Oxford Project Research Articles

Clio’s Stepchildren: How Oxford Missed the Boat in Southeast Asian Studies, 1979-2018

Between 1979 and 2018 Oxford University was presented with numerous opportunities to develop Southeast Asian Studies, nearly all of which were not taken up. This autobiographical article describes how these opportunities arose and how the author tried to generate support for Southeast Asian Studies during the period when he was Laithwaite Fellow in Modern History at Trinity College, Oxford (1979-2008) and following his early retirement in October 2008. The article describes the challenges of developing interest and commitment to area studies in a firmly Eurocentric Oxford history faculty, and the lack of institutional support from the wider University. This culminated in the embarrassing event at the Hong Kong Jockey Club in June 1988, when a substantial endowment for a chair of Nanyang (overseas Chinese) Studies offered by the Macao gambling tycoon, Stanley Ho, was allowed to slip out of the University’s grasp as a result of the ineptitude of its then Pro-Vice Chancellor, Sir Patrick Neill QC. Following that debacle, the article describes the author’s involvement in a number of parallel non-academic activities relating to Southeast Asia. These include lobbying in the University on East Timor, support for Daw Aung San Suu Kyi’s campaign for democracy in Burma through her Oxford-based husband, Dr Michael Aris, in the 1990s, and the establishment of the UK disability charity, The Cambodia Trust (1989-2014), and its spreads to East Timor (2003-5) and Indonesia (2008-12). Reference is also made in passing to the author’s involvement in a Track-2 diplomacy initiative aimed at normalizing US-Vietnam relations in 1989-90, and Oxford Project Southeast Asia initiative (2009-2018), an organization set up by Oxford graduate students from Southeast Asia, which hosted seven high profile Southeast Asian Studies Symposia in Oxford and in Southeast Asia between 2012 and 2018.

System of automatic analysis of methods for recognizing the emotional state of a person

The introduction of methods and means of digital transformation of industry and the social sphere poses new challenges. One of these tasks is the management of active systems, in which simple registration and identification of the initiators of actions is not enough, but a deeper assessment of their state, including psychophysical and emotional, is required. The article is devoted to the analysis of methods and means of recognizing the emotional state of a person. Approaches to automated recognition of a person's emotional state based on primary, secondary and more complex features are analyzed. The main focus is on a comprehensive approach to recognition of a person's emotional state based on the analysis of visual and audio channels using neural networks and computer psyche algorithms. The target of the article is a formalization of methods and development of means to recognize a person's emotional state according to complex audiovisual criteria. Analyzed software for recognizing the emotional state of a person: FaceReaderNoldus, EmoDetect, FaceSecurity, Microsoft Oxford Project Emotion Recognition, eMotion Software, MMER_FEASy. Methods used to recognize the emotional state of a person by his face have been investigated, such as: the method of basic components, the Viola-Jones method, template comparison, the Hopfield neural network, the method based on the localization of key points on the face and the method based on texture information. Separately analyzed methods of recognizing the emotional state of a person from his speech. invention proposes a solution for multilevel recognition of emotional state of a person based on using algorithms of neural networks and computer psyche. Software for recognizing the emotional state of a person was analyzed: the developed approach can be used for various digital applications, ranging from the analysis of the psychophysiological and emotional state of a person - an operator (pilot, driver, etc.), to multimedia mobile applications for analyzing the emotional state of an interlocutor. The trend for remote work and self-employment opens up such areas of application of these applications as consulting psychologists, interviewing online, optimizing the human resources of companies and organizations. Prospects for using the latest versions of emotional analyzers are shown.

COIN HOARDS IN THE ROMAN EMPIRE: A LONG-RANGE PERSPECTIVE. SOME PRELIMINARY OBSERVATIONS

This paper draws on data gathered by two projects, the British Museum/Leicester Hoards project, which gathered records of 3,223 hoards of Iron Age and Roman coins from Britain, and the Oxford Coin Hoards of the Roman Empire project, which is gathering data on Roman coin hoards from across the Roman Empire, to make long-range comparisons of hoarding across different parts of the Empire by century. It adopts a broad-brush approach as the Oxford project is still gathering data. The paper sets out the number of hoards recorded from each country from the reign of Augustus to the end of the fifth century and it shows that Luxembourg, followed by England and Israel have the highest number of coin hoards; it then considers the various factors governing the recovery and recording of hoards and the method of discovery of finds, before examining the chronological distribution of hoarding over the first to fifth centuries. Overall, the third century saw the highest proportion of coin hoards, followed by the fourth century, but there are very wide differences between the hoarding patterns of different countries. Hoards from beyond the frontier are also considered. A final section compares hoarding patterns with single finds of gold coins and suggests avenues for further research.

A Machine Learning Approach to Identify a Circulating MicroRNA Signature for Alzheimer Disease.

Accurate diagnosis of Alzheimer disease (AD) involving less invasive molecular procedures and at reasonable cost is an unmet medical need. We identified a serum miRNA signature for AD that is less invasive than a measure in cerebrospinal fluid. From the Oxford Project to Investigate Memory and Aging (OPTIMA) study, 96 serum samples were profiled by a multiplex (>500 analytes) microRNA (miRNA) reverse transcription quantitative PCR analysis, including 51 controls, 32 samples from patients with AD, and 13 samples from patients with mild cognitive impairment (MCI). Clinical diagnosis of a subset of AD and the controls was confirmed by postmortem (PM) histologic examination of brain tissue. In a machine learning approach, the AD and control samples were split 70:30 as the training and test cohorts. A multivariate random forest statistical analysis was applied to construct and test a miRNA signature for AD identification. In addition, the MCI participants were included in the test cohort to assess whether the signature can identify early AD patients. A 12-miRNA signature for AD identification was constructed in the training cohort, demonstrating 76.0% accuracy in the independent test cohort with 90.0% sensitivity and 66.7% specificity. The signature, however, was not able to identify MCI participants. With a subset of AD and control participants with PM-confirmed diagnosis status, a separate 12-miRNA signature was constructed. Although sample size was limited, the PM-confirmed signature demonstrated improved accuracy of 85.7%, largely owing to improved specificity of 80.0% with comparable sensitivity of 88.9%. Although additional and more diverse cohorts are needed for further clinical validation of the robustness, the miRNA signature appears to be a promising blood test to diagnose AD.

Westgate Oxford Pop Up Museum

ABSTRACTWestgate Oxford is a commercial redevelopment of a large shopping complex in the center of Oxford, with clients Westgate Oxford Alliance and principal contractor Laing O'Rourke. The excavations, carried out by Oxford Archaeology, between 2014 and 2016, were required as part of UK Planning Guidelines and were the largest ever undertaken in the city and principally focused on a large medieval suburban friary. The project won Best Archaeological Project 2016 at the prestigious national British Archaeological Awards, and the outreach program, which included an evolving pop-up museum, was a significant contributing factor. This essay will demonstrate how to set up a pop-up museum in eight steps. The essay will look at how to work with different partners of a project. It will discuss choosing a story to tell and how to deal with a changing narrative on an archaeological site in “real time.” It will show how the Pop Up museum became the principal location for dissemination for the Westgate Oxford project. The essay will conclude with how to keep the story alive and plans for the future of the Westgate Oxford Pop Up Museum.

Exploring the complexities of energy retrofit in mixed tenure social housing: a case study from England, UK

Article 19 of the Energy Efficiency Directive requires EU member states to address split incentives for energy efficiency between the multiple owners of buildings. But, building governance has been relatively neglected by researchers and policy makers working on Europe’s trajectory to a highly energy-efficient building stock. Taking a socio-legal approach, this paper illustrates the complexities that occur with retrofit of mixed tenure (social and private) apartment blocks and, more broadly, how building governance is a determinant of the costs and outcomes of refurbishment projects. Forty-two percent of Europeans live in apartments and mixed tenure apartment blocks and neighbourhoods have become more prevalent in Europe in recent decades. The paper focuses on a detailed study of a large refurbishment project of five tower blocks by Oxford City Council, involving external wall insulation and other energy efficiency measures. In addition to the Council’s social tenants, these blocks house significant numbers of private owners who have challenged the Council’s attempt to recover from them a share of the refurbishment costs. The experience of the Oxford project raises questions about aspects of property law, allocation of project costs and benefits, and issues of communication, engagement and decision-making. The paper also presents qualitative data gathered from social housing providers through a survey and roundtable meeting to provide an indication of the extent to which these issues are affecting energy efficiency refurbishment projects across England.

Kynurenine Pathway Metabolites in Alzheimer's Disease.

Metabolites of tryptophan, produced via the kynurenine pathway (kynurenines), have been linked to Alzheimer's disease (AD) in small cohorts with conflicting results. To compare differences in plasma kynurenine levels between AD and controls and identify potential associations with cognition. The study included 65 histopathologically-confirmed AD patients and 65 cognitively-screened controls from the Oxford Project to Investigate Memory and Ageing (OPTIMA) cohort. Cognition was assessed using the Cambridge Cognitive Examination (CamCog). Tryptophan, kynurenines, neopterin, and vitamin B6 forms were measured in plasma by liquid chromatography-tandem mass spectrometry. Non-parametric statistics, logistic regression and standardized robust regressions were applied with a false discovery rate of 0.05. Tryptophan, xanthurenic acid, 3-hydroxyanthranilic acid, and quinolinic acid were lower in AD (Odds ratios (ORs) 0.24 -0.47; p-values <0.001 -0.01). Pyridoxal 5'phosphate did not differ between AD and controls. Kynurenine, anthranilic acid, quinolinic acid, and markers of immune activation (neopterin, kynurenine/tryptophan ratio, and the PAr index (Pyridoxic acid/(Pyridoxal 5'phosphate + Pyridoxal)) increased with age (β 0.31 -0.51; p-values <0.001 -0.006). Xanthurenic acid decreased with age (β: -0.42, p < 0.001). Elderly AD patients with high quinolinic acid performed worse on the CamCog test, indicated by a significant age*quinolinic acid interaction (β 0.21, p < 0.001). Plasma concentrations of several kynurenines were lower in patients with AD compared to controls. Low xanthurenic acid occurred in both AD and with aging. Inflammation-related markers were associated with age, but not AD. However, elevated QA was associated with poor cognition in older AD patients.

Cognitive decline in the elderly after surgery and anaesthesia: results from the Oxford Project to Investigate Memory and Ageing (OPTIMA) cohort.

SummaryConcerns have been raised about the effects on cognition of anaesthesia for surgery, especially in elderly people. We recorded cognitive decline in a cohort of 394 people (198 women) with median (IQR) age at recruitment of 72.6 (66.6–77.8) years, of whom 109 had moderate or major surgery during a median (IQR) follow‐up of 4.1 (2.0–7.6) years. Cognitive decline was more rapid in people who on recruitment were: older, p = 0.0003; male, p = 0.027; had worse cognition, p < 0.0001; or carried the ε4 allele of apoliprotein E (APOEε4), p = 0.008; and after an operation if cognitive impairment was already diagnosed, p = 0.0001. Cognitive decline appears to accelerate after surgery in elderly patients diagnosed with cognitive impairment, but not other elderly patients.

Review: Hugh H. Benson. Clitophon's Challenge: Dialectic in Plato's Meno, Phaedo, and Republic. Oxford: Oxford University Press, 2015. 328 pages; $65.00/hardcover.

The Philosophical ForumVolume 47, Issue 1 p. 25-29 BOOK REVIEW Review: Hugh H. Benson. Clitophon's Challenge: Dialectic in Plato's Meno, Phaedo, and Republic. Oxford: Oxford University Press, 2015. 328 pages; $65.00/hardcover. Yale Weiss, Yale WeissSearch for more papers by this author Yale Weiss, Yale WeissSearch for more papers by this author First published: 09 February 2016 https://doi.org/10.1111/phil.12093Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume47, Issue1Aristotle's Modal Syllogistic and The Oxford Project: Sixteen Reviews of the Latest Philosophy from OxfordSpring 2016Pages 25-29 RelatedInformation

Review: Alexander X. Douglas. Spinoza and Dutch Cartesianism. Oxford: Oxford University Press, 2015. 192 pages; $47.50/hardcover.

The Philosophical ForumVolume 47, Issue 1 p. 67-71 BOOK REVIEW Review: Alexander X. Douglas. Spinoza and Dutch Cartesianism. Oxford: Oxford University Press, 2015. 192 pages; $47.50/hardcover. Manuel Rodeiro, Manuel RodeiroSearch for more papers by this author Manuel Rodeiro, Manuel RodeiroSearch for more papers by this author First published: 09 February 2016 https://doi.org/10.1111/phil.12098Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume47, Issue1Aristotle's Modal Syllogistic and The Oxford Project: Sixteen Reviews of the Latest Philosophy from OxfordSpring 2016Pages 67-71 RelatedInformation

Review: Margaret Moore. A Political Theory of Territory. Oxford: Oxford University Press, 2015. 280 pages; $74.00/hardcover.

The Philosophical ForumVolume 47, Issue 1 p. 111-115 BOOK REVIEW Review: Margaret Moore. A Political Theory of Territory. Oxford: Oxford University Press, 2015. 280 pages; $74.00/hardcover. Jonathan Kwan, Jonathan KwanSearch for more papers by this author Jonathan Kwan, Jonathan KwanSearch for more papers by this author First published: 09 February 2016 https://doi.org/10.1111/phil.12106Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume47, Issue1Aristotle's Modal Syllogistic and The Oxford Project: Sixteen Reviews of the Latest Philosophy from OxfordSpring 2016Pages 111-115 RelatedInformation

Review: Jerrold Levinson. Musical Concerns: Essays in Philosophy of Music. Oxford: Oxford University Press, 2015. 176 pages; $45.00/hardcover.

The Philosophical ForumVolume 47, Issue 1 p. 103-105 BOOK REVIEW Review: Jerrold Levinson. Musical Concerns: Essays in Philosophy of Music. Oxford: Oxford University Press, 2015. 176 pages; $45.00/hardcover. Erum Naqvi, Erum NaqviSearch for more papers by this author Erum Naqvi, Erum NaqviSearch for more papers by this author First published: 09 February 2016 https://doi.org/10.1111/phil.12104Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume47, Issue1Aristotle's Modal Syllogistic and The Oxford Project: Sixteen Reviews of the Latest Philosophy from OxfordSpring 2016Pages 103-105 RelatedInformation

The Oxford Project: An Introduction

The Philosophical ForumVolume 47, Issue 1 p. 17-18 ORIGINAL ARTICLE The Oxford Project: An Introduction First published: 09 February 2016 https://doi.org/10.1111/phil.12091Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume47, Issue1Aristotle's Modal Syllogistic and The Oxford Project: Sixteen Reviews of the Latest Philosophy from OxfordSpring 2016Pages 17-18 RelatedInformation

Review: Nathaniel J. Goldberg. Kantian Conceptual Geography. Oxford: Oxford University Press, 2015. 271 + xiii pages; $74/hardcover.

The Philosophical ForumVolume 47, Issue 1 p. 79-82 BOOK REVIEW Review: Nathaniel J. Goldberg. Kantian Conceptual Geography. Oxford: Oxford University Press, 2015. 271 + xiii pages; $74/hardcover. Thomas Teufel, Thomas TeufelSearch for more papers by this author Thomas Teufel, Thomas TeufelSearch for more papers by this author First published: 09 February 2016 https://doi.org/10.1111/phil.12100Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume47, Issue1Aristotle's Modal Syllogistic and The Oxford Project: Sixteen Reviews of the Latest Philosophy from OxfordSpring 2016Pages 79-82 RelatedInformation

The effects of two polymorphisms on p21cip1 function and their association with Alzheimer's disease in a population of European descent.

With the exception of ApoE4, genome-wide association studies have failed to identify strong genetic risk factors for late-onset Alzheimer’s disease, despite strong evidence of heritability, suggesting that many low penetrance genes may be involved. Additionally, the nature of the identified genetic risk factors and their relation to disease pathology is also largely obscure. Previous studies have found that a cancer-associated variant of the cell cycle inhibitor gene p21cip1 is associated with increased risk of Alzheimer’s disease. The aim of this study was to confirm this association and to elucidate the effects of the variant on protein function and Alzheimer-type pathology. We examined the association of the p21cip1 variant with Alzheimer’s disease and Parkinson’s disease with dementia. The genotyping studies were performed on 719 participants of the Oxford Project to Investigate Memory and Ageing, 225 participants of a Parkinson’s disease DNA bank, and 477 participants of the Human Random Control collection available from the European Collection of Cell Cultures. The post mortem studies were carried out on 190 participants. In the in-vitro study, human embryonic kidney cells were transfected with either the common or rare p21cip1 variant; and cytometry was used to assess cell cycle kinetics, p21cip1 protein expression and sub-cellular localisation. The variant was associated with an increased risk of Alzheimer’s disease, and Parkinson’s disease with dementia, relative to age matched controls. Furthermore, the variant was associated with an earlier age of onset of Alzheimer’s disease, and a more severe phenotype, with a primary influence on the accumulation of tangle pathology. In the in-vitro study, we found that the SNPs reduced the cell cycle inhibitory and anti-apoptotic activity of p21cip1. The results suggest that the cancer-associated variant of p21cip1 may contribute to the loss of cell cycle control in neurons that may lead to Alzheimer-type neurodegeneration.

Cerebral amyloid angiopathy, subcortical white matter disease and dementia: literature review and study in OPTIMA.

Cerebral amyloid angiopathy (CAA) is of increasing clinical and research interest as the ability to detect it and its consequences by neuroimaging in living subjects has advanced. There is also increasing interest in understanding its possible role in the development of intracerebral hemorrhage, Alzheimer's disease (AD) and vascular dementia. In this article, the literature on this subject is reviewed and novel findings relating CAA to subcortical white matter damage in 224 subjects in the Oxford project to Investigate Memory and Ageing (OPTIMA) are reported. The relationship between CAA and subcortical tissue damage in the OPTIMA subjects was found to be critically dependent on ApoE genotype, there being a positive relationship between measures of CAA and subcortical small vessel disease in ApoEε4 carriers and a significant negative relationship in ApoEε2 carriers. These findings draw attention, as have many other studies, to the importance of ApoE genotype as a major risk factor not only for dementia but also for damage to blood vessels in the aging brain.

Cerebral Subcortical Small Vessel Disease in Subjects With Pathologically Confirmed Alzheimer Disease

The understanding of how cerebrovascular disease (CVD) contributes to dementia is hampered by a lack of agreed and validated pathologic methods to accord weight to the contribution of different aspects of CVD to dementia. A previous study from the Oxford Project to Investigate Memory and Ageing (OPTIMA) validated a scheme for assessing the contribution of subcortical small vessel disease (SVD) toward dementia in the elderly by showing a significant inverse relationship between the severity of SVD and cognition in subjects without any other dementia pathology using this method. In the present paper, the method has been used to assess severity of SVD in 161 cases of neuropathologically confirmed Alzheimer disease. The results showed there was no relationship between the SVD score and cognitive scores acquired in the last 2 years of life. SVD scores were significantly related to age (P<0.0017) and were slightly but significantly higher in females than males (P<0.049). SVD scores were not related to blood pressure at entry to OPTIMA and were significantly lower when compared with the cohort of OPTIMA cases with only CVD (mean 5.06 ± 1.85 vs. 5.9 ± 2.67; P<0.0065). We conclude that when Alzheimer disease pathology is present in elderly subjects, it overwhelms the modest contribution that SVD makes to cognitive impairment.

Population-Based Case–Control Study of White Matter Changes on Brain Imaging in Transient Ischemic Attack and Ischemic Stroke

White matter changes (WMC) are a common finding on brain imaging and are associated with an increased risk of ischemic stroke. They are most frequent in small vessel stroke; however, in the absence of comparisons with normal controls, it is uncertain whether WMC are also more frequent than expected in other stroke subtypes. Therefore, we compared WMC in pathogenic subtypes of ischemic stroke versus controls in a population-based study. We evaluated the presence and severity of WMC on computed tomography and on magnetic resonance brain imaging using modified Blennow/Fazekas scale and age-related white matter changes scale, respectively, in a population-based study of patients with incident transient ischemic attack or ischemic stroke (Oxford Vascular Study) and in a study of local controls (Oxford Project to Investigate Memory and Ageing) without history of transient ischemic attack or ischemic stroke, with stratification by stroke pathogenesis (Trial of Org10172 in Acute Stroke Treatment classification). Among 1601 consecutive eligible patients with first-ever ischemic events, 1453 patients had computed tomography brain imaging, 562 had magnetic resonance imaging, and 414 patients had both. Compared with 313 controls (all with computed tomography and 131 with magnetic resonance imaging) and after adjustment for age, sex, diabetes mellitus, and hypertension, moderate/severe WMC (age-related white matter changes scale) were more frequent in patients with small vessel events (odds ratio, 3.51 [95% confidence interval, 2.13-5.76]; P<0.0001) but not in large artery (odds ratio, 1.03 [95% confidence interval, 0.64-1.67]), cardioembolic (odds ratio, 0.87 [95% confidence interval, 0.56-1.34]), or undetermined (odds ratio, 0.90 [95% confidence interval, 0.62-1.30]) subtypes. Results were consistent for ischemic stroke and transient ischemic attack, for other scales, and for magnetic resonance imaging and computed tomography separately. In contrast to small vessel ischemic events, WMC were not independently associated with other pathogenic subtypes, suggesting that WMC are unlikely to be an independent risk factor for nonsmall vessel events.

An assessment of neurocognitive speed in relation to frailty

to evaluate the relationship between neurocognitive speed (NCS) and frailty; to consider how this relationship is affected by how frailty is operationalised. secondary analysis of the baseline cohort of the Oxford Project To Investigate Memory and Aging (OPTIMA), a longitudinal observational cohort. of 388 participants who underwent a comprehensive intake assessment followed by an annual follow-up for at least 3 years, data on all measures were available on 164 people. NCS was defined as a combined score of <18 on the pattern comparison test (<11 is abnormal) and letter comparison test (<7 is abnormal). Frailty was defined from a modified Phenotype model, the Edmonton Frailty Scales (EFS) and a frailty index (FI); the latter two were adapted here to exclude cognitive measures. in multivariate logistic (NCS as < or ≥18) and linear regression (NCS as continuous variable), only the FI (OR = 0.87) was significant (P < 0.05). When all frailty measures were included in the multivariate analysis only, FI (OR = 0.88) was significant (P < 0.05). Mini-mental Status Examination remained significantly related to NCS throughout all analysis. NCS slows with increasing frailty as shown with the FI.

Differences in Cognitive Profile between TIA, Stroke and Elderly Memory Research Subjects: A Comparison of the MMSE and MoCA

Background: The Montreal Cognitive Assessment (MoCA) appears more sensitive to mild cognitive impairment (MCI) than the Mini-Mental State Examination (MMSE): over 50% of TIA and stroke patients with an MMSE score of ≥27 (‘normal’ cognitive function) at ≥6 months after index event, score <26 on the MoCA, a cutoff which has good sensitivity and specificity for MCI in this population. We hypothesized that sensitivity of the MoCA to MCI might in part be due to detection of different patterns of cognitive domain impairment. We therefore compared performance on the MMSE and MoCA in subjects without major cognitive impairment (MMSE score of ≥24) with differing clinical characteristics: a TIA and stroke cohort in which frontal/executive deficits were expected to be prevalent and a memory research cohort. Methods: The MMSE and MoCA were done on consecutive patients with TIA or stroke in a population-based study (Oxford Vascular Study) 6 months or more after the index event and on consecutive subjects enrolled in a memory research cohort (the Oxford Project to Investigate Memory and Ageing). Patients with moderate-to-severe cognitive impairment (MMSE score of <24), dysphasia or inability to use the dominant arm were excluded. Results: Of 207 stroke patients (mean age ± SD: 72 ± 11.5 years, 54% male), 156 TIA patients (mean age 71 ± 12.1 years, 53% male) and 107 memory research subjects (mean age 76 ± 6.6 years, 46% male), stroke patients had the lowest mean ± SD cognitive scores (MMSE score of 27.7 ± 1.84 and MoCA score of 22.9 ± 3.6), whereas TIA (MMSE score of 28.4 ± 1.7 and MoCA score of 24.9 ± 3.3) and memory subject scores (MMSE score of 28.5 ± 1.7 and MoCA score of 25.5 ± 3.0) were more similar. Rates of MoCA score of <26 in subjects with normal MMSE ( ≥27) were lowest in memory subjects, intermediate in TIA and highest after stroke (34 vs. 48 vs. 67%, p < 0.001). The cerebrovascular patients scored lower than the memory subjects on all MoCA frontal/executive subtests with differences being most marked in visuoexecutive function, verbal fluency and sustained attention (all p < 0.0001) and in stroke versus TIA (after adjustment for age and education). Stroke patients performed worse than TIA patients only on MMSE orientation in contrast to 6/10 subtests of the MoCA. Results were similar after restricting analyses to those with an MMSE score of ≥27. Conclusions: The MoCA demonstrated more differences in cognitive profile between TIA, stroke and memory research subjects without major cognitive impairment than the MMSE. The MoCA showed between-group differences even in those with normal MMSE and would thus appear to be a useful brief tool to assess cognition in those with MCI, particularly where the ceiling effect of the MMSE is problematic.