Screening For Cognitive Dysfunction Research Articles

Association between Serum GDF-15 and Cognitive Dysfunction in Hemodialysis Patients.

Cognitive dysfunction is more frequent in end-stage renal disease (ESRD) patients undergoing hemodialysis compared with the healthy population, emphasizing the need for early detection. Interest in serum markers that reflect cognitive function has recently increased. Elevated serum growth differentiation factor 15 (GDF-15) levels are known to be associated with an increased risk of decreased renal function and cognitive dysfunction. This study investigated the relationship between GDF-15 and cognitive dysfunction in hemodialysis patients using a retrospective analysis of 92 individuals aged ≥ 18 years. Cognitive function was assessed using the Korean version of the Mini-Mental Status Examination (K-MMSE), categorizing patients into normal (≥24 points) and cognitive dysfunction (<24 points). As a result, serum GDF-15 concentrations were at significantly higher levels in the cognitive dysfunction group (7500.42 pg/mL, p = 0.001). Logistic regression indicated an increased risk of K-MMSE scores < 24 points when serum GDF-15 exceeded 5408.33 pg/mL. After indoxyl sulfate exposure in HT22 cells, HT22 cells survival was decreased and GDF-15 expression in HT22 cells was increased. Similarly, exposure to indoxyl sulfate in mouse brain tissue resulted in an increased expression of GDF-15. This study highlights the potential of serum GDF-15 as a marker for cognitive dysfunction in hemodialysis patients, offering a valuable screening tool. Serum GDF-15 is related to cognitive dysfunction in hemodialysis patients and may be helpful in screening for cognitive dysfunction in hemodialysis patients.

Clinicoradiological Features and Long-term Cognitive and Functional Outcome in Patients with Deep Cerebral Venous Thrombosis.

Deep cerebral venous thrombosis (DCVT) can have long-term functional and cognitive sequelae. Although literature exists on cognitive impairment after arterial stroke, cognitive sequelae after cerebral venous thrombosis (CVT) are much less studied. Clinical records of 29 patients diagnosed with DCVT were reviewed. The Modified Telephonic Interview for Cognitive Status (TICS-M) was adapted and validated in the regional language (Kannada) and applied to 18 patients with DCVT, at a mean follow-up duration of 5.32 years. Screening for depression was done via telephonic Patient Health Questionnaire-9 (PHQ-9)-Kannada version, and functional status was screened by applying the modified Rankin Scale (mRS). DCVT had a mortality rate of 10.34% due to acute complications. mRS scores of 0-1 were achieved at follow-up in all patients who survived. Receiver operating characteristic (ROC) analysis revealed a cutoff of ≤44.5 (maximum score of 49) for the diagnosis of cognitive impairment via TICS-M (Kannada version) in DCVT patients. Evidence of cognitive dysfunction was seen in eight patients (42.10%), and three patients (16.66%) had evidence of depression. Survivors of acute DCVT can potentially have long-term cognitive sequelae. Screening for cognitive dysfunction, depression, and functional status can be effectively done using telephonically applied scales that are adapted to the local language. Neuropsychological evaluation and early cognitive rehabilitation can be initiated for patients in whom deficits are identified on cognitive screening.

Evaluation of the determinants of cognitive dysfunction in patients with multiple sclerosis

Abstract Background Cognitive dysfunction is common among patients with multiple sclerosis (MS); however, the determinants of cognitive dysfunction are still unknown. This study aimed to investigate the determinants of cognitive dysfunction in a relatively large sample of patients with MS for rapid screening. Results Fifty-three patients (33.6%) had cognitive dysfunction. According to the Wechsler Memory Scale, patients with relapsing-remitting MS (RRMS) and patients with progressive MS (PMS) had significantly lower scores than the control group. Patients with RRMS compared to the control group were 76.73 ± 8.50 versus 105.58 ± 8.71 (P &lt; 0.01), and patients with PMS compared to the control group were 72.56 ± 6.44 versus 105.58 ± 8.71 (P &lt; 0.01). In patients with RRMS, the factors affecting the emergence of cognitive dysfunction included disability, fatigue, depression, and duration of illness, whereas in patients with PMS, just the disability variable was related to the presence or absence of cognitive dysfunction. Conclusions Our findings showed that disability, fatigue, depression, and duration of illness were factors associated with cognitive dysfunction in patients with RRMS. Proper identification of these factors can be helpful in the screening of cognitive dysfunction in this population.

Attitudes towards screening for cognitive dysfunction: Interviews with Latinx adults with type 2 diabetes

AbstractBackgroundOne in nine Latinx adults over 45 years old experience subjective cognitive decline (SCD). Yet less than half of people with SCD discuss symptoms with their provider (BRFSS, 2015‐2018). Because current diagnostic criteria focus on dementia, a later stage pathology, the window of opportunity for effective interventions may be missed. Cognitive screening can help identify pathology, and it can also assist in identifying those at risk for higher health care utilization. In qualitative interviews, Latinx adults with T2DM frequently avoided asking about cognitive problems or cognitive health due to stigma or discrimination (Cuevas &amp; Zuñiga, 2020). The purpose of this project was to understand relevant factors affecting cognitive screening, which is critical for designing effective and timely interventions.MethodData was collected using semi‐structured interviews with Latinx adults with type 2 diabetes. General questions were asked regarding knowledge of cognitive screening, risks for cognitive dysfunction, and attitudes towards screening. Interviews were transcribed, entered into NVivo software, and analyzed using grounded theory techniques.ResultInterviews ranged from 30 minutes to 1 hour. Participants (n= 30) were 53% Female; mean age: 66.4 years; Mean A1C: 9.7%; and 57% Mexican American. Participants who were younger and had higher levels of education were more likely to report comfort with cognitive screening. Inability to work related to a possible diagnosis of dementia was a concern related to screening for most participants. However, that was not a reason to decline screening. Participants (88%) wanted more information on how the results of screening tests would be used as well as information on how to maintain or improve “brain health.” Although not part of the interview guide 45% said they would prefer to see healthcare providers with similar ethnic backgrounds.ConclusionOverall, screening for cognitive dysfunction was well received by participants. Themes included some hesitancy to be screened but also a desire to know more about risks for dementia and how to maintain health. Given the encouraging results, a larger study further exploring these themes with Latinx adults and comparing them with provider and clinic factors affecting screening is being conducted.

Factors Affecting Cognitive Dysfunction Screening for Latinx Adults With Type 2 Diabetes

Before development of overt type 2 diabetes (T2DM), changes in brain structure and activation patterns are found in insulin resistance, indicating many with T2DM may already have alterations in cognitive function. How best practices are met for screening for cognitive dysfunction, specifically Latinx adults with T2DM who are at higher risk, remains unclear. The purpose of this study was to examine aspects influencing screening Latinx adults with T2DM for cognitive problems by identifying patient-, clinician- and clinic- level factors. This was a mixed methods study which used semi-structured interviews with Latinx adults with T2DM (n=30; mean age: 68; 57% Mexican American); surveys and interviews with health care providers (n = 15); and inventories of four outpatient clinics to identify factors (e.g. time, clinic policies) influencing screening. Data were analyzed via thematic analysis (interviews) and descriptive statistics (surveys and inventories). For patients, screening was important, but inability to work related to a possible diagnosis of dementia was a concern. Providers and patients agreed other health issues (e.g. hyperglycemia) took precedence to screening. Providers (96.7%) were expected to screen but did not have support/time from clinics and relied on patients for initial prompts. Only one clinic reported staff education on cognitive screening with an emphasis on potential cultural differences in test results and adequate resources related to dementia for Latinx adults. Clinics serving Latinx adults have a responsibility to deliver appropriate care. Leadership should consider innovative practices such creation, with patients, of educational materials for screening -a need highlighted by most participants.

Screening of Cognitive Dysfunction Using the Montreal Cognitive Assessment Test and Evaluation of Neurologic Complications in Turkish Adults With Sickle Cell Anemia

Screening of Cognitive Dysfunction Using the Montreal Cognitive Assessment Test and Evaluation of Neurologic Complications in Turkish Adults With Sickle Cell Anemia

Reliability and validity of the Brief Assessment of Impaired Cognition (Chinese version) for stroke patients

Objective and accurate cognitive assessment scales are essential for guiding cognitive rehabilitation following stroke. The aim of this study was to evaluate the validity and reliability of the Mandarin Chinese version of the Brief Assessment of Impaired Cognition (BASIC) in stroke patients. The English version of the BASIC scale was translated into Mandarin Chinese, and 56 stroke patients at a stroke treatment center were enrolled in the study. The Mini-Mental State Examination (MMSE) and BASIC scale were used to evaluate the patients’ cognitive function, and content validity, structural validity, concurrent validity, internal consistency, interrater consistency and reliability and test-retest reliability were used to evaluate the test results. The correlation coefficients between each item of the BASIC scale and the total score were between 0.416 and 0.804 (p < 0.05). The total score on the BASIC scale was correlated with the total score on the MMSE (r = 0.479, p < 0.05). Four factors were extracted by exploratory factor analysis, and the cumulative variance contribution rate was 74.932%. The factor loading of each item on the corresponding factor was > 0.5, indicating that the scale has good structural validity. Internal consistency was good (Cronbach’s α = 0.821), as were interrater (ICC > 0.95) and test-retest reliability (ICC = 0.815–0.941). Therefore, the Chinese version of the BASIC scale has good reliability and validity and can assist in screening for cognitive dysfunction or dementia in stroke patients.

Screening for Cognitive Dysfunction in Amphetamine Users in Saudi Arabia; a Case-control Investigation Using Propensity Score Matching Analysis

ABSTRACT Amphetamine users have deficits in cognitive performance; however, the effects of duration and amount of use on cognitive decline remain elusive. The aim of this study was to evaluate the correlates of cognitive functioning in amphetamine users in Saudi Arabia. This was a case-control community-based study, using an Arabic adaptation of Addenbrooke’s Cognitive Examination (ACE). The study compared users of amphetamine (n = 50) and controls (n = 50) in terms of performance on the ACE. Amphetamine users underperformed controls in the cognitive domains of attention, memory, language, fluency, and visuospatial faculties, even after controlling for psychiatric and sociodemographic variables. Heavy and prolonged use of amphetamine was associated with worse cognitive performance. Use of amphetamine at lower doses was not associated with worsening of cognitive functioning. The study adds to the evidence that amphetamine use is associated with impairment in cognitive functioning in Saudi Arabia. This has implications in terms of designing therapeutic interventions that account for potential cognitive difficulties in amphetamine abusers.

Test–retest reliability of the Turkish translation of the Penn Computerized Neurocognitive Battery

Psychiatric disorders are associated with cognitive dysfunction (CD), and reliable screening and follow-up of CD is essential both for research and clinical practice globally; yet, most assessments are in Western languages. We aimed to evaluate the test–retest reliability of the Turkish version of the Penn Computerized Neurocognitive Battery (PennCNB) to guide confident interpretation of results. Fifty-eight healthy individuals completed the PennCNB Turkish version in two sessions. After quality control, reliability analysis was conducted using Intraclass Correlation Coefficients (ICC), corrected for practice effects. Most measures were not significantly different between the sessions and had acceptable ICC values, with several exceptions. Scores were improved considerably for some memory measures, including immediate Facial Memory and Spatial Memory, and for incorrect responses in abstraction and mental flexibility, with correspondingly acceptable ICCs. Test–retest assessment of the Turkish version of the PennCNB shows that it can be used as a reliable real-time measurement of cognitive function in snapshot cross-sectional or longitudinal determinations. Preliminary validity assessment in this normative sample showed expected positive correlations with education level and negative correlations with age. Thus, the Turkish version of the PennCNB can be considered a reliable neuropsychological testing tool in research and clinical practice. Practice effects should be considered, especially when applied in short intervals. Significantly better performances in the retest, beyond practice effect, likely reflect nonlinear improvements in some participants who “learned how to learn” the memory tests or had insight on solving the abstraction and mental flexibility test.

THE ASSOCIATION OF MILD TBI WITH EARLY ONSET DEMENTIA IN POST-9/11 VETERANS

Evidence produced by studies using ICD-9 codes to identify dementia suggests that mild traumatic brain injury (mTBI) can accelerate age-related neurodegeneration and dementia risk. However, ICD-9 codes are unreliable in identifying early onset dementia (<65 years; EOD) in civilian (positive predictive value [PPV]=58%) and VA (PPV=28%). From 1,724 Veterans <65years of age with 2 or more dementia diagnoses based on ICD-9 codes recommended by VA Dementia Steering Committee, we validated dementia diagnoses in 153 randomly selected cases using medical chart abstractions and reviews by a neuropsychologist panel. We matched valid cases based on age, sex, race/ethnicity, year of entry to VA care, and branch of service to 2490 controls with no indicators of dementia or cognitive impairment. TBI severity was defined using multiple DoD and VA data sources. We also identified diagnoses for mental (e.g., depression, post-traumatic stress disorder, substance use disorders) and other medical conditions (e.g., stroke) associated with dementia. We used conditional logistic regression to examine the association of TBI severity with EOD controlling for comorbidity. After controlling for mental health and other comorbid conditions mild TBI (mTBI) was significantly associated with validated EOD [aOR( 95%CI): mTBI-4.5(2.4-8.9), moderate/severe TBI-21.3(8.4-54.3)]. Stroke, depression, PTSD, and headache were also associated with higher odds of EOD. These findings suggest that Veterans with mTBI are at risk for dementia, and clinicians should consider brief screening for cognitive dysfunction to ensure that they receive timely treatment to mitigate and address the impact of dementia on the individual, caregiver, family, and health care system

Silent Ischemic Stroke Was Revealed after Screening for Cognitive Dysfunction in a Hypertensive Patient with New Onset Atrial Fibrillation – Case Report

Abstract Introduction: Hypertension is one of the most important modifiable risk factor related to cognitive decline and dementia. However, screening for cognitive dysfunction is not part of the routine clinical assessment. Case presentation: In this report, we present the case of a 75 year old hypertensive male patient with new-onset atrial fibrillation, admitted to the Cardiovascular Rehabilitation Clinic Târgu Mureș. Apart from the routine clinical assessment, the evaluation of cognitive functions was performed with three different screening instruments which identified cognitive dysfunction. Depressive state was assessed with the shortened 13 items form of the Beck Depression Inventory BDI-13 (BDI-13) and it showed moderate depression which could influence the results of cognitive tests. Detection of cognitive impairment was followed by magnetic resonance imaging, which revealed not only hypertension specific microvascular impairment but also a sequelae of a former stroke in the territory of the left middle cerebral artery and a possible meningioma. Conclusion: Screening for cognitive dysfunction in high-risk hypertensive patients can be easily performed and in several cases like ours, can unmask silent cerebrovascular pathologies, leading to prognostic and therapeutic consequences.

Application of cognitive screening guidelines by health care providers in diabetes care: A cross-sectional descriptive study.

The risk of cognitive dysfunction is higher in people with diabetes than in the general population, and approximately 50% of those with diabetes will develop cognitive impairments as they age. Screening for cognitive dysfunction in people with diabetes can help identify both pathology and those who are at risk for higher health care utilization, but we do not know how health care providers implement cognitive screening recommendations in this population. In this study, we examined health care providers' knowledge of those recommendations and their application of them, as well as factors associated with guideline use. This study used a cross-sectional, descriptive correlational design with a convenience sample. All data were collected with a 20-question online survey sent to advanced practice nurses (APNs), medical doctors/doctor of osteopathic medicines (MDs/DOs), and physician assistants (PAs) in Central Texas. One-hundred eighty-one health care providers responded. Participants most frequently said they were "moderately familiar" with guidelines for cognitive impairment screening (60.9%). Twenty-three per cent of physicians, 37.4% of APNs, and 8.3% of PAs indicated that they incorporated routine screening into daily practice. However, 64% did not use standardized tools to assess cognitive function. The most common clinical tasks related to cognitive screening were referral for more in-depth cognitive screening (44%) and education of families regarding cognitive problems (29%). Lack of time was the most common barrier to screening (57.7%). Most respondents believed that there was a good rationale for assessing cognitive function in people with diabetes. However, despite some familiarity with guidelines for cognitive function screening, most respondents did not use standardized assessment tools. The results indicate variability in clinical practice regarding assessment and practices, such that there may be some variability in outcomes for patients.

PO-221 Effects of different motor functional therapies on cognitive impairment in type 2 diabetes mellitus

Objective The clinical manifestations of diabetic cognitive dysfunction are decreased visual spatial ability, executive dysfunction, mental activity speed and attention, and decreased abstract logical reasoning. Cognitive dysfunction is irreversible. Timely and accurate assessment and diagnosis, early detection and intervention to delay disease progression are particularly critical. The Cognitive Assessment Scale plays an important role in screening for cognitive dysfunction in diabetes. To observe the effects of motor functional therapy on cognitive impairment and blood glucose, blood lipids, body weight, body composition, and maximal oxygen uptake in patients with type 2 diabetes.&#x0D; Methods A total of 63 elderly patients with type 2 diabetes mellitus in Chengdu community aged ≥65 years and educated for ≥12 years were enrolled in the motor function therapy group according to the simple mental state examination (MMSE) score (diabetes cognitive impairment, MMSE total score) ≥ 20 points, aerobic exercise group, n = 21) and functional function therapy group (diabetes cognitive impairment, MMSE total score ≥ 20 points, resistance exercise group, n = 21). The adult community of diabetes in Chengdu (normal cognitive function) with age ≥ 65 years, education time ≥ 12 years, and MMSE total score ≥ 24 points was used as the control group (n=21). Montreal Cognitive Assessment Scale (MOCA): MOCA is an assessment tool developed by Nasreddine and clinically proven to be used for rapid screening of MCI. There were no statistical differences in baseline data (age, gender, and hypertension incidence) among the 3 groups of patients. The LOTCA scale was used to evaluate the cognitive function of the subjects and to compare between groups. Sixty-three patients with type 2 diabetes were randomly divided into aerobic exercise intensity group (50% VO2max) (n=21), resistance exercise intensity group and control group (n=21). Both the aerobic exercise group and the resistance exercise group underwent a 12-week moderate-intensity exercise three times a week. The resistance middle strength group was trained 2 groups each time, each group was 25 minutes, the group rested for 5 minutes, 55 minutes in total, and the aerobic medium intensity group continued to exercise for 55 minutes. All patients underwent fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), body weight, and fat weight (FW) before and after training. , lean body mass (LBM), maximal oxygen uptake (VO2max) determination; measure the energy expenditure of word movement and the total energy expenditure of the entire exercise process.&#x0D; Results There were no significant differences among the three groups before the test (P&gt;0.05). All the indexes of the medium-intensity resistance exercise group and the medium-intensity aerobic exercise group were significantly different from the control group (P&lt;0.05). After the MOCA score test There was an improvement in the score before the trial, and the total score of LOTCA was significantly different among the three groups. In addition to perceptual sub-items (item identification), the aerobic exercise group and the resistance exercise group LOTCA scale in perceptual sub-projects (incomplete object recognition), visual motion organization and its sub-projects (copying two-dimensional graphics, building blocks) The design and puzzle) project scores were higher than before the test, close to the control group score. The scores of the two groups of exercise therapy in the thinking operation and its sub-projects (Riska organized shape classification, picture arrangement B and geometric reasoning) and attention-focused items were lower than the control group. Compared with the resistance exercise, there was a significant difference in the maximum oxygen uptake between aerobic exercise and resistance exercise (P&lt;0.05). Compared with the total exercise energy consumption in the first 6 weeks, the aerobic exercise group was superior to the resistance exercise group. The total exercise energy expenditure was compared in the last 6 weeks, and the resistance exercise group was superior to the aerobic exercise group.&#x0D; Conclusions Elderly patients with type 2 diabetes may have cognitive impairment earlier. In the absence of differences in exercise, the aerobic exercise group and the resistance exercise group improve cognitive impairment, blood sugar, blood fat, body weight, and body composition in patients with type 2 diabetes. There is no significant difference. Compared with MMSE, LOTCA has the advantage of identifying early cognitive impairment in elderly patients with type 2 diabetes and distinguishing the severity of the damage.&#x0D;  

Guidelines for psychosocial interventions in addictive disorders in India: An introduction and overview

While guidelines for psychosocial interventions in addictive disorders in India were earlier rooted in clinical experience and global empirical evidence, recently there have been efforts to develop guidelines for intervention based on the local needs assessments of specific populations and more appreciably, a testing of the effectiveness of the interventions. This supplement on psychosocial interventions for addictive disorders covers some of the important aspects of psychosocial interventions in five sections. Section I covers the general principles of management and specific assessment approaches, screening for cognitive dysfunction and assessment of co-morbidities. Section II focuses on specific psychosocial interventions including brief interventions, relapse prevention, cognitive behavioural interventions, psychoanalytical interventions, cognitive rehabilitation, interventions in dual disorders, marital and family therapy, psychosocial interventions for sexual dysfunction and sexual addictions. Section III describes innovative approaches including third wave therapies, video-based relapse prevention, digital technology as a tool for psychosocial interventions as well as psychosocial interventions in technological addictions. The latter part of this section also deals with psychosocial interventions in special populations including children and adolescents, women, sexual minorities and the elderly. Section IV pans into community based psychosocial interventions including community camps and workplace prevention. The need to develop task sharing through the involvement of trained health workers to deliver community and home-based interventions is highlighted. Section V underscores the ethical issues in different aspects of psychosocial intervention and the need for research in this area. Although there is a tendency to formulate addiction in either biomedical or psychosocial terms and to view interventions either as pharmacological or psychosocial, these dichotomies neither exist in the affected individual's mind, nor should be present in the treating clinician. A comprehensive understanding of addiction requires an understanding of the person in his/her environment and needs a personalised holistic approach that addresses the diverse physical/mental health, occupational, legal, social and aftercare needs.

VALIDATION OF STUDY PARTNER-REPORTED OUTCOMES COLLECTED ONLINE USING THE BRAIN HEALTH REGISTRY

The goal of this study is to validate study partner (SP)-reported outcomes collected online. SP data is frequently used to assess cognitive and functional status in AD and provides many unique benefits. Development and validation of novel methods for efficiently collecting SP data has great potential for accelerating AD drug development and improving screening of age-related cognitive decline in healthcare settings. BHR is an online registry that collects longitudinal cognitive, health, and lifestyle data using self-report questionnaires and neuropsychological tests, and is actively referring participants to AD clinical studies. The Caregiver and Study Partner Portal (CASPP) within the BHR allows SPs of BHR participants to register, consent, and answer questions online about the participant and themselves. We used multivariable linear regression to analyze associations between participant cognition and these SP-reported variables: memory concerns (SP-SMC), recent cognition changes (SP-RCC), and IADL changes (SP-IADL). Participant cognition was assessed using online Cogstate Brief Battery (CBB). In a subset of BHR participants, we determined the ability of SP data to predict β-amyloid (Aβ) status. Finally, we classified older BHR participants as likely to be eligible for preclinical (PRE), prodromal (PRO), or dementia (DEM) trials; and measured associations between classification group and SP-report. Since June 2016, 2109 SPs (43% of those invited) have joined the CASPP. Most (71%) participant-study partner dyads are older adults spouses; 11% are caregivers. We found significant associations between participant self-reported SMC and SP-SMC, SP-RCC, and SP-IADL (p<0.001 for all). We also found associations between participant CBB memory scores and SP-RCC (p=0.04) and SP-IADL (p=0.02), but not SP-SMC (p=0.48). There were no significant associations with other cognitive domains. SP variables were significantly associated with Aβ. Of all BHR participants with SPs, 94% were PRE, 5% were PRO, and 1% were DEM. We found significant associations between participant classification group and SP-report of function (p<0.001). Collecting SP-reported data online from a large cohort is feasible. Results demonstrate the convergent and predictive validity of CASPP data, which has the potential to greatly facilitate neuroscience research, screening for cognitive dysfunction, and clinical trials.

Prevalence and risk factors of cognitive dysfunction in patients with type 2 diabetes mellitus receiving care in a reference hospital in Cameroon: a cross-sectional study

Diabetes mellitus has been associated with cognitive impairment but this has not been well investigated in sub-Saharan Africa. The aim of this study was to determine the prevalence and risk factors of cognitive dysfunction in patients with type 2 diabetes and to assess its influence on medication adherence. We carried out a cross-sectional study over a period of 4 months at the outpatient diabetes and endocrinology clinic of the Douala General Hospital. Consecutive patients with type 2 diabetes attending the clinic underwent cognitive assessment using the Mini Mental State Exam (MMSE). The patient Health Questionnaire-9 (PHQ-9) was used to rule out the confounding effect of depression, and the Morisky score was used to assess medication adherence. Data were analyzed using SPSS version 20 for Windows. Of the 223 participants (54.3% females) with a mean age of 56 ± 9.5 years, 33 (14.8%) had cognitive dysfunction (12.6, 1.8, and 0.4% having mild, moderate, and severe cognitive dysfunction, respectively). Level of education ≤7 years (OR = 5.314, 95% CI 2.443–11.561, p < 0.001) was the only factor significantly associated with cognitive dysfunction. No significant association was found between cognitive dysfunction and treatment adherence. In conclusion, one out of seven of our patients with type 2 diabetes have cognitive dysfunction, which is strongly associated with low level of education and does not affect treatment adherence and glycemic control. Our results suggest that screening for cognitive dysfunction in our patients should focus on patients with a low level of education.

Screening for Cognitive Dysfunction Helped to Unmask Silent Cerebrovascular Disease in a Hypertensive Diabetic Patient — Case Report

Abstract The current guidelines for the diagnosis and treatment of hypertension recommend screening for cognitive impairment in all hypertensive patients as part of the clinical assessment. However, the implementation of this recommendation in clinical practice is still unsatisfactory. We present the case of an elderly hypertensive female patient in order to highlight the importance of screening for cognitive impairment. A patient with a history of poorly controlled hypertension for the last 12 years and recently diagnosed with type 2 diabetes mellitus is admitted complaining of asthenia, dizziness, visual acuity impairment, and difficulty to remember recent information. Cardiovascular imaging showed 70% internal carotid artery stenosis in a neurologically asymptomatic patient. Cognitive testing showed mild cognitive impairment. Retinal imaging identified stage III hypertensive retinopathy accompanied by irreversible end-organ damage due to microvascular changes. At this point brain MRI was performed, which identified both macro- and microvascular brain lesions in the periventricular white matter and sequelae of a former ischemic stroke in the territory of the left posterior cerebral artery. Cognitive testing helped to unmask silent cerebrovascular disease in an otherwise oligosymptomatic hypertensive diabetic patient. Cognitive function testing should be introduced in routine clinical practice in order to help unmask silent cerebrovascular disease.

Informant questionnaire on cognitive decline in the elderly (IQCODE) for classifying cognitive dysfunction as cognitively normal, mild cognitive impairment, and dementia.

The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) is a reliable, validated informant-based instrument in screening for cognitive dysfunction. However, previous studies have evaluated only the ability to discriminate dichotomously, such as dementia from cognitively normal (CN) individuals or mild cognitive impairment (MCI) from CN. This study investigated the ability of the IQCODE to classify not only dichotomous but also multiple stages of cognitive dysfunction. We examined 228 consecutive participants (76 CN, 76 with MCI, and 76 with dementia). Receiver operating characteristic (ROC) curves determined dichotomous classification parameters. Multi-category ROC surfaces were evaluated to classify three stages of cognitive dysfunction. Dichotomous classification using the ROC curve analyses showed that the area under the ROC curve was 0.91 for dementia from participants without dementia and 0.71 for MCI from CN. Simultaneous multi-category classification analyses showed that the volume under the ROC surface was 0.61 and the derived optimal cut-off points were 3.15 and 3.73 for CN, MCI, and dementia. The Youden index for the IQCODE was estimated as 0.51 and the derived optimal cut-off points were 3.33 and 3.70. The overall classification accuracy by the VUS was 58.3% and that by the Youden index 61.8%. IQCODE is useful to classify the dichotomous and multi-category stages of cognitive dysfunction.

Screening for cognitive dysfunction in ALS: validation of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) using age and education adjusted normative data

Background: Cognitive and behavioural changes are an important aspect in Amyotrophic Lateral Sclerosis (ALS). The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) briefly assesses these changes in ALS. Objective: To validate the ECAS against a standardised neuropsychological battery and assess its sensitivity and specificity using age and education adjusted cut-off scores. Method: 30 incident ALS cases were assessed on both, ECAS and neuropsychological battery. Age and education adjusted cut-off scores were created from a sample of 82 healthy controls. Results: ECAS composite scores (Total, ALS Specific and Non-Specific) were highly correlated with battery composite scores. High correlations were also observed between ECAS and full battery cognitive domains and subtests. The ECAS Total, ALS Specific and Non-Specific scores were highly sensitive to cognitive impairment. ECAS ALS-Specific cognitive domains also evidenced high sensitivity. Individual subtest sensitivity was medium to low, suggesting that caution should be used when interpreting these scores. Low positive predictive values indicated the presence of false positives. Conclusions: Psychometric properties of the ECAS using age and education adjusted norms indicate that the ECAS, when used as an overall measure of cognitive decline, is highly sensitive. Further comprehensive assessment is required for patients that present as impaired on the ECAS.

Screening for cognitive dysfunction in Huntington's disease with the clock drawing test.

The aim of the study is to investigate the performance of the clock drawing test as a screening tool for cognitive impairment in Huntington's disease (HD) mutation carriers. The performance of the clock drawing test was assessed in 65 mutation carriers using the Shulman and the Freund scoring systems. The mini-mental state examination, the Symbol Digit Modalities Test, the Verbal Fluency Test, and the Stroop tests were used as comparisons for the evaluation of cognitive functioning. Correlations of the clock drawing test with various cognitive tests (convergent validity), neuropsychiatric characteristics (divergent validity) and clinical characteristics were analysed using the Spearman's rank correlation coefficient. Receiver-operator characteristic analyses were performed for the clock drawing test against both the mini-mental state examination and against a composite variable for executive cognitive functioning to assess optimal cut-off scores. Inter-rater reliability was high for both the Shulman and Freund scoring systems (ICC = 0.95 and ICC = 0.90 respectively). The clock drawing tests showed moderate to high correlations with the composite variable for executive cognitive functioning (mean ρ = 0.75) and weaker correlations with the mini-mental state examination (mean ρ = 0.62). Mean sensitivity of the clock drawing tests was 0.82 and mean specificity was 0.79, whereas the mean positive predictive value was 0.66 and the mean negative predictive value was 0.87. The clock drawing test is a suitable screening instrument for cognitive dysfunction in HD, because it was shown to be accurate, particularly so with respect to executive cognitive functioning, and is easy and quick to use. Copyright © 2016 John Wiley & Sons, Ltd.