Cognitive Impairment During Combined Normobaric vs. Hypobaric and Normoxic vs. Hypoxic Acute Exposure

2020 ◽  
Vol 91 (11) ◽  
pp. 845-851
Author(s):  
Mathias Roland Aebi ◽  
Nicolas Bourdillon ◽  
Philip Noser ◽  
Grgoire Paul Millet ◽  
Denis Bron
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Cognitive Assessment ◽  
Hypobaric Hypoxia ◽  
Deleterious Effect ◽  
Acute Exposure ◽  
Artery Blood Flow ◽  
Military Pilots ◽  
Normobaric Normoxia ◽  
Altitude Level

INTRODUCTION: Exposure to hypoxia has a deleterious effect on cognitive function; however, the putative effect of hypobaria remains unclear. The present study aimed to evaluate cognitive performance in pilot trainees who were exposed to acute normobaric (NH) and hypobaric hypoxia (HH). Of relevance for military pilots, we also aimed to assess cognitive performance in hypobaric normoxia (HN).METHODS: A total of 16 healthy pilot trainees were exposed to 4 randomized conditions (i.e., normobaric normoxia, NN, altitude level of 440 m; HH at 5500 m; NH, altitude simulation of 5500 m; and HN). Subjects performed a cognitive assessment (KLT-R test). Cerebral oxygen delivery (cDO2) was estimated based middle cerebral artery blood flow velocity (MCAv) and pulse oxygen saturation (Spo2) monitored during cognitive assessment.RESULTS: Percentage of errors increased in NH (14.3 9.1%) and HH (12.9 6.4%) when compared to NN (6.5 4.1%) and HN (6.0 4.0%). Number of calculations accomplished was lower only in HH than in NN and HN. When compared to NN, cDO2 decreased in NH and HH.DISCUSSION: Cognitive performance was decreased similarly in acute NH and HH. The cDO2 reduction in NH and HH implies insufficient MCAv increase to ensure cognitive performance maintenance. The present study suggests negligible hypobaric influence on cognitive performance in hypoxia and normoxia.Aebi MR, Bourdillon N, Noser P, Millet GP, Bron D. Cognitive impairment during combined normobaric vs. hypobaric and normoxic vs. hypoxic acute exposure. Aerosp Med Hum Perform. 2020; 91(11):845851.

scholarly journals Linking the Scores of the Montreal Cognitive Assessment 5-min and the interRAI Cognitive Performance Scale in Older Adults With Mild Physical or Cognitive Impairment

2021 ◽  
Vol 12 ◽  
Author(s):  
Björn Andersson ◽  
Hao Luo ◽  
Gloria H. Y. Wong ◽  
Terry Y. S. Lum
Keyword(s):  
Older Adults ◽  
Hong Kong ◽  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Cognitive Assessment ◽  
Assessment Tools ◽  
Montreal Cognitive Assessment ◽  
Cognitive Performance Scale ◽  
Mild Impairment ◽  
Performance Scale

Background: Bridging scores generated from different cognitive assessment tools is necessary to efficiently track changes in cognition across the continuum of care. This study linked scores from the Montreal Cognitive Assessment-5 min (MoCA 5-min) to the interRAI cognitive Performance Scale (CPS), commonly adopted tools in clinical and long-term care settings, respectively.Methods: We included individual-level data from persons who participated in a home- and community-based care program for older people with mild impairment in Hong Kong. The program used the interRAI-Check Up instrument for needs assessment and service matching between 2017 and 2020. Each participant's cognitive performance was assessed using CPS, CPS Version 2 (CPS2), and MoCA 5-min. We performed equipercentile linking with bivariate log-linear smoothing to establish equivalent scores between the two scales.Results: 3,543 participants had valid data on both scales; 66% were female and their average age was 78.9 years (SD = 8.2). The mean scores for MoCA 5-min, CPS, and CPS2 were 18.5 (SD = 5.9), 0.7 (SD = 0.7), and 1.3 (SD = 1.1), respectively. A CPS or CPS2 score of 0 (intact cognition) corresponds to MoCA 5-min scores of 24 and 25, respectively. At the higher end, a CPS score of 3 (moderately impaired) and a CPS2 score of 5 (moderately impaired Level-2) corresponded to MoCA 5-min scores of 0 and 1, respectively. The linking functions revealed the floor and ceiling effects that exist for the different scales, with CPS and CPS2 measuring more-severe cognitive impairment while the MoCA 5-min was better suited to measure mild impairment.Conclusions: We provided score conversions between MoCA 5-min and CPS/CPS2 within a large cohort of Hong Kong older adults with mild physical or cognitive impairment. This enabled continuity in repeated assessment with different tools and improved comparability of cognitive scores generated from different tools from diverse populations and research cohorts.

scholarly journals Post-stroke cognition with the Oxford Cognitive Screen vs Montreal Cognitive Assessment: a multi-site randomized controlled study (OCS-CARE)

2019 ◽  
Vol 1 ◽  
pp. 12
Author(s):  
Nele Demeyere ◽  
Shuo Sun ◽  
Elise Milosevich ◽  
Kathleen Vancleef
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Outcome Measures ◽  
Patient Outcomes ◽  
Cognitive Assessment ◽  
Screening Tools ◽  
Montreal Cognitive Assessment ◽  
Post Stroke ◽  
Cognitive Screen

Background: Cognitive impairment is common following stroke. The Oxford Cognitive Screen (OCS) was designed to assess focal post-stroke cognitive deficits in five domains. Here, we investigated whether results generated by the OCS vs the domain-general Montreal Cognitive Assessment (MoCA) at baseline impacted patient outcomes at 6 months follow-up.   Methods: Patients <2 months post-stroke were randomized to receive either the OCS and corresponding information leaflet or standard care with the MoCA at baseline. After 6 months, patients received both the OCS and MoCA. The primary registered outcome measures were the Stroke Impact Scale (SIS) and change in stroke severity (National Institutes of Health Stroke Scale; NIHSS) at 6 months. The secondary outcome was change in cognitive performance from baseline to 6-month follow-up. The relationship between scores from the two cognitive screens at follow-up was also explored. Results: A total of 821 patients from 37 different hospital or rehabilitation sites (England, UK) were recruited to the OCS-CARE study, with 467 completing 6-month follow-up. Patient outcomes defined by overall SIS scores and changes in NIHSS did not differ between the OCS or MoCA groups. There were high accordance rates between the OCS and MoCA at 6 months, with severity of cognitive impairment reflected in both screening tools. Cognitive performance in both groups over the 6-month follow-up declined in 22% of patients. A larger proportion of OCS group patients demonstrated improvements in cognitive scores (49% vs 40% in MoCA). Conclusions: The type of cognitive screening test did not impact broad stroke outcome measures, and the two screening tools showed a high overall accordance. The results suggest that more of the domain-specific deficits in OCS recover subacutely, providing a more granular picture of cognitive recovery as well as decline.             Registration: ISRCTN50857950; registered on 27/03/2014.

scholarly journals Integrated Cognitive Assessment: Speed and Accuracy of Visual Processing as a Reliable Proxy to Cognitive Performance

2018 ◽  
Author(s):  
Seyed-Mahdi Khaligh-Razavi ◽  
Sina Habibi ◽  
Maryam Sadeghi ◽  
Haniye Marefat ◽  
Mahdiyeh Khanbagi ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mental Disorders ◽  
Cognitive Performance ◽  
Visual Processing ◽  
Cognitive Assessment ◽  
Large Scale ◽  
Assessment Tool ◽  
Cognitive Screening ◽  
Current Standard ◽  
Language And Education

AbstractVarious mental disorders are accompanied by some degree of cognitive impairment. Particularly in neurodegenerative disorders, cognitive impairment is the phenotypical hallmark of the disease. Effective, accurate and timely cognitive assessment is key to early diagnosis of this family of mental disorders. Current standard-of-care techniques for cognitive assessment are primarily paper-based, and need to be administered by a healthcare professional; they are additionally language and education-dependent and typically suffer from a learning bias. These tests are thus not ideal for large-scale pro-active cognitive screening and disease progression monitoring. We developed the Integrated Cognitive Assessment (ICA), a 5-minute computerized cognitive assessment tool based on a rapid visual categorization task, in which a series of carefully selected natural images of varied difficulty are presented to participants. Overall 448 participants, across a wide age-range with different levels of education took the ICA test. We compared participants’ ICA test results with a variety of standard pen-and-paper tests that are routinely used to assess cognitive performance. ICA had excellent test-retest reliability, and was significantly correlated with all the reference cognitive tests used here, demonstrating ICA’s ability as one unified test that can assess various cognitive domains.

scholarly journals Cognitive Impairment among Young Motorcyclists: A controlled study

2018 ◽  
Vol 3 (7) ◽  
pp. 321
Author(s):  
Anila Ali ◽  
Roslinah Mohamad Hussain
Keyword(s):  
Cognitive Impairment ◽  
Reaction Time ◽  
Cognitive Function ◽  
Cognitive Performance ◽  
Study Design ◽  
Cognitive Assessment ◽  
Noise Exposure ◽  
Controlled Study ◽  
Neuropsychological Battery ◽  
High Noise

The cognitive assessment of young motorcyclists under high-noise exposure has not been investigated previously. Therefore, this study aimed to determine the effects of noise-induced cognitive function and reaction time among undergraduate motorcyclists (aged: 19-25). The study design consisted of experimental (ExG; n=30) and controlled group (CoG; n=30). The ExG performed neuropsychological battery test under motorcycle noise (85-90 dBA) and CoG under controlled laboratory noise (<65 dBA). The result revealed that the CoG had significantly better cognitive performance (p < 0.05) and reaction-time as compared to ExG. The results demonstrated the significant effect of motorcycle noise on decreased cognitive performance and increased reaction time.

Impaired cognitive performance on MoCA testing at discharge in elderly patients following day endoscopy and its relationship to preoperative mild cognitive impairment

2021 ◽  
pp. 0310057X2199745
Author(s):  
Nathan J Chua ◽  
Georgia Dimopoulos ◽  
David A Scott ◽  
Brendan S Silbert ◽  
Lisbeth A Evered
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Performance ◽  
Cognitive Assessment ◽  
Assessment Tool ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Montreal Cognitive Assessment ◽  
Confusion Assessment ◽  
Diagnostic Confusion

In patients admitted to hospital, preoperative mild cognitive impairment predicts postoperative complications. The effect of mild cognitive impairment on discharge readiness among the day stay surgery population is unknown. Our aims were to determine the incidence of impaired cognitive performance at discharge after day stay endoscopy and whether pre-existing mild cognitive impairment was associated with its development. A single-centre cohort study of elective day stay endoscopy patients was undertaken. Over a three-month period, data were collected from 69 patients aged 65 years and over. Patients were cognitively assessed on admission and discharge using the Montreal cognitive assessment tool and the three-minute diagnostic confusion assessment method. At baseline, patients who scored 1.5 or more standard deviations below age-adjusted levels on the Montreal cognitive assessment tool in conjunction with a subjective memory complaint were classified as having mild cognitive impairment. At discharge, patients were classified as having impaired cognitive performance if there was a reduction in the Montreal cognitive assessment tool score by at least two points. We also assessed delirium and subsyndromal delirium at discharge using the three-minute diagnostic confusion assessment method. We identified mild cognitive impairment in 23 patients (33.3%) on admission, and impaired performance on the Montreal cognitive assessment tool test at discharge in 35 (50.7%) patients. There was no association between mild cognitive impairment on admission and impaired cognitive performance at discharge (50.0% versus 51.1%, P = 0.94). This study demonstrates that evidence of impaired cognitive performance on the Montreal cognitive assessment tool testing is present after day stay endoscopy in over 50% of elderly patients, but this is not associated with preoperative cognitive status.

scholarly journals DIABETES STATUS IS ASSOCIATED WITH POOR COGNITIVE PERFORMACE IN SAUDI POPULATION AT HIGH METABOLIC RISK

2016 ◽  
pp. 1-5
Author(s):  
T. Alaama ◽  
M. Basheikh ◽  
A. Khiyami ◽  
M. Mutwalli ◽  
S. Batawi ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Cognitive Assessment ◽  
Female Gender ◽  
Education Level ◽  
University Hospital ◽  
Diabetes Status ◽  
Increased Risk ◽  
Low Education ◽  
Prevalence Of Obesity

Objective: Previous studies have shown that Diabetes mellitus (DM) is associated with an increased risk of cognitive impairment, but little data is available on Arabic populations, inspite of their remarkably high prevalence of DM. In this study we attempt to study the effect of DM on cognitive performance in middle-aged and elderly patients. Design: Observational cross sectional study. Setting: Outpatient clinics in King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Participants: The study included 241 volunteers aged 59.6 ± 9.2 years; 171 outpatients with DM, matched with 70 controls without. Measurements: Volunteers underwent cognitive assessment using the Montreal Cognitive Assessment Test (MoCA) and the Rowland Universal Dementia Assessment Scale (RUDAS). Results: RUDAS score was poorer in diabetics (25,25 ± 2,78 vs. 26,71 ± 2,57 in controls; p<0.0001) who are more likely to have cognitive impairment 16% , than those who are not diabetics 3%; p=0.004. This association was confirmed in multivariate analyses and shown to be independent of female gender and low education level, all of which were associated with worse RUDAS cognitive score.The results were not significant when the MoCA was used, as 85 % of the cases and 78 % of the controls had abnormal results;p=0.194.Among diabetics, there was no statistically significant effect found for glycemic control or DM duration on either one of the tests.The prevalence of obesity was similar in the two groups with 63% in diabetics and 62% in controls. Conclusion: In our population with an alarming prevalence of obesity, diabetes was associated with poorer cognitive performance independent of female gender or low education level, drawing attention to this under-recognized problem of cognitive impairment that could result in significant health and social problems, particularly in areas with high diabetes prevalence. RUDAS was found to be a very reasonable and convenient test to assess cognition in our sample characterized by a low educational level.

Analysis of Functional and Cognitive Impairment in Institutionalized Individuals with Movement Disorders

2019 ◽  
Vol 19 (7) ◽  
pp. 1022-1031 ◽  
Author(s):  
Paula D. Cebrián ◽  
Omar Cauli
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Cognitive Performance ◽  
Functional Impairment ◽  
Movement Disorders ◽  
Neurological Disorders ◽  
Daily Living ◽  
Severe Cognitive Impairment

Background: Many neurological disorders lead to institutionalization and can be accompanied in their advanced stages by functional impairment, and progressive loss of mobility, and cognitive alterations. Objective: We analyzed the relationship between functional impairment and cognitive performance and its related subdomains in individuals with Parkinson’s disease, Alzheimer’s disease accompanied by motor dysfunction, and with other neurological disorders characterized by both motor and cognitive problems. Methods: All participants lived in nursing homes (Valencia, Spain) and underwent cognitive evaluation with the Mini-Mental State Examination; functional assessment of independence in activities of daily living using the Barthel score and Katz index; and assessment of mobility with the elderly mobility scale. Results: The mean age of the subjects was 82.8 ± 0.6 years, 47% of the sample included individuals with Parkinson’s disease, and 48 % of the sample presented severe cognitive impairment. Direct significant relationships were found between the level of cognitive impairment and functional capacity (p < 0.01) and mobility (p < 0.05). Among the different domains, memory impairment was not associated with altered activities of daily living or mobility. The functional impairment and the risk of severe cognitive impairment were significantly (p<0.05) higher in female compared to male patients. Among comorbidities, overweight/obesity and diabetes were significantly (p < 0.05) associated with poor cognitive performance in those individuals with mild/moderate cognitive impairment. Conclusion: In institutionalized individuals with movement disorders there is an association between functional and cognitive impairment. Reduction of over-weight and proper control of diabetes may represent novel targets for improving cognitive function at such early stages.

scholarly journals Using historical data to facilitate clinical prevention trials in Alzheimer disease? An analysis of longitudinal MCI (mild cognitive impairment) data sets

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Manfred Berres ◽  
Andreas U. Monsch ◽  
René Spiegel
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Performance ◽  
Placebo Treatment ◽  
Drug Trial ◽  
The Other ◽  
Data Sets ◽  
Control Groups ◽  
Community Needs ◽  
Clinical Prevention

Abstract Background The Placebo Group Simulation Approach (PGSA) aims at partially replacing randomized placebo-controlled trials (RPCTs), making use of data from historical control groups in order to decrease the needed number of study participants exposed to lengthy placebo treatment. PGSA algorithms to create virtual control groups were originally derived from mild cognitive impairment (MCI) data of the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. To produce more generalizable algorithms, we aimed to compile five different MCI databases in a heuristic manner to create a “standard control algorithm” for use in future clinical trials. Methods We compared data from two North American cohort studies (n=395 and 4328, respectively), one company-sponsored international clinical drug trial (n=831) and two convenience patient samples, one from Germany (n=726), and one from Switzerland (n=1558). Results Despite differences between the five MCI samples regarding inclusion and exclusion criteria, their baseline demographic and cognitive performance data varied less than expected. However, the five samples differed markedly with regard to their subsequent cognitive performance and clinical development: (1) MCI patients from the drug trial did not deteriorate on verbal fluency over 3 years, whereas patients in the other samples did; (2) relatively few patients from the drug trial progressed from MCI to dementia (about 10% after 4 years), in contrast to the other four samples with progression rates over 30%. Conclusion Conventional MCI criteria were insufficient to allow for the creation of well-defined and internationally comparable samples of MCI patients. More recently published criteria for MCI or “MCI due to AD” are unlikely to remedy this situation. The Alzheimer scientific community needs to agree on a standard set of neuropsychological tests including appropriate selection criteria to make MCI a scientifically more useful concept. Patient data from different sources would then be comparable, and the scientific merits of algorithm-based study designs such as the PGSA could be properly assessed.

scholarly journals VAMP-2 is a surrogate cerebrospinal fluid marker of Alzheimer-related cognitive impairment in adults with Down syndrome

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Alberto Lleó ◽  
Maria Carmona-Iragui ◽  
Laura Videla ◽  
Susana Fernández ◽  
Bessy Benejam ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Down Syndrome ◽  
Cognitive Impairment ◽  
Episodic Memory ◽  
Cognitive Performance ◽  
Synaptic Proteins ◽  
Selected Reaction Monitoring ◽  
Synaptic Protein ◽  
Csf Levels ◽  
Syntaxin 1B

Abstract Background There is an urgent need for objective markers of Alzheimer’s disease (AD)-related cognitive impairment in people with Down syndrome (DS) to improve diagnosis, monitor disease progression, and assess response to disease-modifying therapies. Previously, GluA4 and neuronal pentraxin 2 (NPTX2) showed limited potential as cerebrospinal fluid (CSF) markers of cognitive impairment in adults with DS. Here, we compare the CSF profile of a panel of synaptic proteins (Calsyntenin-1, Neuroligin-2, Neurexin-2A, Neurexin-3A, Syntaxin-1B, Thy-1, VAMP-2) to that of NPTX2 and GluA4 in a large cohort of subjects with DS across the preclinical and clinical AD continuum and explore their correlation with cognitive impairment. Methods We quantified the synaptic panel proteins by selected reaction monitoring in CSF from 20 non-trisomic cognitively normal controls (mean age 44) and 80 adults with DS grouped according to clinical AD diagnosis (asymptomatic, prodromal AD or AD dementia). We used regression analyses to determine CSF changes across the AD continuum and explored correlations with age, global cognitive performance (CAMCOG), episodic memory (modified cued-recall test; mCRT) and CSF biomarkers, CSF Aβ42:40 ratio, CSF Aβ1-42, CSF p-tau, and CSF NFL. P values were adjusted for multiple testing. Results In adults with DS, VAMP-2 was the only synaptic protein to correlate with episodic memory (delayed recall adj.p = .04) and age (adj.p = .0008) and was the best correlate of CSF Aβ42:40 (adj.p = .0001), p-tau (adj.p < .0001), and NFL (adj.p < .0001). Compared to controls, mean VAMP-2 levels were lower in asymptomatic adults with DS only (adj.p = .02). CSF levels of Neurexin-3A, Thy-1, Neurexin-2A, Calysntenin-1, Neuroligin-2, GluA4, and Syntaxin-1B all strongly correlated with NPTX2 (p < .0001), which was the only synaptic protein to show reduced CSF levels in DS at all AD stages compared to controls (adj.p < .002). Conclusion These data show proof-of-concept for CSF VAMP-2 as a potential marker of synapse degeneration that correlates with CSF AD and axonal degeneration markers and cognitive performance.

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