Elevated Serum Amyloid A Is Associated With Cognitive Impairment in Ischemic Stroke Patients

Background and PurposeThe impact of serum amyloid A on cognitive impairment after ischemic stroke is unclear. We aimed to investigate the association between serum amyloid A (SAA) levels and post-stroke cognitive impairment (PSCI) at 3 months after ischemic stroke.MethodsOne hundred and ninety-eight patients were enrolled prospectively from June 2020 to April 2021. The SAA concentrations were measured using a commercially available enzyme-linked immunosorbent assay kit after admission. Cognitive function was assessed using the Montreal Cognitive Assessment score at 3 months after the symptom onset. We defined a Montreal Cognitive Assessment score <25 as cognitive impairment.ResultsDuring 3-month follow-up, 80 patients (40.4%) were diagnosed as having PSCI. As compared with patients with cognitively normal ischemic stroke, those with PSCI were older, more likely to have diabetes and white matter lesions, and had a higher baseline National Institutes of Health stroke score and SAA levels. After adjustment for age, the National Institutes of Health stroke score and other covariates, the OR for the highest quartile of SAA compared with the lowest quartile was 5.72 (95% CI, 2.17–15.04, P = 0.001) for PSCI. Also, ordinal logistic regression analysis showed that higher SAA concentrations were associated with increased risk of PSCI severity (OR, 4.31; 95% CI, 1.81–10.33, P = 0.001). Similar results were found when the SAA levels were analyzed as a continuous variable.ConclusionsThis present study demonstrated that increased SAA levels might be associated with PSCI at 3 months after ischemic stroke.

Developing guidelines for the translation and cultural adaptation of the Montreal Cognitive Assessment: scoping review and qualitative synthesis

Background Ethnic minorities in countries such as the UK are at increased risk of dementia or minor cognitive impairment. Despite this, cognitive tests used to provide a timely diagnosis for these conditions demonstrate performance bias in these groups, because of cultural context. They require adaptation that accounts for language and culture beyond translation. The Montreal Cognitive Assessment (MoCA) is one such test that has been adapted for multiple cultures. Aims We followed previously used methodology for culturally adapting cognitive tests to develop guidelines for translating and culturally adapting the MoCA. Method We conducted a scoping review of publications on different versions of the MoCA. We extracted their translation and cultural adaptation procedures. We also distributed questionnaires to adaptors of the MoCA for data on the procedures they undertook to culturally adapt their respective versions. Results Our scoping review found 52 publications and highlighted seven steps for translating the MoCA. We received 17 responses from adaptors on their cultural adaptation procedures, with rationale justifying them. We combined data from the scoping review and the adaptors’ feedback to form the guidelines that state how each question of the MoCA has been previously adapted for different cultural contexts and the reasoning behind it. Conclusions This paper details our development of cultural adaptation guidelines for the MoCA that future adaptors can use to adapt the MoCA for their own languages or cultures. It also replicates methods previously used and demonstrates how these methods can be used for the cultural adaptation of other cognitive tests.

Construct Validity and Psychometric Properties of the Tamil (India) Version of Montreal Cognitive Assessment (T-MoCA) in Elderly

Background: The Montreal Cognitive Assessment (MoCA) is a neuropsychological cognitive tool developed and adapted widely in various languages for screening mild cognitive impairment (MCI). Objectives: The present study aimed to evaluate the psychometric properties of the Tamil (India) Version of MoCA (T-MoCA) and further examine the construct validity of the tool.Method: The authors conducted internal consistency, test-retest, sensitivity-specificity, and construct validity using 233 Tamil-speaking elderly participants. The inclusion criteria of the study participants were 0.5 or less than 0.5 scores in the Clinical Dementia Rating scale (CDR). Further, T-MoCA was used to screen MCI. Results: The result showed that the T-MoCA had high internal consistency (0.83) and high test-retest reliability (0.92). Receiver operating characteristic (ROC) analyses showed an area under the curve (AUC) of 0.91 (95% CI 0.87-0.94) for detecting MCI. Furthermore, the optimal cut-off score to detect MCI was 24, accommodated a sensitivity and specificity of 88.4% and 77.9%, respectively. Conclusions: The Tamil (India) version of the MoCA maintained its core diagnostic properties, furnishing it a valid and reliable tool for the screening of MCI. Also, its latent dimensions help to understand the elders’ cognitive function in a better way.

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.

Aspectos cognitivos e auditivos

Introdução: Dificuldades de desempenho comunicativo e de reconhecimento de fala em ambientes ruidosos são associadas ao envelhecimento. O declínio do reconhecimento da fala com ruído competitivo é devido a uma combinação de fatores auditivos e não-auditivos que acentuam ao longo do tempo e com o avanço da idade. Objetivo: Identificar os aspectos cognitivos e auditivos que contribuem para o declínio do reconhecimento de fala no ruído em idosos. Método: Trata-se de um estudo prospectivo, analítico, observacional e transversal. A amostra foi composta por dois grupos: um de adultos e outro de idosos, selecionados conforme os seguintes critérios de inclusão: ouvintes normais; idade entre 18 e 70 anos, de ambos os sexos. Os aspectos cognitivos foram analisados pelo Montreal Cognitive Assessment e, nos processos auditivos, foram aplicados testes de audiometria tonal limiar, psicofísicos de reconhecimento de fala em escuta difícil e de resolução temporal. Resultados: Quando comparados por grupo etário, os testes psicoacústicos apresentaram diferenças significativas nas condições: 1) SSI / OD - S/R 0 (p=0,001), 2) SSI / OD - S/R -15 (p=0,000), 3) HINT / OE S/R -10 (p=0,03), 5) HINT / OE S/R -15 (p= 0,02) quando aplicado o teste Mann Whitney U. Quando comparados por grupo etário, os testes GIN e TDD não apresentaram diferenças significativas. Já quando os testes psicoacústicos foram comparados independentes do grupo etário, os sujeitos com MoCA normal e alterados não apresentaram diferenças significativas (p=0,280). Conclusão: A partir da amostra estudada, observou-se que os aspectos cognitivos não contribuíram no desempenho da percepção de fala com estímulos competitivos quando comparados os grupos de adultos e idosos. Por outro lado, os aspectos auditivos avaliados mostraram que os idosos apresentam maiores dificuldades de compreensão da fala no ruído quando comparados aos indivíduos mais jovens.

Longitudinal Measurement Properties of the Montreal Cognitive Assessment

Background The Montreal Cognitive Assessment (MoCA) has started to be widely used in longitudinal investigations to measure changes in cognition. However, the longitudinal measurement properties of MoCA have not been investigated. We aimed to examine the measurement invariance of individual MoCA items across four time points. Methods We used longitudinal data collected between 2014 and 2017 from a cohort study on health and well-being of older adults in Hong Kong. The Cantonese version of the MoCA was used. We applied multiple group confirmatory factor analysis of ordinal variables to examine measurement invariance by educational level and across time points. Invariant items were identified by sequential model comparisons. Results We included 1029 participants that answered MoCA items across all time points. We found that items Cube, Clock Hand and Clock Number had significantly different item parameters between participants with and without formal education at all time points. The selected model (RMSEA=0.031; SRMR=0.064) indicated that eight items (Trail, Cube, Clock Shape, Clock Number, Clock Hand, Abstraction, Short-term Memory, and Orientation) did not exhibit measurement invariance over time. However, the differences in item parameter estimate over time were marginal. Accounting for the lack of measurement invariance did not substantially affect classification properties based on cutoff values at the 2nd ( major neurocognitive disorder) and 7th (mild cognitive impairment) percentile. Conclusion Our findings support using MoCA to assess changes in cognition over time in the study population. Future research should examine the longitudinal measurement properties of the test in other populations with different characteristics.