scholarly journals Cognitive testing in the COVID-19 era: can existing screeners be adapted for telephone use?

2021 ◽  
Vol 11 (1) ◽  
pp. 77-82
Author(s):  
Andrew J Larner
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Visual Cues ◽  
Cognitive Testing ◽  
Test Accuracy ◽  
Face To Face ◽  
Index Study ◽  
Accuracy Study ◽  
Established Norm ◽  
Telephone Administration

Aim: To examine whether two existing cognitive screeners might be adapted for telephone administration by omission of item content requiring visual cues or assessment. Materials & methods: Data from a test accuracy study of Mini-Addenbrooke’s Cognitive Examination (MACE) and Free-Cog were used to derive scores for ‘Tele-MACE’ and ‘Tele-Free-Cog’. Results: As in the index study, both Tele-MACE and Tele-Free-Cog proved sensitive for dementia diagnosis. Tele-MACE had a better balance of sensitivity and specificity than observed with MACE. Tele-MACE was sensitive for mild cognitive impairment diagnosis, whereas Tele-Free-Cog was more specific for mild cognitive impairment. Conclusion: Existing cognitive screeners may be adapted for telephone administration. Such developments may prove necessary in the COVID-19 era as remote rather than face-to-face cognitive assessment increasingly becomes the established norm.

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

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.

Protective preparation: a process central to family caregivers of persons with mild cognitive impairment

2017 ◽  
Vol 30 (3) ◽  
pp. 375-384 ◽  
Author(s):  
Ching-Lin Wang ◽  
Li-Min Kuo ◽  
Yi-Chen Chiu ◽  
Hsiu-Li Huang ◽  
Huei-Ling Huang ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Family Caregivers ◽  
Caregiver Burden ◽  
Family Caregiving ◽  
Healthcare Providers ◽  
Theory Approach ◽  
Face To Face ◽  
The Family ◽  
The Impact

ABSTRACTBackground:To develop a theoretical model explaining the longitudinal changes in the caregiving process for family caregivers of persons with mild cognitive impairment (MCI) in Taiwan.Methods:A longitudinal, grounded theory approach using in-depth face-to-face interviews and an open-ended interview guide. We conducted 42 interviews over a two-year period; each participant was interviewed at least once every six months. All participants were interviewed in their home. The participants total of 13 family caregivers of persons with MCI.Results:One core theme emerged: “protective preparation.” This reflected the family caregiving process of preparation for a further decline in cognitive function, and protection from the impact of low self-esteem, accidents, and symptoms of comorbidities for the family member with MCI. Protective preparation contained three components: ambivalent normalization, vigilant preparation, and protective management.Conclusions:Interventions to help family caregivers manage the changes in persons with MCI can reduce caregiver burden. Our findings could provide a knowledge base for use by healthcare providers to develop and implement strategies to reduce caregiver burden for family caregivers of persons with MCI.

Short Montreal Cognitive Assessment

2016 ◽  
Vol 30 (2) ◽  
pp. 104-108 ◽  
Author(s):  
A. J. Larner
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Computerized Adaptive Testing ◽  
Montreal Cognitive Assessment ◽  
Test Accuracy ◽  
Cognitive Screening ◽  
Memory Clinic ◽  
Subjective Memory ◽  
Index Study ◽  
Diagnosis Of Dementia

The diagnostic accuracy of the short Montreal Cognitive Assessment (s-MoCA), a cognitive screening instrument recently derived by item response theory and computerized adaptive testing from the original MoCA, for the diagnosis of dementia and mild cognitive impairment (MCI) was assessed in 2 patient cohorts referred to a dedicated memory clinic in order to examine the validity and reproducibility of s-MoCA. Diagnosis used standard clinical diagnostic criteria for dementia and MCI as reference standard (prevalence of cognitive impairment = 0.43 and 0.46 in each cohort, respectively). There were significant differences in s-MoCA test scores for dementia, MCI, and subjective memory impairment ( P ≤ .01), and s-MoCA effect sizes (Cohen d) were medium to large (range: 0.65-1.42) for the diagnosis of dementia and MCI. Using the cut-off for s-MoCA specified in the index study, it proved highly sensitive (>0.9) for diagnosis of dementia but with poor specificity (≤0.25), with moderate sensitivity (≥0.75) and specificity (≥0.60) for diagnosis of MCI. In conclusion, in these pragmatic diagnostic test accuracy studies, s-MoCA proved acceptable and sensitive for the diagnosis of cognitive impairment in a memory clinic setting, with a performance similar to that of the original MoCA.

scholarly journals BrainCheck: Validation of a Computerized Cognitive Test Battery for Detection of Mild Cognitive Impairment and Dementia

2020 ◽  
Author(s):  
Siao Ye ◽  
Bin Huang ◽  
Kevin Sun ◽  
Huy Q. Phi ◽  
Brian Ko ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Early Detection ◽  
Group Classification ◽  
Cognitive Testing ◽  
Cognitive Test ◽  
True Positive ◽  
Diagnosis Group ◽  
Sensitivity Specificity ◽  
Normal Cognition

AbstractEarly detection of dementia is critical for intervention and care planning, but remains difficult. This study evaluated a computerized cognitive testing battery (BrainCheck) for its diagnostic accuracy and ability to distinguish the severity of cognitive impairment. 99 participants diagnosed with Dementia, Mild Cognitive Impairment (MCI), or Normal Cognition (NC) completed the BrainCheck battery. Statistical analyses compared participant’s performance on BrainCheck based on their diagnosis group BrainCheck battery performance showed significant differences between the NC, MCI, and Dementia groups, achieving ≥88% sensitivity/specificity for separating NC from Dementia, and ≥77% sensitivity/specificity in separating the MCI group from NC/Dementia groups. Three-group-classification found true positive rates ≥80% for the NC and Dementia groups and ≥60% for the MCI group. BrainCheck was able to distinguish between diagnoses of Dementia, MCI, and NC, providing a potentially reliable tool for early detection of cognitive impairment.

scholarly journals Five-year outcomes after IVIG for mild cognitive impairment due to alzheimer disease

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shawn Kile ◽  
William Au ◽  
Carol Parise ◽  
Kimberley Rose ◽  
Tammy Donnel ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Alzheimer Disease ◽  
Brain Atrophy ◽  
Ventricular Volume ◽  
Cognitive Testing ◽  
Percent Change ◽  
Dosing Strategies ◽  
One Year ◽  
Double Blinded

Abstract Background The purpose of this study was to assess the five-year treatment effects of a short course of intravenous immunoglobulin (IVIG) in subjects with mild cognitive impairment (MCI) due to Alzheimer disease (AD). Methods Fifty subjects 50 to 84 years of age with MCI due to AD were administered 0.4 g/kg 10% IVIG or 0.9% saline every two weeks x five doses in a randomized double-blinded design as part of a two-year study. Twenty-seven subjects completed an additional three-year extension study. MRI brain imaging, cognitive testing, and conversion to dementia were assessed annually. Participants were stratified into early MCI (E-MCI) and late MCI (L-MCI). The primary endpoint was brain atrophy measured as annualized percent change in ventricular volume (APCV) annually for five years. ANOVA was used to compare annualized percent change in ventricular volume from baseline between the groups adjusting for MCI status (E-MCI, L-MCI). Results Differences in brain atrophy between the groups, which were statistically significant after one year, were no longer significant after five years. IVIG-treated L-MCI subjects did demonstrate a delay in conversion to dementia of 21.4 weeks. Conclusion An eight-week course of IVIG totaling 2 g/kg in MCI is safe but is not sufficient to sustain an initial reduction in brain atrophy or a temporary delay in conversion to dementia at five years. Other dosing strategies of IVIG in the early stages of AD should be investigated to assess more sustainable disease-modifying effects. Trial registration ClinicalTrials.gov NCT01300728. Registered 23 February 2011.

Utility of Diffusion Modeling of Cogstate Brief Battery Test Performance in Detecting Mild Cognitive Impairment

Assessment ◽  
2022 ◽  
pp. 107319112110690
Author(s):  
Kyler Mulhauser ◽  
Bruno Giordani ◽  
Voyko Kavcic ◽  
L. D. Nicolas May ◽  
Arijit Bhaumik ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Test Performance ◽  
Drift Rate ◽  
Cognitive Testing ◽  
Diffusion Modeling ◽  
Testing Data ◽  
Recognition Learning ◽  
And Diffusion ◽  
Normal Cognition

Cognitive testing data are essential to the diagnosis of mild cognitive impairment (MCI), and computerized cognitive testing, such as the Cogstate Brief Battery, has proven helpful in efficiently identifying harbingers of dementia. This study provides a side-by-side comparison of traditional Cogstate outcomes and diffusion modeling of these outcomes in predicting MCI diagnosis. Participants included 257 older adults (160 = normal cognition; 97 = MCI). Results showed that both traditional Cogstate and diffusion modeling analyses predicted MCI diagnosis with acceptable accuracy. Cogstate measures of recognition learning and working memory accuracy and diffusion modeling variable of decision-making efficiency (drift rate) and nondecisional time were most predictive of MCI. While participants with normal cognition demonstrated a change in response caution (boundary separation) when transitioning tasks, participants with MCI did not evidence this change.

Cognitive telerehabilitation in mild cognitive impairment, Alzheimer’s disease and frontotemporal dementia: A systematic review

2017 ◽  
Vol 25 (2) ◽  
pp. 67-79 ◽  
Author(s):  
Maria Cotelli ◽  
Rosa Manenti ◽  
Michela Brambilla ◽  
Elena Gobbi ◽  
Clarissa Ferrari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Frontotemporal Dementia ◽  
Cognitive Rehabilitation ◽  
Face To Face ◽  
Positive Effects

Introduction Given the limited effectiveness of pharmacological treatments, non-pharmacological interventions in neurodegenerative diseases have gained increasing attention in recent years and telerehabilitation has been proposed as a cognitive rehabilitation strategy. The purpose of this systematic review is to examine the evidence for the efficacy of cognitive telerehabilitation interventions compared with face-to-face rehabilitation in patients with mild cognitive impairment, Alzheimer’s disease and frontotemporal dementia. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search of the Medline database was conducted. Out of 14 articles assessed for eligibility, five studies were identified, three in participants with mild cognitive impairment or Alzheimer’s disease, two in patients with primary progressive aphasia. Results The Physiotherapy Evidence Database scale was used to assess the methodological quality of four out of five studies included in this systematic review, with only one report receiving a high-quality rating. Effect-size analysis evidenced positive effects of telerehabilitation interventions, comparable with those reported for face-to-face rehabilitation. Discussion The available evidence for the effectiveness of cognitive telerehabilitation is limited, and the quality of the evidence needs to be improved. The systematic review provides preliminary evidence suggesting that cognitive telerehabilitation for neurodegenerative disease may have comparable effects as conventional in-person cognitive rehabilitation.

Screening utility of the Montreal Cognitive Assessment (MoCA): in place of – or as well as – the MMSE?

2011 ◽  
Vol 24 (3) ◽  
pp. 391-396 ◽  
Author(s):  
A. J. Larner
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Characteristic Curve ◽  
The Elderly ◽  
Montreal Cognitive Assessment ◽  
Test Accuracy ◽  
Diagnostic Utility ◽  
Memory Clinic ◽  
Index Study ◽  
In Series

ABSTRACTBackground: This aim of this study was to assess the clinical utility of the Montreal Cognitive Assessment (MoCA) as a screening instrument for cognitive impairment in patients referred to a memory clinic, alone and in combination with the Mini-Mental State Examination (MMSE).Methods: This was a pragmatic prospective study of consecutive referrals attending a memory clinic (n = 150) over an 18-month period. Patients were diagnosed using standard clinical diagnostic criteria for dementia (DSM-IV) and mild cognitive impairment (MCI; cognitive impairment prevalence = 43%) independent of MoCA test scores.Results: MoCA proved acceptable to patients and was quick and easy to use. Using the cut-offs for MoCA and MMSE specified in the index paper (≥26/30), MoCA was more sensitive than MMSE (0.97 vs 0.65) but less specific (0.60 vs 0.89), with better diagnostic accuracy (area under Receiver Operating Characteristic curve 0.91 vs 0.83). Downward adjustment of the MoCA cut-off to ≥20/30 maximized test accuracy and improved specificity (0.95) for some loss of sensitivity (0.63). Combining MoCA with the MMSE – either in series or in parallel – did not improve diagnostic utility above that with either test alone.Conclusions: In a memory clinic population, MoCA proved sensitive for the diagnosis of cognitive impairment. Use of a cut-off lower than that specified in the index study may be required to improve overall test accuracy and specificity for some loss of sensitivity in populations with a high prior probability of cognitive impairment. Combining the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) with the MMSE did not improve diagnostic utility.

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