Screening Tool For Cognitive Impairment Research Articles

A novel speech analysis algorithm to detect cognitive impairment in a Spanish population.

Early detection of cognitive impairment in the elderly is crucial for diagnosis and appropriate care. Brief, cost-effective cognitive screening instruments are needed to help identify individuals who require further evaluation. This study presents preliminary data on a new screening technology using automated voice recording analysis software in a Spanish population. Data were collected from 174 Spanish-speaking individuals clinically diagnosed as cognitively normal (CN, n = 87) or impaired (mild cognitive impairment [MCI], n = 63; all-cause dementia, n = 24). Participants were recorded performing four common language tasks (Animal fluency, alternating fluency [sports and fruits], phonemic "F" fluency, and Cookie Theft Description). Recordings were processed via text-transcription and digital-signal processing techniques to capture neuropsychological variables and audio characteristics. A training sample of 122 subjects with similar demographics across groups was used to develop an algorithm to detect cognitive impairment. Speech and task features were used to develop five independent machine learning (ML) models to compute scores between 0 and 1, and a final algorithm was constructed using repeated cross-validation. A socio-demographically balanced subset of 52 participants was used to test the algorithm. Analysis of covariance (ANCOVA), covarying for demographic characteristics, was used to predict logistically-transformed algorithm scores. Mean logit algorithm scores were significantly different across groups in the testing sample (p < 0.01). Comparisons of CN with impaired (MCI + dementia) and MCI groups using the final algorithm resulted in an AUC of 0.93/0.90, with overall accuracy of 88.4%/87.5%, sensitivity of 87.5/83.3, and specificity of 89.2/89.2, respectively. Findings provide initial support for the utility of this automated speech analysis algorithm as a screening tool for cognitive impairment in Spanish speakers. Additional study is needed to validate this technology in larger and more diverse clinical populations.

Evaluation of the Oxford cognitive screen Indonesian version (OCS-Ina) for assessing cognitive function disorders: validation and reliability study

Background and objectives. The Oxford Cognitive Screen (OCS) is a valuable tool for assessing cognitive function, particularly in the context of aphasia and neglect. This study aims to assess the validity and reliability of the Indonesian version of OCS (OCS-INA), which has been adapted and translated following WHO guidelines. Materials and methods. The adaptation and translation process of OCS, in accordance with WHO guidelines, preceded the validity and reliability testing of OCS-INA. The study included participants aged 18 years and above with normal cognitive function, as assessed by the Moca-INA. Data collection took place in social institutions and healthcare facilities that met the specified inclusion criteria. Results. Among the 104 participants meeting the inclusion criteria, a majority were male (51.92%), with ages ranging from 20 to 87 years, and the highest age group being above 60 years (60%). Most participants had a high school education level (35.58%) and were not employed (62.5%). Validity testing, using the Spearman correlation coefficient formula, revealed that the majority of domains had calculated correlation coefficients (r values) exceeding the table values (0.1927). In terms of reliability, the kappa p statistic indicated very good agreement for six examination tasks: semantic (0.874), orientation (0.842), verbal memory (0.822), episodic memory (0.870), and visual field test (1.000). Good agreement scores were obtained for the picture naming test (0.774), sentence reading (0.726), and calculation (0.774). Conclusions. In conclusion, OCS-INA demonstrates both validity and reliability as a screening tool for cognitive impairment. It serves as a valuable complement to existing instruments used for similar purposes.

The Memory Assessment Scale: A Population-based Cognitive Impairment Screening Instrument

This study re-examined the Memory Assessment Scale (MAS), a brief memory test developed in Hawai‘i in 1987, to assess whether it remains a valid and reliable cognitive impairment screening tool in Hawai‘i. Patients suspected of having neurocognitive dysfunction were divided into 2 groups (those with and without mild cognitive impairment) based on their results on a battery of neuropsychological tests. No differences in MAS scores were found between patients with and without mild cognitive impairment. Further research with the MAS comparing patients with mild cognitive disorder to healthy controls is indicated to further examine the efficacy of this population-based test.

Montreal Cognitive Assessment (MoCA) as a screening tool for cognitive impairment in early stages of psychosis

BackgroundCognitive alterations have been reported in early stages of psychosis including people with First Episode Psychosis (FEP), Clinical High-Risk Mental State (CHR), and Psychotic-Like Experience (PLE). This study aimed to compare the cognitive function in early stages of psychosis using the Montreal Cognitive Assessment (MoCA), a low-cost and brief assessment tool of cognitive functions. MethodsA total of 154 individuals, including 35 with FEP, 38 CHR, 44 PLE, and 37 healthy controls (HC), were evaluated with the MoCA in Santiago, Chile. We calculated the mean total score of the MoCA and the standard deviation of the mean. Groups were assessed for a trend to lower scores in a pre-determined sequence (HC > PLE > CHR > FEP) using the Jonckheere-Terpstra test (TJT). ResultsThe mean total MoCA scores were 24.8 ± 3.3 in FEP, 26.4 ± 2.4 in CHR, 26.4 ± 2.3 in PLE, and 27.2 ± 1.8 in HC. The analyses revealed a significant trend (p < 0.05) toward lower MoCA individual domain scores and MoCA total scores in the following order: HC > PLE > CHR > FEP. The mean total scores of all groups were above the cut-off for cognitive impairment (22 points). ConclusionsThe MoCA describes lower scores in cognition across early stages of psychosis and may be a useful low-cost assessment instrument in early intervention centers of poorly resourced settings.

Compassion Versus Accuracy: Lenient Scoring of the Spatial Orientation Items on the Mini-mental State Exam Lowers Sensitivity.

The Mini-mental State Examination (MMSE) is a commonly used screening tool for cognitive impairment. Lenient scoring of spatial orientation errors (SOEs) on the MMSE is common and negatively affects its diagnostic utility. We examined the effect of lenient SOE scoring on MMSE classification accuracy in a consecutive case series of 103 older adults (age 60 or above) clinically referred for neuropsychological evaluation. Lenient scoring of SOEs on the MMSE occurred in 53 (51.4%) patients and lowered the sensitivity by 7% to 18%, with variable gains in specificity (0% to 11%) to psychometrically operationalized cognitive impairment. Results are consistent with previous reports that lenient scoring is widespread and attenuates the sensitivity of the MMSE. Given the higher clinical priority of correctly detecting early cognitive decline over specificity, a warning against lenient scoring of SOEs (on the MMSE and other screening tools) during medical education and in clinical practice is warranted.

THE MINI-MENTAL STATE EXAMINATION IN A CHINESE POPULATION: RELIABILITY, VALIDITY, AND MEASUREMENT INVARIANCE

Abstract The Mini-Mental State Examination (MMSE) is a widely used screening tool for cognitive impairment and dementia in many cultures and regions. However, the properties of the MMSE in the Chinese context have not been evaluated with large population-representative samples. It is also unclear whether item properties of the MMSE differ across age and education subgroups. We study the psychometric properties of the MMSE using data from 8974 respondents aged 60 years or older in the 2018 Chinese Health and Retirement Longitudinal Study (CHARLS). Using item response theory (IRT) for the ordinal data, we confirm a three-dimensional factor structure for the MMSE in CHARLS in accordance with the underlying theoretical framework and establish acceptable model-data fit (SRMSR = 0.036). Total scores and subscale scores of the MMSE correlated positively with each other and correlated negatively with ADL (r = -0.19), IADL (-0.30), and CESD scores (-0.25). The reliability of the total MMSE scores was estimated at 0.78, indicating moderate measurement precision in the study population. Multiple group IRT analysis found that item characteristics and item functioning of 5 items differed by age group and 14 items differed by educational level. This analysis provided evidence on violations to measurement invariance of MMSE items, pointing to a need to account for item-level differences in measurement properties primarily with respect to education level when using the MMSE in CHARLS and, more generally, in Chinese populations. In addition, revised cognitive measures are advised to be used in CHARLS to improve the precision of measurement.

DEVELOPMENT AND EVALUATION OF COGNITIVE IMPAIRMENT SCREENING TOOL BASED ON EYE-TRACKING TECHNOLOGY

Abstract Objectives This study aimed to develop a cognitive impairment screening tool based on eye tracking technology (ET-CIS), and apply ET-CIS to community-dwelling older adults to evaluated its screening performance. Methods ET-CIS were developed based on through systematic review, pre-experiments and expert consultation. We recruited older people in the community from July 2022 to November 2022 and collected data including demographics data, Montreal cognitive assessment, the mini-mental state examination, ET-CIS. The t-test and correlation analysis were conducted to screen out statistically significant parameters with of ET-CIS. The screening models were constructed using standardized score assignment, binary logistics regression analysis, and decision tree model in the training set, and were applied in the validation to evaluate the screening performance. The best model was selected as the final scoring model. Results ET-CIS was constructed including applicable objects, pre-assessment preparation, screening dimensions, specific experiments and parameters. A total of 301 subjects were included, including 163 in the cognitively normal group and 138 in the cognitive impairment group. The results showed that the decision tree model results showed that the sensitivity of the training set was 0.752 and the sensitivity of the validation set was 0.818. We use the decision tree model as the final model. Conclusions In this study, ET-CIS was developed including the evaluation of memory function, executive function, visuospatial function and abstract function. The screening model of ET-CIS in community-dwelling older people showed good discrimination, which demonstrated it could be used to effectively screen cognitive impairment in the community in the future.

A novel sociodemographically‐neutral speech analysis algorithm to detect cognitive impairment in a Spanish population

AbstractBackgroundEarly detection of mild cognitive impairment (MCI) and dementia is crucial for initiation of care. Brief, cost‐effective cognitive screening instruments are needed to identify individuals who require further evaluation. This study presents preliminary data on a new screening technology using automated recordings analysis software in a Spanish population.MethodData were collected from 148 Spanish‐speakings in Spain (MAge = 74.4, MEducation = 12.93, 43.3% males), clinically diagnosed as cognitively normal (CN, n = 78) or impaired (MCI, n = 49; all‐cause dementia, n = 21). Participants were recorded performing four language tasks [Animal fluency, alternating fluency (sports and fruits), phonemic “F” fluency and Cookie Theft Description]. Recordings were processed via text‐transcription and digital‐signal processing techniques to capture neuropsychological variables and audio characteristics. A training sample of 103 subjects with similar demographics (age, sex, education) across groups was used to develop an algorithm to detect cognitive impairment. The features of each task and of speech were used separately to develop five algorithms to compute scores between 0 and 1, and a final algorithm was constructed from these using repeated cross‐validation. Of the 45 remaining original participants, an age‐balanced subset of 28 subjects was used to test the algorithm. General linear modeling was used to quantify demographic biases in the data and in the predicted logistically‐transformed algorithm scores.ResultMean logit algorithm scores were significantly different across groups in both test/training samples (p&lt;1e‐3). Sex‐bias in the test dataset (psex = 1.3e‐5) was reduced by predicted logit scores (psex = 0.01); other demographic variables were not significant across samples (page = 0.31→0.21; peducatiom = 0.69→0.58; pmultilingualism = 0.74→0.32). The final algorithm in test/training samples obtained an AUC of 0.908/0.956, with overall accuracy of 89%/89%, sensitivity of 0.85/0.95, and specificity of 0.92/0.83 in discriminating CN and impaired groups.ConclusionThese findings provide initial support for the utility of this automated speech analysis algorithm as a screening tool for cognitive impairment that does not explicitly use memory tests. Further research is needed to validate algorithm in other languages and cultures.

Brain Function Entropy Analysis during Dual‐Tasking: Application of Functional Near Infrared Spectroscopy to Screen Alzheimer’s Disease

AbstractBackgroundDespite a high prevalence, over half of patients with dementia never receive an evaluation, indicating a need for a quick and objective routine test for screening cognitive decline in older adults. Due to neural death and disconnections, Alzheimer’s disease (AD) is associated with a low value of nonlinear complexity of brain function, which can be quantified using multiscale entropy analysis.MethodOur proposed solution is an upper extremity function dual‐task screening method, during which, brain function is measured by functional near infrared spectroscopy (fNIRS). The aim of this study was to investigate association between fNIRS entropy during upper‐extremity dual‐tasking and cognitive status in older adults. The sample population for this data includes 40 older adults with ages ranging from 65‐96 years. Participants were categorized into cognitive normal (CN), mild cognitively impaired (MCI), and AD based on MoCA test results. The fNIRS device took measurements over the frontal (right and left) and parietal (right and left) brain regions. Participants were first instructed to rest for three minutes, during which they were asked to relax and not think about any specific topic. Participants were then asked to flex and extend their right arm consistently for three minutes, while counting backwards by intervals of three.ResultWe used multivariable repeated measures analysis using mixed effects modeling to assess the effect of cognitive status on multiscale entropy, with task condition (rest and dual‐task) as within‐subject parameter and sex as covariate. We observed a significant effect of cognitive status on multiscale entropy of left frontal (p = 0.0196) and right frontal brain regions (p = 0.0448), with 0.198, 0.267, and 0.301 entropy values on average across AD, MCI, and CN, respectively. There was also a significant effect of task on multiscale entropy of right frontal (p = 0.0165), left frontal (p = 0.0209) and left parietal regions (p = 0.0011), with 39.79% higher entropy during dual‐task compared to rest trials.ConclusionThe results of this study indicate potential for the use of fNIRS multiscale entropy analysis as a screening tool for cognitive impairment. More research is necessary to better understand other potential confounding factors as well as validate this approach in a larger sample size.

Which cut-off value of the Montreal Cognitive Assessment should be used for post-stroke cognitive impairment? A systematic review and meta-analysis of studies on diagnostic test accuracy.

Post-stroke cognitive impairment (PSCI) is one of the serious complications of stroke. The Montreal Cognitive Assessment (MoCA), as a brief cognitive impairment screening tool, is widely used in stroke survivors. However, some studies have suggested that the use of the universal cut-off value of 26 may be inappropriate for detecting cognitive impairments in stroke settings. We conducted this study to identify the optimal cut-off value of the MoCA in screening for PSCI. PubMed, CINAHL, Embase, the Cochrane Library, and Web of Science were searched for eligible studies until March 23, 2023. All studies were screened by two independent researchers. The quality of each article was evaluated by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate mixed effects model was used to pool sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the summary receiver operating characteristic curve. 24 studies with a total of 4,231 patients were included in this review. Despite the lack of evidence of publication bias, a high degree of heterogeneity was observed. Meta-analysis revealed that a cut-off value of 21/22 yielded the best diagnostic accuracy. The optimal cut-off varied in different regions, stroke types, and stroke phases as well. The optimal cut-off of MoCA was 21/22 for stroke populations rather than the initially recommended cut-off of 26. A revised (lower) cut-off should be considered for stroke survivors.

Diagnostic accuracy of Ascertain Dementia 8-item Questionnaire by participant and informant-A systematic review and meta-analysis.

The Ascertain Dementia 8-item Questionnaire (AD8) is a screening tool for cognitive impairment that can be administered to older persons and/or their informants. To evaluate the diagnostic accuracy and compare the predictive parameters of the informant and participant-completed Ascertain Dementia 8-item Questionnaire (iAD8 and pAD8, respectively) in older adults with cognitive impairment. We searched ten electronic databases (including MEDLINE (Ovid), Embase) from tool inception to March 2022. We included studies with patients ≥60 years old that were screened for cognitive impairment using AD8 in any healthcare setting. Predictive parameters were assessed against reference standards to estimate accuracy and diagnostic ability using bivariate random-effects meta-analyses. We used QUADAS-2 criteria to assess risk of bias. A cut-off of ≥2/8 was used to classify mild cognitive impairment (MCI), dementia, and cognitive impairment (MCI or dementia). Seven studies using the iAD8 (n = 794) showed a sensitivity of 80% and specificity of 79% to detect MCI. Nine studies using the iAD8 (n = 2393) established 91% sensitivity and 64% specificity to detect dementia. To detect MCI using the pAD8, four studies (n = 836) showed 57% sensitivity and 71% specificity. To detect dementia using the pAD8, four studies (n = 3015) demonstrated 82% sensitivity and 75% specificity. Recurring high or unclear risk of bias was noted in the domains of "Index test" and "reference standard". The diagnostic accuracy of iAD8 is superior to that of pAD8 when screening for cognitive impairment. The AD8 may be an acceptable alternative to screen for cognitive impairment in older adults when there are limitations to formal testing.

Questionable utility of the Montreal Cognitive Assessment (MoCA) in detecting cognitive impairment in individuals with comorbid PTSD and SUD

Posttraumatic stress disorder (PTSD) is frequently comorbid with substance use disorder (SUD) in individuals seeking treatment for substance use. Further, SUD and PTSD are individually associated with cognitive impairment (CI) and poor treatment outcomes. Despite the frequent use of the Montreal Cognitive Assessment (MoCA) as a screening tool for CI, the validity of the MoCA has not been established in individuals with comorbid SUD-PTSD. We assessed the criterion validity of the MoCA in 128 participants seeking inpatient medically-assisted detoxification using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as a reference for CI. The correlation between the RBANS and MoCA was weaker in those with SUD-PTSD (r = .32) relative to SUD alone (r = .56). Receiver operating characteristic (ROC) curves demonstrated that the MoCA had moderate-to-high ability to discriminate CI in individuals with SUD alone, with an area under the ROC curve of .82 (95% CI .69–.92) and optimal cutoff score of ≤23. However, in individuals with comorbid SUD-PTSD, the ROC analysis was not significant. Results suggest that PTSD, when comorbid with SUD, reduces the criterion-related validity of the MoCA. We recommend exercising caution when classifying CI in individuals with SUD-PTSD using the MoCA and suggest reducing the cutoff score to ≤23 in order to limit the rate of false-positive CI diagnoses in SUD-PTSD populations.

Validation of an iPad version of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS).

The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) is the most widely used screening tool for cognitive impairment in Multiple Sclerosis (MS). However, the administration and scoring procedures of the paper version are time consuming and prone to errors. Aim of our study was to develop a tablet version of BICAMS (iBICAMS), and to assess its reliability compared to the paper version. We administered both BICAMS and iBICAMS to 139 MS patients in two different sessions. We compared scores on both versions using a paired t-test. We used a repeated measures ANOVA to test the impact of rater, order of administration and test-retest time on test-retest performances. We used the Intraclass Correlation Coefficient (ICC) to assess the reliability between BICAMS and iBICAMS. All three sub-tests of the BICAMS (SDMT, CVLT-II and BVMT-R) were different between the paper and the tablet versions. Order of administration influenced test-retest performances at the SDMT (p<0.001), CVLT- II (p<0.001) and BVMT-R (p<0.001). Intraclass coefficient correlation (ICC) revealed a high level of agreement between the paper BICAMS and the iPad version for all three tests: SDMT (0.92), CVLT-II (0.83) and BVMT-R (0.82). We found a high reliability between BICAMS and iBICAMS. Considering the inherent advantages of automated scoring, digital storage of data, standardized timing, the iBICAMS could become a standard in clinical practice.

Olfactory Threshold Test as a Quick Screening Tool for Cognitive Impairment: Analysis of Two Independent Cohorts.

Olfactory dysfunction appears prior to cognitive decline, and thus it has been suggested to be an early predictor of Alzheimer's disease. However, it is currently not known whether and how olfactory threshold test could serve as a quick screening tool for cognitive impairment. To define olfactory threshold test for screening cognitive impairment in two independent cohorts. The participants are comprised of two cohorts in China, 1,139 inpatients with type 2 diabetes mellitus (T2DM, Discovery cohort) and 1,236 community-dwelling elderly (Validation cohort). Olfactory and cognitive functions were evaluated by Connecticut Chemosensory Clinical Research Center test and Mini-Mental State Examination (MMSE), respectively. Regression analyses and receiver operating characteristic (ROC) analyses were carried out to determine the relation and discriminative performance of the olfactory threshold score (OTS) regarding identification of cognition impairment. Regression analysis showed that olfactory deficit (reducing OTS) was correlated with cognitive impairment (reducing MMSE score) in two cohorts. ROC analysis revealed that the OTS could distinguish cognitive impairment from cognitively normal individuals, with mean area under the curve values of 0.71 (0.67, 0.74) and 0.63 (0.60, 0.66), respectively, but it failed to discriminate dementia from mild cognitive impairment. The cut-off point of 3 showed the highest validity for the screening, with the diagnostic accuracy of 73.3% and 69.5%. Reducing OTS is associated with cognitive impairment in T2DM patients and the community-dwelling elderly. Therefore, olfactory threshold test may be used as a readily accessible screening tool for cognitive impairment.

Validation of an iPad version of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) (P3-3.010)

Validation of an iPad version of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) (P3-3.010)

Exploring and Mapping Screening Tools for Cognitive Impairment and Traumatic Brain Injury in the Homelessness Context: A Scoping Review.

Cognitive impairment is common amongst people experiencing homelessness, yet cognitive screening and the collection of history of brain injury rarely features in homelessness service delivery practice. The purpose of this research was to scope and map strategies for screening for the potential presence of cognitive impairment or brain injury amongst people experiencing homelessness and identify instruments that could be administered by homelessness service staff to facilitate referral for formal diagnosis and appropriate support. A search was conducted across five databases, followed by a hand search from relevant systematic reviews. A total of 108 publications were included for analysis. Described in the literature were 151 instruments for measuring cognitive function and 8 instruments screening for history of brain injury. Tools that were described in more than two publications, screening for the potential presence of cognitive impairment or history of brain injury, were included for analysis. Of those regularly described, only three instruments measuring cognitive function and three measuring history of brain injury (all of which focused on traumatic brain injury (TBI)) may be administered by non-specialist assessors. The Trail Making Test (TMT) and the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) are both potentially viable tools for supporting the identification of a likely cognitive impairment or TBI history in the homelessness service context. Further population-specific research and implementation science research is required to maximise the potential for practice application success.

Preliminary study of assessing cognitive impairment in older patients with chronic obstructive pulmonary disease by using a cognitive functional assessment tool via a touchscreen personal computer.

Unique cognitive impairments related to chronic obstructive pulmonary diseases (COPD) have been increasingly reported. Considering the dementia risk and medication management, older patients with COPD should be evaluated for cognitive impairment. This study aimed to examine whether specific cognitive impairments related to COPD could be detected by an assessment tool using a touchscreen personal computer (PC) in older patients with COPD. This study included 28 older male patients with COPD and 30 healthy older male individuals. A touchscreen PC-based cognitive assessment application called CogEvo was used to assess and compare the cognitive function according to five domains: spatial cognition, orientation, working memory, executive function, and attention. Analysis of variance showed an interaction effect on the indices of cognitive function based on five domains between the two groups, indicating differences in the characteristics of cognitive function in such groups. Betweengroup comparisons as a subtest showed that attention, executive function, and working memory were significantly lower in the COPD group than in the healthy group. CogEvo can detect specific cognitive impairments associated with COPD, suggesting that it can be potentially used as a screening tool for cognitive impairment in older patients with COPD.

The Geras Solutions Cognitive Test for Assessing Cognitive Impairment: Normative Data from a Population-Based Cohort

BackgroundThere is a need for the development of accurate, accessible and efficient screening instruments, focused on early-stage detection of neurocognitive disorders. The Geras Solutions cognitive test (GSCT) has showed potential as a digital screening tool for cognitive impairment but normative data are needed.ObjectiveThe aim of this study was to obtain normative data for the GSCT in cognitively healthy patients, investigate the effects of gender and education on test scores as well as examine test-retest reliability.MethodsThe population in this study consisted of 144 cognitively healthy subjects (MMSE>26) all at the age of 70 who were earlier included in the Healthy Aging Initiative Study conducted in Umeå, Sweden. All patients conducted the GSCT and a subset of patients (n=32) completed the test twice in order to establish test-retest reliability.ResultsThe mean GSCT score was 46.0 (±4.5) points. High level of education (>12 years) was associated with a high GSCT score (p = 0.02) while gender was not associated with GSCT outcomes (p = 0.5). GSCT displayed a high correlation between test and retest (r(30) = 0.8, p <0.01).ConclusionThis study provides valuable information regarding normative test-scores on the GSCT for cognitively healthy individuals and indicates education level as the most important predictor of test outcome. Additionally, the GSCT appears to display a good test-retest reliability further strengthening the validity of the test.

Montreal cognitive assessment as a screening instrument for cognitive impairment in systemic lupus erythematosus patients without overt neuropsychiatric manifestations.

The Montreal Cognitive Assessment (MoCA) is an increasingly used screening tool for cognitive impairment. The aim of this study was to examine how MoCA performed in identifying cognitive impairment (CI) domains in SLE patients compared with formal standardized neuropsychological testing (NPT). Factors related to SLE disease, immunologic and psychological state associated with CI were also explored. This cross-sectional study recruited 50 SLE patients without overt neuropsychiatric manifestations from April 2017 to May 2018. The patients were evaluated with MoCA, formal NPT and the Depression, Anxiety, and Stress Scales (DASS) 42-item self-report questionnaire. Values of sensitivity and specificity were computed for different cut-offs of MoCA within each cognitive domain of NPT and descriptive analysis was used to identify the factors affecting cognitive function. The median score for MoCA was 27.5 (range 22-30). Using a MoCA cutoff of <26, 18 (36%) were identified to have CI using NPT compared to 8 (16%) using MoCA. The most frequently affected cognitive domain was executive functioning with 15 affected patients. Sensitivities and specificities of the MoCA range from 50% to 100% and 5.7% to 16.7%, respectively, across cognitive domains. A lower MoCA cutoff of <25 improve sensitivity of identifying impairment in executive functioning from 60% to 80%. In univariate analysis, DASS scores, disease activity, presence of antiphospholipid antibodies, presence of concurrent autoimmune disease, current, and cumulative corticosteroid therapy did not predict cognitive performance. MoCA may be a useful screening tool to identify the most frequently affected cognitive domain which is executive functioning using a lower cutoff of <25 in SLE patients without overt neuropsychiatric manifestations.

Validation of the Informant Quick Dementia Rating System (QDRS) among Older Adults in Singapore.

The Quick Dementia Rating System (QDRS) is a brief and rapid tool that can be administered by an informant without the need for a trained assessor. Our objective was to examine the validity, reliability, and cost-effectiveness of the informant QDRS in a Singapore memory clinic sample. We assessed a total of 177 older adults, among whom, 32 had no cognitive impairment (NCI), 61 had mild cognitive impairment (MCI), and 84 had dementia. Elderly underwent 1) the informant QDRS, 2) the Clinical Dementia Rating (CDR) as the gold standard diagnosis, 3) the Mini-Mental State Examination (MMSE), and 4) the Ascertain Dementia 8 (AD8) as comparisons to the QDRS. The extent to which the QDRS may reduce the recruitment cost (time) of clinical trials was also calculated. The QDRS had excellent internal consistency (Cronbach alpha = 0.939). It correlated highly with the CDR-global (R = 0.897), CDR Sum-of-Boxes (R = 0.915), MMSE (R = -0.848), and the AD8 (R = 0.747), showing good concurrent validity. With an optimal cut-off of 1.5 for MCI (sensitivity 85.2%, specificity 96.3%) and 6 for dementia (sensitivity 90.1%, specificity 89.2%), the QDRS achieved a higher overall accuracy of 85.0%, as compared to MMSE (71.2%) and AD8 (73.4%). A simulated clinical trial recruitment scenario demonstrated that pre-screening with the QDRS followed by a confirmatory CDR would reduce the time needed to identify NCI subjects by 23.3% and MCI subjects by 75.3%. The QDRS is a reliable cognitive impairment screening tool which is suitable for informant-administration, especially for identification of MCI.