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Self-administered gerocognitive examination (SAGE) aids early detection of cognitive impairment at primary care provider visits

Self-administered gerocognitive examination (SAGE) aids early detection of cognitive impairment at primary care provider visits

Detection of Cognitive Impairment From eSAGE Metadata Using Machine Learning.

Using the metadata collected in the digital version of the Self-Administered Gerocognitive Examination (eSAGE), we aim to improve the prediction of mild cognitive impairment (MCI) and dementia (DM) by applying machine learning methods. A total of 66 patients had a diagnosis of normal cognition (NC), MCI, or DM, and eSAGE scores and metadata were used. eSAGE scores and metadata were obtained. Each eSAGE question was scored and behavioral features (metadata) such as the time spent on each test page, drawing speed, and average stroke length were extracted for each patient. Logistic regression (LR) and gradient boosting models were trained using these features to detect cognitive impairment (CI). Performance was evaluated using 10-fold cross-validation, with accuracy, precision, recall, F1 score, and receiver operating characteristic area under the curve (AUC) score as evaluation metrics. LR with feature selection achieved an AUC of 89.51%, a recall of 87.56%, and an F1 of 85.07% using both behavioral and scoring. LR using scores and metadata also achieved an AUC of 84.00% in detecting MCI from NC, and an AUC of 98.12% in detecting DM from NC. Average stroke length was particularly useful for prediction and when combined with 4 other scoring features, LR achieved an even better AUC of 92.06% in detecting CI. The study shows that eSAGE scores and metadata are predictive of CI. eSAGE scores and metadata are predictive of CI. With machine learning methods, the metadata could be combined with scores to enable more accurate detection of CI.

Scoring Accuracy of the Self‐Administered Gerocognitive Examination by Primary Care Providers

AbstractBackgroundPrimary Care Providers (PCPs) are critical for case finding of Mild Cognitive Impairment to provide management, referrals, and treatments. Conducting cognitive assessments are time consuming and difficult to incorporate into time‐limited visits. The Self‐Administered Gerocognitive Examination (SAGE) is a reliable and valid, pen and paper, cognitive assessment tool easily incorporated into a PCP visit without time required for staff to administer. Accurate scoring by PCP or staff is critical to interpreting the degree of impairments and any changes over time.MethodsPatients over 64 years‐old without a diagnosed cognitive disorder, presented for a non‐acute care visit with their PCP and were given a SAGE test during their appointment. The SAGE was administered as part of the provider’s standardized method for screening for cognitive impairment. Detailed scoring instructions were provided to the PCP office before subject enrollment. Differences in SAGE scoring between the PCP office and the Ohio State University Memory Disorders Research Center (MDRC) were evaluated. Paired t test and 95% confidence interval were used to compare the mean SAGE scores.ResultsOf the 110 potential recruits, 93 SAGE tests were graded by the PCP office and by MDRC. Scoring discrepancies, the MDRC scored SAGE minus PCP office scored SAGE, ranged from ‐7 points to +3 points with a total of 80% of the SAGE tests resulting in a scoring error by the PCP office; 74% of the total score discrepancies were within ± 2 points. The mean difference was ‐1.49 with a 95% CI (‐1.82, ‐1.17) and p<0.0001 with PCPs scores tending about 1.5 points higher. The largest discrepancies between the scores occurred with the problem‐solving question (40%) and the 3‐D figure question (29%).ConclusionsThe PCP office provided an incorrect score (typically higher) 80% of the time which downplays cognitive deficits. When scoring mistakes are made, accuracy is diminished, impacting the interpretation of the test results and perceived changes over time. PCP offices need to emphasize accurate scoring or consider utilizing the digital format of SAGE, called eSAGE or BrainTest® (available at https://braintest.com). It can send HIPPA compliant automatically scored results to the PCP office.

Long-term cognition and speech recognition outcomes after cochlear implantation in the elderly

ObjectiveThe purpose of this study is to investigate how cognition, as measured using the Self-Administered Gerocognitive Examination Test (SAGE), and age affect speech recognition scores in older adults (age > 65) at one year and two years after cochlear implantation. Study designThis is a prospective study. SettingThis study was conducted at a single institution. MethodsUnilateral cochlear implantation was performed by two surgeons on adult patients (>65 years) with postlingual bilateral sensorineural hearing loss. There were 230 patients who underwent cochlear implantation from January 2016 to June 2023. Fifty-five of these patients completed the SAGE questionnaire before implantation, one year after implantation, and 2 years after implantation. Paired t-test analysis was used to evaluate pre- and post-operative speech recognition scores (CNC, AzBio in Quiet). ResultsPatients who had normal preoperative cognition on SAGE showed greater improvement in postoperative speech recognition tests at 1 year and 2 years after implantation compared with patients who showed preoperative cognitive impairment. There were no significant differences in postoperative speech outcome between age group 1 (between 65 and 80 years old) and age group 2 (over 80 years old) cochlear implant recipients. There were no changes in cognitive SAGE scores after 2 years implantation. ConclusionCognitive function, as measured by SAGE, is a more reliable predictor than age in determining speech recognition improvement after cochlear implantation. Cochlear implantation did not improve postoperative cognition.

Sweet and Salt Threshold Detection among Dental Implant Patients in Relation to Cognition Status and Salivary Acetylcholinesterase

Background: Wearing a dental implant may affect gustatory function, an essential element of health in older adults that can affect cognition status. This study aimed to assess the sweet and salt taste threshold detection among dental implant patients in relation to cognition status and salivary Acetylcholinesterase compared with partially edentulous and fully dentate patients matching in age and gender. Materials and methods: The study comprised 90 dental implant patients between the ages of 50 and 60 compared with 90 partially edentulous and 90 fully dentate individuals who were age and gender-matched. The participants' cognition status was tested using the Self-Administered Gero-cognitive Examination (SAGE) test, which classified them into poor and good. A two-alternative forced-choice question was used to establish taste threshold sensitivity, with concentrations presented in ascending order. One chemical was investigated for each taste quality (salt and sweet), and each component was delivered at five different concentrations. The enzyme-linked immunosorbent test (ELISA) kit measured salivary Acetylcholinesterase. Spss 22 Chicago Illionis USA was used to examine the data. Results: There was a significant association between sweet and salt taste thresholds and the patient's groups, as the higher patient occurrence concerning the lowest taste threshold was found for the dentate patients. In comparison, the higher patient occurrence for the highest taste threshold was found for the partially edentulous patients. Data analysis showed a significant association between cognitive status and sweet and salt taste threshold for the implant patient group, as the percentage of patients with the lowest taste threshold was higher for good cognitive status; the same result was found concerning partially edentulous and fully dentate patients; however, the association was not significant. The results revealed that the mean value of salivary Acetylcholinesterase (AChE) was higher among the fully dentate group, followed by implant. Then, the partially edentulous groups with statistically insignificant differences for both poor and good cognitive status groups. On the other hand, when comparing the poor and good cognitive status groups, results revealed that the mean value of salivary Acetylcholinesterase was higher among the good than the poor groups, with statistically significant differences among all sample groups. Conclusion: Within the limitation of this investigation, it was confirmed that taste threshold detection is connected with missing teeth and cognition status. The findings show a complicated interplay of several factors that affect gustatory acuity, including oral health and cognition status. Keywords: Threshold, Dental Implant Patients, Salivary Acetylcholinesterase

Self-Administered Test Is Useful in Detecting Cognitive Changes.

According to this study: The Self-Administered Gerocognitive Examination detected significant changes at least six months earlier than the Mini-Mental State Examination in patients with mild cognitive impairment who later developed dementia and in those who had Alzheimer disease dementia.Use of the brief, self-administered test may remove some barriers to identifying cognitive changes.

Identifying Dementia Risk in Older Veterans Using A Mailing Survey.

Evidence suggests that dementia can be prevented. Patients with frailty may be particularly at risk for cognitive impairment (CI). The aim of this study was to determine dementia risk in older Veterans and whether the risk varies according to frailty status. We also evaluated the feasibility of mailed dementia risk screening. Participants were mailed a questionnaire and the Self-Administered Gerocognitive Examination (SAGE). High dementia risk was defined as having mild cognitive impairment (MCI) on SAGE or a CAIDE score ≥6. Out of 5,432 mailed surveys, we obtained a response rate of 19.75%. Most responders completed the questionnaire items. We identified a total of 689 (75.9%) subjects to be at high risk for dementia. Individuals with frailty were at a greater risk for dementia when compared to robust individuals OR:1.921 (95%CI:1.259-2.930), p=.002. The mailed screening represents a convenient, alternative and scalable approach to screen for dementia risk.

Dementia Risk in Older Veterans With Frailty: A Cross-Sectional Study

Frailty, a clinical syndrome characterized by vulnerability to stressors resulting from multisystemic loss of physiological reserve, predicts future cognitive decline. However, frailty has also been proposed as a dementia risk factor, predicting future cognitive impairment. The study aim was to determine frailty in older veterans and its association with risk of dementia. Community-dwelling Veterans ≥50 years completed a mailed socio-demographic questionnaire and Self-Administered Gerocognitive Examination (SAGE), July 2019-May 2020. The information was complemented with EHR data. We calculated the CAIDE score, a validated tool predicting dementia (≥6 points= high risk 20 years later) and the 31-item VA frailty index data (frail ≥.20, non-frail ≤.20). After adjusting for socio-demographic characteristics, smoking, alcohol/substance abuse, OSA and anticholinergic use, odds ratio (OR) and 95% CI were calculated using BLR to assess the cross-sectional association between frailty and dementia risk (CAIDE ≥6 points and MCI). The survey response rate was 19.75% (1,073 of 5,432). Participants mean age was 68.38 (SD=8.49) years, 57.50% (n=617) Caucasian, 69.34% (n=744) non-Hispanic, 95.81% (n=1,028) male, and 36.72% (n=394) frail. 11.84%(n=127) screened positive for MCI and 15.38% (n=165) for dementia. 689 (75.88%) veterans were at high risk for dementia of whom 426 (61.83%) were non-frail and 263 (38.17%) were frail. Frailty was cross-sectionally associated with higher risk for dementia in older Veterans, adjusted OR:1.45 (95%CI:1.016-2.070), p=.041. The mailed screening was a feasible and practical approach to screen for dementia risk. Early identification of patients with frailty can help in the implementation of interventions aimed at preventing or delaying dementia.

Self-Administered Gerocognitive Examination: longitudinal cohort testing for the early detection of dementia conversion

BackgroundSignificant cognitive changes as individuals’ age are not being identified in a timely manner, delaying diagnosis and treatments. Use of brief, multi-domain, self-administered, objective cognitive assessment tools may remove some barriers in assessing and identifying cognitive changes. We compared longitudinal Self-Administered Gerocognitive Examination (SAGE) test scores to non-self-administered Mini-Mental State Examination (MMSE) scores in 5 different diagnostic subgroups.MethodsA cohort study evaluating annual rates of change was performed on 665 consecutive patients from Ohio State University Memory Disorders Clinic. Patients with at least two visits 6 months apart evaluated with SAGE and MMSE and classified according to standard clinical criteria as subjective cognitive decline (SCD), mild cognitive impairment (MCI), or Alzheimer’s disease (AD) dementia were included. The pattern of change in SAGE scores was compared to MMSE. One way and repeated measures ANOVA and linear regression models were used.ResultsFour hundred twenty-four individuals (40 SCD, 94 MCI non-converters to dementia, 70 MCI converters to dementia (49 to AD dementia and 21 to non-AD dementia), 220 AD dementia) met inclusion criteria. SAGE and MMSE scores declined respectively at annual rates of 1.91 points/year (p < 0.0001) and 1.68 points/year (p < 0.0001) for MCI converters to AD dementia, and 1.82 points/year (p < 0.0001) and 2.38 points/year (p < 0.0001) for AD dementia subjects. SAGE and MMSE scores remained stable for SCD and MCI non-converters. Statistically significant decline from baseline scores in SAGE occurred at least 6 months earlier than MMSE for MCI converters to AD dementia (14.4 vs. 20.4 months), MCI converters to non-AD dementia (14.4 vs. 32.9 months), and AD dementia individuals (8.3 vs. 14.4 months).ConclusionsSAGE detects MCI conversion to dementia at least 6 months sooner than MMSE. Being self-administered, SAGE also addresses a critical need of removing some barriers in performing cognitive assessments. Limitations of our single-site cohort study include potential referral and sampling biases. Repetitively administering SAGE and identifying stability or decline may provide clinicians with an objective cognitive biomarker impacting evaluation and management choices.

Identifying mixed Lewy body and Alzheimer’s disease pathologies using functional neuroimaging

AbstractBackgroundLewy body dementia (LBD) and Alzheimer’s disease (AD) are the two most common neurodegenerative causes of dementia. Autopsy studies report many cases with these clinical diagnoses having mixed pathology with alpha‐synuclein, tau and amyloid proteinopathies. There is limited research in trying to distinguish these potential mixed pathology conditions prior to death. We used functional neuroimaging methods including FDG PET, amyloid PET, and DaTscan SPECT to evaluate clinically diagnosed subjects with dementia with Lewy bodies (DLB), AD and PD to investigate how often potential mixed pathologies could be present.MethodEighteensubjects (all Caucasian, male/female ratio 15:3) so far were recruited from Ohio State University Memory Disorder and Movement Disorder Clinics in this currently enrolling study. Subjects were diagnosed based on standard clinical criteria for DLB, PD and AD by fellowship trained cognitive and movement disorders faculty. Cognitive testing including Mini‐Mental State Examination (MMSE) and Self‐Administered Gerocognitive Examination (SAGE) were performed. Neuroimaging evaluations performed by neuroradiology faculty were blinded to clinical diagnosis.ResultNine subjects with clinical diagnosis of Lewy body disease (5 DLB and 4 PD) and nine subjects with clinical diagnosis AD were compared. The Lewy body subjects were 71.3 ± 7.4 years old, MMSE 22.3 ± 5.4, and SAGE 9.7 ± 4.8. AD subjects were 67.1 ± 9.6 years old, MMSE 18.6 ± 5.2, and SAGE 9.0 ± 5.2. One subject (11%) of the clinical AD cases showed mixed LBD and AD features, one subject (11%) of the clinical AD cases was negative for amyloid with normal DaTscan uptake, two subjects (40%) of the clinical DLB cases showed mixed LBD and AD features, one subject (20%) of the clinical DLB cases was positive for amyloid with normal DaTscan uptake, and all four subjects with clinical PD showed neuroimaging findings consistent with PD.ConclusionBased on functional neuroimaging, 21% of clinically diagnosed AD or DLB subjects had evidence of potential mixed pathologies and 14% were misdiagnosed. Although the sample size is small, functional neuroimaging studies revealed possibly incomplete or incorrect diagnoses in about one third of subjects clinically diagnosed by subspecialists using standard clinical diagnostic criteria. Larger studies are required to confirm these findings.

Cognitive disorders in patients with chronic kidney disease in pre-dialysis period

Objective: to study the cognitive status of patients in the pre-dialysis period depending on the stage of chronic kidney disease (CKD) and the category of cardiovascular risk (CVR). Materials and Methods. We examined 98 patients with CKD in the pre-dialysis period (mean age 47.1±11.2 years). The patients were divided into three groups according to the criteria of CVR stratification. Group 1 consisted of 32 patients with a low or moderate CVR, and CKD stage C1 or C2; Group 2 included 34 patients with a high CVR and CKD stage C3a or C3b; Group 3 comprised 32 patients with a very high CVR and CKD stage C4. We used the SAGE test (Self-Administered Gerocognitive Examination) to evaluate cognitive functions. Results. Cognitive impairment (CI) was detected in 57% of the patients: 37.5% in Group 1, 44.1% in Group 2, and 90.5% in Group 3. Dementia was diagnosed in 19% of patients with CI. A correlation was found between the severity of CI, the degree of decrease in glomerular filtration rate, and the education level of CKD patients in the pre-dialysis period (p≤0.001). We established that the examined subjects with CKD were characterized by memory, constructive, spatial and logical thinking disorders. Conclusion. Chronic kidney disease is an independent risk factor for the development of CI. The latter progressed with both CKD stage and the patient’s CVR category, and was detected in 37.5% of patients with a low or moderate CVR, 44.1% of patients with a high CVR, and 90.5% of patients with a very high CVR.

Cross‐sectional association between the area deprivation index (ADI) and cognitive impairment in community‐dwelling older veterans

AbstractBackgroundThe evidence that lower socio‐economic status (SES) may be associated with late‐onset dementia is inconsistent. Differences may be related to how SES was assessed. The area deprivation index (ADI) is a validated, composite measure of neighborhood socioeconomic status representing a geographic area level of social deprivation. Previous research has shown an association between ADI and cognitive impairment, but less is known about the Veteran population. The study aim was to determine the cross‐sectional association between the area deprivation index (ADI) and cognitive impairment in a Veteran population.MethodThis is a cross‐sectional study among community‐dwelling Veterans aged ≥50 years enrolled in a VA primary care clinic from July 2019‐May 2020. Patients were mailed questionnaires including sociodemographic, the Self‐Administered Gerocognitive Examination (SAGE). Clinical information was extracted from the electronic health records (EHR). To assess frailty, we used a 31‐item VA Frailty Index (VA‐FI) generated from EHR data matched to the study date. We calculated the ADI from 17 socioeconomic indicators available from the US Census. ADIs were generated for census tracts corresponding to veterans’ addresses. Higher ADI values are consistent with increased deprivation. After adjusting for age, gender, marital status, race, ethnicity, body mass index and frailty, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using binomial logistic regression models with cognitive impairment (MCI and dementia) as the outcome variable and ADI as the independent variable.ResultParticipants were 1060 Veterans (response rate of 20.14%), mean age of 68.39 (SD=8.52) years, 59.0% Caucasian, 69.2% non‐Hispanic, 95.8% male, 12.0% screened positive for MCI and 15.6% for dementia. Among ADI quintile groups, patients in the highest group had a significantly higher proportion of cognitive impairment (40.59%) when compared to lower groups, p&lt;.001. No significant differences were found between quintiles 1 to 4. The highest ADI quintile was the only group associated with cognitive impairment, adjusted OR: 1.916 (95% CI:1.187‐3.093), p=.008.ConclusionThis study shows a cross‐sectional association between ADI and dementia in community‐dwelling older Veterans. Further investigation of the links between neighborhood social deprivation and cognitive impairment may assist in the development of strategies that lower the incidence of cognitive impairment in these communities.

Self-Administered Gerocognitive Examination (SAGE) for the Early Detection of Cognitive Impairment at Primary Care Provider (PCP) Visits (2775)

Self-Administered Gerocognitive Examination (SAGE) for the Early Detection of Cognitive Impairment at Primary Care Provider (PCP) Visits (2775)

Race-Based Differences in MCI And Dementia: A Propensity Score Matching Study

<h3>Introduction</h3> Mild cognitive impairment (MCI) and dementia are characterized by objective deficits in several cognitive domains. These cognitive disorders are prevalent in the fast-growing older population worldwide. There are several modifiable and non-modifiable risk factors for these cognitive disorders. Research has shown that the African American race is predictive of incident dementia. However, the African-American race is confounded by other risk factors which may explain much of the racial disparity in cognitive disorders, most notably education, socio-economic status and lack of access. The aim of this study was to compare the prevalence of MCI and Dementia between African-American and Caucasian community-dwelling older Veterans after matching of baseline characteristics. <h3>Methods</h3> We conducted a cross-sectional study using propensity score matching (PSM) among community-dwelling Veterans aged ≥50 years enrolled in VA primary care clinics from July 1, 2019 to May 31, 2020. Participants with baseline dementia diagnosis were excluded. Patients received mailed questionnaires including sociodemographic, information about exercise, education and an assessment of cognitive status using the validated Self-Administered Gerocognitive Examination (SAGE). We complemented the information with data from the electronic health records (EHR). To assess frailty, we used a 31-item VA Frailty Index (VA-FI) generated from claims-based data matched to the study date. The VA-FI categorizes patients into robust (<0.10), pre-frail (0.10-0.20) and frail (≥0.21). Geographical socio-economic conditions were determined by using the US Area Deprivation Index (ADI) datasets. The ADI score distribution was divided by tertiles (Low, Middle, High), with higher scores corresponding to more socio-economic deprivation. African American Veterans were matched with Caucasians using PSM with one-to-one nearest neighbor matching without replacement. Matching covariates used to calculate the propensity score included age, gender, marital status, BMI, ethnicity, years of education, frailty (VA-FI), Obstructive Sleep Apnea (OSA), and ADI with a tolerance level of .01. Using a Chi-Square test, we compared the proportion of patients with MCI and Dementia among Caucasians and African-Americans after matching for baseline characteristics. <h3>Results</h3> We obtained a response rate of 19.75% (n =1073) out of 5,432 mailed surveys. After propensity score matching of those Veterans who responded, 202 Caucasians and 202 African-Americans were selected and compared. Participants had a mean age of 68.57(SD=7.9) years, 50.2% were married, 90.6% non-Hispanic and 96% male. Almost all patients had achieved at least 10 years of education (91.8%), 39.9% were obese and 34.9% had OSA. The mean ADI score was 98.29 (SD=20.16) and 37.9% were found to be in the high ADI tertile. Regarding frailty status, 23.5%, 36.1%, and 40.3% were robust, pre-frail and frail respectively. After matching, all the baseline clinical characteristics were comparable between the two groups. Using a Chi-Square test after PSM, we found that the proportions of MCI (43.8%) and Dementia (40.3%) in Caucasian patients were not significantly different from that of African-Americans (MCI=56.3%, Dementia=59.7%), p=.087. <h3>Conclusions</h3> This study results suggest that race alone is not independently associated with MCI or Dementia. Even though some studies have shown that African-Americans are more likely to develop cognitive impairment, this association may be due to other socio-demographic factors that are more prevalent in the African-American population. <h3>Funding</h3> Bruce W. Carter VA Medical Center - Geriatric Research, Education and Clinical Center (GRECC)

Self‐administered gerocognitive examination for the early detection of cognitive impairment at primary care provider visits

AbstractBackgroundCurrently 50%‐75% of dementia cases are undiagnosed, untreated, and unmanaged. The average diagnosis time is 32 months after symptom onset. Primary Care Providers (PCP) are critical for case finding of cognitive impairment to provide management, referrals, and treatments. Cognitive assessments are time consuming and difficult to incorporate into time‐limited PCP visits. Self‐Administered Gerocognitive Examination (SAGE) is a reliable, valid, pen and paper, cognitive assessment that is easily incorporated into PCP visits without needing staff administrators. PCP visits with and without SAGE were compared to determine differences in diagnoses, treatment, and management of new cognitive disorders.MethodSubjects without diagnosed cognitive disorders and with acceptable reading, vision and English language comprehension, aged 65‐89 who completed a non‐acute office visit were enrolled. Two physically separate PCP offices conducted their visits as they normally would for 100 consecutive subjects each. One office, in an additional 100 subjects, used SAGE and asked an informant, if available, to ascertain if the subject experienced significant cognitive change (based on PCP opinion) over the previous year. Chart reviews were conducted 60 days from the initial visit. One‐way analysis of variance and Fisher exact tests were used to compare the groups and outcomes.ResultThere were no differences in age, race, or gender between the intervention (n=100) and control (n=200) subgroups. When SAGE was utilized, the PCP documented detection of new cognitive conditions/concerns six times (9% versus 1.5%) as often (p=0.003). In the intervention group, detection rate was nearly 4‐fold higher when SAGE scores were in the cognitively impaired range (p=0.034). New cognitive conditions/concerns were recorded by the PCP in 31% of 16 cases where informants noticed cognitive changes and in none of 22 where informants noted no changes (p=0.009). Combining low SAGE scores and informant concerns, those with one of the factors were 15‐fold as likely to have new cognitive conditions/concerns documented (p=0.007).ConclusionSAGE was easily incorporated into PCP visits and resulted in significantly increased awareness of new cognitive conditions/concerns leading to new diagnoses, treatment, and management changes, which increased 4‐fold when combined with informant reports of significant cognitive declines over a year.

Mindfulness in Motion and Dietary Approaches to Stop Hypertension (DASH) in Hypertensive African Americans.

Hypertension increases the risk of developing Alzheimer's disease or related dementias. This pilot study's purpose was to examine the feasibility and acceptability of a novel intervention, Mindfulness in Motion (MIM) and Dietary Approaches to Stop Hypertension DASH (MIM DASH), to improve diet, mindfulness, stress, and systolic blood pressure (BP) in older African Americans with mild cognitive impairment (MCI) and hypertension. Cluster randomized controlled trial. Intergenerational community center in a large metropolitan area. African Americans with MCI and hypertension. Participants were divided into six groups randomized 1:1:1 to the MIM DASH group, attention only (non-hypertensive education) group, or true control group. The MIM DASH and attention only interventions were delivered in 8-weekly 2 hour group sessions. MIM included mindful movements from chair/standing, breathing exercises, and guided meditation. The DASH component used a critical thinking approach of problem solving, goal setting, reflection, and self-efficacy. The true control group received a DASH pamphlet at the end. Feasibility was tracked through enrollment and attendance records; acceptability was assessed through interviews. Blood pressure was measured using the Omron HEM-907XL Monitor. Dietary intake was measured by DASH-Q. Mindfulness was measured by the Cognitive and Affective Mindfulness Scale. Stress was measured by the Perceived Stress Scale. MCI was determined using the Self-Administered Gerocognitive Examination. Data were collected at baseline and 3-months. Median session attendance was six for the MIM DASH group and six for the attention only group. There were no changes in diet, mindfulness, or stress. There was a clinically significant reduction in systolic BP in the MIM DASH group (-7.2 mmHg) relative to the attention only group (-.7), and no change between the MIM DASH and true control groups. Results indicate that the MIM DASH intervention was feasible and culturally acceptable in African Americans with hypertension and MCI.

Predicting Speech Outcomes After Cochlear Implantation in Older Adults Using the Self-administered Gerocognitive Examination Test.

The purpose of this study is to determine if a cognitive test, Self-administered Gerocognitive Examination (SAGE), correlates with speech recognition outcomes 1 year after cochlear implantation in adults over 65 years of age. Retrospective study was conducted at a single institution. Surgery was performed by two surgeons on adult patients (>65 yrs) with postlingual bilateral sensorineural hearing loss meeting clinical and audiological candidacy for unilateral cochlear implantation. Patients who performed SAGE preimplantation, and speech testing (CNC, AzBio in quiet, AzBio in noise) before and 1 year after implantation were included. Forty patients with a mean age of 78 were included. The overall mean preoperative SAGE score was 17.4 (95% CI 16.2-18.7). Greater than 17 is considered normal. Data demonstrated a statistically significant linear correlation between preoperative SAGE scores with change in speech testing 1 year postoperatively: CNC-Adjusted R-squared: 0.1955, p value: 0.002508; AzBio in quiet-Adjusted R-squared: 0.1564, p value: 0.006686; AzBio in noise-Adjusted R-squared: 0.1543, p value: 0.007053. Multivariate linear regression analysis revealed that age and SAGE scores both statistically correlated with speech testing 1 year after implantation (p = 0.01 for both). Patients who passed the SAGE (≥17) had statistically significant higher CNC, AzBio in quiet, and AzBio in noise scores 1 year postoperatively compared with patients with low SAGE scores (<17) despite statistically similar age means in each group. SAGE can predict speech recognition testing 1 year after cochlear implantation in older adults over 65 years of age.

Co-occurrence of Convergence Insufficiency and Cognitive Impairment in Parkinsonian Disorders: A Pilot Study.

Background: Convergence insufficiency (CI) in parkinsonian conditions causes disabling visual symptoms during near tasks and usually manifests as double vision. Since double vision is more common in patients who report cognitive symptoms, we sought to determine if symptomatic CI, as opposed to asymptomatic CI, could serve as a marker of cognitive impairment in parkinsonian disorders.Methods: Twenty-four participants with parkinsonian disorders (18 Parkinson's disease, 5 progressive supranuclear palsy, 1 multiple system atrophy) and objective findings of convergence insufficiency on neuro-ophthalmologic examination were included. Subjective visual symptoms and cognitive complaints were recorded, and the Self-Administered Gerocognitive Examination was used as a global cognitive screening measure.Results: 54.1% of parkinsonian participants had cognitive impairment, but there were no significant differences in the degree of convergence insufficiency, measured by near point of convergence (NPC), or cognitive outcomes between those with symptomatic CI, and asymptomatic CI. However, NPC was greater for those with cognitive impairment (x = 18.4 cm), compared to those who were cognitively intact (x = 12.5 cm, p = 0.003).Conclusions: Cognitive impairment commonly co-occurs in parkinsonian disorders with convergence insufficiency and is associated with significantly greater NPC distances. Clinicians should have a high index of suspicion for cognitive impairment in patients with objective findings of convergence insufficiency, whether symptomatic or not. Further investigation of convergence insufficiency in relationship to cognitive impairment in parkinsonian disorders is warranted, as there may be a shared mechanism of dysfunction.

CONVERGENCE INSUFFICIENCY AND COGNITIVE IMPAIRMENT IN PARKINSONIAN DISORDERS

Convergence insufficiency, an inability to coordinate binocular eye movements to maintain single vision during near target viewing, is increasingly recognized as a cause of disabling visual dysfunction for near tasks (i.e. reading) in parkinsonian conditions, and is most often reported by patients as double vision. While cognitive complaints may be more common in patients with Parkinson's disease who report diplopia,1 the relationship between cognitive impairment, subjective visual symptoms, and objectively measured convergence insufficiency has not previously been investigated. Twenty-four participants with parkinsonian disorders (21 Parkinson's disease, 4 progressive supranuclear palsy) referred for neuro-ophthalmologic evaluation with objective findings of convergence insufficiency (near point of convergence of ≥ 10 cm or a near/distance exotropia disparity of ≥ 10 prism diopters), with visual acuity better than 20/40 best corrected, were included in this analysis. Subjective reports of visual symptoms of convergence insufficiency (i.e. near task symptoms of blurred or double vision or eye strain) were recorded. Participants completed the Self-Administered Gerocognitive Examination (SAGE) as a global cognitive screening measure; subjective cognitive complaints were also recorded. Seventy-five percent of all participants reported subjective cognitive complaints, and 41.7% met SAGE criteria for cognitive impairment (total score<17). Seventy-five percent of participants reported subjective visual symptoms that could be attributed to convergence insufficiency. There were no significant differences in demographic variables, measured near point of convergence, or cognitive outcomes between the symptomatic and non-symptomatic convergence insufficiency groups [Table 1]. While there was no significant difference in cognitive scores between participants who reported visual symptoms and those who did not, there was a high rate of cognitive impairment in parkinsonian disorders presenting with objective convergence insufficiency. Beyond the midbrain, cortical control of convergence has been postulated to be controlled reflexively by posterior parietal regions and volitionally by frontal regions. Further investigation into the onset of convergence insufficiency in relationship to cognitive impairment in parkinsonian disorders is warranted, as convergence insufficiency could serve as an additional clinical marker of cognitive impairment in these conditions. Reference: Schindlbeck KA, et al. Characterization of diplopia in non-demented patients with Parkinson's disease. Parkinsonism Relat Disord. 2017 Dec;45:1-6.

Influence of Digital Proficiency, Age, Education, and Cognitive Impairment/Diagnosis on Time to Complete Digital Cognitive Testing using the electronic Self-Administered Gerocognitive Examination (eSAGE) (P6.200)

Influence of Digital Proficiency, Age, Education, and Cognitive Impairment/Diagnosis on Time to Complete Digital Cognitive Testing using the electronic Self-Administered Gerocognitive Examination (eSAGE) (P6.200)