THE RELATIONSHIP BETWEEN CLOCK DRAWING AND COGNITION IN PARKINSON'S

2015 ◽  
Vol 86 (11) ◽  
pp. e4.82-e4
Author(s):  
Jeremy Cosgrove ◽  
Stuart Jamieson ◽  
Stephen Smith ◽  
Jane Alty
Keyword(s):  
Cognitive Impairment ◽  
Executive Function ◽  
Cognitive Assessment ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Montreal Cognitive Assessment ◽  
Visuospatial Ability ◽  
Clock Drawing ◽  
The Relationship ◽  
Normal Cognition

IntroductionClock drawing (CD) requires executive function, attention and visuospatial ability. Our objective was to investigate CD in Parkinson's subjects with and without cognitive impairment.Methods107 subjects completed the Montreal Cognitive Assessment (MoCA), classifying into normal cognition (PD-NC – MoCA ≥26) and cognitive impairment (PD-CI–MoCA <26). CD was scored using MoCA criteria; a maximum of 3 points, one each for correct contour, clock face and clock hands.ResultsPD-CI (n=57) and PD-NC were matched for all demographics except age (PD-CI were older, P 0.032). 35% of PD-CI scored full marks compared to 90% of PD-NC (sensitivity 0.64, specificity 0.9, age adjusted-odds ratio for predicting PD-CI 15.63, 95% CI 5.18 – 47.62, P<0.001). 88% of PD-CI scored points for contour and 60% scored points for clock face. In contrast, all PD-NC scored points for contour and clock face (P <0.001). 42% of PD-CI and 90% of PD-NC correctly drew clock hands (P<0.001).ConclusionsIn this cohort, inability to score maximum points for CD was associated with PD-CI. Correctly drawing clock hands was the hardest component for both groups. Incorrect contour or clock face was highly specific for PD-CI.

Taking the Time to Assess Cognition in Parkinson’s Disease: The Clock Drawing Test

2021 ◽  
pp. 1-10
Author(s):  
Hemant Srivastava ◽  
Allen Joop ◽  
Raima A. Memon ◽  
Jennifer Pilkington ◽  
Kimberly H. Wood ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Executive Function ◽  
Cognitive Assessment ◽  
Epworth Sleepiness Scale ◽  
Cognitive Testing ◽  
Clock Drawing Test ◽  
Clock Drawing ◽  
Drawing Test ◽  
Global Cognition ◽  
Psychomotor Vigilance

Background: Cognitive impairment is common and disabling in Parkinson’s disease (PD). Cognitive testing can be time consuming in the clinical setting. One rapid test to detect cognitive impairment in non-PD populations is the Clock Drawing Test (CDT), which calls upon the brain’s executive and visuospatial abilities to draw a clock designating a certain time. Objective: Test the hypothesis that PD participants would perform worse on CDT compared to controls and that CDT would correlate with other measures of cognition. Methods: This study evaluated two independent CDT scoring systems and differences in CDT performance between PD (N = 97) and control (N = 54) participants using a two-sample t-test. Pearson’s correlations were conducted between the CDT and tests of sleepiness (Epworth Sleepiness Scale) and vigilance (Psychomotor Vigilance Test); executive function (Trails B-A); and global cognition (Montreal Cognitive Assessment). Receiver operating characteristic curves were used to determine cut points on the CDT that identify individuals who need additional cognitive testing. Results: PD participants had worse performance on CDT compared to controls. The CDT was correlated with executive function (Trails B-A) and global cognition (Montreal Cognitive Assessment). The CDT correlated with vigilance (Psychomotor Vigilance Task) only in healthy controls. However, the CDT was not correlated with measures of sleepiness (Epworth Sleepiness Scale) in either group. A cut point of 9 on the Rouleau scale and 18 on the Mendez scale identified PD participants with cognitive impairment. Conclusion: The CDT is a rapid clinical cognitive assessment that is feasible in PD and correlates with other measures of cognition.

Evaluating the Beijing Version of Montreal Cognitive Assessment for Identification of Cognitive Impairment in Monolingual Chinese American Older Adults

2021 ◽  
pp. 089198872110361
Author(s):  
Yue Hong ◽  
Xiaoyi Zeng ◽  
Carolyn W. Zhu ◽  
Judith Neugroschl ◽  
Amy Aloysi ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Demographic Variables ◽  
Chinese Version ◽  
Montreal Cognitive Assessment ◽  
Optimal Cutoff ◽  
Cutoff Scores ◽  
Normal Cognition ◽  
The U.S

Objective: This study aims to evaluate the performance of a Chinese version of the Montreal Cognitive Assessment (MoCA) as a screener to detect mild cognitive impairment (MCI) and dementia from normal cognition in the monolingual Chinese-speaking immigrant population. Method: A cohort of 176 Chinese-speaking older adults from the National Alzheimer’s Coordinating Center Uniform Data Set is used for analysis. We explore the impact of demographic variables on MoCA performance and calculate the optimal cutoffs for the detection of MCI and dementia from normal cognition with appropriate demographic adjustment. Results: MoCA performance is predicted by age and education independent of clinical diagnoses, but not by sex, years of living in the U.S., or primary Chinese dialect spoken (i.e., Mandarin vs. Cantonese). With adjustment and stratification for education and age, we identify optimal cutoff scores to detect MCI and dementia, respectively, in this population. These optimal cutoff scores are different from the established scores for non-Chinese-speaking populations residing in the U.S. Conclusions: Our findings suggest that the Chinese version of MoCA is a valid screener to detect cognitive decline in older Chinese-speaking immigrants in the U.S. They also highlight the need for population-based cutoff scores with appropriate considerations for demographic variables.

VISUOSPATIAL TESTS TO SCREEN FOR IMPAIRED COGNITION IN PARKINSON'S

2015 ◽  
Vol 86 (11) ◽  
pp. e4.81-e4
Author(s):  
Jeremy Cosgrove ◽  
Stuart Jamieson ◽  
Stephen Smith ◽  
Jane Alty
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Odds Ratio ◽  
Mini Mental State Examination ◽  
Disease Duration ◽  
Screening Tool ◽  
Impaired Cognition ◽  
State Examination ◽  
Normal Cognition ◽  
Moca Score

ObjectiveTo determine which test of visuospatial function – copying a wired cube (‘cube’) or interlocking pentagons (‘pentagons’) – is the best screening tool for detecting cognitive impairment in Parkinson's, as defined by abnormal Montreal Cognitive Assessment (MoCA) score.Methods107 Parkinson's subjects completed the MoCA and copied pentagons from the Mini-Mental State Examination (MMSE). They were classified into two groups based on MoCA score: <26 (cognitive impairment (CI)) or ≥26 (normal cognition (NC)). Cube and pentagons were scored using MoCA and MMSE criteria.ResultsThe CI group (n=57) was older (p 0.032) but disease duration, stage and medication were not different. 28% of CI and 72% of NC correctly copied cube. 69% of CI and 92% of NC correctly copied pentagons. Inability to correctly copy cube (p<0.001) or pentagons (p 0.003) was associated with CI. Age adjusted odds ratio for predicting cognitive impairment was 6.85 (2.97–16.39, p 0.001) for incorrect cube and 4.61 (1.41 – 14.93, p 0.011) for incorrect pentagons.ConclusionsIncorrect cube was the most predictive visuospatial marker of cognitive impairment in Parkinson's. This is potentially useful when assessing cognitive function in a busy outpatient clinic, for example. Larger numbers are required for validation.

The Relationship between Cardiorespiratory Fitness and Montreal Cognitive Assessment Scores in Older Adults

Gerontology ◽  
2018 ◽  
Vol 64 (5) ◽  
pp. 440-445 ◽  
Author(s):  
Stephen W. Farrell ◽  
Aidin R. Abramowitz ◽  
Benjamin L. Willis ◽  
Carolyn E. Barlow ◽  
Myron Weiner ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cardiorespiratory Fitness ◽  
Cognitive Assessment ◽  
Montreal Cognitive Assessment ◽  
Categorical Variable ◽  
Healthy Older Adults ◽  
High Level ◽  
The Relationship

Background: Relatively little is known regarding the association between objective measures of physical function such as cardiorespiratory fitness (CRF) and cognitive function tests in healthy older adults. Objective: To evaluate the relationship between CRF and cognitive function in adults aged 55 and older. Methods: Between 2008 and 2017, 4,931 men and women underwent a comprehensive preventive physical exam at the Cooper Clinic in Dallas, Texas. CRF was determined by duration of a maximal treadmill exercise test. Cognitive function was evaluated with the Montreal Cognitive Assessment (MoCA). In a multivariate model, adjusted odds ratios with 95% confidence intervals for MoCA scores < 26 (i.e., cognitive impairment) were determined by using CRF as both a continuous and a categorical variable. Results: The mean age of the sample was 61.0 ± 6.0 years; mean maximal MET values were 10.0 ± 2.2. Mean MoCA scores were 26.9 ± 2.2; 23.4% of the sample had MoCA scores indicative of cognitive impairment. The odds ratio for cognitive impairment was 0.93 (0.88–0.97) per 1-MET increment in CRF. When examined as a categorical variable, and using the lowest CRF quintile as the referent, there was a significantly reduced likelihood for cognitive impairment across the remaining ordered CRF categories (p trend = 0.004). Conclusion: The association between CRF and MoCA score in older adults suggests that meeting or exceeding public health guidelines for physical activity is likely to increase CRF in low fit individuals, maintain CRF in those with a moderate to high level of CRF, and thereby help to maintain cognitive function in healthy older adults.

scholarly journals Incremental Validity of Montreal Cognitive Assessment Index Scores in Mild Cognitive Impairment and Alzheimer Disease

2018 ◽  
Vol 45 (1-2) ◽  
pp. 49-55 ◽  
Author(s):  
Felicia C. Goldstein ◽  
Aaron Milloy ◽  
David W. Loring ◽  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Alzheimer Disease ◽  
Cognitive Assessment ◽  
Incremental Validity ◽  
Montreal Cognitive Assessment ◽  
Effect Sizes ◽  
Assessment Index ◽  
The Individual ◽  
Normal Cognition

Background/Aims: The aim of this paper was to evaluate the incremental validity of the Montreal Cognitive Assessment (MoCA) index scores and the MoCA total score in differentiating individuals with normal cognition versus mild cognitive impairment (MCI) or Alzheimer disease (AD). Methods: Effect sizes were calculated for Alzheimer’s Disease Neuroimaging Initiative research participants with normal cognition (n = 295), MCI (n = 471), or AD (n = 150). Results: Effect sizes for the total score were large (> 0.80) and exceeded the index scores in differentiating those with MCI versus normal cognition, MCI versus AD, and AD versus normal cognition. A combined score incorporating the Memory, Executive, and Orientation indexes also improved incremental validity for all 3 group comparisons. Conclusion: Administration of the entire MoCA is more informative than the index scores, especially in distinguishing normal cognition versus MCI. A combined score has stronger incremental validity than the individual index scores.

Utility of Montreal Cognitive Assessment in Differentiating Dementia With Lewy Bodies From Alzheimer’s Dementia

2017 ◽  
Vol 32 (8) ◽  
pp. 468-471 ◽  
Author(s):  
Erin Yamamoto ◽  
Lyla Mourany ◽  
Rosemary Colleran ◽  
Christine Whitman ◽  
Babak Tousi
Keyword(s):  
Executive Function ◽  
Cognitive Assessment ◽  
Dementia With Lewy Bodies ◽  
Lewy Bodies ◽  
Montreal Cognitive Assessment ◽  
Delayed Recall ◽  
Clock Drawing ◽  
Recall Memory ◽  
Score Pattern ◽  
Neurodegenerative Dementias

Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB) are the 2 most common neurodegenerative dementias. Identification of patients with DLB is necessary to guide appropriate clinical management and medication trials. Patients with DLB are reported to perform poorly on tasks of visuospatial and executive function, compared to patients with AD who perform poorly on memory tasks. Using the Montreal Cognitive Assessment, we found that patients with DLB (n = 73) had statistically significant lower performance in clock drawing (visuospatial and executive function) and higher performance in delayed recall (memory) subscores compared to patients with AD (n = 57). This score pattern should raise suspicion for a DLB diagnosis at initial evaluation of patients with dementia.

Natural course of mild cognitive impairment in Parkinson disease

Neurology ◽  
2017 ◽  
Vol 88 (8) ◽  
pp. 767-774 ◽  
Author(s):  
Kenn Freddy Pedersen ◽  
Jan Petter Larsen ◽  
Ole-Bjørn Tysnes ◽  
Guido Alves
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Confidence Interval ◽  
Parkinson Disease ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Neuropsychological Testing ◽  
Increased Risk ◽  
Normal Cognition

Objective:To examine the incidence, progression, and reversion of mild cognitive impairment in patients with Parkinson disease (PD-MCI) over 5 years.Methods:A population-based cohort of patients with incident PD underwent repeated neuropsychological testing of attention, executive function, memory, and visuospatial abilities at baseline (n = 178), 1 year (n = 175), 3 years (n = 163), and 5 years (n = 150). Patients were classified as PD-MCI and diagnosed with dementia according to published criteria.Results:Thirty-six patients (20.2%) fulfilled criteria for PD-MCI at baseline. Among those with normal cognition at baseline (n = 142), the cumulative incidence of PD-MCI was 9.9% after 1 year, 23.2% after 3 years, and 28.9% after 5 years of follow-up. Overall, 39.1% of patients with baseline or incident PD-MCI progressed to dementia during the 5-year study period. The conversion rate to dementia was 59.1% in patients with persistent PD-MCI at 1 year vs 7.2% in those with normal cognition during the first year (adjusted odds ratio 16.6, 95% confidence interval 5.1–54.7, p < 0.001). A total of 27.8% of patients with baseline PD-MCI and 24.2% of those with incident PD-MCI had reverted to normal cognition at study end, but the reversion rate decreased to 9.4% in those with persistent PD-MCI at 2 consecutive visits. Compared with cognitively normal patients, PD-MCI reverters within the first 3 years of follow-up were at increased risk of subsequently developing dementia (adjusted odds ratio 10.7, 95% confidence interval 1.5–78.5, p = 0.019).Conclusions:Early PD-MCI, regardless of persistence or reversion to normal cognition, has prognostic value for predicting dementia in patients with PD.

scholarly journals Application of the Chinese Version of the Montreal Cognitive Assessment-Basic for Assessing Mild Cognitive Impairment in Parkinson’s Disease

2021 ◽  
Vol 11 (12) ◽  
pp. 1575
Author(s):  
Qian Xu ◽  
Mengxi Zhou ◽  
Chunyan Jiang ◽  
Li Wu ◽  
Qing He ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Mild Cognitive Impairment ◽  
Cognitive Assessment ◽  
Chinese Version ◽  
Montreal Cognitive Assessment ◽  
Cognitive Profiles ◽  
Visuospatial Function

Mild cognitive impairment (MCI) is a common and pivotal non-motor symptom in Parkinson’s disease (PD). It is necessary to use the appropriate tools to characterize the cognitive profiles and identify the subjects at risk of MCI in clinical practice. A cohort of 207 non-demented patients with PD and 52 age- and gender-matched cognitively normal controls (NCs) underwent the Chinese Version of Montreal Cognitive Assessment-Basic (MoCA-BC) evaluation. Patients with PD also received detailed motor and non-motor evaluation by serial scales. Cognitive profiles were investigated in patients with PD-MCI, relative to patients with normal cognition (PD-NC) and cognitively NCs. In addition, differences in demography, major motor and non-motor symptoms were compared between patients with PD-MCI and PD-NC. There were 70 patients with PD-MCI, occupying 33.8% of the total patients. Patients with PD-MCI had impairment in multiple cognitive domains, especially in executive function, memory and visuospatial function on MoCA-BC, relative to cognitively NCs or PD-NC. Compared with PD-NC patients, PD-MCI patients were older (p = 0.002) and had a later onset age (p = 0.007) and higher score of the Unified Parkinson’s Disease Rating Scale (UPDRS) part III (p = 0.001). The positive rate of clinical possible rapid eye movement sleep behavior disorder (cpRBD) in the PD-MCI group was significantly increased relative to the PD-NC group (p = 0.003). Multivariate logistic analysis showed that older age (OR = 1.06; p = 0.012), higher score of UPDRS-III (OR = 1.03; p = 0.018) and the presence of cpRBD (OR = 2.10; p = 0.037) were independently associated factors of MCI in patients with PD. In conclusion, executive function, memory and visuospatial function are the main impaired cognitive profiles in PD-MCI via MoCA-BC. Aging, motor severity and RBD may be independently related factors of MCI in PD.

Evaluation of a Telephone Version for the Montreal Cognitive Assessment: Establishing a Cutoff for Normative Data From a Cross-Sectional Study

2021 ◽  
pp. 089198872110026
Author(s):  
Sivan Klil-Drori ◽  
Natalie Phillips ◽  
Alita Fernandez ◽  
Shelley Solomon ◽  
Adi J. Klil-Drori ◽  
...  
Keyword(s):  
Cognitive Assessment ◽  
Cross Sectional Study ◽  
Montreal Cognitive Assessment ◽  
Cutoff Score ◽  
Cognitive Screening ◽  
Cross Sectional ◽  
A Prospective Study ◽  
Sectional Analysis ◽  
State Examination ◽  
Normal Cognition

Objective: Compare a telephone version and full version of the Montreal Cognitive Assessment (MoCA). Methods: Cross-sectional analysis of a prospective study. A 20-point telephone version of MoCA (Tele-MoCA) was compared to the Full-MoCA and Mini Mental State Examination. Results: Total of 140 participants enrolled. Mean scores for language were significantly lower with Tele-MoCA than with Full-MoCA (P = .003). Mean Tele-MoCA scores were significantly higher for participants with over 12 years of education (P < .001). Cutoff score of 17 for the Tele-MoCA yielded good specificity (82.2%) and negative predictive value (84.4%), while sensitivity was low (18.2%). Conclusions: Remote screening of cognition with a 20-point Tele-MoCA is as specific for defining normal cognition as the Full-MoCA. This study shows that telephone evaluation is adequate for virtual cognitive screening. Our sample did not allow accurate assessment of sensitivity for Tele-MoCA in detecting MCI or dementia. Further studies with representative populations are needed to establish sensitivity.

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