Version Of Montreal Cognitive Assessment Research Articles

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.

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.