Screening For Impairment Research Articles

Molecular physiology unlocks the mystery that relates cognitive impairment with the retina in schizophrenia and autism spectrum disorders: a perspective review

Schizophrenia and Autism spectrum disorders (SSD and ASD) are neurodevelopmental disorders involving cognitive impairment. Timely diagnosis is important for early intervention; currently, no tools are available to help with early diagnosis. Molecular biomarkers of cognitive impairment have been extensively studied, but clinical correlation is crucial in screening for cognitive impairment in SSD and ASD. There has been growing interest in examining the retina to scan for neurological disorders since the retina is the only part of the central nervous system that can be directly imaged non-invasively and in a timely manner. This review discusses biomarkers of cognitive impairment and their correlation to the retina in SSD and ASD. It also discusses the possible involvement of the retina and molecular biomarkers, specifically Disintegrin and metalloproteinase domain-containing protein 10 (ADAM10) and ciliary neurotrophic factor (CNTF) in the pathophysiology of SSD and ASD. A protocol for early diagnosing cognitive impairment and its severity in SSD and ASD is also suggested. This review also mentions insights into the potential use of molecular biomarkers of cognitive impairment to enhance cognitive performance in ASD and SSD and areas where more research is needed to solve the mystery of the relationship between the retina and cognitive impairment in neurodevelopmental psychiatric disorders.

Difpad-Onco offers frailty screening by private practice nurses for elderly cancer patients

Difpad-Onco (nursing screening of the frailty of elderly people, at home, with oncological disease) aims to facilitate and complement the identification of frailties in elderly cancer patients by private practice nurses in the patient's home. It consists of the G8 Oncodage, a Mini-Cog screening for cognitive impairment, a history of falls, and social frailty. It is aimed at all cancer patients aged 70 and over. Around 80% of patients assessed have a G8 score ≤ 14/17, indicating geriatric frailty, and over 60% have more than one frailty (social, dietary, cognitive, falls). The DIFPAD-Onco project represents an innovative experiment in care pathways for elderly cancer patients.

Resistive index of central retinal artery, aortic arterial stiffness and OCTA correlated parameters in the early stage of fabry disease

This study aimed to evaluate the impact of Fabry disease (FD) on retinal microvasculature using optical coherence tomography angiography (OCTA), arterial stiffness, and the resistive index (RI) of the central retinal artery (CRA) in early disease stages. Twenty-nine genetically confirmed FD patients and twenty-six healthy controls were enrolled. Vessel density (VD) values of the superficial, deep, and choriocapillaris plexuses (SCP, DCP, and CC) were measured via OCTA. CRA RI was studied using color Doppler and grayscale sonography, and aortic pulse wave velocity (PWV) was assessed with the Complior method. CRA RI was significantly lower in the control group compared to the Fabry group (p < 0.001). Central VD was found to be significantly higher in the control group compared to the Fabry group in all the retinal layers (SCP (p < 0.001), DCP (p < 0.005), CC (p < 0.001)). PWV was significantly higher in the Fabry group than in the control group (p = 0.03). Fabry disease patients demonstrate elevated arterial stiffness, increased CRA RI, and diminished retinal microvascular density compared to healthy controls, indicating early ocular damage. Continuous monitoring and targeted screening for organ impairment are crucial in FD management. Identifying biomarkers for assessing ocular vascular involvement and treatment response is imperative. Further research is needed.

Selecting a Brief Cognitive Screening Test Based on Patient Profile: It Is Never Too Early to Start

Introduction: Cognitive impairment, marked by a decline in memory and attention, is frequently underdiagnosed, complicating effective management. Cardiovascular risk factors (CVR) and anticholinergic burden (ACB) are significant contributors to dementia risk, with ACB often stemming from medications prescribed for neuropsychiatric disorders. This study evaluates cognitive profiles through three brief cognitive tests, analyzing the impact of CVR and ACB presence. Methods: This cross-sectional study was performed between 2019 and 2023 in community pharmacies and an outpatient clinic in Valencia, Spain. Eligible participants were patients with subjective memory complaints 50 years or older with clinical records of cardiovascular factors. Patients with conflicting information regarding diabetes diagnosis or not taking concomitant medications were excluded. Three brief cognitive tests (Memory Impairment Screening (MIS), Semantic Verbal Fluency Test, and SPMSQ) were assessed. CVR was calculated using the European SCORE2 table, and ACB was assessed using the CALS scale. Results: Among 172 patients with memory complaints and CVR factors, 60% failed at least one cognitive test. These patients were on significantly more medications and had higher blood pressure and HbA1c levels. An increase in CVR and ACB was associated with more failed tests. Additionally, elevated SCORE2 scores were associated with a greater failure rate on the MIS test, while patients with elevated ACB more frequently failed the SPMSQ test. Conclusions: Selecting an adequate brief cognitive test according to patients’ characteristics offers an opportunity to screen patients who are probably cognitively impaired. Whereas the MIS test may be helpful for patients with cardiovascular risk, SPMSQ stands out among patients with significant ACB.

Evaluating the SarQoL® Questionnaire as a Screening Tool for Sarcopenia among Korean Older Adults.

Sarcopenia, characterized by the progressive loss of muscle mass and strength, poses significant risks to physical health, leading to a reduced quality of life (QoL), increased disability, and higher mortality rates among older adults. Early detection and intervention are crucial to prevent the cascading effects of sarcopenia, including falls, fractures, and hospitalization. This study determined an optimal cut-off point of the SarQoL® score that can serve as an effective screening tool among community-dwelling Korean older adults. The study involved 451 South Korean older adults, assessing the correlation between SarQoL® scores and sarcopenia as defined by the Asian Working Group for Sarcopenia (AWGS) criteria. Participants completed the Korean version of the SarQoL questionnaire. Findings revealed that individuals diagnosed with sarcopenia had significantly lower SarQoL® scores compared to non-sarcopenic participants, with a cut-off score of ≤58.5 providing good diagnostic accuracy (AUC = 0.768, sensitivity = 69.3%, specificity = 75.2%). These results underscore the questionnaire's reliability and validity in screening for sarcopenia-related QoL impairment and its potential utility as a clinical tool. Implementing the SarQoL® in routine assessments could improve clinical outcomes by enabling earlier and more precise identification of sarcopenia.

Differential Validity of K-MoCA-22 Compared to K-MoCA-30 and K-MMSE for Screening MCI and Dementia.

Since the onset of the coronavirus disease 2019 pandemic, the Telephone-Montreal Cognitive Assessment (T-MoCA) has gained popularity as a remote cognitive screening tool. T-MoCA includes items from the original MoCA (MoCA-30), excluding those requiring visual stimuli, resulting in a maximum score of 22 points. This study aimed to assess whether the T-MoCA items (MoCA-22) demonstrate comparable discriminatory power to MoCA-30 and Mini-Mental State Examination (MMSE) in screening for mild cognitive impairment (MCI) and dementia. Participants included 233 cognitively normal (CN) individuals, 175 with MCI, and 166 with dementia. All completed the Korean-MoCA-30 (K-MoCA-30) and Korean-MMSE (K-MMSE), with the Korean-MoCA-22 (K-MoCA-22) scores derived from the K-MoCA-30 responses. A receiver operating characteristic (ROC) curve analysis was conducted. K-MoCA-22 showed a strong correlation with K-MoCA-30 and a moderate correlation with K-MMSE. Scores decreased progressively from CN to MCI and dementia, with significant differences between groups, consistent with K-MoCA-30 and K-MMSE. The study also explored modified K-MoCA-22 index scores across 5 cognitive domains. ROC curve analysis revealed that the area under the curve (AUC) for K-MoCA-22 was significantly smaller than that for K-MoCA-30 in distinguishing both MCI and dementia from CN. However, no significant difference in AUC was found between K-MoCA-22 and K-MMSE, indicating similar discriminatory power. Additionally, the discriminability of K-MoCA-22 varied by education level. These results indicate that K-MoCA-22, although slightly less effective than K-MoCA-30, still shows good to excellent discriminatory power and is comparable to K-MMSE in screening for MCI and dementia.

The screening of cognitive impairment in the emergency department: A valuable clinical and epidemiological goal

The screening of cognitive impairment in the emergency department: A valuable clinical and epidemiological goal

Prevalence and factors associated with visual impairment among high school students in Mbarara city, Southwestern Uganda: a cross-sectional study

BackgroundIn most low-income countries, including Uganda, routine screening for Visual Impairment (VI) in schools is not conducted, despite the growing global trend of VI among young people, and its negative impacts on academic performance and social integration. Data on prevalence and factors associated with VI among students in Uganda are limited. We determined the prevalence of VI and identified associated factors among high school students in Mbarara City.MethodsWe conducted a cross-sectional study among high school students in sampled high schools within Mbarara City, southwestern Uganda from September 19, 2023 to October 14, 2023. Participants were selected using multi-stage stratified cluster sampling. We obtained data on socio-demographics and behaviors through interview-administered questionnaires. Visual acuity (VA) was measured using Snellen’s chart at six meters. Participants were considered visually impaired if their VA in the better eye was < 6/12. Logistic regression analysis was used to identify factors associated with VI.ResultsWe enrolled 768 participants from four schools; most were males (56.4%), aged 18–24 years (50.3%). Median age was 18 (inter-quartile range [IQR]: 13–24) years. The prevalence of VI was 2.99% (n = 23; 95%CI 2.00–4.47%]. Age category 18–24 years (adjusted odds ratio [aOR] = 2.73, 95%CI 1.03–7.21, p = 0.043), obesity (aOR = 9.60, 95%CI 1.43–64.51, p = 0.020) and family history of VI (aOR = 7.09, 95%CI 2.87–7.51, p < 0.001), were independently associated with VI.ConclusionThe prevalence of VI among the high school students surveyed was low. However, targeted screening of older students, those with a family history of VI and obese students, could facilitate early detection and timely interventions in the region.

Risk of significant functional impairment across cancer diagnosis and care continuum

ABSTRACTBackgroundThe authors examined baseline physical functional (PF) impairment among cancer outpatients in the National Cancer Institute Cancer Moonshot study Northwestern University Improving the Management of Symptoms During and Following Cancer Treatment (NU IMPACT). They hypothesized that PF impairment, measured with the Patient Reported Outcome Measurement Information System–Physical Function (PROMIS‐PF) survey, would (1) be common and more prevalent for patients receiving treatment compared with no treatment and (2) differ across tumor types, independent of cancer continuum phase.MethodsAdults who were diagnosed with cancer in NU IMPACT (n = 2273) were sampled, and their PROMIS‐PF scores were compared across tumor types and cancer continuum (curative, noncurative, or no treatment), with scores ≤40 indicating moderate–severe impairment. Multivariable logistic regression models were used to evaluate the relation among patient and cancer factors and PF scores using a 95% confidence interval.ResultsForty percent of the surveyed patients reported moderate–severe PF impairment. Patients with melanoma reported the least impairment, and those with lung cancer were 6.5 times more likely to have moderate–severe impairment (95% confidence interval, 2.393–17.769). The noncurative group was 1.5 times more likely to have moderate–severe impairment (95% confidence interval, 1.045–2.145; mean score, 43; p &lt; .001) than the curative (mean score, 6) and no treatment (mean score, 48) groups. One‐third of those who reported PF impairment also had significant pain and/or fatigue.ConclusionsA sizeable minority experienced PF impairment across tumor types for which pain and/or fatigue co‐occurred, particularly in the noncurative group. The PROMIS‐PF survey effectively identified variations in physical function. Future studies will explore how screening for PF impairment can be used to refer patients for appropriate cancer rehabilitation services.

Adaptation and Validation of the Psychological Consequences of Screening Questionnaire (PCQ) for Cognitive Screening in Primary Care.

Context-specific measures with adequate external validity are needed to appropriately determine psychosocial effects related to screening for cognitive impairment. Two-hundred adults aged ≥65 y recently completing routine, standardized cognitive screening as part of their Medicare annual wellness visit were administered an adapted version of the Psychological Consequences of Screening Questionnaire (PCQ), composed of negative (PCQ-Neg) and positive (PCQ-Pos) scales. Measure distribution, acceptability, internal consistency, factor structure, and external validity (construct, discriminative, criterion) were analyzed. Participants had a mean age of 73.3 y and were primarily female and socioeconomically advantaged. Most had a normal cognitive screening result (99.5%, n = 199). Overall PCQ scores were low (PCQ-Neg: = 1.27, possible range 0-36; PCQ-Pos: = 7.63, possible range 0-30). Both scales demonstrated floor effects. Acceptability was satisfactory, although the PCQ-Pos had slightly more item missingness. Both scales had Cronbach alphas >0.80 and a single-factor structure. Spearman correlations between the PCQ-Neg with general measures of psychological distress (Impacts of Events Scale-Revised, Perceived Stress Scale, Kessler Distress Scale) ranged from 0.26 to 0.37 (P's < 0.001); the correlation with the World Health Organization-Five Well-Being Index was -0.19 (P < 0.01). The PCQ-Neg discriminated between those with and without a self-reported subjective cognitive complaint ( = 2.73 v. 0.89, P < 0.001) and was associated with medical visit satisfaction (r = -0.24, P < 0.001) on the Patient Satisfaction Questionnaire. The PCQ-Pos predicted self-reported willingness to engage in future screening ( = 8.00 v. 3.00, P = 0.03). The adapted PCQ-Neg is an overall valid measure of negative psychological consequences of cognitive screening; findings for the PCQ-Pos were more variable. Future studies should address measure performance among diverse samples and those with abnormal screening results. The PCQ scale is an overall valid measure of psychological dysfunction related to cognitive screening in older adults receiving normal screen results.PCQ scale performance should be further validated in diverse populations and those with abnormal cognitive screening results.The adapted PCQ may be useful to both health research and policy stakeholders seeking improved assessment of psychological impacts of cognitive screening.

Educational media utilization for rehabilitation among community-dwelling stroke survivors and their caregivers: a pilot study

Background: Recently, there has been an increasing number of stroke patients. Those who survive still need continuous rehabilitation after being discharged from the hospital. The information and knowledge on stroke rehabilitation at home is crucial for these patients and their caregivers. However, there has never been a study of educational media on rehabilitation for those patients and their caregivers in Thailand. Objective: To explore the educational media used in stroke rehabilitation, list their benefits, and the most satisfying media type for stroke participants and their caregivers after hospital discharge. Materials and methods: Twenty-eight stroke patients and twenty-one primary caregivers from two Subdistrict Municipalities and two Districts in Chaing Mai province were recruited using purposive sampling methods. All participants were aged 18 years and over and could communicate in Thai. All the stroke participants had no cognitive impairment screening by the Mental Status Examination-10 (MSET-10) and had self-rehabilitation therapy at home. A Questionnaire on the use of educational media in stroke rehabilitation with the index of item objective congruence (IOC) range between 0.67-1.00 was used for data collection. The statistics used were descriptive. Results: Stroke patients used information obtained primarily from medical personnel in the community (78.57%), while caregivers used advice from medical personnel the most in the hospitals (57.14%). Regarding the highest satisfaction with educational media, 59% of stroke patients and 42% of caregivers were satisfied with advice from medical personnel in the community. Stroke patients revealed that using a combination of advice from medical professionals, brochure-based media, and only document media was the most beneficial in providing knowledge about rehabilitation. For caregivers, the use of a combination of advice from medical professionals along with paper and video media, and the use of knowledge gained from online channels were the most beneficial. Conclusion: Rehabilitation education materials used by stroke patients and their caregivers at home offer the highest level of satisfaction for the patients and caregivers if the medium of people who can give advice and communicate on issues meets their needs. In addition, patients and caregivers agreed that rehabilitation education should include more than one form of media for maximum benefit. Therefore, health professionals should consider the format of educational media appropriate to the needs of service recipients to be able to use them most effectively.

The Association Between Triglyceride Glucose-Body Mass Index and Kidney Impairment in Patients with Type 2 Diabetes Mellitus.

Insulin resistance is associated with kidney impairment in patients with type 2 diabetes mellitus (T2DM). The triglyceride glucose-body mass index (TyG-BMI), which combines the TyG index with body mass index (BMI), has received significant attention as a tool for evaluating insulin resistance. Thus, the aim of this study was to explore the association between TyG-BMI and kidney impairment in patients with type 2 diabetes mellitus (T2DM). The cross-sectional analysis included 1080 patients with T2DM, and data were collected retrospectively. TyG-BMI was calculated by fasting blood glucose, triglyceride, and body mass index. TyG-BMI was significantly higher in T2DM patients with albuminuria than those without albuminuria (232.16 [206.52-268.02] vs 229.83 [206.11-255.64], p =0.023). T2DM patients with chronic kidney disease (CKD) showed a significantly higher value of TyG-BMI compared with those without CKD (232.23 [206.46-268.28] vs 229.73 [206.11-255.49], p=0.014). Correlation analysis showed a significantly positive association between TyG-BMI and metabolic parameters including BMI (r = 0.866, p < 0.001), TG (r = 0.630, p < 0.001), TC (r = 0.119, p < 0.001), HDL-C (r = -0.374, p < 0.001), FBG (r = 0.297, p < 0.001), and HbA1c (r = 0.116, p < 0.001) in patients with T2DM. The binary logistic regression analysis found that TyG-BMI was an independent factor for albuminuria (OR = 1.004, 95% CI: 1.001-1.008, p = 0.010) and CKD (OR = 1.005, 95% CI: 1.001-1.008, p = 0.005) in patients with T2DM respectively. The study suggests that TyG-BMI is associated with kidney impairment in patients with T2DM. Given that TyG-BMI is a novel parameter of insulin resistance, the study results indicates that clinicians should pay close attention to screening for kidney impairment in T2DM patients with insulin resistance.

Impairment of Cognitive Function Increases Mortality Risk in Relation to Cardiac Sympathetic Denervation and Renal Dysfunction in Patients With Systolic Heart Failure.

In contrast to the well-known prognostic values of the cardiorenal linkage, it remains unclear whether impaired cognitive function affects cardiac prognosis in relation to cardiac sympathetic innervation and renal function in patients with heart failure (HF). A total of 433 consecutive HF patients with left ventricular ejection fraction (LVEF) <50% underwent the Mini-Mental State Examination (MMSE) and a neuropsychological test for screening of cognition impairment or subclinical dementia. Following metaiodobenzylguanidine (MIBG) scintigraphy, patient outcomes with a primary endpoint of lethal cardiac events (CEs) were evaluated for a mean period of 14.8 months. CEs were documented in 84 HF patients during follow-up. MMSE score, estimated glomerular filtration rate (eGFR) and standardized heart-to-mediastinum ratio of MIBG activity (sHMR) were significantly reduced in patients with CEs compared with patients without CEs. Furthermore, overall multivariate analysis revealed that these parameters were significant independent determinants of CEs. The cutoff values of MMSE score (<26), sHMR (<1.80) and eGFR (<47.0 mL/min/1.73 m2) determined by receiver operating characteristic (ROC) analysis successfully differentiated HF patients at more increased risk for CEs from other HF patients. Impairment of cognitive function is not only independently related to but also synergistically increases cardiac mortality risk in association with cardiac sympathetic function and renal function in patients with HF.

Comprehensive geriatric assessment-based frailty clinic in a low middle income country: Time to act

Comprehensive Geriatric Assessment (CGA) is a process of care that involves a holistic, multidimensional, interdisciplinary assessment of an older individual and has been demonstrated to be the choice of management for frailty. By 2050, it is expected that 80 % of the aging population will be living in low and low-middle income countries (LMICs). The implementation of geriatric programs is scarce in LMICs. CGA based frailty clinics could help facilitate early screening for impairment in physical and psychological capacities among pre-frail and frail older individuals allowing for suggestions for targeted interventions. Creating a sound healthcare model which addresses issues of older adults living with frailty is the need of the hour, especially in LMICs. Establishing frailty clinics in low-middle income countries could thus help to create a sustainable age-friendly healthcare model for the vulnerable and poor aging population. It is now the time to act.

Combined use of the Montreal Cognitive Assessment and Symbol Digit Modalities Test improves neurocognitive screening accuracy after cardiac arrest: A validation sub-study of the TTM2 trial

AimTo assess the merit of clinical assessment tools in a neurocognitive screening following out-of-hospital cardiac arrest (OHCA). MethodsThe neurocognitive screening that was evaluated included the performance-based Montreal Cognitive Assessment (MoCA) and Symbol Digit Modalities Test (SDMT), the patient-reported Two Simple Questions (TSQ) and the observer-reported Informant Questionnaire on Cognitive Decline in the Elderly-Cardiac Arrest (IQCODE-CA). These instruments were administered at 6-months in the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. We used a comprehensive neuropsychological test battery from a TTM2 trial sub-study as a gold standard to evaluate the sensitivity and specificity of the neurocognitive screening. ResultsIn our cohort of 108 OHCA survivors (median age = 62, 88% male), the most favourable cut-off scores were: MoCA < 26; SDMT z ≤ -1; IQCODE-CA ≥ 3.04. The MoCA (sensitivity 0.64, specificity 0.85) and SDMT (sensitivity 0.59, specificity 0.83) had a higher classification accuracy than the TSQ (sensitivity 0.28, specificity 0.74) and IQCODE-CA (sensitivity 0.42, specificity 0.60). When using the cut-points for MoCA or SDMT in combination to identify neurocognitive impairment, sensitivity improved (0.81, specificity 0.74), area under the curve = 0.77, 95% CI [0.69, 0.85]. The most common unidentified impairments were within the episodic memory and executive functions domains, with fewer false negative cases on the MoCA or SDMT combined. ConclusionThe MoCA and SDMT have acceptable diagnostic accuracy for screening for neurocognitive impairment in an OHCA population, and when used in combination the sensitivity improves. Patient and observer-reports correspond poorly with neurocognitive performance.ClinicalTrials.gov Identifier: NCT03543371.

Comparison of the Diagnostic Accuracy of Five Cognitive Screening Tests for Diagnosing Mild Cognitive Impairment in Patients Consulting for Memory Loss.

Objectives: We aimed to evaluate and compare the diagnostic capacity of five cognitive screening tests for the diagnosis of mild cognitive impairment (MCI) in patients consulting by memory loss. Methods: A cross-sectional study involving 140 participants with a mean age of 74.42 ± 7.60 years, 87 (62.14%) women. Patients were classified as MCI or cognitively unimpaired according to a comprehensive neuropsychological battery. The diagnostic properties of the following screening tests were compared: Mini-Mental State Examination (MMSE), Addenbrooke's Cognitive Examination III (ACE-III) and Mini-Addenbrooke (M-ACE), Memory Impairment Screen (MIS), Montreal Cognitive Assessment (MoCA), and Rowland Universal Dementia Assessment Scale (RUDAS). Results: The area under the curve (AUC) was 0.861 for the ACE-III, 0.867 for M-ACE, 0.791 for MoCA, 0.795 for MMSE, 0.731 for RUDAS, and 0.672 for MIS. For the memory components, the AUC was 0.869 for ACE-III, 0.717 for MMSE, 0.755 for MoCA, and 0.720 for RUDAS. Cronbach's alpha was 0.827 for ACE-III, 0.505 for MMSE, 0.896 for MoCA, and 0.721 for RUDAS. Correlations with Free and Cued Selective Reminding Test were moderate with M-ACE, ACE-III, and MoCA, and moderate for the other tests. The M-ACE showed the best balance between diagnostic capacity and time of administration. Conclusions: ACE-III and its brief version M-ACE showed better diagnostic properties for the diagnosis of MCI than the other screening tests. MoCA and MMSE showed adequate properties, while the diagnostic capacity of MIS and RUDAS was limited.

S2VQ-VAE: Semi-Supervised Vector Quantised-Variational AutoEncoder for Automatic Evaluation of Trail Making Test.

Computer-aided detection of cognitive impairment garnered increasing attention, offering older adults in the community access to more objective, ecologically valid, and convenient cognitive assessments using multimodal sensing technology on digital devices. In this study, we aimed to develop an automated method for screening cognitive impairment, building on paper- and electronic TMTs. We proposed a novel deep representation learning approach named Semi-Supervised Vector Quantised-Variational AutoEncoder (S2VQ-VAE). Within S2VQ-VAE, we incorporated intra- and inter-class correlation losses to disentangle class-related factors. These factors were then combined with various real-time obtainable features (including demographic, time-related, pressure-related, and jerk-related features) to create a robust feature engineering block. Finally, we identified the light gradient boosting machine as the optimal classifier. The experiments were conducted on a dataset collected from older adults in the community. The experimental results showed that the proposed multi-type feature fusion method outperformed the conventional method used in paper-based TMTs and the existing VAE-based feature extraction in terms of screening performance. In conclusion, the proposed deep representation learning method significantly enhances the cognitive diagnosis capabilities of behavior-based TMTs and streamlines large-scale community-based cognitive impairment screening while reducing the workload of professional healthcare staff.

Clinical and biochemical data for the diagnosis of endogenous hypercortisolism: the "Cushingomic" approach.

The clinical presentation of Cushing's syndrome (CS) overlaps with common conditions. Recommended screening tests are serum cortisol after 1-mg overnight dexamethasone suppression test (DST), urinary free cortisol (UFC), and late-night salivary cortisol (LNSC). We analyzed the diagnostic accuracy of screening tests in 615 patients without CS (263 suspected CS, 319 adrenal and 33 pituitary incidentaloma) and 40 with CS. Principal component analysis, K-means clustering, and neural network were used to compute an integrated analysis among tests, comorbidities, and signs/symptoms of hypercortisolism. The diagnostic accuracy of screening tests for CS was high, DST and UFC were slightly superior to LNSC. The threshold of DST should be adapted to the population considered, especially in adrenal incidentaloma with mild autonomous cortisol secretion: the cutoff to differentiate CS should be increased to 196 nmol/L. Diabetes, hypertension, and obesity were more common in patients without CS: the direction of their vectors was not aligned and their correlation with screening tests was poor. Clustering allowed us to differentiate those patients without CS in cluster one (aged osteoporotic patients with impaired screening tests), cluster two (hypertensive and metabolic phenotype), and cluster three (young subjects with a low likelihood of overt CS). A neural network model that combined screening tests and clinical presentation was able to predict the CS diagnosis in the validation cohort with 99% precision and 86% accuracy. Despite the high diagnostic accuracy of screening tests to detect CS, cortisol-related comorbidities or adrenal incidentaloma should be considered when interpreting a positive test.

Prevalence of Cognitive Defects Among Senior Inmates of Old-Age Homes in a District of South Kerala.

Background Cognitive decline, including mild cognitive impairment and major neurocognitive disorder, is a growing concern among aging populations. The prevalence of these disorders is especially relevant in regions experiencing a surge in elderly care infrastructure, such as Kerala, India. Within the context of sociocultural shifts and a rising elderly population, old-age homes are increasingly becoming the focal point of care and support for cognitive health. This study aims to examine the prevalence of cognitive defects among elderly individuals residing in old-age homes in the Kottayam district of Kerala, India. Additionally, it investigates the relationship between cognitive disorders and sociodemographic variables of the inhabitants in these institutionalized settings. Methodology In this study, 535 elderly subjects were selected from 85 registered old-age homes in Kottayam, Kerala, through systematic cluster sampling. The response rate was 89.6%. Data collection involved a sociodemographic questionnaire, the Picture Memory Impairment Screen (PMIS), and the Mini-Mental Status Examination (MMSE) translated into Malayalam. Data were gathered either from participants, caretakers, or medical records. Ethical guidelines were strictly followed. Statistical analysis was conducted using SPSS Statistics Version 25.0 (IBM Corp., Armonk, NY, USA), employing the chi-square test, t-test, and logistic regression, with a p-value less than 0.05 deemed significant. Results In our study of 535 elderly individuals in Kottayam's old-age homes, age, gender, and education were significantly associated with cognitive impairment, with p-values <0.001, 0.049, and <0.001, respectively. Behavioral factors such as smoking and alcohol consumption showed no significant association. The mean MMSE and PMIS scores were 25.24 and 5.57, respectively. The prevalence of cognitive defects was 170 (31.80%) as per MMSE and 182 (34.00%) according to PMIS. Given the wider acceptance of MMSE, the study established a cognitive defect prevalence of 170 (31.80%) among senior inmates. Conclusions This study reveals a high prevalence (170, 31.80%) of cognitive defects among elderly residents in Kottayam's old-age homes. Age and education were significant predictors, while behavioral factors such as smoking and alcohol were not. These findings underscore the need for targeted healthcare strategies to address cognitive decline in aging populations.

Diagnostic accuracy, reliability, and construct validity of the German quick mild cognitive impairment screen

BackgroundEarly detection of cognitive impairment is among the top research priorities aimed at reducing the global burden of dementia. Currently used screening tools have high sensitivity but lack specificity at their original cut-off, while decreasing the cut-off was repeatedly shown to improve specificity, but at the cost of lower sensitivity. In 2012, a new screening tool was introduced that aims to overcome these limitations – the Quick mild cognitive impairment screen (Qmci). The original English Qmci has been rigorously validated and demonstrated high diagnostic accuracy with both good sensitivity and specificity. We aimed to determine the optimal cut-off value for the German Qmci, and evaluate its diagnostic accuracy, reliability (internal consistency) and construct validity.MethodsWe retrospectively analyzed data from healthy older adults (HOA; n = 43) and individuals who have a clinical diagnosis of ‘mild neurocognitive disorder’ (mNCD; n = 37) with a biomarker supported characterization of the etiology of mNCD of three studies of the ‘Brain-IT’ project. Using Youden’s Index, we calculated the optimal cut-off score to distinguish between HOA and mNCD. Receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic accuracy based on the area under the curve (AUC). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Reliability (internal consistency) was analyzed by calculating Cronbach’s α. Construct validity was assessed by analyzing convergent validity between Qmci-G subdomain scores and reference assessments measuring the same neurocognitive domain.ResultsThe optimal cut-off score for the Qmci-G was ≤ 67 (AUC = 0.96). This provided a sensitivity of 91.9% and a specificity of 90.7%. The PPV and NPV were 89.5% and 92.9%, respectively. Cronbach’s α of the Qmci-G was 0.71 (CI95% [0.65 to 0.78]). The Qmci-G demonstrated good construct validity for subtests measuring learning and memory. Subtests that measure executive functioning and/or visuo-spatial skills showed mixed findings and/or did not correlate as strongly as expected with reference assessments.ConclusionOur findings corroborate the existing evidence of the Qmci’s good diagnostic accuracy, reliability, and construct validity. Additionally, the Qmci shows potential in resolving the limitations of commonly used screening tools, such as the Montreal Cognitive Assessment. To verify these findings for the Qmci-G, testing in clinical environments and/or primary health care and direct comparisons with standard screening tools utilized in these settings are warranted.