Version Of Montreal Cognitive Assessment Research Articles

Importance of focusing on subjective symptoms to maintain quality of life in patients with Parkinson's disease for over 5 years

Parkinson's disease (PD) is a neurodegenerative disorder that causes a variety of motor and non-motor symptoms (NMS), which affect the patient's quality of life (QOL). This study aimed to compare QOL and background in patients with PD based on the disease duration and investigate the factors affecting QOL. Patients with PD were evaluated based on age, sex, disease duration (≤5 years and > 5 years groups), Mini Mental State Examination (MMSE), Japanese version of Montreal Cognitive Assessment (MoCA-J), Levodopa equivalent daily dose (LEDD), Hoehn and Yahr (HY) severity, movement disorder society-sponsored revision of the unified Parkinson's disease rating scale (MDS-UPDRS) parts I–IV, and QOL using the Parkinson's disease questionnaire (PDQ-8). Overall, 102 patients with PD (58 males; mean age = 70.0 years; mean disease duration = 7.3 years) were included in this study. QOL was significantly correlated (r > 0.30, p < 0.05) with disease duration and MDS-UPDRS parts I–IV total scores. When the PDQ-8 total score was compared with MDS-UPDRS parts I–IV total scores based on disease duration classification, it was positively correlated with the scores for parts I and II in the >5 years group. Moreover, MDS-UPDRS parts I and II total scores appeared to be the factors most significantly affecting QOL. The factors affecting QOL in patients with PD were subjective NMS and motor symptoms. Since, physician-rated motor symptoms were not associated with QOL in patients with >5 years PD, subjective symptoms should be evaluated and treated to maintain QOL.

The effects of cognition and visual perception on activities daily living in the elderly

This study aimed to investigate the influence of cognition and visual perception on activities of daily living (ADL) among community-dwelling elderly individuals. Cognition was assessed using the Korean version of Montreal Cognitive Assessment, visual perception was assessed using the Motor Free Visual Perception Test -3, and ADL were assessed using the Modified Barthel Index. The results indicated that cognition, visual perception, and ADL were all positively correlated. Additionally, both cognition and visual perception were found to impact the ADL in the elderly. This study provides evidence that can be used to develop welfare and rehabilitation programs for the elderly, focusing on managing cognitive and visual perception abilities to support independent ADL and enhance quality of life.

Correlation of electrolytes with falling risk, cognitive function, and functional outcome in acute ischemic stroke patient

Stroke outcome is determined on multiple factors. However, there are limited studies discussing the impact of electrolyte imbalance on stroke outcome. In this study, we analyzed sodium, calcium, and potassium level in acute ischemic stroke, and compare their risk of falling, cognitive function, and functional outcome. This was a cross-sectional study in Dr. Moewardi General Hospital, Indonesia between January and June 2023. Patient with acute ischemic stroke were enrolled in this study. Cognitive function was assessed with mini mental state examination (MMSE) and the Indonesian version of montreal cognitive assessment (MoCA-Ina). National Institutes of Health Stroke Scale (NIHSS), Modified Rankin Scale (MRS) and Morse Fall Score (MFS) were used to assessed stroke severity, disability, and risk of falling, respectively. Pearson correlation was then performed to evaluate the correlation of electrolytes level with MMSE, MoCA-Ina, NIHSS, MRS, and MFS. Furthermore, we also analyzed the odds ratio of increasing risk of falling, cognitive function deterioration, and worse functional outcome. A p-value of &amp;lt;0.05 is considered statistically significant. On univariate analysis, natrium is correlated with MMSE (r=0.174; p=0.042), NIHSS (r=-0.412; p=0.011), MRS (r=-0.174; p=0.042), and MFS (r=-0.304; p=0.042). Potassium is correlated with MMSE (r=0.344; p=0.044), MoCA-INA (r=0.341; p=0.048), NIHSS (r=-0.572; p=0.019), (MRS r=-0.376; p=0.017), and MFS (r=-0.612; p=0.031). Calcium is correlated with NIHSS r=-0.348 (p=0.018), MRS r=-0.256 (p=0.036). On odds ratio analysis, low natrium level increased the risk of deteriorating cognitive function, and low level of potassium increased the risk of falling. Electrolyte imbalances correlates with risk of falling and deteriorating cognitive function.

The Prognostic Test Accuracy of the Short and Standard Forms of the Montreal Cognitive Assessment.

Cognitive impairment is a critical concern in stroke care, and international guidelines recommend early cognitive screening. The aim of this study was to determine the prognostic accuracy of both the short and standard forms of the Montreal Cognitive Assessment (MoCA) in predicting long-term cognitive recovery following a stroke. For this study, we used data from the Efficacy of Fluoxetine - a Randomized Controlled Trial in Stroke (EFFECTS) study, which encompassed stroke patients from 35 Swedish centers over the period from 2014 to 2019. Cognitive assessments were initially conducted at 2-15 days post-stroke, with follow-up data gathered at 6 months. We used the MoCA for objective cognitive evaluation. For assessing subjective cognitive impairment, we used the memory and thinking domain of the Stroke Impact Scale. For psychometric evaluation of the short Swedish version of MoCA (s-MoCA-SWE), we used cross tables and binary logistic regression. The study included 1,141 patients (62.2% men; median [interquartile range; IQR] age, 72.3 [13.2] years; median [IQR] stroke severity, 3.0 [3.0]). At baseline, the prevalence of cognitive impairment was 71.7% according to the s-MoCA-SWE (≤12) and 67.0% according to the MoCA (≤25). The s-MoCA-SWE demonstrated a sensitivity of 92.3% for correctly identifying patients with objective cognitive impairment and 81.5% for identifying those with subjective impairments at 6 months. Although the s-MoCA-SWE had higher sensitivity, the MoCA had a more balanced sensitivity and specificity in detecting both subjective and objective cognitive impairments. In both crude and multivariable models, the s-MoCA-SWE was more strongly associated than the MoCA with cognitive impairment at 6 months. Both the short and standard versions of the MoCA appear to be effective in identifying individuals likely to experience persistent cognitive issues following a stroke. Considering the limited time available in an acute stroke unit, the short-form version may be more practical. Nevertheless, further prospective studies are required to validate these findings.

EFFECT OF BALINESE FLUTE INSTRUMENT FOR IMPROVING COGNITIVE FUNCTION IN ELDERLY

Background: Cognitive impairment is mostly affected the elderly population which reduces the quality of life for sufferers and their families. The last research showed that listening to Balinese flute instrument music increased cognitive function, especially in the memory domain. However, the study is still limited to small populations. Objective: to determine whether playing the Balinese flute with or without listening to the "Morning Happiness" song affects the cognitive function of elderly. Methods: This experimental study was conducted on healthy geriatric patients above 55 years old with controlled risk factors or no history of any chronic conditions which were divided into 2 groups. The "Morning Happiness" song will be played with Balinese flute instrument in both groups whereas the intervention will add to listen to similar songs. Results: 28 subjects in the intervention group and 20 subjects in the control group. Both groups were comprised of typical gender distribution with an average of 65.08±6.41 years old. Both the intervention and control groups had improved in MoCA-Ina (The Indonesian Version of Montreal Cognitive Assessment) scores, but the intervention group gained a better Z-score (-3.193, p-value 0.001) than the control group (-1.466, p-value 0.143) after procedural. The delayed recall domain also showed significant improvement in both groups with a Z-score of -3.241 (p-value 0.001) in control and -2.30 (p-value 0.026) in intervention group respectively. Interestingly, the attention domain is improved in the control group with a Z-score of -2.142 (p-value 0.032) rather than in intervention group. Conclusion: The overall MoCa-Ina score was significantly higher in interventional subjects than control, specifically in the delayed recall domain.

Montreal Cognitive Assessment (MoCA): Normative Data for the State of Kerala, South India.

Montreal cognitive assessment (MoCA) is a tool that is widely accepted across the world to measure mild cognitive impairment (MCI). The original cut-off score of MoCA falsely screens a large population of Indians as having MCI. The aim of this study was to develop the normative data for MoCA for the older population of Kerala, South India. We conducted the study among 959 cognitively normal older individuals of Kalliyoor village of Thiruvananthapuram district, Kerala. The validated Malayalam version of MoCA [MoCA-M] was administered by trained volunteers. The mean, median, and 10th percentile of the scores [domain-specific and total] were calculated in various age and educational groups. The mean (SD) MoCA score was 19.4 (7.3). The 10th percentile for the total MoCA score was 9. The 10th percentile for all domains was zero, except for orientation. As age advanced, MoCA scores significantly reduced. The mean total MoCA scores dropped from 20.1 (7) [for ages between 65 and 75 years] to 7.4 (1.6) [for ages above 85 years]. We also obtained a significant improvement in scores among subjects with higher educational standards. The study throws light into the performance of MoCA among the Indian population. This study defines the norms for the Indian population and suggests redefining the threshold for positively screening for MCI using MoCA-M.

The Hong Kong version of Montreal Cognitive Assessment for the Visually Impaired (HKMoCA-VI): Proposed cut-off and cognitive functioning survey of visually impaired elderly in residential homes.

Visual impairment has been strongly associated with the incidence of dementia. Appropriate cognitive screening for the elderly with visual impairment is crucial for early identification of dementia and its management. Due to challenges in processing visually presented stimuli among participants, the cut-off score of the Hong Kong version of the Montreal Cognitive Assessment for the Visually Impaired (HKMoCA-VI), also known as MoCA-BLIND or MoCA-22, was unknown. Besides, the cognitive status of elderly with visual impairment residing in care homes is rarely investigated. The current study aimed to 1) establish the cut-off score for HKMoCA-VI and 2) examine the general cognitive functioning of elderly with visual impairment living in residential homes in Hong Kong in terms of MoCA-VI percentile scores. HKMoCA-VI and the Cantonese version of the Mini-Mental State Examination (CMMSE) were administered to 123 visually impaired elderly residents in care homes in Hong Kong. Percentile scores of HKMoCA-VI by age and education level were determined, and the concurrent validity, sensitivity, and specificity of HKMoCA-VI were assessed. A cut-off score 12 was suggested for HKMoCA-VI, which yielded a sensitivity and specificity of 89.29% and 83.58%, respectively. Moreover, it strongly correlated with CMMSE, indicating satisfactory concurrent validity. HKMoCA-VI is suggested to be a viable cognitive screening tool for elderly individuals with visual impairment in residential homes. Further modifications to enhance the sensitivity and specificity of the measure are proposed.

Serum levels of neurotensin, pannexin-1, and sestrin-2 and the correlations with sleep quality or/and cognitive function in the patients with chronic insomnia disorder.

To examine serum concentrations of neurotensin, pannexin-1 and sestrin-2, and their correlations with subjective and objective sleep quality and cognitive function in the patients with chronic insomnia disorder (CID). Sixty-five CID patients were enrolled continuously and fifty-six good sleepers in the same period were served as healthy controls (HCs). Serum levels of neurotensin, pannexin-1 and sestrin-2 were measured by enzyme-linked immunosorbent assays. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and polysomnography, and mood was evaluated by 17-item Hamilton Depression Rating Scale. General cognitive function was assessed with the Chinese-Beijing Version of Montreal Cognitive Assessment and spatial memory was evaluated by Blue Velvet Arena Test (BVAT). Relative to the HCs, the CID sufferers had higher levels of neurotensin (t=5.210, p<0.001) and pannexin-1 (Z=-4.169, p<0.001), and lower level of sestrin-2 (Z=-2.438, p=0.015). In terms of objective sleep measures, pannexin-1 was positively associated with total sleep time (r=0.562, p=0.002) and sleep efficiency (r=0.588, p=0.001), and negatively with wake time after sleep onset (r=-0.590, p=0.001) and wake time (r=-0.590, p=0.001); sestrin-2 was positively associated with percentage of rapid eye movement sleep (r=0.442, p=0.016) and negatively with non-rapid eye movement sleep stage 2 in the percentage (r=-0.394, p=0.034). Adjusted for sex, age and HAMD, pannexin-1 was still associated with the above objective sleep measures, but sestrin-2 was only negatively with wake time (r=-0.446, p=0.022). However, these biomarkers showed no significant correlations with subjective sleep quality (PSQI score). Serum concentrations of neurotensin and pannexin-1 were positively associated with the mean erroneous distance in the BVAT. Adjusted for sex, age and depression, neurotensin was negatively associated with MoCA score (r=-0.257, p=0.044), pannexin-1 was positively associated with the mean erroneous distance in the BVAT (r=0.270, p=0.033). The CID patients had increased neurotensin and pannexin-1 and decreased sestrin-2 in the serum levels, indicating neuron dysfunction, which could be related to poor sleep quality and cognitive dysfunction measured objectively.

Cognitive impairment and neurocognitive profiles among people living with HIV and HIV-negative individuals older over 50 years: a comparison of IHDS, MMSE and MoCA.

We aimed to examine the l differences in the assessment of neurocognitive impairment (NCI) using cognitive screening tools between PLWH and HIV-negative individuals and further compare the neurocognitive profiles between the two groups. This was baseline evaluation of Pudong HIV Aging Cohort, including 465 people living with HIV (PLWH) and 465 HIV-negative individuals aged over 50 years matched by age (± 3 years), sex and education. NCI was assessed using the Chinese version of Mini-mental State Examination (MMSE), the International HIV Dementia Scale (IHDS) and Beijing version of Montreal Cognitive Assessment (MoCA). In total, 258 (55.5%), 91 (19.6%), 273 (58.7%) of PLWH were classified as having NCI by the IHDS, MMSE and MoCA, compared to 90 (19.4%), 25 (5.4%), 135 (29.0%) of HIV-negative individuals, respectively (p < 0.05); such associations remained significant in multivariable analysis. PLWH showed a larger overlap of NCI detected by IHDS, MMSE, and MoCA. IHDS and MoCA detected almost all of the NCI detected by MMSE. IHDS-motor and psychomotor speeds and MoCA-executive function showed the greatest disparities between two groups. In multivariable analysis, older age and more depressive symptoms were positively associated with NCI regardless of the screening tools or HIV serostatus. PLWH over 50 years old display a higher prevalence of NCI and distinct neurocognitive profiles compared to HIV-negative individuals, despite viral suppression. Given the more considerable overlap in NCI classification in PLWH, it is advisable to choose one screening tool such as IHDS or MoCA to identify those potentially having NCI and then refer to more comprehensive neuropsychological assessment.

A mediation analysis of the role of total free fatty acids on pertinence of gut microbiota composition and cognitive function in late life depression

BackgroundExtensive evidence demonstrates correlations among gut microbiota, lipid metabolism and cognitive function. However, there is still a lack of researches in the field of late-life depression (LLD). This research targeted at investigating the relationship among gut microbiota, lipid metabolism indexes, such as total free fatty acids (FFAs), and cognitive functions in LLD.MethodsTwenty-nine LLD patients from the Cognitive Outcome Cohort Study of Depression in Elderly were included. Cognitive functions were estimated through the Chinese version of Montreal Cognitive Assessment (MoCA). Blood samples were collected to evaluate serum lipid metabolism parameters. Fecal samples were evaluated for gut microbiota determination via 16S rRNA sequencing. Spearman correlation, linear regression and mediation analysis were utilized to explore relationship among gut microbiota, lipid metabolism and cognitive function in LLD patients.ResultsSpearman correlation analysis revealed significant correlations among Akkermansia abundance, total Free Fatty Acids (FFAs) and MoCA scores (P < 0.05). Multiple regression indicated Akkermansia and total FFAs significantly predicted MoCA scores (P < 0.05). Mediation analysis demonstrated that the correlation between decreased Akkermansia relative abundance and cognitive decline in LLD patients was partially mediated by total FFAs (Bootstrap 95%CI: 0.023–0.557), accounting for 43.0% of the relative effect.ConclusionThese findings suggested a significant relationship between cognitive functions in LLD and Akkermansia, as well as total FFAs. Total FFAs partially mediated the relationship between Akkermansia and cognitive functions. These results contributed to understanding the gut microbial-host lipid metabolism axis in the cognitive function of LLD.

Tangram Puzzles in Patients with Neurocognitive Disorders: A Pilot Study

Objective: The tangram puzzle is a serious math puzzle game used to promote mathematic development in children, which improves visuospatial function and creativity. A game to improve cognitive functions is useful for patients with neurocognitive disorders. This pilot study aimed to determine whether this game could improve cognitive function in patients with neurocognitive disorders. Materials: This study recruited patients with mild Alzheimer’s disease or mild cognitive impairment who were followed longitudinally by the Department of Psychiatry, Juntendo University Hospital, or Juntendo Tokyo Koto Geriatric Medical Center (Tokyo, Japan). Methods: Participants were asked to solve Tangram puzzles 2–3 times weekly, spending 30–40 min/session at home with or without family members for approximately 90 (Study 1) or 180 (Study 2) days. Mini-Mental State Examination (MMSE) in Study 1 as well as a Japanese version of the Montreal Cognitive Assessment and Trail Making Test in Study 2 were performed on the initial and final days. Results: Study 1 comprised eight participants and Study 2 comprised nine participants. Statistically significant improvement was observed in MMSE total score (p = 0.016) and orientation segment (p = 0.026) in Study 1. No statistically significant difference was noted in MMSE total score, orientation segment, or MoCA-J (Japanese version of Montreal Cognitive Assessment) score between the initial and final days in Study 2 (p = 0.764, p = 0.583, and p = 0.401, respectively). Conclusions: Study 1 revealed that Tangram puzzles may ameliorate the progression of cognitive functions in patients with neurocognitive disorders within a short time (3 months); however, Study 2 did not show a consistent result. Thus, randomized controlled trials are warranted to draw a conclusion.

Translation and Cross-Cultural Adaptation of Nepali Version of the Montreal Cognitive Assessment.

Montreal Cognitive Assessment is widely used in stroke to detect cognitive impairment. The superiority of it over other outcome measures has been well established. It has been cross-culturally translated and has shown excellent psychometric properties. To assess the intervention effect on cognition of Nepalese individuals with stroke using the Montreal Cognitive Assessment, an adapted Nepali version is required as the Nepalese cultural context and language are completely different than the original was developed. Thus, the objective of this study is to translate and cross-culturally adapt Montreal Cognitive Assessment in the Nepali language and see its test-retest reliability and internal consistency. After translating and cross-culturally adapting the Montreal Cognitive Assessment into Nepali using Beaton guidelines. Its Nepali version was administered to 28 individuals with stroke twice keeping the interval of two weeks. Test-retest reliability and internal consistency were assessed using the Intraclass correlation coefficient and Cronbach's alpha. The Montreal Cognitive Assessment was translated into Nepali with significant cultural adaptations and the Nepali version demonstrated excellent psychometric properties as hypothesized. The test-retest reliability and internal Consistency were excellent. The Intraclass correlation coefficient of the total score was 0.990 and Cronbach's alpha value was 0.994 for total scores. The Nepali version of Montreal Cognitive Assessment is reliable to use as a diagnostictool for detecting cognitive impairment in patients with stroke. It is comprehensive, easy to administer and culturally appropriate.

Application of Cognitive Enhancement Protocol Based on ICT Program to Improve Cognitive Level of Older Adults Residents in Small‐sized City Community: A Pilot Study

AbstractBackgroundA home‐based ICT program to elderly people aged 65 years or older to confirm the effect of the cognitive enhancement program and explore the possibility of remote rehabilitation.MethodThis study from August to October 2022, three subjects were selected and the intervention was conducted for about two months. This intervention was conducted using the Korean version of Mini‐Mental State Examination(MMSE‐K), the Korean version of Montreal Cognitive Assessment(MoCA‐K), the Computer Cognitive Senior Assessment System(CoSAS), and the two shorter form of the Center for Epidemiologic Studies Depression scale(CESD‐10‐D) to evaluated cognitive improvement before and after the program. The therapist remotely set the difficulty lever of cognitive training suitable fore the level of the subject through weekly feedback, and during the program. Interviews were conducted for additional opinions on the cognitive enhancement program.ResultAfter the intervention, all subjects showed improved scores in most items of the Korean version of the Montreal Cognitive Assessment conducted before and after the intervention. In addition, among the items of CoTras, upper cognition, language ability, attention, visual perception, and memory were improved. In addition, subjective satisfaction with the cognitive improvement program was high.ConclusionCognitive rehabilitation training using a home‐based ICT program not only prevented dementia but also made it habitual. Through this study, it was confirmed that remote rehabilitation for the elderly could be possible.

The association of hyperglycemia and kidney dysfunction with cognitive impairment in community‐dwelling older adults in Taiwan

AbstractBackgroundDiabetes was considered one of the risk factors for dementia. However, one‐third of diabetic patients also suffer from kidney disease. It remains unclear the intercorrelation between blood sugar and kidney function that affects the occurrence of mild cognitive impairment for people with normal blood sugar levels. This study aimed to explore the relationship between hyperglycemia and kidney dysfunction (KD) on cognitive impairment in older adults.MethodThis is an eight‐year cohort study (2011‐2019). A total of 509 non‐demented older adults were recruited from the elderly health checkup program at baseline (2011‐2013) with three biannual follow‐ups. Global and domain‐specific (memory, attention, executive function, and language) cognition were assessed by the Taiwanese version of Montreal Cognitive Assessment (MoCA‐T) and a battery of neuropsychological tests, respectively. MCI was defined as a MoCA‐T score of 22 or 23. Hyperglycemia was defined as fasting blood glucose greater than 100 mg/dL. KD was defined as having either glomerular filtration rate &lt; 60 ml/min/1.73 m2 or proteinuria. The generalized linear mixed model was utilized to examine the effects of hyperglycemia and KD on cognitive performance.ResultThe prevalence of MCI was 9.4% at baseline. Hyperglycemia [adjusted odds ratio (aOR) = 1.91] and KD (aOR = 1.98) were significantly associated with the risk of MCI over eight years after adjusting for covariates, respectively. In addition, hyperglycemia and KD were significantly associated with poor performance of logical memory (β:‐0.51 to ‐0.01), executive function (β:‐0.25 to ‐0.003), attention (β:‐0.07 to ‐0.03), and verbal fluency (β:‐0.08 to ‐0.005). Hyperglycemia and KD was associated with an increased risk of MCI participants aged less than 75 years (aOR = 2.19–2.21) and in APOE ε4 non‐carriers (aOR = 2.02–2.15).ConclusionOur finding indicated that poor glycemic control and kidney function were associated with an increased risk of MCI or poor performance of cognitive domains in older adults. Cognitive impairment may be reversible through optimal management of glycemia and kidney disease; interventions (e.g., self‐management education, dietary restriction, and sufficient physical activity, etc.) at the early stage will be helpful to prevent dementia.

경도인지장애 환자에서 전산화 인지훈련 프로그램의 효과

Objective: As the elderly population increases, the proportion of neurocognitive disorder is increasing. Accordingly, research on cognitive intervention therapy to prevent neurocognitive disorder is also becoming active. In particular, this study attempted to evaluate changes in cognitive function before and after training and verify their effectiveness by implementing a computerized cognitive training program for patients with mild cognitive impairment.&#x0D; Methods: A computerized cognitive training program was conducted for 15 patients with mild cognitive impairment. It was conducted twice a week, 30 minutes, and 16 times for 8 weeks, and neurocognitive function was evaluated before and after training. The neurocognitive function tests are as follows; Seoul Neuropsychological Screening Battery, Korean version of Montreal Cognitive Assessment (K-MoCA), Clinical Dementia Rating (CDR), Korean Instrumental Activity of Daily Living (K-IADL), Korean Neuropsychiatric Inventory (K-NPI), and Memory Age-associated Complaint Questionnaire (MAC-Q).&#x0D; Results: There was a statistically significant improvement in memory domain after the implementation of the computerized cognitive training program, but no significant changes in attention, language ability, visuospatial function, and frontal lobe executive function. Among the memory areas, the Seoul Verbal Learning Test: Delayed Recall, Rey Complex Figure Test: Delayed Recall, and Rey Complex Figure Test: Recognition are showed significant improvement. In addition, there was a significant improvement in CDR (sum of box) and K-MoCA scores. There was no statistically significant difference in K-IADL and K-NPI.&#x0D; Conclusion: Computerized cognitive training programs have been effective in improving memory in patients with mild cognitive impairment. In order to verify the effectiveness of dementia prevention, a long-term study of a larger number is needed. The results of this preliminary study will help develop and apply cognitive training contents in the future.

Validation of the Italian version of Montreal Cognitive Assessment (MoCA) in routine clinical practice in community dweller older adults residing in the central area of Sicily

Abstract Background/Objective: The aim of the study was to examine Montreal Cognitive Assessment (MoCA) performance in subjects with normal global cognition according to the Mini Mental State Examination (MMSE) in routine clinical practice. Methods: This was a prospective, clinical validation study in 302 consecutive subjects, referring to our dementia centre for suspected cognitive impairment over a six-month period. The MMSE and the MoCA were administered within two hours of each other. Results: 184 (60.91%) of 302 evaluated subjects with a MMSE score between 26 and 30/30 had a pathological MoCA score (&lt; 26). 112/184 (60.84%) patients with a MMSE score between 26 and 29/30 obtained MoCA scores below the norm; 72/184 (39.13%) patients with a 30/30 MMSE had a MoCA score below the norm. Recall (p &lt;.0001) and attention (p&lt;.0001) were the domains that differed significantly on the two screening instruments. Conclusion: The additional use of MoCA, as a global assessment tool for the initial screening process, has allowed the identification of patients with cognitive deficit, despite their performance at MMSE had been the norm. Keywords: MoCA, MMSE, Cognitive Screening Test.

Prediction of vascular injury and the impact of physical activity on the association between Primary ALdosteronism and cerebral Microbleeds (PALM)

AbstractBackgroundPrimary aldosteronism(PA) induces hypertension and vascular injury. Cerebral microbleed(CMB) is a representative form and can cause cognitive decline over the long term. This study is to investigate vascular damage in PA. Regarding physical activity, a preventive factor for vascular damage and known to increase aldosterone itself, we evaluated difference between aldosteronism and CMB depending on level of usual physical activity.MethodWe recruited PA diagnosed patients aged 13 years or older, who visited Endocrinology clinic in the past 3 years. We excluded patients with other causes of hypertension and major brain lesion. Brain magnetic resonance imaging(MRI), and physiological tests were performed: transcranial doppler(TCD), peak wave velocity(PWV), and sonographic endothelial function test(SEFT). In addition, we performed funduscopy for detecting retinal microhemorrhage, and Korean version of Montreal Cognitive Assessment(K‐MoCA), Clinical Dementia Rating(CDR), Clinical Dementia Rating sum of boxes(CDR‐SOB) for cognitive assessment. Physical activity was investigated using global physical activity questionnaire.ResultTotal 41 participants (age, 46.0±13.4years; 46.3% of male; BMI, 25.8±3.4kg/m2; education, 13.8±2.2years) were enrolled. The mean duration of PA was 1.7±1.7years, and serum findings at diagnosis were as follows: renin (0.5±0.4ng/ml/hr), aldosterone concentration (318.6±203.3pg/mL), potassium (3.6±0.8mMol/L), aldosterone‐to‐renin ratio (91.5±73.7). In 30 of 41 patients, adrenal masses were observed on abdominal Computed Tomography(number, 1.3±0.6; size, 14.8±5.0mm). There were participants with vascular risk factors: hypertension(38, 8.1±6.4), diabetes mellitus(3, 2.5±1.8), and dyslipidemia(2, 7.7±5.8). 1 participant each had been diagnosed with myocardial infarction and cerebrovascular disease. 10 participants had a smoking history (7.8±12.3pack years), and 24 had a drinking history, with the average frequency of drinking per week was 1.2±1.4. Cognitive status was assessed by K‐MoCA(26.8±2.5), CDR(0.2±0.2) and CDRSOB(0.2±0.2). Moderate‐to‐vigorous physical activity was 192.2±246.7 minutes per week. CMB was confirmed in 10 and lacune in 7 cases. There were 9 participants who showed white matter change in Fazekas grade 1‐2. Physiological tests showed abnormality in 1 patient in TCD, 7 in PWV(baPWV, 14.1±1.9 m/s), and 6 in SEFT(flow mediated dilation, 6.6±1.3%).ConclusionIt is expected that more data will be collected through additional participant recruitment and evaluation. It remains to be seen that the analysis with additional data will yield results to test the hypothesis.

Association between olfactory function and cognitive impairment in dementia‐free older adults in Taiwan: A longitudinal cohort study

AbstractBackgroundThe olfactory impairment could be one of the earliest signs of cognitive impairment. However, limited studies have evaluated olfactory function and cognitive domains in Asian older adults. This study aimed to relate olfaction with global and domain‐specific cognition in Taiwan’s community‐dwelling, non‐demented older adults.MethodThis cohort study is part of the Taiwan Initiative for Geriatric Epidemiological Research, including 310 non‐demented older adults between 2015‐2019 with two repeated measures on cognitive function. Global and domain‐specific (memory, executive function, attention, and language) cognition were assessed by the Taiwanese version of Montreal Cognitive Assessment (MoCA‐T) and a battery of neuropsychological tests, respectively. The Sniffin' Sticks‐Odor Identification Test (SS‐OIT) was utilized to identify impaired olfaction. The generalized linear mixed model was used to examine the association of SS‐OIT with cognitive function over time, after adjustment for age, sex, years of education, apolipoprotein E ε4 status, presence of depression, sleep quality, chronic respiratory diseases, smoking, practice effect and follow‐up time. Subgroup analyses were also conducted.ResultBetter olfactory identification ability (i.e., increased SS‐OIT score) was associated with better performance of global cognition (MoCA‐T: β = 0.14, 95% confidence interval = 0.05‐0.24), memory (logical memory ‐ immediate and delayed theme and free recall: β = 0.06 to 0.09), executive function (trail making test‐A: β = 0.05 for baseline, ‐0.03 for interaction with follow‐up years), and verbal fluency (β = 0.08). Anosmia (SS‐OIT score ≦8) was associated with impaired memory [the lowest tertile (T1) vs. higher tertiles (T2+T3), adjusted odds ratio (aOR): 2.40 to 3.06], and verbal fluency (T1 vs. T2+T3, aOR = 2.39). After stratified analyses, the associations above remained significant in apolipoprotein E ε4 non‐carriers (MoCA‐T: β = 0.19; memory: β = 0.08 to 0.11; verbal fluency: β = 0.08), older adults without respiratory diseases (MoCA‐T: β = 0.14; memory: β = 0.06 to 0.10; verbal fluency: β = 0.10), and older adults without depression (MoCA‐T: β = 0.14; memory: β = 0.06 to 0.09; trail making test‐A: β = 0.04 for baseline, ‐0.02 for interaction with follow‐up years; verbal fluency: β = 0.09).ConclusionImpaired olfactory identification is associated with poor global or domain‐specific cognition in non‐demented older adults. Further research is required to validate our findings and clarify the underlying mechanism between anosmia and cognitive impairment.

Cognitive impairment in Neuromyelitis Optica Spectrum Disorder: A retrospective study using the Brief International cognitive Assessment for Multiple Sclerosis (BICAMS)

Background Neuromyelitis Optica Spectrum Disorder (NMOSD) is an inflammatory disease of the central nervous system. The study aimed to characterize the neuropsychological profile of NMOSD by comparing them with multiple sclerosis (MS) patients and healthy controls. Method Sixty-four participants were included:19 NMOSD, 27 MS, and 18 healthy controls. The neuropsychological protocol included the Portuguese version of Montreal Cognitive Assessment, the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), Verbal Fluency (phonemic and semantic), the Hospital Anxiety and Depression Scale, and the Expanded Disability Status Scale for clinical groups. Results NMOSD patients had significant lower cognitive performance when compared to HC mainly in information processing speed, concentration, language processing, and in executive functions (cognitive flexibility, sustained, and divided attention). No significant differences were observed between NMOSD and MS patients. Three predictors for cognitive impairment, according to BICAMS criteria, were found: depression, disease duration, and the level of disability. Conclusion The neuropsychological profile found in the present study for NMOSD is consistent with the previous findings. Information regarding the predictors of cognitive impairment in both diseases and their different associations are important for future research and for guiding interventions more suitable for the neuropsychological needs of affected patients.

Moderate-to-high Intensity Group Exercise Improves Function of Stroke Survivors (P12-8.009)

<h3>Objective:</h3> The aim of this study is to investigate the effect and feasibility of moderate-to-high intensity exercise in stroke survivors. <h3>Background:</h3> Post-stroke exercise need to be encouraged to facilitate optimal recovery and to improve both physical and mental health. However, stroke survivors are easily predisposed to sedentary lifestyle due to physical impairment and functional compromise. Moreover, many clinicians as well as patients tend to be discouraged by exercise-related risk of injury of falls or comorbidities. <h3>Design/Methods:</h3> This study is a randomized controlled trial. Subjects were randomly assigned to either intervention or control group. Subjects in intervention group completed 16 sessions of 90-minute moderate-to-high intensity group-based exercise for 8 weeks. Isometric muscle strength and grip strength of the affected and unaffected side, 10 repetition sit-to-stand test (STS10), 60 second sit-to-stand test (STS60), Short Physical Performance Battery (SPPB), multidirectional reach test, Berg’s Balance scale (BBS), 10-meter walk test, 6 minute walk test, Timed-up-and-go test, physiological cost index, Korean version of modified Barthel index, and Korean version of Montreal Cognitive Assessment (MoCA-K) were measured at baseline and postintervention. <h3>Results:</h3> Total 30 stroke survivors were enrolled in the study and 22 were randomized to group-based moderate-to-high exercise and 8 were randomzied to home-based low intensity exercise. Intervention group showed high compliance as well as high attendance rate. Adverse event was only 2 uneventful falls in 1 subject. After 8 weeks of moderate-to-high intensity group exercise, subjects showed significant improvement in isometric muscle strength of hip extensors and knee flexors and grip strength both in affected and unaffected limbs, and isometric muscle strength of affected shoulder abductor. Also, STS60, SPPB, BBS, and MoCA-K were significantly improved in the intervention group after 8-week of moderate-to-high intensity exercise. <h3>Conclusions:</h3> Moderate-to-high intensity group-based exercise is feasible and safe and improves physical and cognitive function of chronic stroke survivors. <b>Disclosure:</b> The institution of Prof. Jung has received research support from National Rehabilitation Center, Ministry of Health and Welfare, South Korea. Miss Cho has nothing to disclose. Mr. Yoon has nothing to disclose.