Orientation Subtests Research Articles

Cognitive impairment among an Egyptian sample of patients with schizophrenia and bipolar disorders: a comparative study

BackgroundThe cognitive profile among patients with schizophrenia (SZ) and bipolar disorder (BD) has varied widely across different studies. The aim of the current study was to compare different cognitive domains using psychometric and neurophysiological tests in patients with SZ to those with BD. A case–control study was conducted on 30 BD, 30 SZ and 30 age and sex matched control group. Each subject was submitted to the following: Wechsler Adult Intelligence Scale-3rd edition (WAIS-III), Montreal cognitive assessment scale (MoCA), Brief Visuospatial Memory Test-Revised (BVMT-R), Memory Assessment Scales (MAS), and the P300 event related potential (ERP).ResultsSZ and BD patients had significantly lower total and subscales of WAIS-III scores than the control group. SZ patients had significantly higher deterioration index (DI) than controls, while absence of such significant between BD and controls. SZ patients reported significantly lower MoCA scores and subitems, especially in visuospatial, naming, attention, delayed recall, and orientation subtests than controls. Only visuospatial and delayed recall scores were significantly decreased in BD than controls. SZ patients performed poorer on BVMT-R subscales than the control group. Both SZ and BD groups had lower mean values of all subscales except verbal assessment in the four memory tests. P300 latencies and amplitude had no significant difference among the three groups, although the BD group had a shorter P300 latency.ConclusionPatients with SZ and BD had significantly lower scores on various cognitive function domains in comparison to controls with more affection in SZ. The frequency of mood episodes, disease duration, and education level must be considered.

The Global Deterioration Scale for Down Syndrome Population (GDS-DS): A Rating Scale to Assess the Progression of Alzheimer's Disease.

The aim of this study is to adapt and validate the global deterioration scale (GDS) for the systematic tracking of Alzheimer's disease (AD) progression in a population with Down syndrome (DS). A retrospective dual-center cohort study was conducted with 83 participants with DS (46.65 ± 5.08 years) who formed the primary diagnosis (PD) group: cognitive stability (n = 48), mild cognitive impairment (n = 24), and Alzheimer's disease (n = 11). The proposed scale for adults with DS (GDS-DS) comprises six stages, from cognitive and/or behavioral stability to advanced AD. Two neuropsychologists placed the participants of the PD group in each stage of the GDS-DS according to cognitive, behavioral and daily living skills data. Inter-rater reliability in staging with the GDS-DS was excellent (ICC = 0.86; CI: 0.80-0.93), and the agreement with the diagnosis categories of the PD group ranged from substantial to excellent with κ values of 0.82 (95% CI: 0.73-0.92) and 0.85 (95% CI: 0.72, 0.99). Performance with regard to the CAMCOG-DS total score and orientation subtest of the Barcelona test for intellectual disability showed a slight progressive decline across all the GDS-DS stages. The GDS-DS scale is a sensitive tool for staging the progression of AD in the DS population, with special relevance in daily clinical practice.

Italian telephone-based Mini-Mental State Examination (Itel-MMSE): item-level psychometric properties.

BackgroundThe Italian telephone-based Mini-Mental State Examination (Itel-MMSE), despite being psychometrically sound, has shown relevant ceiling effects, which may negatively impact the interpretation of its scores. In address to overcome such an issue, this study aimed at providing item-level insights on the Itel-MMSE through Item Response Theory (IRT) analyses.MethodsFive-hundred and sixty-seven healthy Italian adults (227 males, 340 females; mean age: 51 ± 17 years, range 18–96; mean education: 13.31 ± 4.3 years). A two-parameter logistic IRT model was implemented to assess item discrimination and difficulty of the Itel-MMSE. Construct unidimensionality, statistical independence of items, and model and item fit were tested. Informativity levels were also assessed graphically.ResultsWith respect to the Itel-MMSE total score, ceiling effects were found in 92.7% of participants. Unidimensionality was violated; both model and item fit were poor; a few items showed statistical dependence. Both the whole test and its items proved to be scarcely informative, especially for medium-to-high levels of ability, except for attention and spatial orientation subtests, which consistently yielded the highest discriminative capability.DiscussionThe Itel-MMSE appears to be most informative in low-performing healthy individuals. However, the present findings should not lead practitioners to aprioristically equate ceiling effects/low informativity to clinical uselessness. Items assessing attention and, to a lesser extent, spatial orientation appear to be the most informative.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40520-021-02041-4.

Development of a novel cognitive composite outcome to assess therapeutic effects of exercise in the EXERT trial for adults with MCI: The ADAS-Cog-Exec.

IntroductionUse of cognitive composites as primary outcome measures is increasingly common in clinical trials of preclinical and prodromal Alzheimer's disease (AD). Composite outcomes can decrease intra‐individual variability, resulting in improved sensitivity to detect longitudinal change and increased statistical power. We developed a novel composite outcome, the ADAS‐Cog‐Exec, for use in the EXERT trial—a Phase 3 randomized, controlled, 12‐month exercise intervention in mild cognitive impairment (MCI).MethodsThree combinations of cognitive measures selected from the Alzheimer's Disease Assessment Scale‐Cognitive Subscale version 13 (ADAS‐Cog13), tests of executive function, and the Clinical Dementia Rating (CDR) were created based on previously documented sensitivity to longitudinal change in MCI and to the effects of exercise. Optimally weighted composites of each combination were modeled using data from the ADNI‐1 MCI cohort. Ten‐fold cross‐validation was performed to obtain a bias‐corrected mean to standard deviation ratio (MSDR). The cognitive composites were assessed for their sensitivity to detect 12‐month change in MCI.ResultsThe MSDR of 12‐month change for each of the composite outcomes tested exceeded that of the ADAS‐Cog13 total score. The composite with the highest MSDR (MSDR = 0.48) and associated statistical power included scores on ADAS‐Cog13 Word Recall, Delayed Word Recall, Orientation, and Number Cancellation subtests; Trail‐Making Tests A & B, Digit Symbol Substitution and Category Fluency; and cognitive components of the CDR (Memory, Orientation, Judgement & Problem Solving).DiscussionAn optimally weighted cognitive composite measure was identified and validated for use in EXERT. This composite contained selected subtests from the ADAS‐Cog13, additional measures of executive function, and box scores for cognitive components of the CDR. Because this composite score demonstrated high sensitivity to longitudinal change in MCI it will be used as the primary outcome measure for the EXERT trial.

Discriminative Ability of Montreal Cognitive Assessment Subtests and Items in Racial and Ethnic Minority Groups.

The Montreal Cognitive Assessment (MoCA) is a popular screening tool for Mild Cognitive Impairment (MCI). The psychometric properties of the MoCA have not been widely examined in minority groups. We aimed to analyze the discriminate ability of subtests and items by race and ethnicity given gold-standard clinical diagnosis of cognitive status. We analyzed data from the National Alzheimer Coordinating Center Uniform Data Set March 2018 data freeze. Stepwise regression was used to determine which subtests predicted cognitive status (normal cognition, MCI, or dementia), by race/ethnicity. Item discrimination and difficulty was calculated by race/ethnicity and cognitive status. In our sample (n=3895), with an average age of 69.7, 80.7% were non-Hispanic white, 15.0% were non-Hispanic black, and 4.2% were Hispanic. Among non-Hispanic whites all subtests, education, and age predicted clinician diagnosis, while visuospatial/executive, attention, language, delayed recall, and orientation subtests were predictive among non-Hispanic blacks and visuospatial/executive, delayed recall, and orientation subtests and education were predictive among Hispanics. Item discrimination and difficulty varied by race/ethnicity and cognitive status. By understanding the psychometric properties of MoCA subtests, we can focus on subtests that have higher discrimination and more diagnostic utility. Subtests should be further evaluated for use in screening of minority individuals.

Use of the MMSE in the Prediction of Driving Fitness: Relevance of Specific Subtests.

To examine the association between performance on subtests of the Mini-Mental State Examination (MMSE) and driving competence in people with cognitive impairment (CI) as well as those with no cognitive impairment (NCI). Retrospective observational study. Participants referred for a DriveWise evaluation at Beth Israel Deaconess Medical Center in Boston, Massachusetts, were included in the study. A total of 419 participants referred for a DriveWise evaluation was studied. The average age of the sample was 77.69 years. In this study, people with an MMSE score lower than 25 were included in the CI group; 41% of participants had CI. All participants underwent mental status screening with the MMSE, and all underwent a 45-minute road test modeled after the Washington University Road Test adapted for use in Boston streets. In both groups, poor road test performance was associated with low scores on the MMSE. In drivers with CI, MMSE total score and performance on the attention subtest were significantly lower for those who failed the road test. In drivers with NCI, the MMSE total score and orientation subtests were significantly lower for those who failed the road test. Clinicians working with older people should know that the MMSE is an effective tool to screen for driving safety, but MMSE subtests are differentially sensitive to driving safety in people with and without CI. Poor performance on specific MMSE subtests may prompt further evaluation of driving competence with a road test. J Am Geriatr Soc 67:790-793, 2019.

Characteristics of cognitive functions in patients of different age with dyscirculatory encephalopathy and metabolic syndrome

Objective — to establish the characteristics of cognitive changes in patients of different age subgroups with metabolic syndrome (MetS).Methods and subjects. 503 patients aged 45 to 89 years with dyscirculatory encephalopathy (DE) of mixed etiology were examined. Patients were divided into two groups: 1 — without MetS (n = 198), 2 — with MetS (n = 305). Patients in both clinical groups were also divided into 3 age subgroups: 45 — 59 — middle age, 60 — 74 years — elderly, 75 — 89 years old — senile age. The general‑clinical, neurological, neuropsychological, laboratory and instrumental examinations were conducted.Results. The patients with DE and MetS had worse indicators of cognitive functions, compared to the patients without MetS (the speed of sensory motor responses, mental performance, the volume of active attention, the efficacy of information processing, lower rates on the clock drawing test and the Frontal Assessment Battery). The severity of cognitive decline in patients of both clinical groups accrued with aging. The most pronounced negative effect of MetS on cognitive functions was observed in the subgroup of middle‑aged patients, which was depicted in significantly lower overall MMSE score. According to the MMSE subtest profile, patients with DE and MetS of all age subgroups had significantly worse, comparing with patients without MetS, parameters of the short‑term memory and reproduction of verbal material. It should be noted that in the middle and elderly age, changes in the cognitive profile are similar, whereas in the senile age subgroup it varies due to an increase in deterioration in time orientation subtest paramters.Conclusions. Patients with DE with MetS had more severe impairment of cognitive functions. Significant influence of age on the severity of cognitive impairment was found: the severity of cognitive deficits in patients of both clinical groups increased in aging.

Incidental findings on brain MRI of cognitively normal first-degree descendants of patients with Alzheimer's disease: a cross-sectional analysis from the ALFA (Alzheimer and Families) project

ObjectivesTo describe the prevalence of brain MRI incidental findings (IF) in a cohort of cognitively normal first-degree descendants of patients with Alzheimer's disease (AD).DesignCross-sectional observational study.SettingAll scans were obtained with...

Developing a Very Low Vision Orientation and Mobility Test Battery (O&M-VLV).

This study aimed to determine the feasibility of an assessment of vision-related orientation and mobility (O&M) tasks in persons with severe vision loss. These tasks may be used for future low vision rehabilitation clinical assessments or as outcome measures in vision restoration trials. Forty legally blind persons (mean visual acuity logMAR 2.3, or hand movements) with advanced retinitis pigmentosa participated in the Orientation & Mobility-Very Low Vision (O&M-VLV) subtests from the Low Vision Assessment of Daily Activities (LoVADA) protocol. Four categories of tasks were evaluated: route travel in three indoor hospital environments, a room orientation task (the "cafe"), a visual exploration task (the "gallery"), and a modified version of the Timed Up and Go (TUG) test, which assesses re-orientation and route travel. Spatial cognition was assessed using the Stuart Tactile Maps test. Visual acuity and visual fields were measured. A generalized linear regression model showed that a number of measures in the O&M-VLV tasks were related to residual visual function. The percentage of preferred walking speed without an aid on three travel routes was associated with visual field (p < 0.01 for all routes) whereas the number of contacts with obstacles during route travel was associated with acuity (p = 0.001). TUG-LV task time was associated with acuity (p = 0.003), as was the cafe time and distance traveled (p = 0.006 and p < 0.001, respectively). The gallery score was the only measure that was significantly associated with both residual acuity and fields (p < 0.001 and p = 0.001, respectively). The O&M-VLV was designed to capture key elements of O&M performance in persons with severe vision loss, which is a population not often studied previously. Performance on these tasks was associated with both binocular visual acuity and visual field. This new protocol includes assessments of orientation, which may be of benefit in vision restoration clinical trials.

Differences in cognitive profiles between traumatic brain injury and stroke: A comparison of the Montreal Cognitive Assessment and Mini-Mental State Examination

PurposeTo investigate the profiles of cognitive impairment through Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) in patients with chronic traumatic brain injury (TBI) or stroke and to evaluate the sensitivity of the two scales in patients with TBI. MethodsIn this cohort study, a total of 230 patients were evaluated, including TBI group (n = 103) and stroke group (n = 127). The cognitive functions of two groups were evaluated by designated specialists using MoCA (Beijing version) and MMSE (Chinese version). ResultsCompared with the patients with stroke, the patients with TBI received significantly lower score in orientation subtest and recall subtest in both tests. MoCA abnormal rates in the TBI group and stroke group were 94.17% and 86.61% respectively, while MMSE abnormal rates were 69.90% and 57.48%, respectively. In the TBI group, 87.10% patients with normal MMSE score had abnormal MoCA score and in the stroke group, about 70.37% patients with normal MMSE score had abnormal MoCA score. The diagnostic consistency of two scales in the TBI group and the stroke group were 72% and 69%, respectively. ConclusionIn our rehabilitation center, patients with TBI may have more extensive and severe cognitive impairments than patients with stroke, prominently in orientation and recall domain. In screening post-TBI cognitive impairment, MoCA tends to be more sensitive than MMSE.

Utility of the Neurobehavioral Cognitive Status Examination (COGNISTAT) in differentiating between depressive states in late-life depression and late-onset Alzheimer's disease: a preliminary study.

BackgroundIt is often difficult to differentiate between the depressive states seen in late-life depression and late-onset Alzheimer’ disease (AD) in the clinical setting.MethodsThirty-four outpatients were recruited, all fulfilling the criteria of aged 65 years or above, scores of 14 or more on the Hamilton depression rating scale (HAM-D), and 26 or less on the Mini-Mental State Examination (MMSE). At the initial visit, they were administered the Neurobehavioral Cognitive Status Examination (COGNISTAT). At 1 month, a diagnosis of either senile depression (n = 24) or Alzheimer’ disease (n = 10) was made.ResultsThe COGNISTAT revealed that the late-life depression group showed significantly higher scores in orientation and comprehension subtests compared with the AD group. At the study endpoint (6 months after treatment), MMSE detected significant improvements in the late-life depression group (n = 15), but no changes in the late-onset AD group (n = 7). Scores for memory, similarities, and judgment on the second COGNISTAT were significantly improved in the depressed group, whereas calculation scores deteriorated significantly in the AD group.ConclusionThe COGNISTAT could prove useful in differentiating late-life depression from late-onset AD, despite similar scores on MMSE.

Ecological assessment of mild cognitive impairment and Alzheimer disease using the Rivermead Behavioural Memory Test

IntroductionThe Rivermead Behavioural Memory Test (RBMT) is a short, ecologically valid memory test battery that can provide data about a subject's memory function in daily life. We used RBMT to examine daily memory function in patients with mild cognitive impairment (MCI), Alzheimer disease (AD), and in healthy controls. We also evaluated differences between the memory profiles of subjects whose MCI remained stable after 1 year and those with conversion to AD. Patients and methodsSample of 91 subjects older than 60 years: 30 controls, 27 MCI subjects and 34 AD patients. Subjects were assessed using MMSE and RBMT. ResultsThe 40 men and 51 women in the sample had a mean age of 74.29±6.71 and 5.87±2.93 years of education. For the total profile, screening RBMT scores (P<.001) and total MMSE scores (P<.05), control subjects scored significantly higher than those with MCI, who in turn scored higher than AD patients. In all subtests, the control group (P<.001) and MCI group (P<.05) were distinguishable from the AD group. Prospective, retrospective, and orientation subtests found differences between the MCI and control groups (P<.05). MCI subjects who progressed to AD scored lower at baseline on the total RBMT and MMSE, and on name recall, belongings recall, story immediate recall, route delayed recall, orientation (P<.05), face recognition, story delayed recall, and messages delayed recall sections (P<.01). ConclusionsRBMT is an ecologically valid episodic memory test that can be used to differentiate between controls, MCI subjects, and AD subjects. It can also be used to detect patients with MCI who will experience progression to AD.

Neurocognitive predictors of performance‐based functional capacity in bipolar disorder

Neurocognitive impairment can predict functional capacity in individuals with bipolar disorder, though little research has examined whether different neurocognitive domains impact specific types of tasks. This study examined the relationship between several neurocognitive variables and the UCSD Performance-Based Skills Assessment (UPSA; Patterson etal., 2011) to identify the domains and tests that best predict the performance across the subscales. Forty-seven euthymic participants who were diagnosed with either Bipolar I or Bipolar II were recruited and assessed on a battery of neuropsychological measures and the UPSA. Correlational and regression analyses were run to identify neurocognitive predictors of UPSA subscales. Per the literature, verbal learning and memory and executive function composites were first examined. Verbal learning and memory predicted the Communication subscale and Total score variables above and beyond the estimated FSIQ and symptom rating scales. In a secondary exploratory analysis, the Benton Judgment of Line Orientation subtest predicted the Finance subscale while the California Verbal Learning Test predicted the UPSA total score. Verbal learning and memory emerged as the strongest predictor of functional capacity, suggesting that this domain should be investigated in future mediational and longitudinal studies with the UPSA.

Validation of Montreal Cognitive Assessment and Discriminant Power of Montreal Cognitive Assessment Subtests in Patients With Mild Cognitive Impairment and Alzheimer Dementia in Turkish Population

Montreal Cognitive Assessment (MoCA) is a new cognitive tool developed for screening mild cognitive impairment (MCI). The authors examined validity of MoCA and discriminating power of subtests in a Turkish population comprising of 474 participants (246 healthy controls, 114 subjects with MCI and 114 subjects with dementia). The ANCOVAs showed that age and education had a main effect on MoCA scores. Cut scores were computed according to different education levels. The overall cut-off values for MCI and dementia were found to be lower compared to western studies. MoCA was found to have good internal consistency. The subtests most useful in discriminating MCI from healthy controls were recall, visuospatial and language, while in discriminating dementia from MCI were visuospatial, orientation and attention subtests. The results demonstrated that MoCA is a valid and reliable instrument in screening MCI, and compared with the MMSE, MoCA was proved to have superior sensitivity and specificity in detecting MCI.

The Importance of Orientation in Evaluating Recovery in Pediatric Traumatic Brain Injury

Objective: Decisions about whether children who have sustained a traumatic brain injury are ready to transition from a medical facility to home and school life requires insight into their cognitive status. This study evaluates whether orientation to time, place, and self (Ox3) serves as sufficient indicator of general cognitive status to support such decisions. Design: Participants with and without TBI were administered the PTBI in one to three individual testing sessions. Performance on Ox3 items were compared between groups, as well as performance on subtests representing broader cognitive and linguistic skills. Setting: Pediatric brain injury in patient acute and rehab units. Participants: Twenty-eight children with TBI (18 male, 10 female) between the ages of 6 and 16 years of age served as participants. Of these, 12 were initially classified as severe, 6 moderate, and 10 mild on the Glasgow Coma Scale. Interventions: NA Main Outcome Measures: The Pediatric Test of Brain Injury (PTBI) is a criterion-referenced, standardized test designed to measure neurocognitive, language and literacy abilities in children recovering from brain injury. The entire test, including its Orientation subtest, was administered to participants during the acute phase of recovery (within 3 months of injury). Results: Despite no differences between the TBI and control group on the Orientation subtests, deficits occurred in other cognitive-linguistic domains that are relevant to functioning outside medical and rehabilitation environments. Furthermore, even neurologically-normal children sometimes failed some Ox3 items. Conclusion: The findings on Orientation items from the PTBI indicates that caution is warranted in applying the “Ox3” standard for evaluating cognitive status to a pediatric TBI population.

Evaluación ecológica en el deterioro cognitivo leve y enfermedad de Alzheimer mediante el Rivermead Behavioural Memory Test

IntroductionThe Rivermead Behavioural Memory Test (RBMT) is a short, ecologically-valid memory test battery that can provide data about a subject's memory function in daily life. We used RBMT to examine daily memory function in patients with mild cognitive impairment (MCI), Alzheimer disease (AD), and in healthy controls. We also evaluated differences between the memory profiles of subjects whose MCI remained stable after 1 year and those with conversion to AD. Patients and methodsSample of 91 subjects older than 60 years: 30 controls, 27 MCI subjects and 34 AD patients. Subjects were assessed using MMSE and RBMT. ResultsThe 40 men and 51 women in the sample had a mean age of 74.29±6.71 and 5.87±2.93 years of education. For the total profile and screening RBMT scores (P<.001) and total MMSE scores (P<.05), control subjects scored significantly higher than those with MCI, who in turn scored higher than AD patients. In all subtests, the control group (P<.001) and MCI group (P<.05) were distinguishable from the AD group. Prospective, retrospective, and orientation subtests found differences between the MCI and control groups (P<.05). MCI subjects who progressed to AD scored lower at baseline on the total RBMT and MMSE, and on name recall, belongings, story−immediate recall, route−delayed recall, orientation (P<.05), face recognition, story−delayed recall, and messages−delayed recall sections (P<.01). ConclusionsRBMT is an ecologically-valid episodic memory test that can be used to differentiate between controls, MCI subjects, and AD subjects. It can also be used to detect patients with MCI who will experience progression to AD.

The Montreal Cognitive Assessment in Persons with Traumatic Brain Injury

The objective of this study was to examine the performance of patients with traumatic brain injury (TBI) on the Montreal Cognitive Assessment (MoCA). The MoCA was administered to 214 patients with TBI during their acute care hospitalization in a Level 1 trauma center. The results showed that patients with severe TBI had lower scores on the MoCA compared with patients with mild and moderate TBI, F(2, 211) = 10.35, p = .0001. This difference was found for visuospatial/executive, attention, and orientation subtests (p < .05). Linear regression demonstrated that age, education, TBI severity, and the presence of neurological antecedents were the best predictors of cognitive impairments explaining 42% of the total variability of the MoCA. This information can enable clinicians to predict early cognitive impairments and plan cognitive rehabilitation earlier in the recovery process.

Normative performance on the executive clock drawing task in a multi-ethnic bilingual cohort: a project FRONTIER study.

The executive clock drawing task (CLOX) test is a neuropsychological measure intended to aid in the assessment and detection of dementia in older populations. Few studies have provided normative data for this measure, with even less research available regarding the impact of sociodemographic factors on test scores. This study presents normative data for the CLOX in a sample of English and Spanish-speaking Hispanic and non-Hispanic Whites. The total sample included 445 cognitively healthy older adults seen as part of an ongoing study of rural cognitive aging, project FRONTIER. Unlike previous studies, criteria for "normality" (i.e., unimpaired) for CLOX1 and CLOX2 were based not merely on global impairment, but also on domain-specific impairment of executive functioning on the Executive Interview 25-item Examination and/or Trail Making Test B, or visuospatial/constructional impairment on the Line Orientation and Figure Copy subtests of the Repeatable Battery for the Assessment of Neuropsychological Status, respectively. Hierarchical regression analyses revealed that CLOX1 scores require adjustment by Age across ethnicities, whereas Education and Gender are necessary stratification markers for CLOX1 performance only in non-Hispanic Whites. None of the demographic variables were valid predictors of CLOX2 performance, negating the need for such adjustments. In addition to being the first study to provide separate normative data for CLOX performance in Hispanic and non-Hispanic White samples, the current study offers a novel approach to defining "normal" by cognitive domain. We also highlight the need to directly examine the impact of sociodemographic factors before applying normative corrections based on factors that have negligible impact on test scores.

Validation studies of the Portuguese experimental version of the Montreal Cognitive Assessment (MoCA): confirmatory factor analysis

The Montreal Cognitive Assessment (MoCA) is a cognitive screening instrument created with the purpose of overcoming some of the insufficiencies of the Mini-Mental State Examination (MMSE). The MoCA evaluates more cognitive areas and is comprised of more complex tasks as compared with the MMSE, which makes it a more sensitive instrument in the detection of Mild Cognitive Impairment (MCI), a state that often progresses to dementia. In this study we performed an analysis of the psychometric and diagnostic properties of the Portuguese experimental version of the MoCA in a clinical sample of 212 subjects with MCI and several dementia subtypes in a memory clinic setting. Additionally, we performed a Confirmatory Factor Analysis (CFA) to assess the MoCA's latent factorial structure. In a clinical population, the MoCA is a valid and reliable instrument with good psychometric properties, revealing high sensitivity in identifying MCI and dementia patients who generally score within the normal range on the MMSE. By using the parcels method, CFA results showed very good/excellent adjustment indexes. The practical implications of this CFA study allow us to propose a two factor model factorial structure for the MoCA: a first factor designated Memory, which includes memory, language and orientation subtests (the latter being closely correlated with the former), and a second factor designated Attention/Executive Functions, comprised of attention, executive functions and visuospacial abilities tasks.

A validity study of the Working Group's Orientation Test for individuals with moderate to severe intellectual disability

Decline in orientation skill has been reported as an early indicator of Dementia of Alzheimer's Type (DAT). Orientation subtest of the Working Group's Test Battery was examined whether this test is useful to identify DAT patients among adults with moderate to severe ID. Sixteen DAT patients and 35 non-demented normal controls with moderate to severe ID were followed for a year using Orientation Test. The scores on the baseline evaluation and the longitudinal changes over a 1-year period among the DAT patients and the normal controls were compared. The effects of age and etiologies of ID on the performance of Orientation were also examined. The DAT group's score was significantly poorer than that of the normal control group on the baseline evaluation. The score changes over the 1-year period were not significantly different between the groups. However, there was a considerable overlap between the score distributions of the two groups. The effects of age and etiologies of ID on the performance of Orientation were not significant. Screening DAT patients based only on the score of the Orientation Test of the Working Group's Test Battery may produce a large number of diagnostic errors.