Montreal Cognitive Assessment Tool Research Articles

The association between asymptomatic and mild neurocognitive impairment and adherence to antiretroviral therapy among people living with human immunodeficiency virus.

BackgroundAsymptomatic cognitive impairment in human immunodeficiency virus (HIV)-infected patients has recently been recognised as part of HIV-associated neurocognitive disorders. This has been implicated as one of the causes of poor adherence to antiretroviral therapy (ART).ObjectiveTo assess the association between neurocognitive impairment (asymptomatic and mild forms) and adherence to ART.MethodsThis was a cross-sectional survey involving 218 participants consecutively sampled from those attending the HIV treatment clinic at Aga Khan University Hospital in Nairobi. Data collected included quantitative primary data on pre-defined baseline characteristics, neurocognitive assessment by Montreal Cognitive Assessment (MoCA) tool (Appendix 1), instrumental activities of daily living by Lawton score and objective and subjective adherence measures by medication possession ratio (MPR) and simplified medication adherence questionnaire (SMAQ) (see Appendix 2). Univariate and bivariate analyses were conducted to determine the strengths of association between predictor and the outcome variables.ResultsAmong the 218 participants in the study, a total of 69% had asymptomatic to mild neurocognitive impairment as assessed by the MoCA tool, while a total of 66% were determined as being adherent to ART by objective measures (by MPR) compared to subjective rates of 77% as assessed by SMAQ. However, no statistically significant association was observed between the presence of asymptomatic or mild neurocognitive impairment and likelihood of adherence to ART (p > 0.05).ConclusionEven though asymptomatic and mild forms of cognitive impairment are prevalent in the population studied, there was no significant association between cognitive impairment and adherence to treatment.

Association between physical activity and walking capacity with cognitive function in peripheral artery disease patients

To identify the association between objectively measured physical activity and walking capacity with cognitive function in patients with symptomatic peripheral artery disease. This was an observational, cross sectional study. One hundred and thirty patients (age 67±8 years) were recruited at a tertiary centre specializing in vascular disease. Cognitive function (global, memory, executive function and attention) was evaluated using the Montreal Cognitive Assessment tool. Physical activity levels (total, light, and moderate-vigorous) were obtained using an accelerometer. A 6min and 4mwalk test were undertaken to assess walking capacity. Crude and covariate adjusted, linear regression analyses confirmed significant associations between physical activity levels and walking capacity with cognitive function. Positive and significant associations were observed between moderate to vigorous physical activity (p=.039) and walking capacity (p=.030) with memory after adjusting for covariates. No significant association was identified between light physical activity and usual gait speed with any cognitive function outcome. Greater memory performance was associated with greater moderate to vigorous physical activity levels and walking capacity in patients with symptomatic peripheral artery disease. Clinical interventions focused on improving moderate to vigorous physical activity levels and walking capacity may provide important therapies to potentially enhance cognitive health in patients with peripheral artery disease.

Cognitive Function Declines Significantly during Haemodialysis in a Majority of Patients: A Call for Further Research

Introduction: Cognitive impairment (CI) is very common condition that occurs in haemodialysis patients and it is associated with reduced functional capacity and mortality. We assessed the change in cognitive function during haemodialysis and associated risk factors. Methods: All patients ≥50 years, on haemodialysis for ≥3 months, no dementia from 2 dialysis centres were selected. Cognition was assessed before and after a haemodialysis session using parallel versions of the Montreal Cognitive Assessment (MOCA) tool. Multiple regression was used to examine potential confounders. Results: Eight-two patients completed both tests – median age 73 (52–91) years, 59% male, dialysis vintage 41 (3–88) months. Sixty-two (76%) had CI at baseline. Cognition declined over dialysis (MOCA 21 ± 4.8 to 19.1 ± 4.1, p < 0.001) and domains affected were attention, language, abstraction and delayed recall. Age and dialysis vintage were independently associated with decline. Conclusion: Cognitive function declines over a haemodialysis session and this has significant clinical implications over health literacy, self-management and tasks like driving. More research is needed to find the cause for this decline in cognition.

Abstract WP127: Effects of EDAS Revascularization and Intensive Medical Management on the Cognitive Function of Patients With Intracranial Atherosclerosis

Introduction: Cognitive decline after transient ischemic attacks (TIA) or stroke is common. Evaluation with the Montreal Cognitive Assessment (MoCA) tool has shown a decrease in cognitive scores in more than 30% of patients at 1 year. We hypothesize that indirect revascularization with EDAS plus intensive medical management (IMM) would decrease the rate of decline. Methods: This is a prospective study of EDAS plus IMM in symptomatic patients with intracranial arterial stenosis of more than 70%. Patients had MoCA evaluations at baseline, 1 month, 6 months, and 12 months after EDAS. Differences in MoCA at baseline and follow-up were compared using mixed model repeated measures ANOVA. Results: Thirty-one patients with no aphasia or neglect were included. Mean age was 48.3 +/- 16.6 years. Twenty-one were females (70%). The mean MoCA scores at baseline and 12-months were 23.6 +/- 4.3 and 25.5 +/- 4.1, respectively. MoCA ≥ 1 improvement was seen in 78.9% at 12 months. However, differences in MoCA scores at these time points did not reach statistical significance (p= 0.49, Fig. 1). Only 9% of patients had a decline of ≥2 MoCA points at 12 months. These results are comparable to the twelve month MoCA data from the SAMMPRIS trial, which showed a mean MoCA for IMM of 25.4 +/- 3.73 and for percutaneous angioplasty and stenting (PTAS) of 25.6 +/- 3.89. The rate of decline of MoCA scores after EDAS plus IMM was significantly less than the reported natural history after TIA or strokes outside the SAMMPRIS trial (9% vs. 30%, p=0.03). Conclusion: Compared to historical data, the decline in MoCA scores after TIA and stroke was lower in patients treated with EDAS plus maximum medical therapy and has similar effects to those reported in the SAMMPRIS IMM and PTAS groups.

Screening for Mild Cognitive Impairment in Patients with Heart Failure Identifies Increase Healthcare Utilisation and Activities of Daily Living: A Cross-Sectional Study

Aims: To screen heart failure patients for mild cognitive impairment (MCI), using the Montreal Cognitive Assessment tool (MoCA) and describe the association of MCI with healthcare utilisation.

Genetic Variants in CSMD1 Gene Are Associated with Cognitive Performance in Normal Elderly Population.

Recently, genetic markers rs10503253 and rs2616984 in the CUB and Sushi multiple domains-1 (CSMD1) gene have been reported to be associated with schizophrenia and cognitive functions in genome-wide association studies. We examined the associations of the above SNPs with cognitive performance evaluated by the Montreal Cognitive Assessment (MoCA) tool in a cohort of the normal elderly from the Russian population. Significant association of rs2616984 genotypes with the MoCA scores was found using nonparametric analysis. No association of rs10503253 with MoCA scores was observed using both parametric and nonparametric statistics. Significant combined effect of two-locus CSMD1 genotypes on MoCA scores was demonstrated by median test. Allele “A” and genotype “AA” of rs2616984 were significantly associated with the lower MoCA scores in comparison of 1st and 4th quartiles of MoCA total score distribution. The results suggest that genetic variants in CSMD1 gene are likely a part of genetic component of cognitive performance in the elderly.

Intraoperative oxygen concentration and neurocognition after cardiac surgery: study protocol for a randomized controlled trial

BackgroundPostoperative cognitive dysfunction (POCD) is a common complication of cardiac surgery. Studies have identified potentially injurious roles for cardiopulmonary bypass (CPB) and subsequent reperfusion injury. Cognitive dysfunction has also been linked to the deleterious effects of hyperoxia following ischemia-reperfusion injuries in several disease states, but there has been surprisingly little study into the role of hyperoxia in reperfusion injury after CPB. The potential for tightly regulated intraoperative normoxia to ameliorate the neurocognitive decline following cardiac surgery has not been investigated in a prospective manner. We hypothesize that the use of a protocolized management strategy aimed towards maintenance of an intraoperative normoxic level of oxygen, as opposed to hyperoxia, will reduce the incidence of POCD in older patients undergoing cardiac surgery.Methods/DesignOne hundred patients aged 65 years and older undergoing non-emergency coronary artery bypass grafting surgery on cardiopulmonary bypass will be enrolled in this prospective, randomized, controlled trial. Subjects will be randomized to receive a fraction of inspired oxygen of either 35% or 100% while under general anesthesia throughout the intraoperative period. The primary outcome measure will be the incidence of POCD in the acute postoperative phase and up to 6 months. The assessment of neurocognition will be undertaken by trained personnel, blinded to study group, with the telephone Montreal Cognitive Assessment (t-MoCA) tool. Secondary outcome measures will include assessment of delirium using the Confusion Assessment Method (CAM and CAM-ICU), as well as time to extubation, days of mechanical ventilation, length of ICU and hospital stay and mortality at 6 months. With the aim of later identifying mechanistic aspects of the effect of oxygen tension, blood, urine, and atrial tissue specimens will be taken at various time points during the perioperative period and later analyzed.DiscussionThis trial will be one of the first randomized controlled studies to prospectively assess the relationship between intraoperative oxygen levels and postoperative neurocognition in cardiac surgery. It addresses a promising biological avenue of intervention in this vulnerable aging population.Trial registrationClinicalTrials.gov Identifier: NCT02591589, registered February 13, 2015.

HIV and Cognitive Impairment in Clinical Practice: The Evaluation of a Stepwise Screening Protocol in Relation to Clinical Outcomes and Management.

Neurocognitive impairment (NCI) is an increasingly important comorbidity in an ageing HIV+ population. Despite the lack of available treatment modalities, screening for NCI is recommended. In the UMC Utrecht, yearly NCI screening is done using the Montreal Cognitive Assessment (MoCA) tool and the HIV Dementia Scale (HDS). The aim of this study was to evaluate this screening protocol in relation to clinical outcomes and management. A retrospective cohort study was performed in suppressed adult HIV+ patients. Apart from the MoCa and the HDS, the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) and the Hospital Anxiety and Depression Scale (HADS) were performed. Patients scoring below average on cognitive screening tests or with subjective cognitive complaints were further evaluated using a standardized protocol, including optimizing cART and checking for somatic disorders. In patients with cognitive complaints and participation restrictions, cognitive rehabilitation was proposed. Two hundred eighty-six patients were screened. The vast majority were MSM with an average age of 49 years. One hundred forty-four out of 286 patients (50%) had an abnormal test score and/or had subjective cognitive complaints. Restrictions in participation were present in 23% of patients. Six patients on Efavirenz switched their regimes, as this drug is known for its potential central nervous system (CNS) side effects. A depressive component was present in 58 patients (40%). Five patients had a clinical relevant laboratory abnormality. Moreover, six patients were referred for cognitive rehabilitation, which resulted in a 100% success rate in set goals in the five evaluable patients. Although the protocol was not fully adhered to in all patients, it did result in detectable underlying causes of NCI in 59% of patients, and 21% was referred for further treatment. Moreover, cognitive rehabilitation appears to be a very successful intervention for patients with NCI who experience subjective complaints and participation restrictions.

PREOPERATIVE DEMENTIA SCREENING AND POSTOPERATIVE DELIRIUM IN OLDER SURGICAL PATIENTS

People 65 years or older are having surgery later in life and are at risk of developing a major postoperative complication, delirium., The Montreal Cognitive Assessment, is a preoperative cognitive screening tool which was used to screen thirty-three older orthopedic surgical patients to reduce the incidence of this serious postoperative complication. Patients who scored below normal were identified as at riskand monitored to ascertain if identification and monitoring influenced their postoperative course. At the first postoperative visit each patient was evaluated for falls, confusion, and the ability to follow the required postoperative home exercise program to identify an undetected episode of delirium after discharge. Of the patients screened, 34.1% (n = 14) of patients fell below the cutoff for normal cognition. Subsequent monitoring and nursing interventions may have influenced their postoperative course as there were no reported episodes of delirium in the 90-day period. Thus, preoperative screening with the Montreal Cognitive Assessment tool provides a baseline cognitive assessment and early identification of patients at higher risk for postoperative delirium, and therefore, identification of patients at risk for postoperative delirium may allow for early interventions and decrease postoperative delirium.

Validation of an informant-based cognitive screening tool for Parkinson disease.

The objective of this study was to establish the psychometric properties of the AD8 Dementia Screening Interview in patients with Parkinson disease (PD) with or without cognitive impairment using the Montreal Cognitive Assessment Tool (MoCA) for comparison. The AD8 was translated into Malay for Malay-speaking participants. A correlation analysis and a receiver operator characteristic curve were generated to establish the psychometric properties of the AD8 in relation to the MoCA. One hundred fifty patients and their caretakers completed the AD8 and MoCA. Using a cutoff score of 1/8, the AD8 had 81% sensitivity and 59% specificity for the detection of cognitive impairment in PD. With a cutoff score of 2/8, the AD8 had 83% specificity and 64% sensitivity. The area under the receiver operator characteristic curve was 80%, indicating good-to-excellent discriminative ability. These findings suggest that the AD8 can reliably differentiate between cognitively impaired and cognitively normal patients with PD and is a useful caregiver screening tool for PD.

Cognitive function and advanced kidney disease: longitudinal trends and impact on decision-making.

Background: Cognitive impairment commonly affects renal patients. But little is known about the influence of dialysis modality on cognitive trends or the influence of cognitive impairment on decision-making in renal patients. This study evaluated cognitive trends amongst chronic kidney disease (CKD), haemodialysis (HD) and peritoneal dialysis (PD) patients. The relationship between cognitive impairment and decision-making capacity (DMC) was also assessed. Methods: Patients were recruited from three outpatient clinics. Cognitive function was assessed 4-monthly for up to 2 years, using the Montreal Cognitive Assessment (MoCA) tool. Cognitive trends were assessed using mixed model analysis. DMC was assessed using the Macarthur Competency Assessment tool (MacCAT-T). MacCAT-T scores were compared between patients with cognitive impairment (MoCA <26) and those without. Results: In total, 102 (41 HD, 25 PD and 36 CKD) patients were recruited into the prospective study. After multivariate analysis, the total MoCA scores declined faster in dialysis compared with CKD patients [coefficient = −0.03, 95% confidence interval (95% CI) = −0.056 to − 0.004; P = 0.025]. The MoCA executive scores declined faster in the HD compared with PD patients (coefficient = −0.12, 95% CI = −0.233 to − 0.007; P = 0.037). DMC was assessed in 10 patients. Those with cognitive impairment had lower MacCAT-T compared with those without [median (interquartile range) 19 (17.9–19.6) versus 17.4 (16.3–18.4); P = 0.049]. Conclusions: Cognition declines faster in dialysis patients compared with CKD patients and in HD patients compared with PD patients. Cognitive impairment affects DMC in patients with advanced kidney disease.

Hyponatremia, Cognitive Function, and Mobility in an Outpatient Heart Failure Population.

BackgroundThe association of hyponatremia with cognitive impairment and mobility in heart failure (HF) patients is unknown. The purpose of this study was to determine if hyponatremia is associated with cognitive and mobility impairment as measured by simple, validated, and time-sensitive tests.Material/MethodsThis was a prospective study in patients with reduced and preserved ejection fraction (HFrEF, HFpEF) seen in outpatient HF clinics. Hyponatremia was defined as sodium level ≤136 mEq/L. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) tool, and mobility was measured with the Timed Up and Go test (TUG-t).ResultsA total of 121 patients were evaluated; 30% were hyponatremic (134±1.9 mEq/l, range 128–136 mEq/l). Overall, 92% of hyponatremic patients had cognitive impairment (MoCA <26) compared to 76% of the non-hyponatremic patients [relative risk 1.2 (confidence interval: 1.02–1.4, p=0.02)]. In regard to mobility, 72% of hyponatremic patients and 62% of non-hyponatremic patients (p=0.4) had TUG-t times that were considered to be worse than average. A total of 84% (N=76) of HFrEF and 71% (N=22) of HFpEF patients had cognitive impairment (p=0.86). HFrEF patients had significantly lower overall MoCA scores (21.2±3.7 vs. 23.3±3.6, p=0.006) and similar TUG-t times compared to HFpEF patients.ConclusionsMost heart failure patients (HFrEF and HFpEF) seen in an ambulatory setting had impairment of cognitive function and mobility, with a higher prevalence among those with hyponatremia. Screening can be done using tests that can be administered in a clinical setting.

Atrial fibrillation and cognitive function in patients with heart failure: a systematic review and meta-analysis.

Cognitive impairment and dementia are established complications of heart failure (HF) in adult patients and impair medication adherence and self-care. Atrial fibrillation (AF) is suggested to play an independent role in the cognitive decline in patients with HF. The objective of this systematic review was to assess the effect of AF on cognitive function in these patients. Medline (PubMed), Scopus, and the CENTRAL databases were queried from their inception up to April 30, 2016. The search included primary research articles evaluating the effect of AF on cognition in HF patients. There were five eligible studies, including a total of 1670 patients with HF; of these, 449 (26.9%) had AF. Different AF types were studied, including persistent, paroxysmal, or permanent. Four cognitive tests were used to assess cognitive function (Mini-Mental State Examination, Short Portable Mental Status Questionnaire, Modified Mini-Mental Examination, and Montreal cognitive assessment tool). Using the inverse variance method and a random effects model, we observed that presence of AF was significantly associated with increased risk of cognitive impairment in HF patients (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.30-2.87), although with significant heterogeneity (I 2 =39%). This heterogeneity can be attributed to the different populations and types of AF studied as well as to varying cognitive assessment methods. Concomitant AF may exacerbate cognitive dysfunction in HF patients. However, data are sparse and heterogeneous. Well-designed, prospective studies are needed to (a) establish a causative link and (b) identify the underlying mechanism in order to design appropriate interventions to attenuate risk of cognitive impairment in patients with HF.

Cognitive Impairment in Patients with Psoriasis: A Cross-Sectional Study Using the Montreal Cognitive Assessment.

Psoriasis is a multisystem chronic inflammatory disorder that is thought to be associated with cognitive impairment. We aimed to investigate cognitive performance using the Montreal Cognitive Assessment (MoCA) in patients with psoriasis. In total, 77 patients with psoriasis and 83 age- and sex-matched control subjects were enrolled in this prospective cross-sectional study. Physical and/or histopathological findings were used to diagnose psoriasis vulgaris, and patients with psoriasis were evaluated according to disease characteristics, including duration, severity, onset age, medical treatment, and cosmetic involvement. All participants provided sociodemographic data and completed the Beck Depression Inventory. Cognitive functions were evaluated using the MoCA tool. The MoCA scores were significantly lower in the psoriasis group than in the control group (p=0.004). More psoriasis patients than control subjects presented with deficits in visuospatial domain (p=0.037) and executive functioning (p=0.010). In the multivariate model, the presence of psoriasis (odds ratio [OR] 3.64; 95% confidence interval [CI] 1.65-8.02; p=0.001), education level (3.74; 95% CI 1.65-8.48; p=0.002), and area of residence (3.56; 95% CI 1.61-7.87; p=0.002) were found to be independently associated with cognitive impairment in patients with psoriasis and control subjects. On the other hand, no correlations were observed between disease characteristics and cognitive impairment in patients with psoriasis vulgaris (p>0.05). The results suggest that psoriasis patients might have early or subtle cognitive impairment, including visuospatial domain and executive functioning.

Psychometric properties of Malay neuropsychiatry unit cognitive assessment tool among Alzheimer's disease patients in comparison to Malay Montreal Cognitive Assessment.

This study aims to establish psychometric properties of the Malay Neuropsychiatry Unit Cognitive Assessment Tool (Malay NuCOG) in Alzheimer's disease. NuCOG was translated to Malay language and compared with Montreal Cognitive Assessment Tool on 80 individuals. The Malay NuCOG showed good internal consistency and reliability (Cronbach's alpha = 0.895). It demonstrated 100% sensitivity and 87.5% specificity at the cutoff score of 78.50/100. The Malay NuCOG is a valid and reliable cognitive instrument that is sensitive and specific for the detection of dementia and has clinical advantages in its ability to examine individual cognitive domains.

Epilepsy in patients with primary brain tumors: The impact on mood, cognition, and HRQOL.

A primary brain tumor (PBT) is often a fatal disease of the nervous system and has a serious impact on health-related quality of life (HRQOL). Presence of epilepsy and adverse reactions from tumor and epilepsy treatments may cause additional decline in HRQOL. We aimed to study the impact of epileptic seizures on cognition, mood, and HRQOL in patients with brain tumor-related epilepsy. Patients were grouped on an ordinal scale according to epilepsy burden from none to severe based on the presence of epileptic seizures and seizure frequency: L1, no epilepsy; L2, with epilepsy, seizure-free in the last 6 months with antiepileptic drugs; and L3, with epilepsy, at least one seizure in the last 6 months with AEDs. Health-related quality of life was measured by Functional Assessment of Cancer Therapy-Brain (FACT-Br) and Quality of Life in Epilepsy-31 (QOLIE-31) tools, cognition by the Montreal Cognitive Assessment (MoCA) tool and Frontal Assessment Battery (FAB), mood by the Hospital Anxiety and Depression Scale (HADS), activities of daily living (ADLs) by the Barthel Index (BI), and performance status by the Karnofsky Performance Status (KPS) scale in patients with primary brain tumors at least one month following neurosurgery with or without radiotherapy and chemotherapy. Eighty-one patients with a diagnosis of primary brain tumors were recruited. Sixty-eight percent of patients were diagnosed with primary brain tumor-related epilepsy, 50.61% patients had cognitive impairment, 33% had abnormal scores in the anxiety scale, and 34% had abnormal scores in the depression scale. There were no statistically significant differences in these scores among L1, L2, and L3 groups. There were statistically significant differences in duration of disease and KPS and BI scores between L1 and L3 groups. The L3 group has significantly longer duration of disease and scored low in both the BI and KPS scale when compared to the L1 group. All patients with primary brain tumors scored significantly low in FACT-Br 'physical well-being' (PWB) and 'emotional well-being' (EWB) and high in 'social well-being' (SWB) when compared to healthy controls. When scores of each group were individually compared to healthy controls, the L3 group showed the lowest scores in PWB, EWB, and 'functional well-being'. In SWB, L1 and L2 groups showed statistically significantly high scores when compared to normative data. The QOLIE-31 applied to groups with epilepsy showed statistically significantly lower scores in the L3 group when compared to the L2 group in 'cognitive' and 'social functioning' domains. On multivariate analysis, both poor performance status and frequency of seizures were found to be independent risk factors for poor HRQOL when FACT-Br mean scores were compared. Level of seizures was found to be an independent risk factor for poor HRQOL when QOLIE-31 scores were compared between L2 and L3 groups. Presence of brain tumors could be attributed to cognitive impairment irrespective of the presence of epilepsy in our cohort. High seizure burden is an independent risk factor for poor HRQOL in patients with primary brain tumors. The QOLIE-31 is a more sensitive tool than the FACT-Br because of the presence of a seizure-related questionnaire.

6 Frailty is Associated with Undiagnosed Early Cognitive Impairment in older patients (≥75 years) with non-ST Elevation Acute Coronary Syndrome Managed by Invasive Strategy: Abstract 6 Table 1

Introduction Non ST elevation Acute Coronary Syndrome (NSTEACS) is more common in older patients and invasive treatment is an established management strategy in the United Kingdom. Frailty is an independent marker of adverse cardiovascular (CV) outcomes in older patients. Older patients with atherosclerotic disease are at risk of developing cognitive impairment. Frailty and cognitive impairment in older patients with NSTEACS can be a predictor of poor CV outcomes. The prevalence of undiagnosed early cognitive impairment in frail older patients with NSTEACS managed by invasive strategy is not known. Methods Cognitive status was assessed using Montreal Cognitive Assessment (MoCA) tool (maximum score 30, normal ≥26) in consecutive patients (≥ 75 years) admitted to a tertiary cardiac centre for invasive management of NSTEACS as a sub-study of an ongoing prospective study. Patients with known severe dementia were excluded from the study. Frailty status was assessed by Fried (Cardiovascular Health Study) frailty assessment tool (score 0–5) and patients categorised into frail (score ≥3) and non-frail (score 0–2) groups. Results MoCA score was available in 175 (89.3%) patients. About a third (30.8%) of these patients were frail and half of the patients (50.3%) had MoCA score Conclusion Undiagnosed early cognitive impairment is very common in 75+ year old patients presenting with NSTEACS managed by invasive strategy. Cognitive impairment is more common in frail patients compared to non-frail patients. Combination of frailty and cognitive impairment may have an adverse impact on the cardiovascular outcomes of older patients with NSTEACS managed by invasive strategy. Frailty and cognitive assessment may need to be part of risk assessment in older patients planned for invasive management.

(938) - Depression as a Predictor of Compliance and Morbidities After Orthotopic Heart Transplantation

s S337 the Montreal Cognitive Assessment (MOCA) tool (r= .76, p< .05). Further, the scale takes only 10-15 to administer. Conclusion: Our results show that the inductive methodologies outlined in this paper can be effectively applied across settings and other clinical treatment areas to create valid and robust measures of knowledge that are responsive to individual patient preferences, needs and values, and help to ensure that patient values guide clinical decision-making.

Training recollection in healthy older adults: clear improvements on the training task, but little evidence of transfer.

Normal aging holds negative consequences for memory, in particular for the ability to recollect the precise details of an experience. With this in mind, Jennings and Jacoby (2003) developed a recollection training method using a single-probe recognition memory paradigm in which new items (i.e., foils) were repeated during the test phase at increasingly long intervals. In previous reports, this method has appeared to improve older adults’ performance on several non-trained cognitive tasks. We aimed to further examine potential transfer effects of this training paradigm and to determine which cognitive functions might predict training gains. Fifty-one older adults were assigned to either recollection training (n = 30) or an active control condition (n = 21) for six sessions over 2 weeks. Afterward, the recollection training group showed a greatly enhanced ability to reject the repeated foils. Surprisingly, however, the training and the control groups improved to the same degree in recognition accuracy (d′) on their respective training tasks. Further, despite the recollection group’s significant improvement in rejecting the repeated foils, we observed little evidence of transfer to non-trained tasks (including a temporal source memory test). Younger age and higher baseline scores on a measure of global cognitive function (as measured by the Montreal Cognitive Assessment tool) and working memory (as measured by Digit Span Backward) predicted gains made by the recollection training group members.

ClereMed: Lessons Learned From a Pilot Study of a Mobile Screening Tool to Identify and Support Adults Who Have Difficulty With Medication Labels.

BackgroundIn order to take medications safely and effectively, individuals need to be able to see, read, and understand the medication labels. However, one-half of medication labels are currently misunderstood, often because of low literacy, low vision, and cognitive impairment. We sought to design a mobile tool termed ClereMed that could rapidly screen for adults who have difficulty reading or understanding their medication labels.ObjectiveThe aim of this study was to build the ClereMed prototype; to determine the usability of the prototype with adults 55 and over; to assess its accuracy for identifying adults with low-functional reading ability, poor ability on a real-life pill-sorting task, and low cognition; and to assess the acceptability of a touchscreen device with older adults with age-related changes to vision and cognition.MethodsThis pilot study enrolled adults (≥55 years) who were recruited through pharmacies, retirement residences, and a low-vision optometry clinic. ClereMed is a hypertext markup language (HTML)-5 prototype app that simulates medication taking using an iPad, and also provides information on how to improve the accessibility of prescription labels. A paper-based questionnaire included questions on participant demographics, computer literacy, and the Systems Usability Scale (SUS). Cognition was assessed using the Montreal Cognitive Assessment tool, and functional reading ability was measured using the MNRead Acuity Chart. Simulation results were compared with a real-life, medication-taking exercise using prescription vials, tablets, and pillboxes.ResultsThe 47 participants had a mean age of 76 (SD 11) years and 60% (28/47) were female. Of the participants, 32% (15/47) did not own a computer or touchscreen device. The mean SUS score was 76/100. ClereMed correctly identified 72% (5/7) of participants with functional reading difficulty, and 63% (5/8) who failed a real-life pill-sorting task, but only 21% (6/28) of participants with cognitive impairment. Participants who owned a computer or touchscreen completed ClereMed in a mean time of 26 (SD 16) seconds, compared with 52 (SD 34) seconds for those who do not own a device (P<.001). Those who had difficulty, struggled with screen glare, button activation, and the “drag and drop” function.ConclusionsClereMed was well accepted by older participants, but it was only moderately accurate for reading ability and not for mild cognitive impairment. Future versions may be most useful as part of a larger medication assessment or as a tool to help family members and caregivers identify individuals with impaired functional reading ability. Future research is needed to improve the sensitivity for measuring cognitive impairment and on the feasibility of implementing a mobile app into pharmacy workflow.