Montreal Cognitive Assessment Total Score Research Articles

The Effects of Carotid Revascularization on 1-Year Cognitive Performance in Patients With Carotid Artery Stenosis.

The impact of carotid revascularization on cognitive function for patients with severe carotid artery stenosis remains uncertain. This study is aimed to investigate the 1-year neurocognitive outcomes of patients who accept carotid revascularization and identify the risk factors associated with postoperative cognitive decline. From April 2019 to April 2021, patients with ≥70% carotid artery stenosis who were treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS) were recruited for this study. The Montreal Cognitive Assessment (MoCA) instrument was used to evaluate cognitive function preoperatively and at 3, 6, and 12 months postoperatively. Logistic regression analysis was built to identify potential risk factors for postoperative long-term cognitive decline. A total of 89 patients who met the criteria were enrolled and completed 1-year follow-up. At 3, 6, and 12 months after carotid revascularization, the total MoCA score, attention, language fluency, and delayed recall score were significantly improved compared with the baseline scores (p<0.05). At 12 months, there was also a significant improvement in cube copying compared with baseline (p=0.034). Logistic regression analysis showed that the advancing age, left side, and symptomatic carotid artery stenosis were independent risk factors for cognitive deterioration at 12 months after surgery. Overall, carotid revascularization has a beneficial effect on cognition function in patients with severe carotid artery stenosis, while advancing age, left side, and symptomatic carotid artery stenosis were significantly related to a decreased cognitive score after carotid revascularization. This study focused on the changes in cognitive function within 1 year after carotid revascularization in patients with severe carotid stenosis. Of course, carotid revascularization can improve the cognition function in these patients. On the other hand, we found the advancing age, left side and symptomatic carotid artery stenosis were significantly associated with decreased cognitive scores at 1 year after carotid revascularization, which suggests that clinicians may need to be aware of patients with these characteristics.

Montreal Cognitive Assessment Scores Do Not Associate With Communication Challenges Reported by Adults With Alzheimer's Disease or Parkinson's Disease.

Screening for cognitive-communication challenges in people with Alzheimer's disease (AD) or Parkinson's disease (PD) may benefit from multiple kinds of information about the client (e.g., patient-reported, performance-based). The purposes of this report are (a) to describe, using recently published score range descriptors (e.g., "mild," "moderate"), the patient-reported communication challenges of people with AD or PD using the Communicative Participation Item Bank (CPIB) and the Aphasia Communication Outcome Measure (ACOM); and (b) to examine the relationships between the performance-based Montreal Cognitive Assessment (MoCA), a cognitive screener, and patient-reported CPIB and ACOM scores. Participants were a convenience sample of 49 community-dwelling adults with AD or PD. Participants completed the measures in person as part of a larger assessment battery. MoCA total scores ranged from 7 to 28. CPIB T-scores fell in the following ranges: 31% were "within normal limits," 57% reflected "mildly" restricted participation, and 12% reflected "moderately" restricted participation. ACOM T-scores fell in the following ranges: 50% were either "within normal limits" or reflected "mild" impairment, 29% reflected "mild-moderately" impaired functional communication, and 21% reflected "moderately" impaired functional communication. There were only weak and nonsignificant correlations between T-scores on the ACOM or CPIB and scores on the MoCA, and there were no group differences on the ACOM or CPIB between individuals who screened positive versus negative on the MoCA. When screening individuals with AD or PD, patient-reported communication challenges seem to be complementary to information provided by the MoCA and perhaps most useful in screening for mild communication challenges.

Exploring the link between tooth loss, cognitive function, andbrain wellness in the context of healthy aging.

The aim of this study was to evaluate the utility of using MRI-derived tooth count, an indirect and nonspecific indicator of oral/periodontal health, and brain age gap (BAG), an MRI-based measure of premature brain aging, in predicting cognition in a population of otherwise healthy adults. This retrospective study utilized data from 329 participants from the University of South Carolina's Aging Brain Cohort Repository. Participants underwent neuropsychological testing including the Montreal Cognitive Assessment (MoCA), completed an oral/periodontal health questionnaire, and submitted to high-resolution structural MRI imaging. The study compared variability on cognitive scores (MoCA) accounted for by MRI-derived BAG, MRI-derived total tooth count, and self-reported oral/periodontal health. We report a significant positive correlation between the total number of teeth and MoCA total scores after controlling for age, sex, and race, indicating a robust relationship between tooth count and cognition, r(208) = .233, p < .001. In a subsample of participants identified as being at risk for MCI (MoCA <= 25, N = 36) inclusion of MRI-based tooth count resulted in an R2 change of .192 (H0 = 0.138 → H1 = 0.330), F(1,31) = 8.86, p = .006. Notably, inclusion of BAG, a valid and reliable measure of overall brain health, did not significantly improve prediction of MoCA scores in similar linear regression models. Our data support the idea that inclusion of MRI-based total tooth count may enhance the ability to predict clinically meaningful differences in cognitive abilities in healthy adults. This study contributes to the growing body of evidence linking oral/periodontal health with cognitive function.

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.

Impaired Standing Balance in Older Adults with Cognitive Impairment After a Severe Fall.

Introduction Fall-related sequelae as well as balance and gait impairments are more pronounced in older adults, who are cognitively impaired (OACI) compared to older adults who are cognitively healthy (OACH). Evidence is scarce about differences in standing balance and gait in OACH and OACI after a fall, even though these are major risks for recurrent falls. Thus, the aim of the study was to investigate early impairments in gait and balance, by adding Inertial Measurement Units (IMUs) to a functional performance test in OACH and OACI after a severe fall with presentation to the emergency department (ED) and immediate discharge. Methods The study sample was stratified into participants with and without probable cognitive impairment using the result of the Montreal Cognitive Assessment total score (maximum of 30 points). The cutoff for probable cognitive impairment was set at ≤ 24. Standing balance and gait parameters were measured using three IMUs in n=69 OACH (72.0 ± 8.2 years) and n=76 OACI (78.7 ± 8.1 years). Data were collected at participants' homes as part of a comprehensive geriatric assessment in the "SeFallED" study within four weeks after presentation to the ED after a severe fall (German Clinical Trials Register ID: 00025949). ANCOVA was used for statistical analysis, adjusted for age. Results The data indicated significantly more sway for OACI compared to OACH during balance tasks, whereas no differences in gait behavior were found. In detail, differences in standing balance were revealed for mean velocity (m/s) during parallel stance with eyes open (ηp2=0.190, p<0.001) and eyes closed on a balance cushion (ηp2=0.059, p=0.029), as well as during tandem stance (ηp2=0.034, p=0.044) between OACI and OACH. Further differences between the two groups were detected for path length (m/s2) during parallel stance with eyes open (ηp2=0.144, p<0.001) and eyes closed (ηp2=0.044, p<0.027) and for range (m/s2) during tandem (ηp2=0.036, p=0.036) and parallel stance with eyes closed (ηp2= 0.045, p=0.032). Conclusion Even though both groups have experienced a severe fall with presentation to the ED in the preceding 4 weeks, balance control among OACI indicated a higher fall risk than among OACH. Therefore, effective secondary falls prevention efforts have to be established, particularly for OACI.

Exploring Cognitive Dysfunction in Long COVID Patients: Eye Movement Abnormalities and Frontal-Subcortical Circuits Implications via Eye-Tracking and Machine Learning

BackgroundCognitive dysfunction is regarded as one of the most severe aftereffects following coronavirus disease 2019 (COVID-19). Eye movements, controlled by several brain areas, such as the dorsolateral prefrontal cortex and frontal-thalamic circuits, provide a potential metric for assessing cortical networks and cognitive status. We aimed to examine the utility of eye movement measurements in identifying cognitive impairments in long COVID patients. MethodsWe recruited 40 long COVID patients experiencing subjective cognitive complaints and 40 healthy controls and used a certified eye-tracking medical device to record saccades and antisaccades. Machine learning was applied to enhance the analysis of eye movement data. ResultsPatients did not differ from the healthy controls regarding age, sex, and years of education. However, the patients' Montreal Cognitive Assessment total score was significantly lower than healthy controls. Most eye movement parameters were significantly worse in patients. These included the latencies, gain (computed as the ratio between stimulus amplitude and gaze amplitude), velocities, and accuracy (evaluated by the presence of hypermetric or hypometria dysmetria) of both visually and memory-guided saccades; the number of correct memory saccades; the latencies and duration of reflexive saccades; and the number of errors in the antisaccade test. Machine learning permitted distinguishing between long COVID patients experiencing subjective cognitive complaints and healthy controls. ConclusionOur findings suggest impairments in frontal subcortical circuits among long COVID patients who report subjective cognitive complaints. Eye-tracking, combined with machine learning, offers a novel, efficient way to assess and monitor long COVID patients' cognitive dysfunctions, suggesting its utility in clinical settings for early detection and personalized treatment strategies. Further research is needed to determine the long-term implications of these findings and the reversibility of cognitive dysfunctions.

Montreal Cognitive Assessment (MoCA) XpressO: Validation of a digital self-administered cognitive prescreening tool.

The need for cognitive testing is increasing with the aging population and the advent of new Alzheimer disease therapies. To respond to the increased demand, the XpressO was developed as a self-administered digital cognitive prescreening tool that will help distinguish between populations of subjective and objective cognitive impairment according to the Montreal Cognitive Assessment (MoCA). This is a prospective validation study. XpressO is composed of tasks that assess memory and executive functions. It is validated compared to the digital MoCA as a gold standard. Out of 118 participants screened from the MoCA Clinic and a family practice clinic, 88 met inclusion criteria, two participants had missing data due to incomplete tasks, 86 participants were included in the analysis; the mean age was 70.34 years. A logistic regression model was built, and its accuracy was evaluated by the sensitivity, specificity, and Area Under the Curve (AUC) of the Receiver Operating Characteristic. Analysis showed strong correlation between (1) XpressO memory tasks scores and the MoCA Memory Index Score (p-values < 0.001), and between (2) XpressO sub-test scores and MoCA total score (p-values < 0.005). The AUC for predicting MoCA performance is 0.845. To classify individuals with normal and abnormal MoCA scores, two threshold values were introduced for the total XpressO scores: sensitivity of 91% at a cutoff of 72, specificity of 90% at a cutoff of 42, and an undetermined range in between. XpressO demonstrated high AUC, high sensitivity and specificity to predict cognitive performance compared to the digital MoCA. It may provide efficient cognitive prescreening by identifying individuals who would benefit from further clinical assessments, potentially reducing waiting times and high burden on healthcare clinics.

The relationship between social phobia and cognitive impairment in idiopathic generalized epilepsy patients: a cross-sectional study

Objectives: Epilepsy, a neurological disorder affecting approximately 65 million people worldwide, frequently presents with various comorbidities, including cognitive impairment. The factors contributing to cognitive impairment are complex and multifaceted. This study aimed to investigate the influence of social phobia on cognitive function in patients with idiopathic generalized tonic-clonic epilepsy. Methods: This prospective study recruited 87 adult idiopathic generalized tonic-clonic epilepsy patients diagnosed according to the International League Against Epilepsy 2017 classification. Differential diagnosis involved electroencephalography, magnetic resonance imaging, and neurological examinations. All participants were assessed for cognitive impairment, social phobia, depression, and anxiety using the Montreal Cognitive Assessment, Liebowitz Social Anxiety Scale, Beck Depression Inventory, and Beck Anxiety Inventory, respectively. Results: A significant majority (73.6%) of participants reported social phobia. Compared to those without social phobia, the Montreal Cognitive Assessment total score was significantly lower in the social phobia group (P=0.002). Additionally, epilepsy duration was significantly longer in the social phobia group (P=0.03). Montreal Cognitive Assessment scores showed a negative correlation with Liebowitz Social Anxiety Scale-avoidance, Liebowitz Social Anxiety Scale-total, and age (P=0.003, P=0.005, and P&amp;lt;0.001, respectively). Conclusions: This study suggests that individuals with idiopathic generalized tonic-clonic epilepsy experiencing social phobia may exhibit lower cognitive function compared to those without. This indicates that comorbid social phobia might negatively impact cognitive abilities in idiopathic generalized tonic-clonic epilepsy patients.

The Montreal Cognitive Assessment: Norms and Reliable Change Indices for Standard and MoCA-22 Administrations.

The Montreal Cognitive Assessment (MoCA) is among the most frequently administered cognitive screening tests, yet demographically diverse normative data are needed for repeated administrations. Data were obtained from 18,410 participants using the National Alzheimer's Coordinating Center Uniform Data Set. We developed regression-based norms using Tobit regression to account for ceiling effects, explored test-retest reliability of total scores and by domain stratified by age and diagnosis with Cronbach's alpha, and reported the cumulative change frequencies for individuals with serial MoCA administrations to gage expected change. Strong ceiling effects and negative skew were observed at the total score, domain, and item levels for the cognitively normal group, and performances became more normally distributed as the degree of cognitive impairment increased. In regression models, years of education was associated with higher MoCA scores, whereas older age, male sex, Black and American Indian or Alaska Native race, and Hispanic ethnicity were associated with lower predicted scores. Temporal stability was adequate and good at the total score level for the cognitively normal and cognitive disorders groups, respectively, but fell short of reliability standards at the domain level. MoCA total scores are adequately reproducible among those with cognitive diagnoses, but domain scores are unstable. Robust regression-based norms should be used to adjust for demographic performance differences, and the limited reliability, along with the ceiling effects and negative skew, should be considered when interpreting MoCA scores.

Abstract A030: The Montreal Cognitive Assessment (MoCA) administered virtually or via Duo APP in primary brain tumor patients: a preliminary analysis

Abstract Background: Primary brain tumor (PBT) patients experience cognitive dysfunction (CD) because of both their tumor and its treatment. Evaluating CD in PBT populations may inform patient outcomes and clinical management and allow exploration of biologic underpinnings associated with its occurrence. The Montreal Cognitive Assessment (MoCA) is a brief assessment of objective measures of cognition that evaluates 8 specific cognitive domains. Our group has previously reported the feasibility of MoCA, and this study includes using the newly developed MoCA Duo APP to evaluate and report the cognitive function of patients with PBT. Associations between total MoCA scores and clinical and demographic characteristics were explored. Methods: This cohort consisted of adult PBT patients (n=172) enrolled in the NCI-NOB Natural History Study (NCT02851706: PI T. Armstrong). Assessments were performed between February 2020 and July 2023 by MoCA certified assessors and administered in the clinic or via telehealth. MoCA scores range from 0 to 30 (normal cognition ≥ 26). Healthcare providers collected demographic and clinical characteristics, with Karnofsky performance status (KPS) scores categorized as poor (≤ 80) or good (≥ 90). Descriptive statistics, independent t-tests, one-way ANOVAs, and Pearson’s correlation were conducted using IBM SPSS Statistics software. Results: The majority of patients were male (58%), white (81%), had ≥12 years of education (87%), had high-grade (3/4) tumors (65%), and a good KPS score (68%). The mean MoCA score was 25 (median: 26; range: 6-30) with a mean completion time of 10.7 minutes (median: 10; range: 6.1-41.1). Forty-two percent (n=73) were classified as abnormal. The median scores were lowest in the visuospatial/executive (4/5; range: 0-5), abstraction (2/3; range: 0-3) and delayed recall (4/5; range: 0-5) domains. A univariate analysis identified lower MoCA scores in patients with high-grade tumors (p&amp;lt;0.001), poor KPS scores (p&amp;lt;0.001), who underwent two or more surgeries (p=0.004) or treatments (p=0.038), had recurrence (p=0.002), had progression on current imaging (p=0.017), and had current anticonvulsant (p=0.014) and corticosteroid use (p=0.036). Age at diagnosis (r=-0.157, p=0.021) and at visit (r=-0.193, p=0.005) had a weak negative correlation with MoCA scores. Conclusions: Our results indicate that patient age, tumor progression, treatment, and concomitant medications are associated with MoCA scores. Further analysis will evaluate tumor methylation status and blood-based biomarkers associated with occurrence to develop prediction models that can be evaluated in larger cohorts. Future investigations should compare MoCA scores to other forms of cognitive assessment, including patient-reported outcomes, incorporating multiple timepoints to monitor CD in patients throughout their treatment and survivorship care. Citation Format: McKenzie C. Kauss, Elizabeth Vera, Kimberly Reinhart, Hope Miller, Jaime Garcia, Morgan Johnson, Madhura V. Managoli, Maeve Pascoe, Kaitlynn Slattery, Alex R. Wollet, Mark R. Gilbert, Alvina Acquaye-Mallory, Terri S. Armstrong, Vivian A. Guedes. The Montreal Cognitive Assessment (MoCA) administered virtually or via Duo APP in primary brain tumor patients: a preliminary analysis [abstract]. In: Proceedings of the AACR Special Conference on Brain Cancer; 2023 Oct 19-22; Minneapolis, Minnesota. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_1):Abstract nr A030.

Hippocampal amide proton transfer values are associated with cerebral small vessel disease imaging markers and total burden: a community-based cross-sectional study.

Neurodegeneration has been suggested to be associated with cerebral small vessel disease (CSVD). The association between different CSVD imaging markers and the extent of neurodegeneration could be indirectly confirmed by examining the relationship between CSVD imaging markers and the hippocampal amide proton transfer (APT) values. The associations between hippocampal APT values with CSVD imaging markers and CSVD total load need to be further validated. The aim of this study was to investigate potential variations in hippocampal APT values among individuals with CSVD imaging markers and varying degrees of CSVD total burden. A cross-sectional study (retrospective analysis of prospectively-acquired data) was conducted at Nanxishan Hospital of Guangxi Zhuang Autonomous Region. From May 2020 to June 2021, 165 individuals (age, 40-76 years; male/female, 103/62) were included in this study. The inclusion criteria for the participants were as follows: The presence of lacunar infarction (LI), and/or cerebral microbleed (CMB); moderate-to-severe enlarged perivascular space (EPVS) (>20); deep white matter hyperintensity (WMH) > Fazekas 2 or periventricular WMH > Fazekas. The exclusion criteria comprised the following: History of craniocerebral operation; Cases with significant pathology incidentally identified during magnetic resonance (MR) scan; Drug or alcohol abuse. The differences of hippocampal APT values between CSVD imaging makers presence or absence groups and different CSVD total burden groups were compared using independent t-test and one-way analysis of variance (ANOVA). The correlations between APT values and CSVD imaging markers were analyzed using Pearson correlation analysis. A mediation analysis model was used to investigate the mediating effect of the hippocampal APT values in the association between CSVD total loads and Montreal Cognitive Assessment (MoCA) score was assessed. The hippocampal APT values among different CSVD total load groups were significantly different (P<0.001). The hippocampal APT values were significantly different between the imaging markers presence and absence groups. The P values for the LI, WMH EPVS, and CMB presence or absence groups were <0.001, <0.001, 0.034, and 0.002, respectively. The hippocampal APT values were significantly correlated with CMB (P<0.01), LI (P<0.01) and WMH (P<0.01). The mediation models demonstrated that the APT values of the hippocampus partially mediated the association between CSVD total load and MoCA score, the proportion of mediation attributable was calculated as 17.50%. Hippocampal APT values were associated with CSVD imaging markers and total burden. Hippocampal APT values may serve as a biomarker for the early detection of neurodegeneration in CSVD patients.

A mediation analysis of the role of total free fatty acids on pertinence of gut microbiota composition and cognitive function in late life depression

BackgroundExtensive evidence demonstrates correlations among gut microbiota, lipid metabolism and cognitive function. However, there is still a lack of researches in the field of late-life depression (LLD). This research targeted at investigating the relationship among gut microbiota, lipid metabolism indexes, such as total free fatty acids (FFAs), and cognitive functions in LLD.MethodsTwenty-nine LLD patients from the Cognitive Outcome Cohort Study of Depression in Elderly were included. Cognitive functions were estimated through the Chinese version of Montreal Cognitive Assessment (MoCA). Blood samples were collected to evaluate serum lipid metabolism parameters. Fecal samples were evaluated for gut microbiota determination via 16S rRNA sequencing. Spearman correlation, linear regression and mediation analysis were utilized to explore relationship among gut microbiota, lipid metabolism and cognitive function in LLD patients.ResultsSpearman correlation analysis revealed significant correlations among Akkermansia abundance, total Free Fatty Acids (FFAs) and MoCA scores (P < 0.05). Multiple regression indicated Akkermansia and total FFAs significantly predicted MoCA scores (P < 0.05). Mediation analysis demonstrated that the correlation between decreased Akkermansia relative abundance and cognitive decline in LLD patients was partially mediated by total FFAs (Bootstrap 95%CI: 0.023–0.557), accounting for 43.0% of the relative effect.ConclusionThese findings suggested a significant relationship between cognitive functions in LLD and Akkermansia, as well as total FFAs. Total FFAs partially mediated the relationship between Akkermansia and cognitive functions. These results contributed to understanding the gut microbial-host lipid metabolism axis in the cognitive function of LLD.

Abnormal functional connectivity of the occipital thalamus with the superior occipital gyrus is associated with mild cognitive impairment in elderly individuals with primary insomnia

AbstractStudy objectivesPrimary insomnia (PI) triggers a decline in cognitive function, and the thalamus plays an integral role in this process; however, the mechanisms are unclear. The purpose of this study was to investigate the altered functional connectivity (FC) of the thalamus in PI patients with mild cognitive impairment (MCI) and to explore the potential neural mechanisms of thalamic involvement in these patients.MethodsThis case–control study was conducted in older adults from various communities in Fuzhou, China with a PI diagnosis. These participants underwent neuropsychological assessment and were matched in a 1:2 ratio to the healthy control (HC) group and the PI group according to sex, age, and education level. Resting‐state functional magnetic resonance imaging was used to explore changes in thalamic FC in PI patients. To further compare changes in thalamic and whole‐brain FC, we further divided the PI group into cognitively normal patients and patients with MCI according to the diagnostic criteria for MCI. The relationship between abnormal FC and cognitive function was investigated.ResultsThe 28 HCs and 58 participants with PI showed significant differences in Montreal Cognitive Assessment (MoCA) scores (p = .044). In comparison to the HC group, the PI group showed enhanced FC of the occipital thalamus with the left inferior occipital gyrus, right lingual gyrus, left middle temporal gyrus, left superior marginal gyrus, left dorsolateral superior frontal gyrus, and right anterior central gyrus. The MoCA total score and the executive function, attention, and abstraction scores of PI patients with MCI (PI–MCI) were worse than those of PI patients without MCI. In comparison to the simple PI group, FC was enhanced in the PI–MCI group between the left occipital thalamus and the middle occipital gyrus, and between the right occipital thalamus and the right superior frontal gyrus, left middle frontal gyrus, right superior occipital gyrus, and orbital inferior frontal gyrus. There was a significant negative correlation between the MoCA total score and the enhanced FC between the right occipital thalamus and right superior occipital gyrus (r = −.419, p = .042).ConclusionThe early onset of cognitive impairment in patients with PI is associated with altered FC between the thalamus and the cortex. Enhanced FC between the thalamus and the visual cortex, that is, the superior occipital gyrus, which is involved in attentional processing, may play a role in the early onset of cognitive impairment in insomnia patients. Moreover, due to the fact that PI patients “overdraw” the compensatory capacity of these brain regions earlier, the PI–MCI may fall into the abyss of “decompensation” faster and face more severe cognitive impairments.

Abstract TP38: Cognitive Decline After Stroke Correlates With Small Vessel Disease and Race

Introduction: An Asian study found 30% of patients showed a cognitive decline measured by Montreal Cognitive Assessment (MoCA) score one year after stroke. There is limited US data on this subject. We investigated 1) decline rate in MoCA one year post-stroke 2) racial differences in baseline MoCA post-stroke and 3) if racial differences in small vessel disease (SVD) correlated with the decline in MoCA. Methods: MoCA was assessed in the PREMIERS trial (NCT#02541032) at baseline and one year after index stroke. Sub-scores for each MoCA domain were combined into a total score. The Fazekas scale was used to rate white matter signal abnormalities on patient MRI FLAIR images at baseline. Patients were categorized by total, deep white matter (DWM), and periventricular white matter scores. They were then sub-categorized into none/mild or moderate/severe groups. A one year cognitive decline was defined as a decline in MoCA scores by ≥2 points. Results: Of 280 patients, 30.4% had a ≥2 decline in MoCA score, with no significant difference between AA and white (29.4% vs. 32.9%, p=0.57). However, AA patients had lower baseline total MoCA scores (20.4±4.6 vs. 22.6±3.9, p&lt;0.001), visuospatial/executive (3.1±1.5 vs. 3.7±1.3, p&lt;0.001), naming (2.5±0.7 vs. 2.8±0.4, p=0.001), and attention (4.2±2.1 vs. 4.9±1.9, p&lt;0.001) sub-scores. Overall, baseline MoCA was lower in patients with moderate/severe total Fazekas scores (20.1±5.0 vs. 21.6±4.2, p=0.015) and DWM sub-scores (20.1±5.2 vs. 21.4±4.2, p=0.048). In AA, baseline MoCA remained lower in patients with moderate/severe total Fazekas scores (19.6±5.1 vs. 21.0±4.2, p=0.039) and DWM sub-scores (19.4±5.5 vs. 21.0±4.1, p=0.055). This was contrary to White patients with moderate/severe total Fazekas scores (22.3. ±4.4 vs. 23.0±3.9, p=0.50) and DWM sub-scores (23.1±2.3 vs. 22.7±4.4, p=0.73). Conclusion: We report that 30.4% of patients in this US-based study showed a decline in MoCA score one year post-stroke, which aligns with a similar study conducted in Asia. A significant association was found between the AA race and lower baseline total MoCA score compared to white patients. Moderate/severe total and DWM Fazekas scores are also significantly associated with lower baseline MoCA scores, a finding specific to AA patients.

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.

Montreal Cognitive Assessment and the Clock Drawing Test to Identify MCI and Predict Dementia in Isolated REM Sleep Behavior Disorder.

Patients with isolated/idiopathic REM sleep behavior disorder (iRBD) are at high risk for developing mild cognitive impairment (MCI) and dementia with Lewy bodies (DLB). However, there is a lack of scientific knowledge regarding the accuracy of cognitive screening tools to identify these conditions in iRBD. This study aimed to determine in iRBD the psychometrics of 2 screening tests to discriminate patients with MCI and those at risk of DLB. We retrospectively selected and followed 64 patients with polysomnography-confirmed iRBD seen in sleep clinic between 2006 and 2021, 32 with MCI (mean age 68.44 years, 72% men), 32 without MCI (67.78 years, 66% men), and 32 controls (69.84 years, 47% men). Participants underwent a neurologic evaluation and neuropsychological assessment for MCI diagnosis. They also completed the Montreal Cognitive Assessment (MoCA) and Clock Drawing Test (CDT). Fifty-three patients were followed (mean of 5.10 ± 2.64 years); 6 developed DLB, and 16 developed Parkinson disease. An independent cohort of 10 patients with iRBD who later developed DLB was also recruited and followed. Receiver operating characteristic curves with area under the curve (AUC) were performed assessing the discriminant value of the MoCA and CDT. The cut-off values that best differentiated patients who developed DLB from controls were on the MoCA total score (≤25/30 with 100% [95% CI 61%-100%] sensitivity and 78% [61%-89%] specificity, AUC = 0.888) and delayed recall (≤3/5 with 83% [44%-97%] sensitivity and 78% [61%-89%] specificity, AUC = 0.875). Both values yielded a sensitivity of 90% (60%-98%) to detect patients at risk of DLB in the independent cohort. Cutoffs that best discriminated patients with MCI from controls were: ≤25/30 (MoCA total score) with 72% [55%-84%] sensitivity, 78% [61%-89%] specificity, AUC = 0.803 and ≤2/5 (MoCA delayed recall) with 63% [45%-77%] sensitivity, 94% [80%-98%] specificity, AUC = 0.843. No acceptable optimal values were found for the CDT. In iRBD, the MoCA demonstrates adequate psychometric properties to identify patients most at risk of developing DLB and to screen for MCI, whereas the CDT does not. This study provides Class II evidence that the MoCA, but not the CDT, is useful in screening patients with iRBD for the risk of developing DLB.

The role of physical function and physical activity on cognitive function in the elderly

The aim of this study is to clarify the role of physical activity level and physical function on cognitive function of the elderly. A nested case–control investigation from a middle-aged and elderly cognitive health cohort was conducted. 103 mild cognitive impairment (MCI) patients were selected for the purpose of the study and matched 1:1 according to age and sex. Handgrip strength, gait speed and 5-time chair stand test were used to evaluate physical function. The physical activity scale for the elderly (PASE) was used to assess physical activity level. The Montreal cognitive assessment (MoCA) was used to quickly screen the mild cognitive impairment of the subjects. Body composition was estimated by bioelectrical impedance analysis. The total score of MoCA and the scores of different cognitive domains in two groups were different, handgrip strength was lower in the MCI group. Multivariate logistic regression model results showed that handgrip strength decreased could increase the risk of MCI(OR = 3.008, 95%CI: 1.421,6.369), higher PASE score was correlated with lower risk of MCI (OR = 0.402, 95%CI: 0.168,0.966). After combining body composition indices, handgrip strength and PASE score remained significantly associated with the occurrence of MCI, and there is an interaction. Logistic regression models were used for receiver operating characteristic curve analysis, all models demonstrate a good level of predictive performance for MCI. Physical activity level and physical function are associated with mild cognitive impairment. Higher physical activity level, normal handgrip strength are correlated with lower risk of MCI.

Associations Between Cardiac Function and Brain Health in Diverse Middle-Aged Adults: The Dallas Heart Study-2

BackgroundPrevious studies have linked cardiovascular risk factors during midlife to cognitive function in later life. However, few studies have looked at the association between cardiac function, brain structure, and cognitive function and even less have included diverse middle-aged populations. ObjectivesThe objective of this study was to determine associations between cardiac and brain structure and function in a multiethnic cohort of middle-aged adults. MethodsA cross-sectional study was conducted in participants of the Dallas Heart Study phase 2 (N = 1,919; 46% Black participants). Left ventricular (LV) mass, LV ejection fraction, LV concentricity, and peak systolic strain (LV Ecc) were assessed by cardiac magnetic resonance imaging. White matter hyperintensities (WMH) volume was measured by fluid attenuated inversion recovery magnetic resonance imaging. The Montreal Cognitive Assessment was used to measure cognitive functioning. Associations between cardiac and brain measures were determined using multivariable linear regression after adjusting for cardiovascular risk factors, education level, and physical activity. ResultsLV ejection fraction was associated with total Montreal Cognitive Assessment score (β = 0.06 [95% CI: 0.003-0.12], P = 0.042) and LV Ecc was associated with WMH volume (β = 0.08 [95% CI: 0.01-0.14], P = 0.025) in the overall cohort without significant interaction by race/ethnicity. Higher LV mass and concentricity were associated with larger WMH volume in the overall cohort (β = 0.13 [95% CI: 0.03-0.23], P = 0.008 and 0.10 [95% CI: 0.03-0.17], P = 0.005). These associations were more predominant in Black than White participants (β = 0.17 [95% CI: 0.04-0.30] vs β = −0.009 [95% CI: −0.16 to 0.14], P = 0.036 and β = 0.22 [95% CI: 0.13-0.32] vs β = −0.11 [95% CI: −0.21 to −0.01], P < 0.0001, for LV mass and concentricity, respectively). ConclusionsSubclinical cardiac dysfunction indicated by LVEF was associated with lower cognitive function. Moreover, LV mass and concentric remodeling were associated with higher WMH burden, particularly among Black individuals.

LONGITUDINAL CHANGE IN PERFORMANCE ON THE MONTREAL COGNITIVE ASSESSMENT IN THE PEOPLE WITH DEMENTIA

Abstract The Montreal Cognitive Assessment (MoCA), a widely employed cognitive screening tool, is designed to identify mild cognitive impairment and diverse forms of dementia. Through its multidimensional evaluation of cognitive domains, MoCA supports clinicians in precise assessment and intervention planning for individuals manifesting cognitive deficits. Despite MoCA’s prevalence, limited research has explored its temporal dynamics in individuals experiencing memory loss, particularly across different stages of dementia. This study examined the MoCA changes of a longitudinal study analyzing the conversational speech in 8 older adults (5 males 3 females) with mild- to moderate-stage of dementia. Repeated biweekly measures at 12 intervals over six months were employed to gauge changes in total MoCA scores and its sub-tasks. Our findings reveal: 1) a significant negative correlation (r=-0.22, p=0.03) between the total MoCA score and the total time spent in tests; 2) most participants present a positive correlation (r=0.03 to 0.6) in their first memory trial session and a negative correlation (r=-0.1 to -0.8)in the second trial between words recalled and the time spent; 3) over 60% of participants demonstrating a declining trend in naming sessions, while orientation sessions exhibit no clear trend. These outcomes imply MoCA’s susceptibility to a “learning effect” with repeated measurements in people with dementia. Future longitudinal studies should consider alternate MoCA versions or extended assessment intervals to mitigate this effect.

THE POTENTIAL OF MULTIDOMAIN MOBILE PROGRAMS IN SUPPORTING COGNITIVE HEALTH OF SENIORS IN RESIDENTIAL FACILITIES

Abstract This study pilot tested the efficacy of a mobile-based multidomain application, Silvia Program, on cognitive functioning of residents in assisted living facilities (ALFs). After a 12-week randomized pilot trial using a two-group pretest-posttest design (Silvia group vs. usual care group), we assessed the cognitive functioning using the Montreal Cognitive Assessment (MoCA). Results are that the total MoCA scores of the Silvia group showed significant improvement while the total scores of the control group declined. The present study provides suggestive evidence for an overall positive effect of the use of the Silvia Program on the cognitive functioning among residents in ALFs.