patients from 2010 to 2017 with amyloid-PET scans (positive or negative) and MoCA test scores were included. We studied the relationship between amyloid-PET status and MoCA scores and the influence of age, sex, education, and race. A MoCA score cutoff for amyloid-PET positivity was estimated. Among the 684 clinic patients with dementia, 99 fulfilled inclusion criteria. Amyloid-PET positivity was associated significantly with lower MoCA scores (median=19, U=847, P=0.01). The MoCA score cutoff (25) used for minimal cognitive impairment (MCI) predicted amyloid-PET positivity suboptimally (sensitivity=94.6%, specificity=13.9%). A MoCA score cutoff of 20 patients had optimal sensitivity (64.2%) and specificity (67.4%). Amyloid-PET positivity is associated with lower MoCA scores. Clinical utility of amyloid-PET scan is likely to be suboptimal at the MoCA score cutoff for minimal cognitive impairment.

Cognitive Impairment is Associated with Mortality in Hemodialysis Patients.

The prevalence of cognitive impairment in hemodialysis patients is notably high. In previous studises performed in the general population, cognitive impairment has been associated with increased mortality. We evaluated the relationship between global cognitive function tested by a short screening instrument and mortality in hemodialysis patients. Cognitive testing was performed in 242 maintenance hemodialysis patients under standardized conditions at baseline using the Montreal Cognitive Assessment (MoCA).Cognitive impairment was defined as a MoCA test score ≤24 points, as published previously. All-cause mortality was monitored during a median follow-up of 3.54 years. Kaplan-Meier plot and Cox regression model adjusted for known risk factors for mortality in hemodialysis patients were used to examine a possible association between global cognitive function and all-cause mortality. A MoCA test score ≤24 points resulted in a significant almost 3-fold higher hazard for all-cause mortality (unadjusted hazard ratio [HR]: 2.812; 95% confidence interval [95% CI]: 1.683-4.698; p < 0.001). After adjustment, this association was attenuated but remained significant (adjusted HR: 1.749; 95% CI: 1.007-3.038; p = 0.047). Impairment of global cognitive function measured by a short screening instrument was identified for the first time as an independent predictor of all-cause mortality in hemodialysis patients. Thus, implementing the MoCA test in clinical routine could contribute to a better risk stratification of this patient population.

Correlation between inner retinal layer thickness and cognitive function in HIV: new insights from an exploratory study.

To compare retinal layer thickness in HIV-infected subjects with (CI-HIV) and without (NCI-HIV) cognitive impairment, with a control population and to correlate this with the cognitive status of the patient and other clinical parameters. Single-center cross-sectional study. Participants with controlled HIV infection aged between 40 and 70 years and sex-matched and age-matched controls were enrolled. Retinal nerve fiber layer (RNFL), ganglion cell layer (GCL) and inner plexiform layer (IPL) thickness were assessed using optical coherence tomography. These measurements in HIV patients were compared with those in controls. Age-related and sex-related changes were compared in both groups. Other variables studied in HIV patients included: duration of HIV infection, CD4 cell count nadir, antiretroviral therapy regimen and cognitive status using the Montreal Cognitive Assessment (MoCA) test. Sixty-nine individuals, 34 with and 35 without cognitive impairment, and 70 controls were enrolled. GCL was significantly thinner in CI-HIV patients compared with NCI-HIV patients and controls (P = 0.01 and P = 0.02, respectively). GCL and IPL thickness significantly decreased with age in patients with HIV (P = 0.0003, P = 0.02, respectively, for the entire cohort). This change was not seen in controls. MoCA test score significantly decreased with age in HIV patients and controls. GCL thickness positively correlated with cognitive function across the entire HIV cohort (P = 0.02). GCL was thinner in HIV patients with cognitive impairment. GCL thickness correlated positively with cognitive function and negatively with age in HIV patients. GCL thickness may reflect accelerated cognitive aging in HIV.

Cognitive Profile in Tramadol Addicts

Background and Objective: Cognitive impairment is one of the consequencesof substance abuse. Tramadol abuse is a public health problemin Egypt. The objective of this study was to study the effect of tramadol addiction on cognitive functions, determine if cognitive impairment caused by tramadol is reversible or not and to study the impact of other related factors as duration of intake and dose of tramadol on cognition. Methods: This study included 30 patients with active tramadol abuse, 30 patients abstinent from tramadol for 3 to 6 months and 30 control subjects (matched for age, sex, and education) who were recruited from Kasr Al-Aini psychiatric and addiction hospital (from outpatient clinic and inpatient admitted patients), Egypt.The participants were interviewed using Montreal Cognitive Assessmenttest (MoCA), Trail making test A and B and had urine screening for drugs. Results: 53.33%(n=16) of active group had impaired total MoCA scores compared to 10 % (n=3) in control group.This was statistically significant with P value <0.0001.46.67% (n=14) of abstinent group had impaired total MoCA scores compared to 10 % (n=3) in control group. This was statistically significant with P value 0.002. As regard MoCAsubscores; we found statistically significant impairment in delayed recall and verbal fluency subscores in both the active and abstinent group. There was no statistically significant impairment in Trail making tests A and B.Therewas no association between cognitive impairment and sociodemographicor clinical factors. Conclusions: Cognitive impairment occurs commonly among tramadolabusepatients. Memory impairment and verbal fluencyare the most common cognitive domainsto be affected. Cognitive impairment is not reversible after 3 to 6 months.There is no effect of tramadol dose or duration of abuse on cognitive impairment.

Cognitive disorders in chronic kidney disease and hemodialysis patients

Introduction Cognitive impairment (CI) is common in individuals with chronic kidney disease (CKD) and among those treated with hemodialysis (HD). It may jeopardize treatment adherence by affecting the efficiency of every-day tasks, including correct medication and dietary rules. The severity of CKD is associated with the severity of CI, independent of age, education, and other key confounders. It is important to identify those patients with CI to reduce the considerable morbidity associated with this condition and improve their quality of life. Objectives The aim of the present study is to assess cognitive functions in patients with chronic renal diseases and patients on regular HD and to identify CI in these patients. Patients and methods A total of 30 patients with CKD were recruited from the outpatient clinic of Alamerya General Hospital (group I), and 30 HD patients were enrolled in the dialysis unit of the Alamerya General Hospital (group II). Moreover, 30 sex-matched and age-matched patients were recruited as controls (group III). Montreal Cognitive Assessment (MoCA) and Depression Anxiety Stress scale-21 were used as cognitive and neurological tests. Result The mean executive functions score was significantly lower in group II (2.37±0.67) in comparison with group I (3.33±0.48), with a P value less than 0.001, and it is also significantly lower in groups I and II in comparison with the control group (3.90±0.31), with a P value of 0.002 and less than 0.001, respectively. The mean attention score was significantly lower in group I (4.20±0.81) and group II (4.23±0.94) in comparison with the control group (5.27±0.69), with a P value of less than 0.001. The mean memory score was significantly lower in group I (3.10±0.40) and group II (2.57±0.90) in comparison with the control group (4.47±0.73), with a P value of less than 0.001. The mean total MoCA test score was significantly lower in group II (22.87±1.68) in comparison with group I (24.27±1.26), with a P value of less than 0.017, and it is also significantly lower in groups I and II in comparison with the control group (28.33±1.47), with a P value of less than 0.001. Conclusion Impaired renal function affects total MoCA score in the studied groups.

Frailty Phenotype and Neuropsychological Test Performance: A Preliminary Analysis.

Frailty is a common problem that affects adults older than 65 years. Correlations between the frailty phenotype and neuropsychological impairment have not been thoroughly researched. To examine the association between frailty phenotype, neuropsychological screening test results, and neuropsychological domains known to characterize patients with mild cognitive impairment and dementia. This retrospective medical record analysis consisted of ambulatory patients aged 65 years or older seen in an outpatient geriatric practice. All patients were assessed with the Montreal Cognitive Assessment (MoCA). A portion of those patients also underwent a comprehensive neuropsychological evaluation that assessed executive control, naming/lexical access, and declarative memory expressed as 3 neuropsychological index scores. Frailty phenotype was determined using criteria by Fried et al. Simple correlation found that lower MoCA test scores were associated with a higher level of frailty (r=-0.34, P<.032). Regression analyses found that greater frailty was associated with worse performance on tests that assessed executive control and working memory (backward digit span; r2=0.267; β=-0.517; P<.011) and delayed recognition memory (r2=0.207; β=-0.455; P<.025). A correlation was found between frailty and neuropsychological impairment, which suggests that frailty may be a potential indicator for the emergence of mild cognitive impairment and dementia.

The use of the Model of Occupational Self Efficacy in improving the cognitive functioning of individuals with brain injury: A pre- and post-intervention study.

Individuals diagnosed with a Traumatic Brain Injury (TBI) often experience major limitations in returning to work despite participating in rehabilitation programmes. The aim of the study was to determine whether individuals who sustained a traumatic brain injury experienced improved cognitive functioning after participating in an intervention programme that utilizes the Model of Occupational Self-Efficacy (MOOSE). Ten (10) individuals who were diagnosed with a mild to moderate brain injury participated in the study. The research study was positioned within the quantitative paradigm specifically utilizing a pre and post intervention research design. In order to gather data from the participants, the Montreal Cognitive Assessment (MOCA) was used to determine whether the individual with brain injury's cognitive functioning improved after participating in a vocational rehabilitation model called the Model of Occupational Self Efficacy (MOOSE). All the participants in this study presented with an improvement in MOCA test scores. The results of the study revealed a statistically significant effect of the intervention (i.e. MOOSE) on cognitive functioning measured using the Montreal Cognitive Assessment, F(4, 6) = 15.95, p = 0.002. The findings of this study indicated that MOOSE is a useful model to facilitate the return of individuals living with a TBI back to work. It is also suggested that cognitive rehabilitative activities be included as part of the vocational rehabilitation programme.

ARTEMIDA Trial (A Randomized Trial of Efficacy, 12 Months International Double-Blind Actovegin): A Randomized Controlled Trial to Assess the Efficacy of Actovegin in Poststroke Cognitive Impairment.

Poststroke cognitive impairment is a debilitating consequence of stroke. The aim of this study was to assess whether Actovegin confers cognitive benefit in patients who have had an ischemic stroke. This was a 12-month, parallel-group, randomized, multicenter, double-blind, placebo-controlled study. Eligible patients were ≥60 years of age with a Montreal Cognitive Assessment test score of ≤25 points. Patients were randomized into 2 groups within 1 week of acute supratentorial ischemic stroke in a 1:1 ratio: Actovegin (a deproteinized hemoderivative of calf blood, 2000 mg/d for ≤20 intravenous infusions followed by 1200 mg/d orally) or placebo for 6 months. Patients were treated in accordance with standard clinical practice for a further 6 months. The primary end point was the change from baseline in Alzheimer's Disease Assessment Scale, cognitive subscale, extended version at 6 months. Two-hundred forty-eight patients were randomized to Actovegin and 255 patients to placebo. At month 6, the least squares mean change from baseline in Alzheimer's Disease Assessment Scale, cognitive subscale, extended version was -6.8 for Actovegin and -4.6 for placebo; the estimated treatment difference was -2.3 (95% confidence interval, -3.9, -0.7; P=0.005). Recurrent ischemic stroke was the most frequently reported serious adverse event, with a nonsignificantly higher number for Actovegin versus placebo. Actovegin had a beneficial effect on cognitive outcomes in patients with poststroke cognitive impairment. The safety experience was consistent with the known safety and tolerability profile of the drug. These results warrant confirmation in additional robustly designed studies. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01582854.

Relationship between glycated hemoglobin A1c and cognitive function in nondemented elderly patients with type 2 diabetes.

Elderly patients with type 2 diabetes are at a greater risk for cognitive decline. The purpose of this study was to assess the relationship between the degree of hyperglycemia and cognitive status in nondemented, elderly diabetics. Between Jan 2013 and Dec 2014, 1174 geriatric patients with type 2 diabetes were enrolled in the study (579 males; age ≥ 60 years; from Fuzhou, Fujian, China). Cognitive function was measured with the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). A statistically significant, age-adjusted association was observed between the A1C levels and the scores on two cognitive tests (MMSE and MoCA). Specifically, a 1% higher A1C value was associated with a 0.21-point lower MMSE score (95% CI; compare -0.11 to -0.28; P < 0.0001), as well as a 0.11-point lower MoCA score (95% CI; compare -0.10 to -0.38; P < 0.0001). Higher A1C levels were not significantly associated with lower MMSE and MoCA test scores after adjusting for all variables. No significant correlation was found between the two variables in patients older than 80 years of age (n = 215; OR = 1.019; 95% CI = 0.968 - 1.099; p = 0.251). Evidence strongly suggests that chronic hyperglycemia is associated with a decline in cognitive function in nondemented elderly patients with type 2 diabetes. When cognitive assessments are made, comprehensive factors such as advanced age, education level, duration of diabetes, hypertension and other vascular risks should be taken into account. For older geriatric patients (age ≥ 80 years), there is no significant correlation between A1c levels and cognitive function.

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.