Does a combined intervention program of repetitive transcranial magnetic stimulation and intensive occupational therapy affect cognitive function in patients with post-stroke upper limb hemiparesis?

Low-frequency repetitive transcranial magnetic stimulation（LF-r TMS） to the contralesional hemisphere and intensive occupational therapy（i OT） have been shown to contribute to a significant improvement in upper limb hemiparesis in patients with chronic stroke. However, the effect of the combined intervention program of LF-r TMS and i OT on cognitive function is unknown. We retrospectively investigated whether the combined treatment influence patient＇s Trail-Making Test part B（TMT-B） performance, which is a group of easy and inexpensive neuropsychological tests that evaluate several cognitive functions. Twenty-five patients received 11 sessions of LF-r TMS to the contralesional hemisphere and 2 sessions of i OT per day over 15 successive days. Patients with right- and left-sided hemiparesis demonstrated significant improvements in upper limb motor function following the combined intervention program. Only patients with right-sided hemiparesis exhibited improved TMT-B performance following the combined intervention program, and there was a significant negative correlation between Fugl-Meyer Assessment scale total score change and TMT-B performance. The results indicate the possibility that LF-r TMS to the contralesional hemisphere combined with i OT improves the upper limb motor function and cognitive function of patients with right-sided hemiparesis. However, further studies are necessary to elucidate the mechanism of improved cognitive function.

Validity,reliability,and psychometric properties of a computerized,cognitive assessment test(Cognivue^®)Validity,reliability,and psychometric properties of a computerized,cognitive assessment test(Cognivue^®)

BACKGROUND Cognitive issues such as Alzheimer’s disease and other dementias confer a substantial negative impact.Problems relating to sensitivity,subjectivity,and inherent bias can limit the usefulness of many traditional methods of assessing cognitive impairment.AIM To determine cut-off scores for classification of cognitive impairment,and assess Cognivue®safety and efficacy in a large validation study.METHODS Adults(age 55-95 years)at risk for age-related cognitive decline or dementia were invited via posters and email to participate in two cohort studies conducted at various outpatient clinics and assisted-and independent-living facilities.In the cut-off score determination study(n=92),optimization analyses by positive percent agreement(PPA)and negative percent agreement(NPA),and by accuracy and error bias were conducted.In the clinical validation study(n=401),regression,rank linear regression,and factor analyses were conducted.Participants in the clinical validation study also completed other neuropsychological tests.RESULTS For the cut-off score determination study,92 participants completed St.Louis University Mental Status(SLUMS,reference standard)and Cognivue^®tests.Analyses showed that SLUMS cut-off scores of<21(impairment)and>26(no impairment)corresponded to Cognivue^®scores of 54.5(NPA=0.92;PPA=0.64)and 78.5(NPA=0.5;PPA=0.79),respectively.Therefore,conservatively,Cognivue^®scores of 55-64 corresponded to impairment,and 74-79 to no impairment.For the clinical validation study,401 participants completed≥1 testing session,and 358 completed 2 sessions 1-2 wk apart.Cognivue^®classification scores were validated,demonstrating good agreement with SLUMS scores(weightedκ0.57;95%CI:0.50-0.63).Reliability analyses showed similar scores across repeated testing for Cognivue^®(R2=0.81;r=0.90)and SLUMS(R2=0.67;r=0.82).Psychometric validity of Cognivue^®was demonstrated vs.traditional neuropsychological tests.Scores were most closely correlated with measures of verbal processing,manual dexterity/speed,visual contrast sensitivity,visuospatial/executive function,and speed/sequencing.CONCLUSION Cognivue^®scores≤50 avoid misclassification of impairment,and scores≥75 avoid misclassification of unimpairment.The validation study demonstrates good agreement between Cognivue^®and SLUMS;superior reliability;and good psychometric validity.

Cognitive screening for adult psychiatric outpatients: Comparison of the Cognivue® to the Montreal Cognitive Assessment

In this editorial we comment on the article by Cahn-Hidalgo D published in a recent issue of the World Journal of Psychiatry 2020;10(1);1-11.We focus on the importance of utilizing psychometrically valid cognitive screening tools when assessing for cognitive decline in older adults in a psychiatric outpatient setting.We compared the use of Cognivue®to use of the montreal cognitive assessment(MoCA)as a cognitive screening tool.A total of 58 patients aged 55 and over participated in this comparison study.Patients completed cognitive screening on Cognivue®,a new Food and Drug Administration-cleared computer screening device,and the MoCA.The results of patient performance using these two instruments were analyzed.Sixteen(28%)patients screened negative for cognitive impairment on both assessments.Forty-two(72%)patients screened positive on one or both of the assessments.There was 43%agreement between Cognivue®and the MoCA in identifying patients with cognitive impairment,and individual subtests were weakly correlated.The MoCA was determined to be the preferred instrument due to its high sensitivity and specificity(100%and 87%,respectively)when screening for cognitive impairment.We propose that the use of Cognivue®cognitive screening tool be closely reviewed until more research proves that the test meets the standards for reliability and validity.It is important for clinicians to remember that screeners should not be used to diagnosis patients with neurocognitive disorders;instead,they should be used to determine whether further evaluation is warranted.Additionally,misdiagnosing of neurocognitive disorders can pose unnecessary psychological and emotional harm to patients and their families and also lead to incorrect treatment and undue healthcare costs.

Usefulness of the Japanese version of Rapid Dementia Screening Test for mild cognitive impairment in older patients with cardiovascular disease:a cross-sectional study

BACKGROUND Cognitive decline is common among older patients with cardiovascular disease(CVD) and can decrease their self-management abilities. However, the instruments for identifying mild cognitive impairment(MCI) are not always feasible in clinical practice. Therefore, this study evaluated whether MCI could be detected using the Japanese version of the Rapid Dementia Screening Test(RDST-J), which is a simple screening tool for identifying cognitive decline.METHODS This retrospective single-center study included patients who were ≥ 65 years old and hospitalized because of CVD.Patients with a pre-hospitalization diagnosis of dementia were excluded. Each patient's cognitive function had been measured at discharge using the RDST-J and the Japanese version of the Montreal Cognitive Assessment(Mo CA-J), which is a standard tool for MCI screening. The correlation between the two scores was evaluated using Spearman's rank correlation coefficient. Receiver operating characteristic(ROC) analysis was also to evaluate whether the RDST-J could identify MCI, which was defined as a Mo CA-J score of ≤ 25 points.RESULTS The study included 78 patients(mean age: 77.2 ± 8.9 years). The RDST-J and Mo CA-J scores were strongly correlated(r = 0.835, P < 0.001). The ROC analysis revealed that an RDST-J score of ≤ 9 points provided 75.4% sensitivity and 95.2% specificity for identifying MCI, with an area under the curve of 0.899(95% CI: 0.835-0.964). The same cut-off value was identified when excluding patients with a high probability of dementia(RDST-J score of ≤ 4 points).CONCLUSIONS The RDST-J may be a simple and effective tool for identifying MCI in older patients with CVD.

A new direction for Alzheimer's research

Despite decades of research, at present there is no curative therapy for Alzheimer＇s disease. Changes in the way new drugs are tested appear to be necessary. Three changes are presented here and will be discussed. The first change is that Alzheimer＇s disease must be considered a disease of four major pathological processes, not one. The four processes are： 1） vascular hy- poperfusion of the brain with associated mitochondrial dysfunction, 2） destructive protein inclusions, 3） uncontrolled oxidative stress, and 4） proinflammatory immune processes second- ary to microglial and astrocytic dysfunction in the brain. The second change recommended is to alter the standard cognitive measurement tools used to quantify mental decline in test patients. Specifically the Dementia Severity Rating Scale （DSRS） should supersede Mini-Mental State Examination （MMSE） and other popular tests, and a measurement scale developed in research should be used to produce a linear and non-irregular baseline. Finally, accepting the concept that four etiologies cause Alzheimer＇s disease leads to the last necessary change, that new thera- pies must be employed directed against all four causes, likely as a combination. There are drugs ready to be employed in such a combinations which are available and used clinically for other purposes so can be used ＂offlabel＂ and one such combination is suggested.