Montreal Cognitive Assessment Test Research Articles

Predictors of the dynamics of changes in cognitive functions in patients 6 months after carotid endarterectomy

Background. Carotid atherosclerosis is one of the urgent problems due to the high risk of developing ischemic stroke and cognitive impairment. The dynamics of clinical disorders in patients with carotid stenosis is determined by a complex of neurophysiological, angiological, tissue and biomolecular reactions, the characteristics of which can act as predictors of the course of the pathology.The aim of the work. To determine the neurophysiological parameters and predictors of cognitive dysfunction in patients who underwent carotid endarterectomy.Materials and methods. The study included 59 people with carotid atherosclerotic disease. All included patients underwent carotid endarterectomy. We assessed the degree of stenosis of the internal carotid artery and cognitive status using the FAB (Frontal Assessment Battery) scale and MoCA (Montreal Cognitive Assessment) Test and recorded electroencephalogram (EEG), P300 cognitive evoked potentials and heart rate variability in patients at various terms (before surgery, 6 months after the surgery). Patients were divided into groups based on the dynamics of cognitive tests using cluster analysis (k-means) with identification of elements included in the clusters: patients of cluster 1 had a “preserved” profile of cognitive status; patients of cluster 2 – moderate cognitive dysfunction.Results. Patients of cluster 1 had a higher power of beta oscillations in the frontal lead, a higher amplitude of the P3 component of the P300 potential, and a greater variability of R-R intervals in terms of the total indicator and high-frequency power. We proposed a model that allows us to classify patients into groups according to the dynamics of cognitive function scores. According to the data obtained, the most significant predictors of the dynamics of cognitive status were the initial characteristics of the EEG and the P300 cognitive evoked potential.Conclusions. We determined the clinical and neurophysiological correlates of cognitive dysfunction: an association with greater preservation of activating effects on the EEG, processes of recognition and decision-making in the associative zones of the cortex, and less pronounced activity of stress-implementing mechanisms. Indicators of EEG spectral analysis and characteristics of the P300 cognitive evoked potential are predictors of the cognitive status dynamics.

Pretransplant Cognitive Function and Kidney Transplant Outcomes: A Prospective Cohort Study

Background and hypothesisCognitive impairment is common in patients being evaluated for a kidney transplant (KT). The association between pre-transplant cognitive function and post-transplant outcomes is unclear. Study DesignWe performed a prospective cohort study to assess the association between pre-transplant cognitive function and clinically relevant post-transplant outcomes. Setting and PopulationIn this single center study, participants from the transplant clinic were evaluated during their pre-transplant clinic visits and followed prospectively. OutcomesOur primary outcome measure was allograft function. Secondary outcomes were length of hospitalization for KT, hospital readmission within 30 and 90 days, graft loss, graft rejection within 90 days and one year, and mortality. Analytic approachWe measured cognitive function with the Montreal Cognitive Assessment (MoCA) test. We assessed the association of pre-transplant MoCA score with post-transplant outcomes; we used linear mixed effects models to assess the association with the change in estimated glomerular filtration rate (eGFR), Poisson regression for length of hospitalization, Cox proportional hazard model for graft loss and mortality, and a logistic regression model for readmission and rejection. ResultsWe followed 501 participants for 2.7±1.5 years. The mean age of the patients was 53±14 years and the mean pre-transplant MoCA score was 25±3. Lower pre-transplant MoCA scores did not adversely affect the primary outcome of allograft function or the secondary outcomes. Although higher MoCA scores predicted a higher decline in graft function (β -0.28, 95% CI -0.55, -0.01, p= 0.04), the effect was small and not clinically significant. Older age was associated with longer hospitalization, lower likelihood of rejection, and higher mortality. Deceased donor KT (vs. living donor KT) was associated with longer hospitalization but better graft function. Longer time on dialysis prior to KT was associated with longer hospitalization. A history of diabetes mellitus was associated with higher mortality. LimitationsSingle center study limiting generalizability. ConclusionsPre-transplant MoCA scores were not associated with the primary outcome of allograft function or the secondary outcomes.

Consequences of age and education correction of cognitive screening tests - A simulation study of the MoCA test in Italy.

Cognitive screening tools are widely used in clinical practice to screen for age-related cognitive impairment and dementia. These tools' test scores are known to be influenced by age and education, leading to routine correction of raw scores for these factors. Despite these corrections being common practice, there is evidence suggesting that corrected scores may perform worse in terms of discrimination than raw scores. To address the ongoing debate in the field of dementia research, we assessed the impact of the corrections on discrimination, specificity, and sensitivity of the Montreal Cognitive Assessment test in Italy, both for the overall population and across age and education strata. We created a realistic model of the resident population in Italy in terms of age, education, cognitive impairment and test scores, and performed a simulation study. We confirmed that the discrimination performance was higher for raw scores than for corrected scores in discriminating patients with cognitive impairment from individuals without (areas under the curve of 0.947 and 0.923 respectively). With thresholds determined on the overall population, raw scores showed higher sensitivities for higher-risk age-education groups and higher specificities for lower-risk groups. Conversely, corrected scores showed uniform sensitivity and specificity across demographic strata, and thus better performance for certain age-education groups. Raw and corrected scores show different performances due to the underlying causal relationships between the variables. Each approach has advantages and disadvantages, the optimal choice between raw and corrected scores depends on the aims and preferences of practitioners and policymakers.

Olfactory Function as a Potential Predictor of Cognitive Impairment in Men and Women.

Different previous studies indicated olfactory function as a predictor of several types of cognitive impairment, in particular related to neurodegenerative disease. However, scanty data are available on the role of odor threshold (OT), odor discrimination (OD), and odor identification (OI) as a predictor of cognitive impairment. The aim of this study was to evaluate potential correlations between each factor of the olfactory function versus each specific cognitive domain of the Montreal Cognitive Assessment (MoCA) test on healthy subjects in relation to gender and age. Sniffin' Sticks and MoCA tests were used to determine olfactory function and cognitive abilities, respectively. In men, significant correlations were found in OT versus language index score and OI versus language and executive index score, while in women, OD and OI were correlated to visuospatial index score. Our data suggested that olfactory function (OT, OD, and OI) may be considered a predictor for cognitive impairment in relation to gender and age.

β-Alanine supplementation improves fractional anisotropy scores in the hippocampus and amygdala in 60–80-year-old men and women

Recently, β-alanine (BA) supplementation was shown to improve cognitive function in older adults with decreased cognitive function. Mechanisms supporting these improvements have not been well defined. This study examined the effects of 10-weeks of BA supplementation on changes in circulating brain inflammatory markers, brain derived neurotrophic factor (BDNF), and brain morphology. Twenty participants were initially randomized into BA (2.4 g·d−1) or placebo (PL) groups. At each testing session, participants provided a resting blood sample and completed the Montreal cognitive assessment (MoCA) test and magnetic resonance imaging, which included diffusion tensor imaging to assess brain tissue integrity. Only participants that scored at or below normal for the MoCA assessment were analyzed (6 BA and 4 PL). The Mann-Whitney U test was used to examine Δ (POST–PRE) differences between the groups. No differences in Δ scores were noted in any blood marker (BDNF, CRP, TNF-α and GFAP). Changes in fractional anisotropy scores were significantly greater for BA than PL in the right hippocampus (p = 0.033) and the left amygdala (p = 0.05). No other differences were noted. The results provide a potential mechanism of how BA supplementation may improve cognitive function as reflected by improved tissue integrity within the hippocampus and amygdala.

The Effects of Multidisciplinary Intensive Rehabilitation on Cognitive and Executive Functions in Parkinson's Disease: A Clinical Database Analysis.

Background/Objectives: This study is based on data collected from a medical health record review to assess whether multidisciplinary intensive rehabilitation treatment in Parkinson's disease (PD) patients can improve global cognitive functioning and executive functions. Methods: The data related to PD patients were extrapolated from a clinical database called "NeuroRehab". A total of 104 PD patients (51 males; 53 females) performed 6 weeks of multidisciplinary intensive rehabilitation treatment in clinical practice from January 2019 to May 2023. This training program was characterized by three daily sessions of 60 min of activities (muscle relaxation and stretching exercises, moderate physical aerobic exercise, and occupational therapy). The patients were classified and stratified according to disease severity (according to the Hoehn and Yahr scale), postural instability and gait difficulty (PIGD) or tremor-dominant (TD) subtypes, disease duration (DD), and the presence of dyskinesias. The effect of multidisciplinary intensive rehabilitation treatment on cognitive and executive functions was evaluated through the administration of cognitive tests, such as the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Frontal Assessment Battery (FAB). All the parameters were evaluated at the baseline (T0) and at the end of the rehabilitation program (T1). Results: The multidisciplinary intensive rehabilitation treatment significantly improved cognitive performance. The MMSE, MoCA, and FAB test scores after the rehabilitation program (T1) were significantly higher compared to the scores obtained at the baseline (T0). Moreover, further analyses on subgroups of the patients who scored below the cut-off in the MMSE showed that at least 50% of patients overcame the cut-off score. Interestingly, the same analyses performed for the MoCA and FAB revealed a higher rate of improvement in cognitive functions, with normal scores in both tests after 6 weeks of multidisciplinary intensive rehabilitation treatment. Conclusions: This study revealed the potential effects of a 6-week multidisciplinary rehabilitation program in improving cognitive status in a PD inpatient cohort.

Cerebrovascular dysregulation and postoperative cognitive alterations after carotid endarterectomy.

There are controversial data about the effect of carotid endarterectomy regarding postoperative cognitive function. Our aim was to analyze the effect of cerebral tissue saturation monitored by near-infrared spectroscopy (NIRS) on cognitive function. Perioperative data of 103 asymptomatic patients undergoing elective carotid surgery under general anesthesia were analyzed. Preoperatively and 3months after the operation, MMSE (Mini Mental State Examination) and MoCA (Montreal Cognitive Assessment) tests were conducted. For cerebral monitoring, NIRS was used, and the lowest rSO2 value and the degree of desaturation were calculated. Cognitive changes were defined as one standard deviation change from the preoperative test scores, defined as postoperative neurocognitive decline (PNCD) and cognitive improvement (POCI). PNCD was found in 37 patients (35.92%), and POCI was found in 18 patients (17.47%). Female gender, patients with diabetes, and the degree of desaturation were independently associated with PNCD. The degree of desaturation during the cross-clamp period negatively correlated with the change in the MoCA scores (R = - 0.707, p = 0.001). The 15.5% desaturation ratio had 86.5% sensitivity and 78.8% specificity for discrimination. For POCI, a desaturation of less than 12.65% had 72.2% sensitivity and 67.1% specificity. POCI was associated with lower preoperative MOCA scores and a lower degree of desaturation. We found a significant relation between the change of postoperative cognitive function proven by the MoCA test and cerebral tissue saturation during the clamping period in patients undergoing carotid endarterectomy.

Spatiotemporal Gait Analysis of Patients with Spinocerebellar Ataxia Types 3 and 10 Using Inertial Measurement Units: A Comparative Study.

Given the high morbidity related to the progression of gait deficits in spinocerebellar ataxias (SCA), there is a growing interest in identifying biomarkers that can guide early diagnosis and rehabilitation. Spatiotemporal parameter (STP) gait analysis using inertial measurement units (IMUs) has been increasingly studied in this context. This study evaluated STP profiles in SCA types 3 and 10, compared them to controls, and correlated them with clinical scales. IMU portable sensors were used to measure STPs under four gait conditions: self-selected pace (SSP), fast pace (FP), fast pace checking-boxes (FPCB), and fast pace with serial seven subtractions (FPS7). Compared to healthy subjects, both SCA groups had higher values for step time, variability, and swing time, with lower values for gait speed, cadence, and step length. We also found a reduction in speed gain capacity in both SCA groups compared to controls and an increase in speed dual-task cost in the SCA10 group. However, there were no significant differences between the SCA groups. Swing time, mean speed, and step length were correlated with disease severity, risk of falling and functionality in both clinical groups. In the SCA3 group, fear of falling was correlated with cadence. In the SCA10 group, results of the Montreal cognitive assessment test were correlated with step time, mean speed, and step length. These results show that individuals with SCA3 and SCA10 present a highly variable, short-stepped, slow gait pattern compared to healthy subjects, and their gait quality worsened with a fast pace and dual-task involvement.

Comparative Analysis of MoCA and DigiMoCA Test Results: A Pilot Study

This study examined the cognitive performance of older adults aged 60 and above using the Montreal Cognitive Assessment (MoCA) test and DigiMoCA, a digital tool for cognitive screening administered by means of a smart speaker, to investigate whether the additional variables utilised by DigiMoCA allow for the identification of significant differences between individuals with depressive symptoms and those with mild cognitive impairment, which are not detected using the original MoCA test. A total of 73 senior adults located in Northwestern Spain, 22 male and 51 female, participated in this study. Subjects were divided into four groups based on the presence of depressive symptoms and mild cognitive impairment, with the aim of analysing the results of each dimension of the MoCA and DigiMoCA tests and assessing the additional insights provided by the digital administration tool. The results indicate significant differences among groups. Individuals with depressive symptoms exhibited poorer performance in forward number span, attention, and clock drawing compared to healthy controls. Furthermore, individuals with depressive symptoms and mild cognitive impairment exhibited significantly worse memory and orientation compared to those with cognitive impairment alone. Correlations revealed that a greater severity of depressive symptoms was associated with poorer performance across cognitive domains, including visuospatial skills, attention, language, memory, and phonemic verbal fluency. This study also illustrated how the exploitation of additional variables systematically captured by digital instruments, such as completion times or response delays to individual interactions, may facilitate the early identification of cognitive and depressive conditions, providing initial evidence about the importance of integrating advanced digital tools in cognitive assessment to inspire the development of more effective, personalised interventions.

Understanding the Association Between Type 2 Diabetes Mellitus and Cognitive Impairment: A Single-centre Experience

Background The global prevalence of diabetes mellitus has been increasing, leading to a rise in morbidity associated with the disease. While diabetic nephropathy, retinopathy and neuropathy are routinely screened in diabetic patients, the cognitive decline associated with diabetes is often overlooked. Purpose The purpose of this study is to investigate the prevalence of cognitive impairment and its associated risk factors among patients with type 2 diabetes mellitus (T2DM). Methods An observational cross-sectional study was conducted for two months. The Montreal Cognitive Assessment (MoCA) test, which consists of 30 questions, was used to assess cognitive function. In-depth clinical history along with glycaemic parameters were collected. The chi-square test was used to find out the association between categorical variables and cognitive impairment. Pearson’s correlation test was performed to determine the correlation between glycaemic parameters and cognitive impairment. Results A total of 96 patients participated in the study. The mean HbA1c (%) was 9.08 ± 1.73, and the mean MoCA score was 25.14 ± 1.63. Mild cognitive impairment (MCI) was noted in 56% patients. Attention was the most common cognitive domain defect found in all MCI patients—100%. Delayed recall and memory were the second most common cognitive domain defect found—92.5%. Higher HbA1c, high FBS and higher PPBS were found to be statistically associated with MCI. A negative correlation was found between glycaemic parameters (HbA1c, FBS and PPBS levels) and MoCA scores. Conclusion More than half of our study participants reported mild cognitive impairment. It highlights the need for the implementation of routine cognitive testing for diabetes patients. There is a strong negative correlation between MoCA scores and parameters of glycaemic control; higher levels of HbA1c, FBS, and PPBS are seen in people with a lower MoCA score, indicating mild cognitive impairment. Further studies are needed to evaluate whether improving glucose levels helps in improving cognition or not.

The impact of age-related hearing loss on cognitive decline: The mediating role of brain age gap

In recent years, the relationship between age-related hearing loss, cognitive decline, and the risk of dementia has garnered significant attention. The significant variability in brain health and aging among individuals of the same chronological age suggests that a measure assessing how one’s brain ages may better explain hearing-cognition links. The main aim of this study was to investigate the mediating role of Brain Age Gap (BAG) in the association between hearing impairment and cognitive function.This research included 185 participants aged 20–79 years. BAG was estimated based on the difference between participant’s brain age (estimated based on their structural T1-weighted MRI scans) and chronological age. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) test while hearing ability was measured using pure-tone thresholds (PTT) and words-in-noise (WIN) perception. Mediation analyses were used to examine the mediating role of BAG in the relationship between age-related hearing loss as well as difficulties in WIN perception and cognition.Participants with poorer hearing sensitivity and WIN perception showed lower MoCA scores, but this was an indirect effect. Participants with poorer performance on PTT and WIN tests had larger BAG (accelerated brain aging), and this was associated with poorer performance on the MoCA test. Mediation analyses showed that BAG partially mediated the relationship between age-related hearing loss and cognitive decline.This study enhances our understanding of the interplay among hearing loss, cognition, and BAG, emphasizing the potential value of incorporating brain age assessments in clinical evaluations to gain insights beyond chronological age, thus advancing strategies for preserving cognitive health in aging populations.

Investigation of the behavior of tinnitus patients under varying listening conditions with simultaneous electroencephalography and pupillometry.

This study aims to control all hearing thresholds, including extended high frequencies (EHFs), presents stimuli of varying difficulty levels, and measures electroencephalography (EEG) and pupillometry responses to determine whether listening difficulty in tinnitus patients is effort or fatigue-related. Twenty-one chronic tinnitus patients and 26 matched healthy controls having normal pure-tone averages with symmetrical hearing thresholds were included. Subjects were evaluated with 0.125-20kHz pure-tone audiometry, Montreal Cognitive Assessment Test (MoCA), Tinnitus Handicap Inventory (THI), EEG, and pupillometry. Pupil dilatation and EEG alpha power during the "encoding" phase of the presented sentence in tinnitus patients were less in all listening conditions (p<.05). Also, there was no statistically significant relationship between EEG and pupillometry components for all listening conditions and THI or MoCA (p>.05). EEG and pupillometry results under various listening conditions indicate potential listening effort in tinnitus patients even if all frequencies, including EHFs, are controlled. Also, we suggest that pupillometry should be interpreted with caution in autonomic nervous system-related conditions such as tinnitus.

Preoperative walking exercise to improve prognosis in patients with supratentorial brain tumours after craniotomy: protocol for a randomised controlled trial

IntroductionCardiopulmonary complications and cognitive impairment following craniotomy have a significantly impact on the general health of individuals with brain tumours. Observational research indicates that engaging in walking is linked to...

Cognitive Dysfunction Screening in Peritoneal Dialysis Patients: A Cross-Sectional Study.

Mild cognitive impairment (MCI) in peritoneal dialysis (PD) patients has been described as a risk factor for worse outcomes such as peritonitis, technique failure, and mortality. In this study, we aimed to determine the prevalence of MCI in a population of PD patients and identify the possible risk factors associated with MCI. We performed an observational, cross-sectional study to evaluate cognitive function using the Montreal Cognitive Assessment (MOCA) test and the Mini Mental State Examination (MMSE) test in PD patients. Patients with diagnosis of dementia or severe neurologic impairment, active cancer, or infection were excluded. We evaluated 66 patients (mean age 60 years); 53% were male. Prevalence of MCI assessed by MOCA test and MMSE test was 65% and 33%, respectively. Predictors of MCI with MOCA test were higher age (P = 0.0001), lower education level (P = 0.005), need of a helper (P = 0.009), and continuous ambulatory PD modality (P = 0.019). Higher Charlson comorbidity index (P = 0.002), coronary artery disease (P = 0.006), and peripheral artery disease (P = 0.033) were also associated with MCI. Lower Kt/V (P = 0.012) and lower levels of normalized protein catabolic rate (nPCR; P < 0.000) were related to MCI. MCI patients had more episodes of peritonitis (P = 0.047). Multivariable analysis showed that lower education, Kt/V, and nPCR were the most relevant factors connected to MCI (P = 0.029, P = 0.037, and P = 0.019, respectively). In our PD population, MCI was detected in more than half of the patients. Patients with MCI were older, had lower education level, more disease burden, and higher risk for developing peritonitis. Lower Kt/V and nPCR levels were associated with MCI.

The study of the relationship between moderate to severe sleep obstructive apnea and cognitive impairment, anxiety, and depression.

The present study endeavored to investigate the interconnection between obstructive sleep apnea (OSA) and cognitive function, alongside the manifestations of depression and anxiety. Simultaneously, an analysis was conducted to discern the factors exerting influence upon cognitive function. A cohort of 102 patients, who had undergone polysomnography (PSG) at Binhu Hospital, Anhui Medical University, between January 2022 and June 2023, was encompassed in the study. Employing the PSG findings, these individuals were classified into two distinct categories: the grouping consisted of those with either negligible or mild OSA, and the other comprised individuals with moderate to severe OSA. Utilizing the Montreal Cognitive Assessment (MoCA-Beijing), Stroop Color and Word Test (SCWT), Digit Span Test (DST), Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS), scores were recorded and analysed for each of the respective assessments. Additionally, discrepancies and associations between these groups were also scrutinized. The group exhibiting moderate to severe OSA demonstrated significantly elevated measurements in parameters such as neck circumference, BMI, completion times for SCWT-A, B, C, Sleep Inefficiency Index (SIE), SAS, and SDS, in comparison to the No or Mild OSA group. Furthermore, the moderate-severe OSA group manifested notably diminished MoCA scores in areas of visual-spatial and executive function, memory, language, abstraction, delayed recall, orientation, total MoCA score, lowest oxygen saturation (LSaO2), average oxygen saturation, Digit Span Test-backward(DST-b), and Digit Span Test-forward(DST-f), as contrasted with the no-mild OSA group. These inter-group disparities exhibited statistical significance (p < 0.05). The MoCA total score portrayed inverse correlations with age, Apnea-Hypopnea Index (AHI), BMI, SIE, SAS, SDS, CT90%, AHT90%, and Hypoxic Apnea Duration (HAD) (ranging from -0.380 to -0.481, p < 0.05). Conversely, it displayed positive correlations with DST-f, DST-b, LSaO2, and average oxygen saturation (ranging from 0.414 to 0.744, p < 0.05). Neck circumference, AHI, and SAS were autonomously linked to MoCA scores (OR = 1.401, 1.028, 1.070, p < 0.05), while AHI exhibited an independent correlation with SDS and SAS scores (OR = 1.001, p = 0.003). Patients grappling with moderate to severe OSA frequently reveal cognitive impairment and concomitant emotional predicaments encompassing depression and anxiety. These manifestations share an intimate association with AHI, LSaO2, and average oxygen saturation. Notably, anxiety, when coupled with OSA, emerges as an autonomous influential element impinging upon cognitive impairment.

Cognıtıve functıons in idiopathic intracranial hypertensıon.

Cognitive problems in idiopathic intracranial hypertension (IIH) is generally overlooked in the presence of disabling headache and threat to visual function. The aim of this study was to search for cognitive deficits in patients with IIH using neuropsychologic tests in addition to P300 potential recordings to assess cognition related brain activity. Fifty IIH patients were examined using Montreal Cognitive Assessment Test, Stroop Test and Visual Aural Digit Span Test to measure different domains of cognition at the time of diagnosis. P300 potentials were recorded by using an oddball paradigm. Hospital Anxiety and Depression Scalewas used to determine anxiety and depression. Quality of life (QoL) was assessed by SF-36. The results were compared with fifty healthy controls with matching age, gender and body mass index. Neuropsychologic tests revealed wide cognitive impairment including attention, working memory, executive function, naming, language, delayed recall and orientation in IIH patients. In addition, quality of life was affected in the sub-parameters of general health perceptions, emotional role functioning, vitality, mental health and bodily pain. P300 potential latencies were long and the amplitudes were reduced indicating deficits in attention and working memory. Anxiety scores were high, and health-related QoL was low mainly involving vitality, emotional and mental health. Cognitive dysfunction was not correlated with the levels of anxiety and the correlation with headache severity was mild. A multidomain cognitive decline mainly involving attention and working memory was recorded in IIH patients. It was not correlated with anxiety and only a mild correlation with headache severity was present which may indicate a casual relationship between raised intracranial pressure and cognitive deficits. Screening is important as neuropsychological rehabilitation might be relevant in these patients.

Listening handicap in tinnitus patients with normal extended high frequencies from the perspective of the autonomic nervous system–Effort or fatigue?

ObjectiveIn previous studies, the results regarding the presence of listening effort or fatigue in tinnitus patients were inconsistent. The reason for this inconsistency could be that extended high frequencies, which can cause listening handicap, were not within normal limits. Therefore, this study aimed to evaluate the listening skills in tinnitus patients by matching the normal hearing thresholds at all frequencies, including the extended high frequency. MethodsEighteen chronic tinnitus patients and thirty matched healthy controls having normal pure-tone average with symmetrical hearing thresholds was included. Subjects were evaluated with 0.125–20 kHz pure-tone audiometry, Montreal cognitive assessment test (MoCA), Tinnitus Handicap Inventory (THI), Matrix Test, Pupillometry. ResultsPupil dilatation in the 'coding' phase of the sentence presented in tinnitus patients was less than in the control group (p < 0.05). There was no difference between the groups for Matrix test scores (p > 0.05) Also, there was no statistically significant correlation between THI and Pupillometry components nor between MoCA (p > 0.05). ConclusionEven though tinnitus patients had normal hearing in the range of 0.125–20 kHz, their autonomic nervous system responses during listening differed from healthy subjects. This difference was interpreted for potential listening fatigue in tinnitus patients.

Mild cognitive impairment in pemphigus.

Pemphigus is a group of autoimmune blistering disorders that have been associated with dementia in previous studies. Mild cognitive impairment (MCI) can be the first stage of progression into dementia. The objective of the present study was to evaluate the frequency of MCI in pemphigus patients compared to a control group. This case-control study included 80 patients with pemphigus referred to the dermatology clinics of Shohadaye Tajrish and Loghman Hakim hospitals, Tehran, Iran, in 2021. A group of 80 individuals without pemphigus who visited the same clinics for cosmetic consultation or interventions were regarded as controls. Age, sex, marital status, and education were recorded for all participants. Disease duration, medications, and severity were noted for pemphigus patients. The Persian version of the Montreal Cognitive Assessment (MoCA) test was used to assess cognitive function. MCI was significantly more frequent in pemphigus patients than in controls (55% vs. 37.5%, P = 0.026). Furthermore, the total MoCA score was significantly lower in pemphigus patients compared to controls (23.98 ± 3.77 vs. 25.21 ± 3.45, P = 0.032); however, among MoCA's different domains, only the executive functions score was significantly lower in pemphigus patients (P = 0.010). After adjustment, multivariable logistic regression analysis revealed that every 1-year higher education in patients decreased the odds of MCI by 52% (adjusted odds ratio = 0.483, 95% confidence interval 0.326; 0.715, P < 0.001). The frequency of MCI was found to be significantly higher, and overall scores of the MoCA test, as well as its executive function domain, were significantly lower among pemphigus patients in this study compared to the control group. Additionally, a higher level of education was associated with decreased odds of MCI in pemphigus patients. Identifying pemphigus patients with MCI through the use of the MoCA test can facilitate early intervention, enabling them to seek help and support.

The screening of cannabis addiction using machine learning, MoCA, and anxiety/depression tests

A new cannabis addiction screening approach is developed based on the use of Machine Learning (ML) alongside with psychological and cognitive assessment tests. The Hospital Anxiety and Depression (HAD) test is used to determine the Absence of Anxiety and Depression “No Disorder” or the presence of “Anxiety Only”, “Depression Only”, and both “Anxiety and Depression”. These features are considered to evaluate the psychological effects of cannabis use. In addition to that, the Montreal Cognitive Assessment (MoCA) test is chosen as a feature to assess the cognitive state of the participants. Also, the Age of First Cannabis Use (AFCU) is included as a feature to incorporate participants with no prior cannabis use alongside with those who have used cannabis before. The portion of participants with prior experience consuming cannabis comprises a subset containing passive users and a subset of users that have developed cannabis addiction. This 6-month study was conducted in Marrakech, Morocco in a center affiliated to the National Association of Drug-Risk Reduction of Morocco known as RdR-Maroc with the participation of 146 subjects. The participants in this study are grouped into two groups of 73 participants each. Both case and control groups were clinically assessed by a professional. In this paper, the classical statistical data analysis for the AFCU (M=15.6; SD=2.4), MoCA (M=25.0; SD=2.4), and HAD (58 cases with no disorder, 88 cases with disorder) failed to separate between the two classes. Also, the feature selection for modeling is performed using Spearman correlation, Kendall correlation, and the Odds Ratio (OR). These statistics showed that the selected features were associated to addiction except for “Anxiety Only”. Moreover, ML models such as Logistic Regression (LR), Support Vector Machine (SVM), Artificial Neural Network (ANN), kth-Nearest Neighbor (KNN), and Decision Tree (DT) were used to classify participants into two categories (Addict vs. Non-Addict) based on the selected features mentioned earlier. The Receiver Operating Characteristic (ROC) curve is used to overview the quality of the models and showed that they all captured the nonlinearities underlined in the data. On the other hand, the Area Under the Curve (AUC) allowed the ranking of these models and indicated that the SVM model outperformed all other models with an AUC of 0.97. After that, the SVM model was compared to the Cannabis Use Disorder (CUD) based screening method issued by the fifth edition of the Diagnostic and Statistical Manual of mental disorders (DSM-5). The SVM model's accuracy of 96.6 % outperformed the CUD questionnaires accuracy of 87.7 %. The validity of the proposed approach was investigated where the SVM model presented high validity characteristics (sensitivity=1, specificity=0.93) compared to the CUD questionnaire (sensitivity=0.75, specificity=1). Hence, the proposed approach provided satisfactory results compared to current adopted CUD based screening test. Our findings expand current research on the development of simple and powerful tools for cannabis addiction screening with the purpose of early detection in order to establish preventive and therapeutic strategies that could potentially mitigate the prevalence of cannabis addiction.

COGNITIVE FUNCTION, CAROTID STRUCTURAL CHANGES AND KIDNEY FUNCTION: ARE THERE RELATIONSHIP IN PATIENTS WITH RESISTANCE HYPERTENSION?

Objective: To evaluate the relationship between cognitive function, carotid structural changes and kidney function in patients with resistance hypertension (RH). Design and method: In 98 pts with RH (average age 54,3±2,5; 55 males) we measure ultrasonographically carotid diameter (CD) and intima-media thickness (IMT). Cognitive function was assessed in all pts by Montreal cognitive assessment (MoCA) test. All patients underwent full clinical and laboratory screening evaluation. Kidney function was estimated by glomerular filtration rate (GFR) using the CKD-EPI creatinine equation. All pts were divided into 2 groups depending on the value of GFR: group I (n=59) - GFR &gt; 60 (ml/min/1,73m2) and group II (n=39) – GFR &lt; 60 (ml/min/1,73m2). Results: Patients with GFR &lt; 60 (ml/min/1,73m2) had significantly greater carotid structural changes: pts of gr.I had CD 7,79±0,07 mm and IMT 1,22±0,02 mm vs pts of gr.II 8,92±0,08 mm (p&lt;0,05) and 1,77±0,03 mm (p&lt;0,05) accordingly. Cognitive function was more impaired in pts gr II: MoCA score of gr I pts was 25,3±1,8 and gr II pts – 22,1±1,4. GFR was significantly correlated with MoCA score and carotid structure (MoCA score: r=0,61, p&lt;0,05, CD: r=0,55, p&lt;0,05, IMT: r=0,68, p&lt;0,05). Adjustment for age, blood pressure, BMI and gender did not abolish association between GFR and MoCA score, parameters of carotid structure. Conclusions: There is relationship between kidney function, carotid structure and cognitive function in pts with resistance hypertension. GFR may have prognostic value for cognitive function damage in patients with resistance hypertension.