Montreal Cognitive Assessment Tool Research Articles

Association between type of menopause and mild cognitive impairment: The REDLINC XII study

ObjectiveTo evaluate the association between type of menopause (spontaneous or surgical) and mild cognitive impairment (MCI). Study designThis study was a cross-sectional, observational, and sub-analytical investigation conducted within gynecological consultations across nine Latin American countries. MethodWe assessed sociodemographic, clinical, and anthropometric data, family history of dementia, and the presence of MCI using the Montreal Cognitive Assessment (MoCA) tool. ResultsThe study involved 1185 postmenopausal women with a mean age of 55.3 years and a body mass index of 26.4 kg/m2. They had an average of 13.3 years of education, and 37 % were homemakers. Three hundred ninety-nine experienced menopause before 40, including 136 with surgical menopause (bilateral oophorectomy). Out of the 786 women who experienced menopause at 40 or more years, 110 did so due to bilateral oophorectomy. There were no differences in MoCA scores among women who experienced menopause before or after the age of 40. However, lower MoCA scores were observed in women with surgical menopause than in those with spontaneous menopause (23.8 ± 4.9 vs. 25.0 ± 4.3 points, respectively, p < 0.001). Our logistic regression model with clustering of patients within countries found a significant association between MCI and surgical menopause (OR 1.47, 95 % CI: 1.01–2.16), use (ever) of menopausal hormone therapy (OR 0.33, 95 % CI: 0.21–0.50), and having >12 years of education (OR 0.21, 95 % CI: 0.14–0.30). ConclusionWhen comparing women who experience spontaneous menopause over the age of 40 with those who undergo it before this age, there was no observed increased risk of developing MCI, while those with surgical menopause, independent of age, are more prone to cognitive decline. Women who have ever used menopausal hormone therapy have a lower MCI risk. Further research is warranted to delve deeper into this topic.

Loneliness and global cognitive functioning in racially and ethnically diverse US midlife and older adults.

Few studies have examined the association of loneliness and cognitive functioning in the US. We used two common measures of loneliness and examined their association in a large sample of US Black, Latino, and White adults (ages ≥ 50). We analyzed Wave 3 of the National Social Life, Health, and Aging Project (N = 2,757). We examined loneliness using one item from the CES-D and the Felt Loneliness Measure (NFLM); cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA) tool, where higher scores indicated better functioning. We used weighted ordinary least squares regressions to examine the effects of loneliness (CES-D loneliness and NFLM in separate models) on MoCA scores. In exploratory analyses, we examined if these relationships varied by race and ethnicity. We adjusted all models for sociodemographic and other salient factors (e.g., chronic disease, depressive symptoms, living alone). Mean age was 63.49 years, 52% were female, and 9% were Black and 6% Latino persons. Approximately 54% endorsed feeling lonely on at least one measure; 31% (CES-D) and 46% (NFLM). The relationship between loneliness measures was positive and significant, X 2 (1, N = 2,757) = 435.493 p < 0.001. However, only 40% of lonely individuals were identified as lonely on both assessments. CES-D loneliness was inversely (βˆ = -0.274, p = 0.032) associated with MoCA scores and this association did not vary by race and ethnicity. Greater NFLM loneliness was positively associated (βˆ = 0.445, p < 0.001) with higher MoCA scores for Latino participants only. Loneliness appears to be an important predictor of cognitive functioning. However, the association of loneliness and cognitive functioning varied when using the CES-D loneliness item or the NFLM. Future work is needed to understand how loneliness and its clinically relevant dimensions (social, emotional, existential, chronicity) relate to global and individual cognitive domains. Research is needed with racially and ethnically diverse midlife and older adults, particularly to understand our counterintuitive finding for Latino participants. Finally, findings also support the need for research on interventions to prevent cognitive decline targeting loneliness.

The Role of the Glymphatic System in Perioperative Neurocognitive Disorders.

The glymphatic system plays a crucial role in clearing metabolic waste from the central nervous system and is most active during sleep. Patients with obstructive sleep apnea (OSA) have a dysfunctional glymphatic system that correlates with disease severity. In addition, these patients have worse outcomes after surgery. The status of the glymphatic system during the perioperative period is unclear and can be examined with magnetic resonance imaging (MRI)-based diffusion tensor imaging (DTI). This study assessed perioperative glymphatic system changes in OSA surgical patients and possible relationships with perioperative neurocognitive disorders. DTI data from 13 OSA patients having laparoscopic abdominal surgery with general anesthesia were acquired and analyzed using a 3.0-T MRI scanner. Diffusivity maps in the x-axis (Dxx), y-axis (Dyy), z-axis (Dzz), x-y axis (Dxy), y-z axis (Dyz), and x-z axis (Dxz) were calculated. Diffusion values for the projection and association fibers were extracted, and DTI analysis along the perivascular space (ALPS) was performed. The patients' cognition was assessed using the Montreal Cognitive Assessment tool. Evaluations were carried out within 5 days before surgery and within the first 48 hours after surgery. The ALPS index decreased after surgery, and this correlated with a decrease in general cognition scores and specific memory domains, including visuospatial and delayed recall. The glymphatic system in OSA patients is worsened after surgery and this may contribute to an increased risk for long-term postoperative cognitive disorders. This study suggest that the glymphatic system might play a role in the pathophysiology of perioperative neurocognitive disorders and be a potential therapeutic target.

Interplay of age, gender, education, and heart rate in dementia among older adults in Wakiso, Uganda: a cross sectional study

Background In this cross-sectional study conducted in Wakiso, Uganda, from May to July 2023, we investigated the interactions among age, sex, education, and heart rate in relation to dementia and Mild Cognitive Impairment (MCI) among individuals aged 65 years and older. Methods We purposively sampled 106 participants, focusing on those with Alzheimer’s disease and related dementias, leveraging collaborations with local health teams. Data collection involved comprehensive questionnaires covering sociodemographic details and health parameters, and employed the Montreal Cognitive Assessment Tool for dementia screening. Results Our findings highlight a nuanced landscape of risk factors; each additional year of age was associated with a 1.19- and 1.22-times increased risk of MCI and dementia, respectively. Gender analysis revealed a protective effect against MCI in males, but no significant impact on dementia risk. Education emerged as a protective factor, with each additional year associated with a 28% reduction in MCI risk, although its effect on dementia risk remains ambiguous. Significantly, an elevated heart rate was strongly linked to an increased risk of both MCI and dementia, underscoring the potential cardiovascular dimension in cognitive health. Conclusions This study contributes to the understanding of the complex interplay of risk factors for dementia, emphasizing the need for further research to elucidate the underlying mechanisms and interventions for healthy cognitive aging in the older adult population.

Exploring the dynamic interplay between learning and working memory within various cognitive contexts.

The intertwined relationship between reinforcement learning and working memory in the brain is a complex subject, widely studied across various domains in neuroscience. Research efforts have focused on identifying the specific brain areas responsible for these functions, understanding their contributions in accomplishing the related tasks, and exploring their adaptability under conditions such as cognitive impairment or aging. Numerous models have been introduced to formulate either these two subsystems of reinforcement learning and working memory separately or their combination and relationship in executing cognitive tasks. This study adopts the RLWM model as a computational framework to analyze the behavioral parameters of subjects with varying cognitive abilities due to age or cognitive status. A related RLWM task is employed to assess a group of subjects across different age groups and cognitive abilities, as measured by the Montreal Cognitive Assessment tool (MoCA). Analysis reveals a decline in overall performance accuracy and speed with differing age groups (young vs. middle-aged). Significant differences are observed in model parameters such as learning rate, WM decay, and decision noise. Furthermore, among the middle-aged group, distinctions emerge between subjects categorized as normal vs. MCI based on MoCA scores, notably in speed, performance accuracy, and decision noise.

Montreal Cognitive Assessment (MoCA) as a screening tool for cognitive impairment in early stages of psychosis

BackgroundCognitive alterations have been reported in early stages of psychosis including people with First Episode Psychosis (FEP), Clinical High-Risk Mental State (CHR), and Psychotic-Like Experience (PLE). This study aimed to compare the cognitive function in early stages of psychosis using the Montreal Cognitive Assessment (MoCA), a low-cost and brief assessment tool of cognitive functions. MethodsA total of 154 individuals, including 35 with FEP, 38 CHR, 44 PLE, and 37 healthy controls (HC), were evaluated with the MoCA in Santiago, Chile. We calculated the mean total score of the MoCA and the standard deviation of the mean. Groups were assessed for a trend to lower scores in a pre-determined sequence (HC > PLE > CHR > FEP) using the Jonckheere-Terpstra test (TJT). ResultsThe mean total MoCA scores were 24.8 ± 3.3 in FEP, 26.4 ± 2.4 in CHR, 26.4 ± 2.3 in PLE, and 27.2 ± 1.8 in HC. The analyses revealed a significant trend (p < 0.05) toward lower MoCA individual domain scores and MoCA total scores in the following order: HC > PLE > CHR > FEP. The mean total scores of all groups were above the cut-off for cognitive impairment (22 points). ConclusionsThe MoCA describes lower scores in cognition across early stages of psychosis and may be a useful low-cost assessment instrument in early intervention centers of poorly resourced settings.

Is catheter ablation associated with preservation of cognitive function? An analysis from the SAGE-AF observational cohort study.

To examine the associations between catheter ablation treatment (CA) vs. medical management and cognitive impairment among older adults with atrial fibrillation (AF). Ambulatory patients who had AF, were ≥65-years-old, and were eligible to receive oral anticoagulation could be enrolled into the SAGE (Systematic Assessment of Geriatric Elements)-AF study from internal medicine and cardiology clinics in Massachusetts and Georgia between 2016 and 2018. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) tool at baseline, 1-, and 2 years. Cognitive impairment was defined as a MoCA score ≤ 23. Multivariate-adjusted logistic regression of longitudinal repeated measures was used to examine associations between treatment with CA vs. medical management and cognitive impairment. 887 participants were included in this analysis. On average, participants were 75.2 ± 6.7 years old, 48.6% women, and 87.4% white non-Hispanic. 193 (21.8%) participants received a CA before enrollment. Participants who had previously undergone CA were significantly less likely to be cognitively impaired during the 2-year study period (aOR 0.70, 95% CI 0.50-0.97) than those medically managed (i.e., rate and/or rhythm control), even after adjusting with propensity score for CA. At the 2-year follow-up a significantly greater number of individuals in the non-CA group were cognitively impaired (MoCA ≤ 23) compared to the CA-group (311 [44.8%] vs. 58 [30.1%], p = 0.0002). In this 2-year longitudinal prospective cohort study participants who underwent CA for AF before enrollment were less likely to have cognitive impairment than those who had not undergone CA.

Cognitive Screening and Hearing Assessment in Patients With Chronic Tinnitus.

The study aimed to assess the relationship of tinnitus with hyperacusis with cognitive impairment as indicated by the Montreal Cognitive Assessment (MoCA) tool. This multicenter cross-sectional study included individuals with chronic tinnitus from the "Unification of Treatments and Interventions for Tinnitus Patients" (UNITI) database. Participants were recruited from four different tertiary clinical centers located in Athens and Granada (Mediterranean group), as well as Berlin and Regensburg (German group). In total, 380 individuals with a diagnosis of non-pulsatile chronic tinnitus (permanent and constant tinnitus lasting more than 6 months) and no evidence of severe cognitive impairment (MoCA score >22) were enrolled. The evaluation utilized the following tools: MoCA, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (GÜF), Patient Health Questionnaire (PHQ-9), and the European School for Interdisciplinary Tinnitus Research Screening Questionnaire. MoCA scores differed between German and Mediterranean individuals (P<0.01), necessitating separate analyses for each group. In both cohorts, MoCA scores were significantly associated with education level, age, hearing threshold at 8 kHz, and THI. Furthermore, a significant correlation was observed between PHQ-9 scores and both THI and GÜF (P<0.01 for both Germans and those from the Mediterranean). Our data suggest an association between tinnitus handicap, high-frequency hearing loss, and mild cognitive impairment. Additionally, PHQ-9 scores were associated with tinnitus and hyperacusis scores, independent of hearing loss thresholds.

Relationship between blood pressure and cognitive impairment in elderly outpatients with cardiometabolic diseases.

The aim of this study was to clarify the relationship between high or low blood pressure (BP) and cognitive function in elderly outpatients with cardiometabolic diseases. We evaluated the association between BP and the Dementia Assessment Sheet for Community-based Integrated Care System-21 items (DASC-21), Mini Mental State Examination (MMSE), and Montreal Cognitive Assessment Tool (MoCA) (N = 677). The patients' mean age was 79.2 ± 6.3 years (male 35.3%), and BP was 132.1 ± 18.1/73.5 ± 12.2 mmHg. Systolic BP (SBP) was linearly related to the DASC-21 score (r = -0.122, P = 0.004), but not to the MMSE score (P = 0.101) or MoCA score (P = 0.802). Multiple linear regression analysis showed that lower SBP was significantly related to the DASC-21 score, even after controlling for confounding factors (B = -0.411 per 10 mmHg; 95% confidence interval [CI], -0.673 to -0.149; P = 0.002). Moreover, logistic regression analysis showed that lower SBP was associated with DASC-21 ≥ 31 (odds ratio = 0.838 per 10 mmHg, P = 0.048). An MMSE score ≤23 was significantly associated with higher SBP in patients without a history of hypertension but with lower SBP in those with hypertension, those on hypertensive medication, and those with dyslipidemia. Higher BP was associated with a higher prevalence of probable dementia in those without a history of hypertension, even in late life. In those with hypertension and those taking antihypertensives with comorbidities of stroke or heart failure, lower BP was associated with probable dementia, which was largely dependent on reduced activities of daily living, as measured by the DASC-21 score. Geriatr Gerontol Int 2024; 24: 110-117.

Cognitive impairment and the associated factors among women with a history of pregnancy complications in rural southwestern Uganda.

Worldwide, there is a growing concern about the rising number of people with declining cognitive functioning. However, findings on this phenomenon are inconclusive. Our study aimed to assess the prevalence of cognitive impairment and the associated factors in women with a history of pregnancy complications in rural southwestern Uganda. This was a cross-sectional study carried out among women above 40 years of age in the greater Kabale district of southwestern Uganda between March and April 2022. Study participants were identified using a consecutive sampling method. Predictor variables included pregnancy complications and other social demographic factors that were assessed by semi-structured interviews while cognitive functioning as an outcome variable was assessed by Montreal Cognitive Assessment (MoCA-B) tool. Data were analyzed using STATA at a 95% Confidence level. Logistic regression analyses were selected for statistical modelling while odds ratios were calculated to assess the strength of associations between the predictor and outcome variables. In total, 75% (212/280) of participants had some form of cognitive impairment, with 45% (123/280) falling into mild CI, 31% (86/280) moderate CI and 4% (10/280) severe CI. Twenty-three percent (68/280) of participants fell into category of normal cognitive functioning. Participants with >65 years of age had higher odds of developing cognitive impairment (OR = 2.94; 95%CI: 0.96-9.04, p = 0.06) than those with < 65 years of age. Protective factors to cognitive impairment include delivering from a health facility (OR = 0.31,95% CI:0.16-0.60, p = < .001), primary and post primary levels of education (OR = 0.05; 95% CI: 0.02-0.13, p<0.001, OR = 0.04; 95%CI: 0.02-0.23, p<0.001) respectively. Results from this study show a high prevalence of cognitive impairment among women with a history of pregnancy complications in rural southwestern Uganda. Interventions geared toward preventing cognitive impairment among females with a history of pregnancy complications should be emphasized.

Characteristics of cognitive functioning in persons with chronic sensorineural hearing loss

Aim to identify the features of cognitive status in chronic sensorineural hearing loss (CNHL) by analyzing the subscales of the Montreal Cognitive Assessment test.&#x0D; Material and methods. The study involved 45 people (aged 44 - 86 years, average age 57.8711.74 years) with chronic sensorineural hearing loss. The study design included assessment of complaints and anamnesis, examination of ENT organs, tonal threshold audiometry (AC-40, Interacoustics, Denmark), tympanometry (AC 226, Interacoustics, Denmark). Cognitive status was assessed using the Montreal Cognitive Assessment tool (MoCA) on seven subscales: Executive and visuospatial function, Naming, Attention, Language, Abstraction, Delayed recall, and Orientation.&#x0D; Results. The average total score for MoCA in persons with chronic SNHL (n=45) was 25.092.86 points out of 30 possible points, which indicates a trend towards a decrease in cognitive function. Cognitive impairments in individuals with SNHL were more pronounced on the subscales Executive and visuospatial function, Language and Delayed recall. Despite rather high average scores on the subscale Executive and visuospatial function, 100% completion was noted less than in half of the subjects in 46.66% (n = 21).&#x0D; Conclusion. Considering the cognitive characteristics of individuals with SNHL may improve the effectiveness of rehabilitation.

Listening to speech-in-noise with hearing aids: Do the self-reported outcomes reflect the behavioral speech perception task performance?

The aim of this study is to examine the relationship between behavioral speech-in-noise listening tasks and self-reported speech-in-noise outcomes of hearing aid user adult listeners. To measure the self-reported outcomes of hearing, the Hearing Handicap Inventory for Adults [HHI-A], Speech, Spatial and Qualities of Hearing Scale (SSQ) and Amsterdam Inventory for Auditory Disability and Handicap were employed. To screen the cognitive abilities, Montreal Cognitive Assessment (MoCA) tool was used. Turkish matrix sentence test (TMST) was used for speech-in-noise test. Eighteen adult hearing aid users (mean age of 36.6years) were participated. Results showed that some self-reported listening-in-noise outcomes are correlated with lab-based measurements of speech-in-noise test scores but not with the aided speech intelligibility thresholds. Given the present limitations of relying solely on self-report measures, it is important to complement them with objective measures to ensure a comprehensive evaluation.

Glutathione peroxidase and superoxide dismutase as markers of brain dysfunction in adolescents with diabetic ketoacidosis

Introduction. Diabetic ketoacidosis (DKA) is the most prevalent and severe acute complication of type 1 diabetes mellitus (DM) in children and adolescents. Oxidative stress (OS) is viewed on the one hand as a possible pathophysiological element in the development of this complication, and on the other, as an important factor that triggers the development of cerebral insufficiency in patients with type 1 DM.Aim: to study the content of antioxidant enzymes in adolescents with type 1 DM in the setting of DKA and determine the correlation between the concentration of glutathione peroxidase (GP) and superoxide dismutase (SOD) and brain dysfunction after the manifestation of DKA.Materials and methods. The study involved 52 adolescents (mean age − (16.7±1.25) years), of whom 26 were patients with type 1 DM complicated by DKA (study group; duration of disease − (6.5±0.46) years) and 26 were apparently healthy adolescents (control group). Cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA) test. Concentration of GP and SOD was assessed in serum samples by ELISA. Mann-Whitney test was used to assess differences between means, and Spearman’s coefficient was used to calculate correlations.Results. Assessment using the MoCA tool showed a statistically significant cognitive decline in adolescents who had an episode of DKA (p = 0.0001). Another statistically significant finding in DKA was the lower mean levels of both GP (p = 0.0031) and SOD (p = 0.0173). Negative correlation was discovered between values obtained in the MoCA test and duration of disease and number of hospital admissions with DKA, and between GP levels and number of admissions with DKA, as reflected in patient history. Positive correlation was discovered between GP and SOD levels and values obtained in the MoCA test.Discussion. Patients were found to have decreased antioxidant defense, along with brain dysfunction, after the manifestation of DKA. DKAassociated impairment of antioxidant defense is one of the pathophysiological mechanisms underpinning the development of cognitive dysfunction in adolescents with type 1 DM. Conclusion GP and SOD can be viewed as markers of DKA-associated brain dysfunction in patients with type 1 DM.

#6696 COGNITIVE IMPAIRMENT IN PATIENTS ON HEMODIALYSIS EXPERIENCE FROM A CENTER IN SANTA ROSA GUATEMALA

Abstract Background and Aims Cognitive impairment in patients with chronic kidney disease (CKD) involves multiple factors such as inflammation, uremic toxins and endothelial dysfunction, having rates of up to 10.7 cases per 1000/patient year and that can increase in renal replacement therapy (RRT). The cognitive impairment can progress to dementia and this has adverse long-term outcomes such as mortality. The prevalence of cognitive impairment is 19% to 77% in patients with hemodialysis therapy. The aims of this study was determine the prevalence of cognitive impairment in hemodialysis patients and possible associated factors. Method A cohort study was conducted in a hemodialysis unit of Santa Rosa, Guatemala. Patients over 18 years of age were included with more than two months of having started hemodialysis and with 3 sessions per week. Patients with a previous diagnosis of dementia, with visual-hearing deficits, illiterate, a history of cerebrovascular events or psychiatric disorders and who did not agree to participate in the study were excluded. For cognitive assessment, the Montreal Cognitive Assessment tool (MoCA test) was used, taking a score of less or equal than 26 points as cognitive impairment. A value of p&amp;lt;0.05 was taked significant. Results 78 patients were screened, however 30 patients were discarded due to exclusion criteria. A total of 48 patients were analyzed. A mean age was of 51 years, the majority of whom were male, 40% had only a basic level of education and 38% did not know the cause of CKD. Arterial hypertension was the most frequent comorbidity and the most used antihypertensive were beta-blockers. As for medications for complications of CKD, vitamin D and erythropoietin are the most used. The patients had an average time on hemodialysis of 41.3 months, the last calculated Kt/V was of 1.73 (mean), the mean hemoglobin level was 9.9 g /dl and the mean MoCA test score performed for the study was 23.3 points. Regarding the primary objective, it was determined that the prevalence of cognitive impairment was 67% and when analyzing the variables it was found that age and level of education are associated with greater cognitive impairment, older patients (p: 0.002) and with lower level of education (p: 0.02). In analysis the cognitive domains, it is founded that those patients who present alterations in the attention and delayed recall domain are those that are statistically more associated with cognitive impairment and their counterpart those who have conserved the naming and language domain are those that are associated with having a normal global cognitive practice (Table 1). A correlation analysis was performed where it was found that there is a negative correlation which is moderate and statistically significant between age and the MoCA test score (Table 2). Conclusion The prevalence of cognitive impairment was 67%, age and educational level seem to be influencing factors, with older patients and those with lower educational level being the most affected. Within the cognitive domains, attention and delayed recall are the most affected and most associated with cognitive impairment. It is important to conduct further studies evaluating other variables that have been shown to influence cognitive status such as vitamin B12, vitamin D and homocysteine. It is important to perform cognitive evaluation of patients on hemodialysis and other RRT to have an early diagnosis and intervene early considering that cognitive impairment can progress to dementia and this is a cause of abandonment in treatment and mortality.

Cognitive impairment in adults under compulsory psychiatric care: association with psychotic symptoms and high-dose antipsychotics

Background There is limited evidence on the association between cognitive function, psychotic symptoms and doses of antipsychotics in adults under compulsory psychiatric care. Aims We assessed (a) the degree of cognitive impairment in adults involuntarily hospitalised for compulsory psychiatric care and (b) correlation of Montreal Cognitive Assessment (MoCA) score with psychotic symptoms, polypharmacy and prescription of high-dose antipsychotics. Method This was a nationwide, cross-sectional study, conducted at the only referral state hospital for compulsory psychiatric care in Cyprus (December 2016–February 2018). Τhe MoCA was applied for the assessment of cognitive functioning. The Positive and Negative Syndrome Scale (PANSS) was applied for the assessment of psychotic symptoms. Results The sample comprised 187 men and 116 women. The mean MoCA score was 22.09 (reported scale range (RSR): 3–30); the mean PANSS general symptoms subscale score was 49.60 (RSR = 41–162). The participants who reported positive psychiatric history (mean 21.71, s.d. 5.37), non-adherence to pharmacotherapy (mean 21.32, s.d. 5.56) and prescription of high-dose antipsychotics (with medication prescribed as needed: mean 21.31, s.d. 5.70; without medication prescribed as needed: mean 20.71, s.d. 5.78) had lower mean MoCA scores compared with those who reported negative psychiatric history (mean 23.42, s.d. 4.51; P = 0.017), adherence to pharmacotherapy (mean 23.10, s.d. 6.61; P = 0.003) and no prescription of high-dose antipsychotics (with medication prescribed as needed: mean 22.56, s.d. 4.90; without medication prescribed as needed: mean 22.60 s.d. 4.94; P = 0.045–0.005), respectively. Mean MoCA score was mildly and inversely associated with total PANSS score (r = −0.15, P = 0.03), PANSS general (r = −0.18, P = 0.002) and PANSS negative (r = −0.16, P = 0.005) symptoms subscales, respectively. Conclusions Our findings support the evaluation of cognitive functioning in adults under compulsory psychiatric care via the MoCA tool, with focus on those prescribed high-dose antipsychotics, with positive mental health history and non-adherence to pharmacotherapy.

502 The Prospective Geriatric Patient Reported Outcomes (GERI-PRO) Study: Understanding Post- Traumatic Injury Recovery from the Patient’s Perspective

OBJECTIVES/GOALS: Patient reported outcomes (PROs) provide unique insight to the patients experience with their healthcare related quality of life QoL. This study aims to 1. Characterize geriatric trauma patients’(GTPs) perceived QoL, at time of injury vs. 3- and 6-months post-injury. 2. Introduce and validate a PROs tool, known as the Five Favorite Activities. METHODS/STUDY POPULATION: This is a prospective cohort study of older adults (≥65) presenting to our trauma center with mild traumatic brain injury and/or mild spine, thoracic or extremity fractures. Participants will be asked to complete the NIH-validated Patient-Reported Outcome Measure Information System (PROMIS)-29, PROMIS Cognitive and Functional Abilities, Life-Space Levels and Five Favorite Activities assessment (a list of the five favorite overall and daily activities) tools. Cognitive function will be measured using Montreal Cognitive Assessment tool. Physical function will be evaluated using the Activity Measure for Post-Acute Care 6-click tool. Patients will be contacted at 3- and 6- months post discharge and asked to complete the assessment tools listed above to evaluate changes in QoL during the recovery process. RESULTS/ANTICIPATED RESULTS: We hypothesize that geriatric trauma patients will experience a decline in QoL, physical and cognitive function post-injury. This decline will be associated with a decrease in return to the ability to participate in their pre-injury Five Favorite Activities . DISCUSSION/SIGNIFICANCE: First, this study is one of the first to evaluate PROMs in GTPs. Second, the Five Favorite Activities PROM, will provide a unique, direct and individualized characterization of what GTPs find important to their recovery post injury compared to the current generic PROMs. This information can be utilized in the future to align goal of care with expectations

MP37-07 COGNITIVE IMPAIRMENT, TECHNOPHILIA, AND SACRAL NEUROMODULATION DEVICE USE IN AN OLDER PATIENT POPULATION WITH OVERACTIVE BLADDER

You have accessJournal of UrologyCME1 Apr 2023MP37-07 COGNITIVE IMPAIRMENT, TECHNOPHILIA, AND SACRAL NEUROMODULATION DEVICE USE IN AN OLDER PATIENT POPULATION WITH OVERACTIVE BLADDER Chen Shenhar, Jacquelyn Booher, Lauren Gleich, Sarah Martin, Glenn T. Werneburg, Emily Slopnick, Sandip P. Vasavada, Bradley Gill, Howard B. Goldman, and Jacqueline Zillioux Chen ShenharChen Shenhar More articles by this author , Jacquelyn BooherJacquelyn Booher More articles by this author , Lauren GleichLauren Gleich More articles by this author , Sarah MartinSarah Martin More articles by this author , Glenn T. WerneburgGlenn T. Werneburg More articles by this author , Emily SlopnickEmily Slopnick More articles by this author , Sandip P. VasavadaSandip P. Vasavada More articles by this author , Bradley GillBradley Gill More articles by this author , Howard B. GoldmanHoward B. Goldman More articles by this author , and Jacqueline ZilliouxJacqueline Zillioux More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Anticholinergics, a common treatment for overactive bladder (OAB), are associated with new-onset dementia and their use for >3 months was recently cautioned against in all age groups. Non-anticholinergic therapies, including sacral neuromodulation (SNM), should therefore be optimized; however, data on SNM in older or cognitively impaired (CI) populations are limited. The aim of this study was to assess cognitive impairment, technophilia, and device utilization in an older population undergoing SNM for refractory OAB. METHODS: This is a secondary analysis of an ongoing IRB-approved prospective study on cognitive function and SNM outcomes, focusing on technophilia and device utilization. Patients aged ≥60 years undergoing test-phase SNM for refractory OAB were recruited. Cognitive function was assessed using the validated Montreal Cognitive Assessment (MoCA) tool, with scores <26/30 considered CI. Baseline functional status and technology comfort/use were assessed using a novel questionnaire, and OAB symptoms were assessed initially and at follow-up utilizing validated questionnaires (OAB-q SF, IIQ7, UDI-6, PGI-I). Patient device utilization, familiarity with communicator and ability to adjust amplitude/program were recorded at follow-up. Baseline technology use/comfort and post-implant device utilization were compared based on CI. RESULTS: Fifty-eight patients underwent test-phase (36 PNE, 22 Stage 1). Mean age was 73±8 years and 95% were women. Mean MoCA score was 23.1±4.4, and 67% met CI criteria. Forty-nine (85%) had successful test-phase, of which 45 patients have undergone full implant and 38 have available follow-up data. At baseline, patients with CI had lower use and comfort levels with various technologies (Table 1). At mean 4.1±2 months follow-up, patients with CI were less involved in changing programs (p=0.004) or amplitudes (p=0.007) on their own, but patient-reported improvement did not differ (Table 1). CONCLUSIONS: Older patients presenting for SNM for OAB have a high incidence of CI. Despite lower baseline self-reported use/comfort with technology and lower SNM device utilization post-implant among those with CI, patient-reported outcomes appear similar over short-term follow-up. Source of Funding: Investigator initiated Medtronic research grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e515 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chen Shenhar More articles by this author Jacquelyn Booher More articles by this author Lauren Gleich More articles by this author Sarah Martin More articles by this author Glenn T. Werneburg More articles by this author Emily Slopnick More articles by this author Sandip P. Vasavada More articles by this author Bradley Gill More articles by this author Howard B. Goldman More articles by this author Jacqueline Zillioux More articles by this author Expand All Advertisement PDF downloadLoading ...

Accuracy of the Montreal Cognitive Assessment tool for detecting mild cognitive impairment: A systematic review and meta-analysis.

This systematic review evaluates the accuracy of the Montreal Cognitive Assessment (MoCA) for detecting mild cognitive impairment (MCI). We searched MEDLINE, PSYCInfo, EMBASE, and Cochrane CENTRAL (1995-2021) for studies comparing the MoCA with validated diagnostic criteria to identify MCI in general practice. Screening, data extraction, and risk of bias assessment were performed independently, in duplicate. Pooled sensitivity and specificity for MoCA cutoffs were estimated using bivariate meta-analysis. Thirteen studies [2158 participants, 948(44%) with MCI] were included; 10 used Petersen criteria as the reference standard. Risk of bias of studies were high or unclear for all domains except reference standard. Sensitivity and specificity were 73.5%(95% confidence interval: 56.7-85.5) and 91.3%(84.6-95.3) at cutoff <23; 79.5%(67.1-88.0) and 83.7%(75.4-89.6) at cutoff <24; and 83.8%(75.6-89.6) and 70.8(62.1-78.3) at cutoff <25. MoCA cutoffs <23 to <25 maximized the sum of sensitivity and specificity for detecting MCI. The risk of bias of included studies limits confidence in these findings.

Prevalence of Cognitive Decline in Type 2 Diabetes Mellitus Patients: A Real-World Cross-Sectional Study in Mysuru, India

The goal of this research is to study the prevalence of cognitive impairment in diabetes mellitus (DM) patients and establish the necessity of detecting and treating it early in these patients. A cross-sectional study was conducted at a tertiary care hospital in Mysuru for 4 months examined diabetic patients (test) and nondiabetic subjects (control) for cognitive decline using the Montreal Cognitive Assessment (MoCA) tool. Cognitive functions such as visuospatial/executive function, naming, attention, language, abstraction, delayed recall, and orientation were assessed in both groups. The diabetic group showed a significantly lower total MoCA score than the non-diabetic group (18.99 ± 0.48 and 26.21 ± 0.46, respectively; p < 0.001). Assessment of scores in diabetic patients demonstrated the significant influence of age demographics on cognitive impairment (p-value < 0.001). Furthermore, a higher proportion of diabetic patients displayed cognitive impairment despite a higher score in a single subdomain, making it evident that diabetes is diverse and multifactorial in origin, where oxidative stress and inflammatory responses play a predominant role. This study suggested that the local T2DM population residing in Mysuru (India) has a high prevalence of cognitive impairment, evident from poor performance in almost all cognitive domains assessed by MoCA. Future studies could examine the generalizability of cognitive function findings in diabetic patients across diverse geographic regions and ethnic groups, as well as investigate interventions such as lifestyle modifications and medication to prevent or delay cognitive decline in those with diabetes.

Can vigilance predict the status of safe functional gait and risk of falls in patients with peripheral vestibular disorders? A cross-sectional study

ObjectivesPeripheral vestibular disorders except from reflexes dysfunction correspond also to cognitive decline. The objectives of this cross-sectional study were to a) identify correlations among variables of functional gait, cognitive function, and perceived dizziness and b) explore variables that could be used as prognostic factors of functional gait in people with peripheral vestibular deficits. MethodsWe recruited 154 people with peripheral vestibular deficits. The participants presented with moderate disability in terms of the Dizziness Handicap Inventory questionnaire (mean: 48.00, 95% confidence interval: 45.24–50.75), deficits in the Functional Gait Assessment test (mean: 22.75, 95% confidence interval: 22.13–23.40) and indication of mild cognitive impairment based on Montreal Cognitive Assessment tool (mean: 25.18, 95% confidence interval: 24.75–25.60). ResultsStatistically significant correlations found among functional gait and gender, age, educational level, perceived level of disability and the total score of the Montreal Cognitive Assessment tool. Several components of the cognitive screening test (executive function, vigilance, language skills, verbal fluency) also correlated statistically significant with functional gait. Linear regression models revealed that age, perceived level of disability and vigilance significantly predicted functional gait variability (R2 = 0.350; p < 0.001) as well as high risk of falling, as indicated by a score on Functional Gait Assessment test <22/30 (R2 = 0.380). ConclusionsCognitive impairments affect functional gait in people with peripheral vestibular disorders. Thus, the integration of cognitive functional assessment must be considered as a prerequisite for functional assessment and designing rehabilitation programs that will include dual task training.