Version Of Montreal Cognitive Assessment Research Articles

Could olfactory identification be a prognostic factor in detecting cognitive impairment risk in the elderly?

Aging contributes to the deterioration of the olfactory system in humans. Several studies indicate that the olfactory identification test alone may function as a screening test for olfactory dysfunction and they are more feasible to apply in clinical practice. Olfactory identification may be a predictor for cognitive impairment. Multiple studies have considered the use of odor identification as a measure to identify the conversion from normality to mild cognitive impairment or dementia. The objectives were (i) to elucidate the associations between cognitive status and olfactory identification performance in aging; (ii) understand the predictive value of olfactory capacity in identifying subjects with cognitive impairment risk; and (iii) to study how cognitive status and olfactory identification relate with other variables of wellness in aging, such as functional capabilities and clinical measures. For this purpose, a group of 149 participants (77.15 ± 7.29 years; 73 women of 76.7 ± 8 years and 76 men of 77.6 ± 6.52 years) were recruited and were subjected to a sociodemographic questionnaire, a psychological screening tool of general cognitive status, an olfactory identification evaluation, and clinical measures. The participants were divided into groups based on their cutoff scores of previous scientific reports about the Spanish version of Montreal Cognitive Assessment. Our results indicate an age-associated decline in olfactory identification ability and intensity of odor perception. The predictive ability of olfactory identification scores for the risk of mild and severe impairment is around 80%. Olfactory identification decreases with cognitive function. Performance in odor identification is associated with impairment of episodic memory and executive functions. These findings further our current understanding of the association between cognition and olfaction, and support olfactory assessment in screening those at higher risk of dementia.

Can the fNIRS-derived neural biomarker better discriminate mild cognitive impairment than a neuropsychological screening test?

Early detection of mild cognitive impairment (MCI), a pre-clinical stage of Alzheimer's disease (AD), has been highlighted as it could be beneficial to prevent progression to AD. Although prior studies on MCI screening have been conducted, the optimized detection way remain unclear yet. Recently, the potential of biomarker for MCI has gained a lot of attention due to a relatively low discriminant power of clinical screening tools. This study evaluated biomarkers for screening MCI by performing a verbal digit span task (VDST) using functional near-infrared spectroscopy (fNIRS) to measure signals from the prefrontal cortex (PFC) from a group of 84 healthy controls and 52 subjects with MCI. The concentration changes of oxy-hemoglobin (HbO) were explored during the task in subject groups. Findings revealed that significant reductions in HbO concentration were observed in the PFC in the MCI group. Specially, the mean of HbO (mHbO) in the left PFC showed the highest discriminant power for MCI, which was higher than that of the Korean version of montreal cognitive assessment (MoCA-K) widely used as a screening tool for MCI. Furthermore, the mHbO in the PFC during the VDST was identified to be significantly correlated to the MoCA-K scores. These findings shed new light on the feasibility and superiority of fNIRS-derived neural biomarker for screening MCI.

Transient cognitive impairment in the acute phase of stroke – prevalence, risk factors and influence on long-term prognosis in population of patients with stroke (research study – part of the PROPOLIS study)

BackgroundCognitive impairment is a common complication of the acute phase of stroke, which can be transient and resolve while still in the hospital. This study evaluated the prevalence and risk factors for transient cognitive impairment and their impact on long-term prognosis in a population of acute-phase stroke patients.MethodsConsecutive patients admitted to a stroke unit with acute stroke or transient ischemic attack were screened twice for cognitive impairment using the parallel version of Montreal Cognitive Assessment: the first time between the first and third day and the second time between the fourth and seventh day of hospitalization. If the second test score increased by two or more points, transient cognitive impairment was diagnosed. Patients were scheduled for follow-up visits three and 12 months after stroke. Outcome assessment included place of discharge, current functional status, dementia, or death.ResultsFour hundred forty-seven patients were included in the study, 234 (52.35%) were diagnosed with transient cognitive impairment. Delirium was the only independent risk factor for transient cognitive impairment (OR 2.417, 95%CI 1.096–5.333, p = 0.029). In the analysis of effects on three- and twelve-month prognosis, patients with transient cognitive impairment had a lower risk of hospital or institution stay 3 months after stroke compared with patients with permanent cognitive impairment (OR 0.396, 95%CI 0.217–0.723, p = 0.003). There was no significant effect on mortality, disability or risk of dementia.ConclusionsTransient cognitive impairment, which often occurs in the acute phase of stroke, does not increase the risk of long-term complications.

TRANSLATION, CULTURALADAPTATION AND VALIDATION OF GUJARATI VERSION OF MONTREAL COGNITIVE ASSESSMENT (MOCA) IN OLDER ADULTS

Context: Mild cognitive impairment (MCI) is a term used to describe a level of decline in cognition which is seen as an intermediate stage between normal ageing and dementia in older adults. The Montreal Cognitive Assessment (MoCA) is a useful screening tool validated for MCI. It has been translated in various languages other than English, including various Indian languages such as Hindi, Malayalam, etc. Aims: For the cognitive screening of Gujarati speaking older adults, the Gujarati version of MoCA is required. The present study, therefore, aimed to develop Gujarati version of the MoCA and investigate its validity and reliability for screening MCI in gujarati speaking older adults. Settings and Design: It is a cross sectional study design. The scale was translated in Gujarati as per suggested guidelines and its psychometric properties were evaluated. Qualitative and quantitative validation through expert review was done and content validity Index (CVI) was calculated. Study participants were 30 older adults. Two estimators of reliability i.e., internal consistency reliability and test retest reliability were evaluated. Statistical analysis and results: The content validity was established through qualitative reviews and with I-CVI of each item on scale more than or equal to 0.78 and SCVI/Ave = 0.93. The scale has good internal consistency, Cronbach's alpha (α) =0.74 and high test-retest reliability, intra class correlation coefcient (ICC) =0.87. Conclusions:The Gujarati translated version of MoCAis a valid and reliable tool for detecting mild cognitive impairment in older adults.

Association of ambient air pollutants and cognitive impairment in a community‐dwelling elderly population: A four‐year cohort study

AbstractBackgroundLong‐term ambient air pollution has known to affect cognitive function. However, limited studies investigated the relationship between co‐exposure to ambient air pollutants and cognitive functions in non‐demented older adults. Therefore, this study aimed to explore this association in a community‐based prospective cohort study.MethodThis four‐year prospective cohort study is part of the ongoing Taiwan Initiative Geriatric Epidemiological Research (TIGER, 2011‐present) and included 286 non‐demented older adults between 2015‐2019. Ambient air pollution data were collected from 29 monitoring stations from Taiwan Environmental Protection Administration (TEPA) between 1994 and 2019. Global and domain‐specific (memory, attention, executive function, and language) cognitive functions were assessed using the Taiwanese version of Montreal Cognitive Assessment (MoCA‐T) and a battery of neuropsychological tests. The generalized linear mixed models were used to evaluate the association of co‐exposure to air pollutants with cognitive function adjusting for important covariates. Furthermore, we conducted stratified analyses by olfaction, known as an early marker of dementia.ResultExcept for PM2.5, the annual average exposure of the other five pollutants was below the TEPA standards. A 25‐year high‐level exposure of NO2 (≥ 27.7 ppb) was associated with good performance executive function (β = 0.25) over four years. For joint effect, high‐level (the highest tertile) PM2.5 with low to medium concentration level of NO2, CO, or SO2 were significantly associated with the poor performance of memory (β = ‐0.39 to ‐0.35). Similarly, high‐level PM2.5 with low to medium concentration level of NO2, PM10 with O3 were significantly associated with poor executive function (β = ‐0.28 to ‐0.19). In participants with normal olfaction, high co‐exposure level to PM2.5 and PM10, with CO, SO2, O3, and NO2 was significantly associated with poor memory and executive function (β = ‐0.55 to ‐0.30). No significant associations were found in participants with abnormal olfaction.ConclusionLong‐term low to medium‐level co‐exposure to NO2, CO, or SO2 and high‐level PM2.5 was associated with poor memory; co‐exposure to O3 with PM10 and co‐exposure to NO2 with PM2.5 was associated with poor executive function. A revision on exposure standards shall be considered to protect older adults at the preclinical phase of dementia.

Effects of exercise intensity and frequency on improving cognitive performance in middle-aged and older adults with mild cognitive impairment: A pilot randomized controlled trial on the minimum physical activity recommendation from WHO.

Background: The World Health Organization physical activity guidelines recommend adults and older adults to accumulate at least 150–300 min of moderate or 75–150 min of vigorous aerobic-type physical activity weekly for health benefits including improvements of cognitive performance. However, the optimal exercise intensity and frequency for maximizing the cognitive benefits remain unclear. Purpose: We conducted a parallel, assessor-blinded, pilot randomized controlled trial to evaluate the effectiveness of different intensities and frequencies of the WHO-recommended minimal volume of aerobic-type physical activity on improving cognitive performance in middle-aged and older adults with mild cognitive impairment (MCI). Methods: Participants were randomly allocated to the stretching exercise control group (CON), once-a-week and thrice-a-week moderate-intensity walking groups (M1 and M3), and once-a-week and thrice-a-week vigorous-intensity walking groups (V1 and V3). Intervention duration was 12 weeks. The primary outcome was global cognitive performance assessed by the Hong Kong version of Montreal Cognitive Assessment. Secondary outcomes were self-report and objective cognitive performances, mental health, sleep quality, and cardiorespiratory fitness. Results: Thirty-seven participants completed the study (CON: n = 7, M1: n = 7, M3: n = 7, V1: n = 8, V3: n = 8). Participants in all four walking exercise groups demonstrated significant improvements in global cognitive performance assessed by the Hong Kong version of the Montreal Cognitive Assessment after the intervention when compared to CON (p < 0.001). The walking exercise interventions also significantly mitigated the anxiety severity (p < 0.005) and improved the cardiorespiratory fitness (p < 0.05) of the participants in the walking exercise groups. Conclusion: 150-min moderate- or 75-min vigorous-intensity walking exercise performed once- or thrice-weekly showed similar effects on improving cognitive performance in middle-aged and older adults with MCI. The 12-week walking exercise interventions also reduced anxiety severity and improved cardiorespiratory fitness of the participants. Clinical Trial Registration: clinicaltrials.gov, identifier NCT04515563

MoCA 7.1: Multicenter Validation of the First Italian Version of Montreal Cognitive Assessment.

Background:The early detection of neurocognitive disorders, especially when mild, is a key issue of health care systems including the Italian Dementia National Plan. The Mini-Mental State Examination (MMSE), i.e., the reference screening tool for dementia in Italian Memory Clinics, has low sensitivity in detecting mild cognitive impairment (MCI) or mild dementia.Objective:Availability of a 10-minute screening test sensitive to MCI and mild dementia, such as the Montreal Cognitive Assessment (MoCA), is relevant in the field. This study presents initial validity and reliability data for the Italian version of MoCA 7.1 that is being collected as part of a large ongoing longitudinal study to evaluate the rate of incident MCI and dementia in older adults.Methods:MoCA 7.1 and MMSE were administered to cognitive impaired patients (n = 469; 214 with MCI, 255 with dementia; mean age: 75.5; 52% females,) and healthy older adults (n = 123, mean age: 69.7, 64 % females).Results:Test-retest (0.945, p < 0.001) and inter-rater (0.999, p < 0.001) reliability of MoCA 7.1, assessed on randomly selected participants with normal cognition, MCI, dementia, were significant. MoCA 7.1 showed adequate sensitivity (95.3%) and specificity (84.5%) in detecting MCI compared to MMSE (sensitivity: 53.8%; specificity: 87.5%). The Area Under the Curve of MoCA 7.1 was significantly greater than that of MMSE (0.963 versus 0.742). MoCA 7.1 showed similar results in detecting both MCI and dementia.Conclusion:MoCA 7.1 is a reliable and useful tool that can aid in the diagnosis of MCI and dementia in the Italian population.

Correlations between COMT polymorphism and brain structure and cognition in elderly subjects: An observational study.

The catechol-O-methyltransferase (COMT) gene has been noted to play an important role in individual variations in the aging process. We investigated whether COMT polymorphism could influence cognition related to white matter networks. More specifically, we examined whether methionine (Met) allele loading is associated with better individual cognitive performance. Thirty-four healthy elderly participants were recruited; each participant's COMT genotype was determined, and Korean version of Montreal Cognitive Assessment scores and a diffusion tensor image were obtained for all participants. The Met carrier group showed significantly lower mean diffusivity, axial diffusivity, and radial diffusivity values for the right hippocampus, thalamus, uncinate fasciculus, and left caudate nucleus than the valine homozygote group. The Met carrier group also scored higher for executive function and attention on the Korean version of Montreal Cognitive Assessment. Based on these results, we can assume that the COMT Met allele has a protective effect on cognitive decline contributing to individual differences in cognitive function in late life period.

A Randomized Pilot Study of a Cognitive Intervention for the Elderly with Mild Cognitive Impairment

The extension of life increased the prevalence of many non-communicable and chronic diseases, including neurodegenerative diseases. Identifying Mild Cognitive Impairment (MCI) in the early stage would allow to providing intervention at early that may reduce the progression of Alzheimer’s and other related cognitive disorders. The present study aimed to examine the effects of a new Indian adapted Motivationally Enhanced Compensatory Cognitive Training program for the elderly with MCI (IAME-CCT-MCI). This is a 4-week intervention program, utilized randomized pilot study with single-group pretest-posttest design conducted with 32 elderly participants screened with MCI using Tamil version of Montreal Cognitive Assessment (T-MoCA). The primary outcome measure was T-MoCA used to measure cognitive impairment, followed by PGI Battery for Assessment of Mental Efficiency in the Elderly (PGI-BAMEE). PGI Memory Scale (PGI-MS) was used to measure as the secondary outcome. The PGI-BAMEE consists of four subtests to assess mental efficiency, general information, orientation towards time and place, perceptuo-motor functions, and depressive symptomology. Whereas, the PGI-MS contains a detailed assessment of ten types of memory, viz., remote memory, recent memory, attention-concentration, delayed recall, immediate recall, verbal retention for similar pairs, verbal retention for dissimilar pairs, visual retention, and recognition. Through the paired t-test analysis, the IAME-CCT-MCI intervention program significantly improved the T-MoCA score and PGI-Memory Scale scores. The subtests of PGI-BAMEE were also significantly improved during the immediate pretest-posttest period. The findings provides preliminary support for the potential efficacy of the IAME-CCT-MCI cognitive intervention when delivered to the elderly with MCI.

IDF21-0471 Study on Cognitive impairment in patients with type 2 diabetes mellitus

Background: Cognitive assessment in diabetic patients is useful for early detection of diabetes dependent cognitive dysfunction (DDCD). The present study evaluated cognitive impairment using Malayalam version of Montreal Cognitive Assessment (M‐MoCA) in patients with diabetes and compared it with the score in normal subjects.

Aquaporin-4, Connexin-30, and Connexin-43 as Biomarkers for Decreased Objective Sleep Quality and/or Cognition Dysfunction in Patients With Chronic Insomnia Disorder.

ObjectivesTo examine serum concentrations of aquaporin-4 (AQP4), connexin-30 (CX30), connexin-43 (CX43), and their correlations with cognitive function in the patients with chronic insomnia disorder (CID).MethodsWe enrolled 76 subjects with CID and 32 healthy controls (HCs). Serum levels of AQP4, CX30, and CX43 were measured by enzyme-linked immunosorbent assays. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and polysomnography, and mood was evaluated with 17-item Hamilton Depression Rating Scale and 14-item Hamilton Anxiety Rating Scale. Cognitive function was evaluated by the Chinese-Beijing Version of Montreal Cognitive Assessment (MoCA-C) and Nine Box Maze Test.ResultsThe serum levels of AQP4, CX43, and CX30 were significantly reduced in the CID group compared to the HCs. Partial correlation analysis showed that the biomarkers showed no significant correlations with PSQI score, AHI, ODI and TS90, but AQP4, CX43, and CX30 were positively associated with the percentage and total time of slow wave sleep in the CID group. Serum concentrations of AQP4 and CX30 were positively associated with MoCA-C score in the CID group, and AQP4 level negatively correlated with spatial working memory errors.ConclusionsSubjects with CID patients have decreased serum levels of AQP4, CX30, and CX43 indicating astrocyte dysfunction, which could be related to poor objective sleep quality and/or cognition dysfunction.

Montreal Cognitive Assessment: Exploring the impact of demographic variables, internal consistency reliability and discriminant validity in a South African sample

The Montreal Cognitive Assessment (MoCA) is widely used to screen for cognitive impairment and has shown a good capacity to identify cognitive impairment. However, its psychometric properties have not been sufficiently studied in the South African context. Therefore, this study aimed to investigate (1) the influence of demographic variables (age, years of education, and gender) on total MoCA scores; (2) the internal consistency reliability of the test and (3) the discriminant validity of the total MoCA score. This study analysed secondary quantitative data, utilising a cross-sectional, between-subjects design. All participants completed the English MoCA version 8.1. The control sample (n = 89) included healthy South African adults who speak English as a second or third language and who have been educated in public schools. The clinical sample (n = 83) included patients with human immunodeficiency virus (HIV) and a comorbid disorder, either psychiatric (n = 70) or neurocognitive (n = 13). Total MoCA scores were significantly correlated with years of education (p 0.001) and age (p = 0.007) but not gender. Cronbach’s alpha was 0.64 revealing moderate internal consistency. The total MoCA score was not a significant predictor of diagnostic status, indicating poor discriminant validity of the MoCA in this sample. The MoCA appears not to be a useful screening or diagnostic tool in samples with similar characteristics.

Application of Repetitive Transcranial Magnetic Stimulation over the Dorsolateral Prefrontal Cortex in Alzheimer's Disease: A Pilot Study.

Repetitive transcranial magnetic stimulation (rTMS) is reportedly a potential tool to understand the neural network; however, the pathophysiological mechanisms underlying cognitive function change remain unclear. This study aimed to explore the cognitive function changes by rTMS over the bilateral dorsolateral prefrontal cortex (DLPFC) in Alzheimer’s disease (AD). We evaluated the feasibility of rTMS application for mild cognitive dysfunction in patients with AD in an open-label trial (UMIN000027013). An rTMS session involved 15 trains at 120% resting motor threshold on each side (40 pulses/train at 10 Hz). Efficacy outcome measures were changes from baseline in cognitive function, assessed based on the AD Assessment Scale-cognitive subscale, Mini-Mental State Examination, Japanese version of Montreal Cognitive Assessment (MoCA-J), Behavioral and Psychological Symptom of Dementia, and Instrumental Activity of Daily Living scores. Sixteen patients with AD underwent five daily sessions of high-frequency rTMS over the bilateral DLPFC for 2 weeks. All participants completed the study; no major adverse effects were recorded. The MoCA-J score increased by 1.4 points (±0.15%) following 2 weeks of stimulation. At 1 month following rTMS cessation, all cognitive functional scores returned to the original state. Our findings suggest that the DLPFC plays an important role in the neural network in AD.

Electroacupuncture for Cancer-Related Cognitive Impairment: A Clinical Feasibility Study.

Background:Cancer-related cognitive impairment (CRCI) is a significant problem for cancer patients, as the number of cancer survivors experiencing cognitive impairments is increasing in the absence of standard treatment. There have been attempts to improve the cognitive function of patients with cancer using acupuncture; however, no studies have been conducted using electroacupuncture. Thus, we designed a preliminary study to investigate the feasibility of a clinical trial using electroacupuncture in CRCI patients.Methods:We conducted a single-arm, pilot, clinical trial to investigate the feasibility of a study protocol for further large-scale clinical trials of electroacupuncture in CRCI patients. All participants were treated with electroacupuncture twice a week for 30 minutes at a time, for 8 weeks on acupoints GV20, GV24, EX-HN1, and GB20, HT7, PC6, and KI3. Both subjective and objective outcomes of cognitive function, quality of life (QoL), and psychological factors were measured in all participants at baseline, week 4, 8, and 12. For safety assessment, vital signs, laboratory examinations, and adverse events (AEs) were observed throughout the trial.Results:A total of 12 participants were enrolled at Daejeon and Dunsan Korean Medicine Hospital of Daejeon University from 21 April 2017 to 31 January 2018. After 8 weeks of treatment, electroacupuncture significantly improved both subjective and objective cognitive outcomes, including the perceived cognitive impairments scale of the Functional Assessment of Cancer Therapy-Cognitive Function, QoL scale of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire-C30, Korean version of Montreal Cognitive Assessment, Boston Naming Test, Seoul Verbal Learning Test, and Rey Complex Figure Test. During the entire trial period, 19 AEs were observed, with no serious AEs. Additionally, it was found that all feasibility outcomes, including recruitment, completion, and adherence rates, achieved successful results as the ratio exceeded 0.8.Conclusion:Our study results revealed that electroacupuncture improved cognitive complaints in cancer patients, and we expect electroacupuncture to be a safe and effective management therapy for CRCI patients. These feasibility trial results will be used as preliminary data for future randomized controlled clinical trials.Trial registration number:Korean Clinical Trial Registry (KCT0002168).

Evaluation of Vascular Cognitive Impairment Using the ICMR-Neuro Cognitive Tool Box (ICMR-NCTB) in a Stroke Cohort from India.

Vascular cognitive impairment (VCI) presents with a spectrum of cognitive impairment due to stroke and poses a huge socioeconomic burden especially in low middle-income countries. There is a critical need for early recognition and identification of VCI patients. Therefore, we developed and validated culturally appropriate neuropsychological instruments, the ICMR-Neuro Cognitive Tool-Box (ICMR-NCTB) and Montreal Cognitive Assessment (MoCA) to diagnose vascular MCI and dementia in the Indian context. A total of 181 participants: 59 normal cognition, 25 stroke with normal cognition, 46 vascular MCI (VaMCI) and 51 vascular dementia (VaD) were recruited for the study. The ICMR-NCTB and MoCA were administered to patients with VCI and major cognitive domains were evaluated. The ICMR-NCTB was found to have good internal reliability in VaMCI and VaD. The sensitivity of the ICMR-NCTB to detect VaMCI and VaD ranged from 70.8% to 72.9% and 75.9% to 79.7%, respectively, and the specificity for VaMCI and VaD ranged from 84.8% to 86.1% and 82.5% to 85.2%, respectively. The MoCA had excellent sensitivity and specificity to detect VaMCI and VaD at ideal cut-off scores. The ICMR-NCTB is a valid neuropsychological toolbox that can be used for comprehensive cognitive assessment and diagnosis of VCI in India. In addition, the Indian version of MoCA is more adept as a screening instrument to detect VCI due to its high sensitivity. The ICMR-NCTB will aid in early detection and management of many patients, thereby reducing the burden of vascular MCI and dementia in India.

Association of dual impairment in physical performance and cognition with cognitive change over two years in older adults

AbstractBackgroundDementia has a great impact in the ageing world. Much of the growing will happen in low and middle income regions, especially in Asia and Africa. Identifying the target population before clinical symptoms is most important for early intervention of preventing dementia. Recently, the concept of motoric cognitive risk syndrome has been introduced. However, the analogue of this syndrome is poorly evaluated. Therefore, we aim to explore the association of dual impairment in physical performance and cognition with cognitive impairment.MethodThis cohort study is part of the ongoing Taiwan Initiative of Geriatric Epidemiological Research. A total of 315 participants aged 65 and older were identified between 2015 and 2017 at the University Taiwan University hospital with a two‐ year follow‐up (2017‐2019). Dual impairment were defined as the concurrence of slow gait speed (&lt; 1 m/s) and poor cognitive domain or low grip strength (&lt; 28kg for men and &lt; 18kg for women) and poor cognitive domain. Cognitive impairment was defined as the lowest tertile of the change of Taiwanese version of Montreal Cognitive Assessment (MoCA‐T) over 2 years. Logistic regression models were used to evaluate the association between dual impairment and the change of cognitive function adjusted for age, sex, education, and apolipoprotein e4 status.ResultThe mean age of this population was 75.17 years old. Forty‐eight participants (15.24%) with dual impairment of low handgrip strength and low verbal fluency were identified. Multivariable analyses showed that dual impairment of low grip strength and low verbal fluency increased the risk of cognitive decline [adjusted odds ratios (aOR)=2.42, 95% confidence interval (CI)=1.20−4.88]. However, dual impairment of slow gait speed and low verbal fluency were not associated with cognitive decline (aOR=1.62, 95% CI=0.94–2.78).ConclusionOur findings indicate that older adults with dual impairment of low grip strength and low verbal fluency were at a higher risk of cognitive impairment, which emphasizes the importance of complexity in pre‐dementia syndrome. Further research is warranted to clarity the underlying mechanisms of cognitive impairment and opportunities for early intervention.

Association between patterns of multiple chronic conditions and cognitive impairment in community‐dwelling older adults in Taiwan

AbstractBackgroundPrevious studies mainly explored the effect of single chronic disease on cognition. However, limited focuses have been put on the co‐existence of diseases, symptoms, and functional impairments and how their combinations affect older adults. This study aimed to identify sex‐specific patterns of multiple chronic conditions (MCC) and to relate them with cognitive impairment in a six‐year cohort study.MethodWe included 516 non‐demented older adults at baseline (2011‐2013) from the ongoing Taiwan Initiative for Geriatric Epidemiological Research, with three biennially follow‐ups. The global and domain‐specific (memory, attention, executive function, and language) cognition were assessed using the Taiwanese version of Montreal Cognitive Assessment and a battery of neuropsychological tests. Exploratory factor analysis was utilized to identify patterns of 33 self‐reported chronic conditions. For each pattern, the factor score of each participant was calculated by summing up the product of the status of a specific condition and its corresponding factor loadings. The generalized linear mixed model was utilized to examine the association between MCC patterns and cognitive performance adjusted for age, years of education, apolipoprotein E ε4 status, cigarette smoking, alcohol consumption, and years of follow‐up.ResultThree MCC patterns were identified for each sex, which included (1) Mental‐Exhaustion, (2) Cancer‐Thyroid, and (3) Frailty‐Cardiometabolic patterns in females; and (1) Mental‐Skeletal, (2) Cardiometabolic‐Renal, and (3) Thyroid‐Prostate patterns in males. Among females, higher factor scores of the Mental‐Exhaustion and Frailty‐Cardiometabolic patterns were significantly associated with poor performance of global cognition (β: ‐0.16), logical memory (β:‐0.11 to ‐0.07) and executive function (β:‐0.32). Among males, higher factor scores of the Mental‐Skeletal and Thyroid‐Prostate patterns were significantly associated with poor performance of memory (β:‐0.11) and attention (β:‐0.13). In contrast, a protective effect was observed between Cancer‐Thyroid pattern and memory (β:0.12 to 0.13) or attention (β:0.16), as well as between Cardiometabolic‐Renal pattern and verbal fluency (β:0.15).ConclusionMCC patterns identified in this Asian population were different from those observed in western countries, and these patterns were associated with poor global or domain‐specific cognition. Further research was required to validate our findings and to clarify the underlying mechanism between MCC and cognitive impairment.

The association between sleep and cognitive pre‐frailty in community‐dwelling older adults: A two‐year cohort study

AbstractBackgroundSleep has been related to cognition and frailty, respectively. Cognitive frailty, the co‐existence of mild cognitive impairment (MCI) and physical frailty, has been proposed in 2013 and its relation with sleep remains unclear. To predict cognitive frailty in the preclinical stage, this study aimed to explore the relationship between sleep and cognitive pre‐frailty in non‐demented older adults.MethodThis study is part of the ongoing Taiwan Initiative for Geriatric Epidemiological Research. After exclusion of participants with specific conditions and loss to follow‐up, 324 older adults from the senior health checkup program of National Taiwan University Hospital were included at baseline (2015‐2017). Outcome of this study was the coexistence of MCI and pre‐frailty (cognitive pre‐frailty) and were assessed at baseline and two‐year follow‐up (2017‐2019). Global and domain‐specific cognition were assessed by Taiwanese version of Montreal Cognitive Assessment and a battery of neuropsychological tests, respectively. Pre‐frailty was defined as the existence of one or two out of five conditions using modified Fried’s frailty phenotype. Sleep variables was available at baseline, which included global sleep quality [assessed by Pittsburgh Sleep Quality Index (PSQI), score range: 0‐21)], sleep duration (in hours), and daytime sleepiness (assessed by Epworth Sleepiness Scale, ESS, score range: 0‐24). Generalized linear mixed model was utilized to assess the association between sleep and cognitive pre‐frailty over 2 years adjusting for age, sex, years of education and other important covariates.ResultParticipants’ mean age was 75.2 years at baseline. Prevalence of cognitive pre‐frailty was 1.85% at baseline and 2.55% at two‐year follow‐up. Instead of a linear relationship, we found a non‐linear association between sleep and cognition. When mean PSQI score and mean sleep duration deviated from the corresponding sample mean (PSQI score: 6.3; sleep duration: 6.2 hours), the severity of cognitive pre‐frailty increased [quadratic PSQI score: adjusted odds ratio (aOR)=1.02, 95% confidence interval (CI)=0.01‐0.04; quadratic sleep duration: aOR=1.15, 95% CI=0.04‐0.23]. No significant association was found between daytime sleepiness and cognitive pre‐frailty.ConclusionThis study found a nonlinear association of global sleep quality and sleep duration with cognitive pre‐frailty over two years in the community‐dwelling older adults.

Cognitive rehabilitation in Covid‐19 patients with dementia of the Alzheimer’s type

BackgroundDementia of Alzheimer’s type has been characterized as marked deterioration in cognitive processes. The impairment has been progressive and could not be reverse because of its irreversible nature. However, there are some therapies or intervention like Cognitive Rehabilitation which have been proved to be effective for DAT in enhancing the patients' abilities to manage for decreased cognitive functioning. Recent scenario brings an attention on differences in cognitive rehabilitation in dementia of Alzheimer’s disease patients with Covid 19 positive (experimental group) and dementia of Alzheimer’s disease patients with Covid 19 negative (control group).MethodThe present study has been an attempt to compare the effect of video games in cognitive rehabilitation in experimental and control group by incorporating a definite time, frequency and duration for video games in their activities of daily living on 2 cases each for experimental and control group who were matched on Hindi version of Montreal Cognitive Assessment (MoCA).ResultThe findings revealed that the score of MoCA has been increased by mean of 1.5 point in dementia of Alzheimer’s disease patients with Covid 19 positive and mean of 2.5 points in dementia of Alzheimer’s disease patients with Covid 19 negative.ConclusionThe cognitive rehabilitation using video games has been effective in both experimental and control group, however, it was better in control group as compared to experimental group.

Relationship Among Homocysteine, Inflammation and Cognitive Impairment in Patients with Acute Ischemic Stroke and Transient Ischemic Attack.

PurposeTo investigate the associations among homocysteine (Hcy), inflammation and cognitive impairment in patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA).Patients and MethodsPatients included were enrolled from a subgroup of China National Stroke Registry-III (CNSR-III). We used a Chinese version of Montreal Cognitive Assessment (MoCA) to screen for cognitive impairment. We used high-sensitivity C-reactive protein (hsCRP) level to reflect the inflammatory status, which was assessed at baseline together with Hcy concentration. The primary outcome was the incidence of post-stroke cognitive impairment (PSCI) at 3 months after AIS and TIA. Multivariable logistic regression analysis was used to evaluate the correlation between Hcy and hsCRP, and their effects on cognition.ResultsWe enrolled 1466 patients with a median age of 62 (54–70) years old, including 895 (61.05%) patients with elevated Hcy levels, 466 (31.79%) with increased hsCRP concentrations, and 755 (51.50%) with PSCI. In the group of patients with hyperhomocysteinemia (HHcy), higher hsCRP levels were related to cognitive impairment, whether or not adjusted for multiple potential confounders (crude OR: 1.71,95% CI: 1.29–2.27, p < 0.01; adjusted OR: 1.42, 95% CI: 1.04–1.93, p = 0.03). No significant interactions for the impact on PSCI were observed in subgroups stratified by age, sex or Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification (P interaction > 0.05 for all).ConclusionHigh inflammatory levels increase the risk of cognitive impairment in HHcy patients after AIS and TIA.