Screening for cognitive impairment in systemic lupus erythematosus: Application of the Montreal Cognitive Assessment (MoCA) in a Greek patient sample

Background Cognitive impairment (CI) is one of the most frequent neuropsychiatric manifestations of systemic lupus erythematosus (SLE). Given that extensive neuropsychological testing is not always feasible in routine clinical practice, brief cognitive screening tools are desirable. The aim of this study was to evaluate the Montreal Cognitive Assessment (MoCA) as a screening tool for CI in SLE. Methods Consecutive SLE patients followed at a single centre were evaluated using MoCA and an extensive neuropsychological test battery (NPT), including the Digits Forward and Digits Backwards, Rey Auditory Verbal Learning Memory Test, Trail Making Test, Stroop Colour-Word Test, Semantic and Phonetic Verbal Fluency tests and a 25-problem version of the General Adult Mental Ability test. The criterion validity of MoCA was assessed through receiver operating characteristic (ROC) analyses using three different case definitions: i) against normative population data, ii) and iii) against average performance of a comparison group of rheumatoid arthritis (RA) patients, to adjust for possible confounding effects of chronic illness and inflammatory processes on cognitive performance. The effect of patient-related (age, years of education, anxiety, depression, fatigue and pain) and disease-related (activity, damage, age at diagnosis, disease duration, use of glucocorticoid, psychotropic and pain medication) parameters on the MoCA was examined. Results A total of 71 SLE patients were evaluated. MoCA significantly correlated with all NPT scores and was affected by education level ( p < 0.001), but not by other demographic or clinical variables. The optimal cutoff for detecting CI, as defined on the basis of normative population data, was 23/30 points, demonstrating 73% sensitivity and 75% specificity. A cutoff of 22/30 points, using neuropsychological profiles of the RA group as inflammatory disease controls, exhibited higher sensitivity (100%, based on both definitions) and specificity (87% and 90%, depending on the definition). The standard cutoff of 26/30 points displayed excellent sensitivity (91–100%) with significant expenses in specificity (43–45%). Conclusion The MoCA is an easily applied tool, which appears to be reliable for identifying CI in SLE patients. The standard cutoff score (26/30) ensures excellent sensitivity while lower cutoff scores (22–23/30) may, also, provide higher specificity.

Personality dimensions of patients can change during the course of parkinson’s disease

Background Studies assessing personality dimensions by the “Temperament and Character Inventory” (TCI) have previously found an association between Parkinson’s disease (PD) and lower Novelty Seeking and higher Harm Avoidance scores. Here, we aimed to describe personality dimensions of PD patients with motor fluctuations and compare them to a normative population and other PD populations. Methods All PD patients awaiting Deep Brain Stimulation (DBS) answered the TCI before neurosurgery. Their results were compared to those of historical cohorts (a French normative population, a de novo PD population, and a PD population with motor fluctuations). Results Most personality dimensions of our 333 included PD patients with motor fluctuations who are candidates for DBS were different from those of the normative population and some were also different from those of the De Novo PD population, whereas they were similar to those of another population of PD patients with motor fluctuations. Conclusions During the course of PD, personality dimensions can change in parallel with the development of motor fluctuations, either due to the evolution of the disease and/or dopaminergic treatments.

The use of the Montreal Cognitive Assessment (MoCA) to assess cognitive impairment in Prader-Willi syndrome

Purpose When a comprehensive neuropsychological assessment cannot be carried out, a quick and discriminant tool of good psychometric properties can be useful to practitioners. The purpose of this paper is to examine the use of the Montreal Cognitive Assessment (MoCA) in patients with Prader–Willi syndrome (PWS) and to test its reliability for cognitive assessment in a population with intellectual disabilities. Design/methodology/approach Thirty-seven adults with PWS took the MoCA. Reliability of the battery was tested using Cronbach’s alphas. The performance of PWS adults in each subtest was then compared to that of a normative population of healthy adults. Findings The MoCA was found to be unreliable in PWS. The subtests analyses indicated that the PWS sample underperformed the normative population of healthy adults on most subtests of the MoCA. A sub-sample aged between 17and 29 years showed normal performance on Naming and Memory, and a sub-sample aged from 30 to 39 years showed similar performance on Language, Memory and Orientation relative to age-matched normative healthy adults. Research limitations/implications Results showed that the current version of the MoCA, if taken as a whole test for cognitive assessment, does not present with adequate psychometric properties, which the authors interpret as reflecting the heterogeneity in PWS cognitive profiles. If used in PWS, the MoCA may however be useful in examining cognitive functions separately using subtest-based comparisons to normative data. Originality/value This research contributes to a better assessment of cognitive profile in PWS and people with learning disabilities by arguing that the use of psychometric tests should depend more on the specificity of the population under evaluation.

Health-Related Quality of Life, Satisfaction with Care, and Cosmetic Results in Relation to Treatment among Patients with Keratinocyte Cancer in the Head and Neck Area: Results from the PROFILES Registry

Background: Little is known about the impact of keratinocyte cancer (KC) and its treatment on health-related quality of life (HRQoL). Objectives: The objectives of the present study were (1) to evaluate HRQoL among patients with KC in a population-based setting and compare this with an age- end sex-matched normative population and (2) to compare HRQoL, satisfaction with care, and cosmetic results among patients who underwent conventional excision, Mohs’ micrographic surgery, or radiotherapy. Method: A random sample of 347 patients diagnosed with cutaneous basal cell or squamous cell carcinoma in the head and neck area between January 1, 2010, and December 31, 2014, were selected from the Netherlands Cancer Registry (NCR) and were invited to complete a questionnaire on HRQoL, satisfaction with care, and cosmetic results. Data were collected within Patient-Reported Outcomes Following Initial Treatment and Long-term Evaluation of Survivorship (PROFILES). Outcomes were compared to an age- and sex-matched normative population. Results: Two hundred fifteen patients with KC returned a completed questionnaire (62% response). Patients with KC reported better global quality of life (79.6 vs. 73.3, p < 0.01) and less pain (p < 0.01) compared to the normative population. No statistically significant differences in HRQoL, satisfaction with care, and cosmetic results were found between patients with KC who underwent conventional excision, Mohs’ micrographic surgery, or radiotherapy. Conclusions: The impact of KC and its treatment seems relatively low and more positive than negative as patients reported better HRQoL compared to an age- and sex-matched normative population, probably due to adaptation. No statistically significant differences between treatment types were found concerning HRQoL, patient satisfaction, and cosmetic results. This information could be used by healthcare professionals involved in KC care to improve patients’ knowledge about different aspects of the disease as patient’s preference is an important factor for treatment choice.