207 - Cognitive deficits in specific settings: challenges for the assessment and disease management

General synopsis of the Symposium: Cognitive impairment is an important geriatric syndrome. As the global population ages exponentially, the prevalence of cognitive impairment and dementia is increasing, and mental status assessment is key in the evaluation of older adults. However, there are several pitfalls during cognitive testing and special clinical situations that demands a more in-depth knowledge and attention from the examiner. The overall objective of this symposium is to show strategies and particularities of cognitive assessment in different settings (in the clinic, inside the hospital) and clinical scenarios (early onset impairment, mental illness comorbidity).

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Elevated Inflammatory Markers and Arterial Stiffening Exacerbate Tau but Not Amyloid Pathology in Older Adults with Mild Cognitive Impairment

Journal of Alzheimer s Disease ◽

10.3233/jad-201382 ◽

2021 ◽

pp. 1-13

Author(s):

Alexandra L. Clark ◽

Alexandra J. Weigand ◽

Kelsey R. Thomas ◽

Seraphina K. Solders ◽

Lisa Delano-Wood ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Inflammatory Markers ◽

Memory Performance ◽

Cognitive Testing ◽

Interactive Effects ◽

Protein Biomarkers ◽

Age Related ◽

T Tau

Background: Age-related cerebrovascular and neuroinflammatory processes have been independently identified as key mechanisms of Alzheimer’s disease (AD), although their interactive effects have yet to be fully examined. Objective: The current study examined 1) the influence of pulse pressure (PP) and inflammatory markers on AD protein levels and 2) links between protein biomarkers and cognitive function in older adults with and without mild cognitive impairment (MCI). Methods: This study included 218 ADNI (81 cognitively normal [CN], 137 MCI) participants who underwent lumbar punctures, apolipoprotein E (APOE) genotyping, and cognitive testing. Cerebrospinal (CSF) levels of eight pro-inflammatory markers were used to create an inflammation composite, and amyloid-beta 1–42 (Aβ 42), phosphorylated tau (p-tau), and total tau (t-tau) were quantified. Results: Multiple regression analyses controlling for age, education, and APOE ɛ4 genotype revealed significant PP x inflammation interactions for t-tau (B = 0.88, p = 0.01) and p-tau (B = 0.84, p = 0.02); higher inflammation was associated with higher levels of tau within the MCI group. However, within the CN group, analyses revealed a significant PP x inflammation interaction for Aβ 42 (B = –1.01, p = 0.02); greater inflammation was associated with higher levels of Aβ 42 (indicative of lower cerebral amyloid burden) in those with lower PP. Finally, higher levels of tau were associated with poorer memory performance within the MCI group only (p s < 0.05). Conclusion: PP and inflammation exert differential effects on AD CSF proteins and provide evidence that vascular risk is associated with greater AD pathology across our sample of CN and MCI older adults.

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A Modified CAIDE Risk Score as a Screening Tool for Cognitive Impairment in Older Adults

Journal of Alzheimer s Disease ◽

10.3233/jad-210269 ◽

2021 ◽

pp. 1-14

Author(s):

Magdalena I. Tolea ◽

Jaeyeong Heo ◽

Stephanie Chrisphonte ◽

James E. Galvin

Keyword(s):

Risk Factors ◽

Older Adults ◽

Cognitive Impairment ◽

Risk Score ◽

Clinical Sample ◽

Community Sample ◽

Community Dwelling ◽

Cognitive Testing ◽

Risk Scores ◽

Predictive Values

Background: Although an efficacious dementia-risk score system, Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) was derived using midlife risk factors in a population with low educational attainment that does not reflect today’s US population, and requires laboratory biomarkers, which are not always available. Objective: Develop and validate a modified CAIDE (mCAIDE) system and test its ability to predict presence, severity, and etiology of cognitive impairment in older adults. Methods: Population consisted of 449 participants in dementia research (N = 230; community sample; 67.9±10.0 years old, 29.6%male, 13.7±4.1 years education) or receiving dementia clinical services (N = 219; clinical sample; 74.3±9.8 years old, 50.2%male, 15.5±2.6 years education). The mCAIDE, which includes self-reported and performance-based rather than blood-derived measures, was developed in the community sample and tested in the independent clinical sample. Validity against Framingham, Hachinski, and CAIDE risk scores was assessed. Results: Higher mCAIDE quartiles were associated with lower performance on global and domain-specific cognitive tests. Each one-point increase in mCAIDE increased the odds of mild cognitive impairment (MCI) by up to 65%, those of AD by 69%, and those for non-AD dementia by > 85%, with highest scores in cases with vascular etiologies. Being in the highest mCAIDE risk group improved ability to discriminate dementia from MCI and controls and MCI from controls, with a cut-off of ≥7 points offering the highest sensitivity, specificity, and positive and negative predictive values. Conclusion: mCAIDE is a robust indicator of cognitive impairment in community-dwelling seniors, which can discriminate well between dementia severity including MCI versus controls. The mCAIDE may be a valuable tool for case ascertainment in research studies, helping flag primary care patients for cognitive testing, and identify those in need of lifestyle interventions for symptomatic control.

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Can Virtual Assistants Perform Cognitive Assessment in Older Adults? A Review

Medicina ◽

10.3390/medicina57121310 ◽

2021 ◽

Vol 57 (12) ◽

pp. 1310

Author(s):

Carmen Moret-Tatay ◽

Isabel Iborra-Marmolejo ◽

María José Jorques-Infante ◽

José Vicente Esteve-Rodrigo ◽

Carla H. A. Schwanke ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Language Processing ◽

Cognitive Assessment ◽

Chronic Conditions ◽

Community Dwelling ◽

Screening Process ◽

Digital Devices ◽

The Given ◽

Community Dwelling Older Adults

Community-dwelling older adults have raised the scientific community’s interest during the COVID-19 era as their chronic conditions might be aggravated by the consequences of confinement. Digital devices in this field to monitor cognitive impairment are an emerging reality of an innovative nature. However, some groups may not have benefited from these developments as much as, for example, younger people. The aim of this manuscript is to carry out a review on the development of digital devices, and specifically virtual assistants, for the detection of cognitive impairment in older adults. After a screening process, eight studies were found under the given criteria, and this number was even smaller for those using virtual assistants. Given the opportunities offered by virtual assistants through techniques such as natural language processing, it seems imperative to take advantage of this opportunity for groups such as older adults.

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Refining sleep measurement using the Motionwatch8©: How many days of monitoring do we need to get reliable estimates of sleep quality for older adults with Mild Cognitive Impairment?

10.21203/rs.2.20676/v2 ◽

2020 ◽

Author(s):

Ryan S. Falck ◽

Cindy K. Barha ◽

Patrick C.Y. Chan ◽

Teresa Liu-Ambrose

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Sleep Duration ◽

Older Adult ◽

Cognitive Assessment ◽

Cognitive Status ◽

Field Methods ◽

Sleep Measurement ◽

Reliability Coefficients

Abstract Background Mild cognitive impairment (MCI) is a transition stage between healthy cognition and dementia, and is linked to poorer sleep. Objective, reliable, and low-burden field methods to measure older adult sleep are also currently needed. The MotionWatch8© (MW8) wrist-worn actigraph provides estimates of sleep with 14 days of observation; however, there may be underlying differences in the reliability of sleep estimates based on MCI status. We therefore investigated the number of MW8 monitoring days required to estimate sleep in older adults with MCI and without. Methods Older adults (55+ years; N=151) wore the MW8 for ≥14 days. The Montreal Cognitive Assessment was used to categorize participants with probable MCI (scores of <26/30) and participants without MCI (≥26/30). We calculated intra-class reliability coefficients for 1-, 7-, and 14-days of wear-time, and performed Spearman-Brown predictions to determine the number of monitoring days needed for an ICC=0.80. Results Older adults with MCI were older ( p <0.01), more likely to be male ( p =0.03), and had shorter sleep duration ( p <0.01). Spearman-Brown analyses indicated that the number of monitoring days needed for an ICC=0.80 in older adults with probable MCI was 7 days for sleep duration, 4 days for fragmentation, and 4 days for efficiency; adults without MCI required 4 days for duration, 6 days for fragmentation, and 3 days for efficiency. Conclusions Our results indicate that while the reliability of MW8 estimates of sleep differs based on cognitive status, 7 days of MW8 monitoring provides reliable estimates of sleep for adults with MCI and those without.

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Effect of Brain Training Game on Mild Cognitive Impairment (MCI) in Older Adults

10.53350/pjmhs211592272 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2272-2275

Author(s):

Hafsah Arshad ◽

Kinza Anwar ◽

Hafsah Gul Khattak ◽

Imran Amjad ◽

Yaser Majeed

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Abilities ◽

Cognitive Assessment ◽

Verbal Fluency ◽

Sampling Technique ◽

Montreal Cognitive Assessment ◽

Brain Training ◽

Neurocognitive Functions

Aim: To determine effects of Kinect- based games on neurocognitive functions in older adults with mild cognitive impairment. Methodology: A quasi experimental pre-post trail was conducted on 18 mild cognitive impairment (MCI) older adults. The subjects were recruited to access cognitive impairment through purposive sampling technique. The inclusion criteria were elderly aged ≥ 50 years, both genders, able to read and write, whereas older adults with severe cognitive impairments, neurological disorders and un controlled comorbidities were excluded. Brain training was provided for 30 minutes with 5-minute warm-up time and 5-minute cool-down time for 6 weeks. Blind assessor measured readings at baseline and after six weeks. The outcome measures were Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MOCA), Trail making test A & B and verbal fluency test (Semantic &Phonemic). The data was analyzed at baseline and after six weeks of intervention Results: Significant improvements were observed in post-test measurements (p <0.05) in MMSE, MoCA, TMT A & B and verbal fluency (Semantic &Phonemic) tests after 6 weeks of treatment. Conclusion: Kinect-based virtual reality games are beneficial in improving cognitive abilities of older adults with mild cognitive impairment. Keywords: Cognitive training, Mild cognitive impairment, Montreal Cognitive Assessment

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Abstract 220: Comparison of 3 Cognitive Exams in Cardiac Arrest Survivors

Circulation ◽

10.1161/circ.130.suppl_2.220 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Allison Koller ◽

Jon Rittenberger ◽

Patrick Morgan ◽

Melissa Repine ◽

Jeffrey Kristan ◽

...

Keyword(s):

Cardiac Arrest ◽

Cognitive Impairment ◽

Cognitive Deficits ◽

Cognitive Testing ◽

Percentile Score ◽

Pairwise Correlations ◽

The Mean ◽

Highly Correlated ◽

Alpha Error

Background: Cognitive deficits may detract from quality of life after cardiac arrest (CA). The pattern and prevalence of these deficits are not well documented. We used the Computer Assessment of Mild Cognitive Impairment (CAMCI), the Montreal Cognitive Assessment (MOCA) and the 41 Cent Test to assess cognitive impairment in survivors of CA. We hypothesized that CAMCI subscales and other scores that were highly correlated could identify specific domains of impairment in CA survivors. Methods: Four researchers administered the CAMCI, MOCA, and/or the 41 Cent Test to CA survivors after discharge from the intensive care unit between 2010 and 2014. Physicians screened patients with the Mini-Mental State Exam to determine when this cognitive testing was feasible. We compared the distribution of scores between patients who presented with coma and those who awoke immediately after CA. Pairwise correlations between the different subscales and tests were considered significant with alpha error of 0.05. Results: Ninety-two participants completed the CAMCI, of which 18 participants completed the CAMCI, MOCA and 41 Cent Test. The mean (SD) percentile score for CAMCI was 32.2 (20.3) out of possible 100, for the MOCA was 20.3 (5.2) out of a possible 30 points and the 41 Cent Test was 5.4 (1.1) out of a possible 7 points. MOCA correlated strongly with the overall CAMCI score (r = 0.82) and with the executive accuracy subscale of the CAMCI (r = 0.75). The executive accuracy subscale and overall CAMCI score correlated with one another (r = 0.81) when all 92 CAMCI exams were considered. The MOCA and 41 Cent Test were correlated with each other (r = 0.63). Conclusion: The CAMCI detects cognitive impairment after CA; the MOCA correlates strongly with the overall CAMCI and the executive function subscale of the CAMCI. The 41 Cent Test may not be as effective as the MOCA in detecting cognitive deficits.

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Detecting Subtle Cognitive Impairment in Multiple Sclerosis with the Montreal Cognitive Assessment

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2020.97 ◽

2020 ◽

Vol 47 (5) ◽

pp. 620-626 ◽

Cited By ~ 1

Author(s):

Kim Charest ◽

Alexandra Tremblay ◽

Roxane Langlois ◽

Élaine Roger ◽

Pierre Duquette ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Cognitive Deficits ◽

Cognitive Assessment ◽

Cognitive Status ◽

Montreal Cognitive Assessment ◽

Rapid Screening ◽

Cognitive Complaints ◽

Subjective Complaints ◽

Subjective Cognitive Complaints

ABSTRACT:Background:Although cognitive deficits are frequent in multiple sclerosis (MS), screening for them with tools such as the Montreal Cognitive Assessment (MoCA) test is usually not performed unless there is a subjective complaint. The Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) is among the instruments most commonly used to assess self-reported subjective complaints in MS. Nonetheless, it does not always accurately reflect cognitive status; many patients with cognitive deficits thus fail to receive appropriate referral for detailed neuropsychological evaluation. The objective of this study was to examine the validity of the MoCA test to detect the presence of objective cognitive deficits among patients with MS without subjective complaints using the Minimal Assessment of Cognitive Function in MS (MACFIMS) as the gold standard.Methods:The sample included 98 patients who were recruited from a university hospital MS clinic. The MSNQ was used to select patients without subjective cognitive complaints who also completed the MACFIMS, MoCA test and MSQOL-54.Results:23.5% of patients without subjective cognitive complaints had evidence of objective cognitive impairment on the MACFIMS (z score < -1.5 on two or more tests). The MoCA had a sensitivity of 87% and a specificity of 68% for detecting objective cognitive impairment in this patient population using a cut-off score of 27.Conclusion:A significant proportion of patients without self-reported cognitive impairment do have evidence of cognitive deficits on more exhaustive cognitive assessment. The MoCA is a rapid screening test that could be used to target patients for whom a more detailed neuropsychological assessment would be recommended.

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Attended With and Head-Turning Sign can be clinical markers of cognitive impairment in older adults

International Psychogeriatrics ◽

10.1017/s1041610217001181 ◽

2017 ◽

Vol 29 (11) ◽

pp. 1763-1769 ◽

Cited By ~ 16

Author(s):

Pinar Soysal ◽

Cansu Usarel ◽

Gul Ispirli ◽

Ahmet Turan Isik

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Cognitive Assessment ◽

Screening Methods ◽

Operating Characteristics ◽

Head Turning ◽

Sensitivity Specificity

ABSTRACTBackground:Comprehensive neurocognitive assessment may not be performed in clinical practice, as it takes too much time and requires special training. Development of easily applicable, time-saving, and cost effective screening methods has allowed identifying the individuals that require further evaluation. The aim of present study was to assess the diagnostic value of the Attended With (AW) and Head-Turning Sign (HTS) for screening cognitive impairment (CI).Methods:Comprehensive geriatric assessment was performed in 529 elderly outpatients, and the presence or absence of AW and HTS was investigated in them all.Results:Of the 529 patients, of whom the mean age was 75.67 ± 8.29 years, 126 patients were considered as CI (102 dementia, 24 mild CI). The patients with positive AW had significantly lower scores on Mini-Mental State Examination, Cognitive State Test, and Montreal Cognitive Assessment, and activities of daily living compared to AW (−) patients (p < 0.001). Similar significant findings were obtained in the patients with positive and negative HTS (p < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of AW in detecting CI were 92%, 37%, 31.4%, and 93.7%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of HTS were 80%, 64%, 41.8%, and 91.5%, respectively. The area under the receiver-operating characteristics curve was 0.90 for AW and 0.82 for HTS.Conclusion:AW and HTS are fast, simple, effective, and sensitive methods for detecting CI. Therefore, they can be used for older adults attending the primary care settings with memory loss. Those with positive AW or HTS can be referred to the relevant centers for detailed cognitive assessment.

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Considering the Technological and Sensory Needs of Patients With Cognitive Impairment in the Era of Telehealth

Innovation in Aging ◽

10.1093/geroni/igab046.326 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 86-86

Author(s):

Esther Oh ◽

Julie Yi ◽

Corrine Pittman ◽

Carrie Price ◽

Carrie Nieman

Keyword(s):

Systematic Review ◽

Older Adults ◽

Cognitive Impairment ◽

Cognitive Assessment ◽

Routine Care ◽

Support Staff ◽

Care Partners ◽

Sensory Impairments ◽

Memory Care ◽

Important Means

Abstract During the COVID-19 pandemic, telehealth has become an important means of delivering memory care. Telehealth that is responsive to the technological abilities and preferences as well as the sensory needs of persons living with dementia is critical to advancing access to care. We conducted a systematic review to investigate the use of telehealth among older adults with cognitive impairment. The search yielded 3,551 titles and abstracts that led to 17 full-text articles. Studies showed that telehealth can be used for routine care, cognitive assessment and telerehabilitation with good efficacy and satisfaction. Three studies investigated telemedicine delivery in the home and 16/17 studies relied on support staff and care partners to navigate technology. No studies reported adaptations to account for sensory impairments and 5/17 studies excluded individuals with sensory impairments. This talk will review barriers and facilitators totelehealth for older adults with cognitive impairment and adaptations to address sensory needs.

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