Role of comprehensive geriatric assessment in screening for mild cognitive disorders

BACKGROUND The role of comprehensive geriatric assessment(CGA)in screening for mild cognitive disorders was not known.AIM To evaluate the role of CGA in screening for mild cognitive disorders.METHODS A total of 100 elderly people who underwent health examinations in our hospital and community between January 2020 and December 2021 were included for analysis.Using Petersen as the diagnostic gold standard,healthy individuals were included in the control group and patients with mild cognitive impairment were assigned to the study group.The correlation between the cognitive function of the patients and their baseline clinical profiles was analyzed.Patients'Montreal Cognitive Assessment(MoCA)and CGA screening results were compared,and the sensitivity and specificity were calculated to assess the screening role of CGA.RESULTS CGA assessment yielded higher diagnostic accuracy than MoCA.The results of the multivariate regression analysis showed no correlation of gender,age,body mass index and literacy with cognitive function.Patients with mild cognitive impairment obtained significantly lower MoCA scores than healthy individuals(P<0.05).In the CGA scale,patients with mild cognitive impairment showed significantly lower Mini-mental State Examination,Miniature Nutritional Assessment and Berg Balance Scale scores,and higher Activity of Daily Living,Instrumental Activities of Daily Living Scale and Frailty Screening Inventory scores than healthy individuals(P<0.05),whereas the other assessment scales showed no significant differences(P>0.05).The CGA provides higher diagnostic sensitivity and specificity than the MoCA(P<0.05).CONCLUSION CGA allows accurate identification of mild cognitive impairment with high sensitivity and specificity,facilitating timely and effective intervention,and is thus recommended for clinical use.

Clinical Application of Loewenstein Occupational Therapy Cognitive Assessment Battery-Second Edition in Evaluating of Cognitive Function of Chinese Patients with Post-stroke Aphasia

Objective To investigate the clinical application value of Loewenstein Occupational Therapy Cognitive Assessment(LOTCA)battery in Chinese patients with post-stroke aphasia.Methods Cognitive functions of 59 Chinese patients with aphasia following a stroke were assessed with the Chinese version of the second edition of LOTCA battery and their linguistic functions were tested with the Western Aphasia Battery(WAB)Scale,respectively.The results of LOTCA were analyzed and compared across different groups,in the light of gender,age,educational background,the length of illness,and the degree of aphasia.Results Neither the score of subtests of the LOTCA nor the overall scores of LOTCA of aphasia patients with different gender and educational background differed(all P>0.05).In different age groups,apart from thinking operation(F=3.373,P=0.016),visuomotor organization(F=3.124,P=0.022),attention(F=3.729,P=0.009)and the total score(F=2.683,P=0.041),there was no difference in terms of the other subtest scores of LOTCA(all P>0.05).In the groups of different length of time with illness,apart from orientation(F=2.982,P=0.039)and attention(F=3.485,P=0.022),the score of other subtests and the total score of LOTCA were not different(all P>0.05).In the groups of different degree of aphasia,apart from attention(F=2.061,P=0.074),both the score of other subtests and the total score of LOTCA differed(all P<0.05).Conclusion LOTCA might be suitable to assessing the cognitive ability of post-stroke Chinese patients with aphasia.

A Brief Clinical Assessment of Cognitive Deficit with Impaired Daily Living Functioning in Parkinson’s Patients with and without Dementia

Cognitive decline in Parkinson’s disease (PD) is defined as dementia which affects activities of daily living (ADL) function. Dementia is one of the recognized issues in the treatment of Parkinson’s disease patients (PDP) as it is becoming a major contributor to morbidity. The objective of our study was to evaluate the cognitive decline in Parkinson’s disease patients (PDP) and the influence of cognition on daily living function deterioration in cognitively impaired and cognitively unimpaired PDP. Cognitively impaired PDP (n = 24), and cognitively unimpaired PDP (n = 16) were administered MoCA and MMSE performance based tests for cognitive measurements and Alzheimer’s Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) to determine everyday functioning. The significances of MoCA and MMSE among cognitively impaired PDP and cognitively unimpaired PDP in univariant analysis were P < 0.001 and P < 0.05. In partial correlation, MoCA was strongly related to ADL function as compare to MMSE (r = 0.623, P = 0.001). Cognitively impaired PDP showed significantly lower score on visuo-construction and attention. Among all variables of MoCA domains, attention is strongly associated with instrumental activity daily living (IADL) scores (logistic regression coefficient = 0.672, P = 0.01). These results suggest that dementia affects daily living performances especially the IADL tasks like attention and execution. Therefore, the assessment of complex daily activities particularly IADL is probably useful for the diagnosis of early stage cognitive impairment in PDP. Further MMSE test is less sensitive than MoCA for detecting significant cognitive decline in PDP and impaired attention is an important determinant of ADL functions in cognitively impaired PDP.

Agreement and conversion formula between mini-mental state examination and montreal cognitive assessment in an outpatient sample

AIM To explore the agreement between the mini-mental state examination(MMSE) and montreal cognitive assessment(Mo CA) within community dwelling older patients attending an old age psychiatry service and to derive and test a conversion formula between the two scales.METHODS Prospective study of consecutive patients attending outpatient services.Both tests were administered by the same researcher on the same day in random order.RESULTS The total sample(n = 135) was randomly divided into two groups.One to derive a conversion rule(n = 70),and a second(n = 65) in which this rule was tested.The agreement(Pearson's r) of MMSE and Mo CA was 0.86(P < 0.001),and Lin's concordance correlation coefficient(CCC) was 0.57(95%CI:0.45-0.66).In the second sample Mo CA scores were converted to MMSE scores according to a conversion rule from the first sample which achieved agreement with the original MMSE scoresof 0.89(Pearson's r,P < 0.001) and CCC of 0.88(95%CI:0.82-0.92).CONCLUSION Although the two scales overlap considerably,the agreement is modest.The conversion rule derived herein demonstrated promising accuracy and warrants further testing in other populations.

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.

The Neurocognitive Assessment of HIV-Infected School-Aged Nigerian Children

Objective: Studies available on cognitive function among school-aged HIV-infected African and in particular Nigerian children are few. The purpose of the study was to assess the neurocognitive function of a group of HIV-infected schoolaged (6 - 15 years) children using the Raven’s Standard Progressive Matrices (RPM). Method: Cognitive assessments of 69 HIV positive children and 69 age- and sex-matched apparently healthy HIV negative control children were performed using the Raven’s Standard Progressive Matrices (RPM). The children were subdivided (Piaget’s developmental staging) into two sub-groups: the concrete operation stage (6 - 11 years) and the formal operation stage (12 - 15 years) for analysis. Result: The mean RPM score for the HIV positive children was 18.2 (8.0 - 47.0, SD 9.8) which was significantly lower than the score of 27.2 (8.0 - 52.0, SD 13.8) for the HIV negative children (p < 0.001). On the RPM grading and using the HIV negative children as the standard, 56.5% of the HIV positive children had cognitive performance at below average to intellectually defective range. Conclusion: School-aged HIV positive children had significantly lower cognitive scores compared with age and gender-matched HIV negative children. Routine neuropsychological evaluation of all school-aged HIV-infected children is recommended. Early detection of cognitive impairment will help in planning appropriate interventions.

The relationship of montreal cognitive assessment scores to framingham coronary and stroke risk scores

We examined the relationship between a brief cognitive screening measure and Framingham Coronary and Stroke Risk scores. We administered the Montreal Cognitive Assessment (MoCA) to participants in the Dallas Heart Study, a community-based multiethnic study investigating the development of atherosclerosis. The composition of the group was 50% African American, 36% Caucasian and 14% Hispanic. There were 765 subjects (mean age 51 years) who had both Coronary and Stroke Risk scores and an additional 144 subjects with only Coronary Risk scores available. There was a small significant inverse relationship between MoCA and Framingham Coronary and Stroke Risk scores. MoCA scores were influenced by education, but were not influenced by age or by the presence of one or more apoE4 alleles.

Handling Uncertainty in Human Cognitive Reliability Method for Safety Assessment Based on DSET

Human Reliability Analysis(HRA)is an important part in safety assessment of a large complex system.Human Cognitive Reliability(HCR)model is a method of evaluating the probability that operators fail to complete during diagnostic decision making within a limited time,which is widely used in HRA.In the application of this method,cognitive patterns of humans are required to be considered and classified,and this process often relies on the evaluation opinions of experts which is highly subjective and uncertain.How to effectively express and process this uncertain and subjective information plays a critical role in improving the accuracy and applicability of HCR.In this paper,a new model was proposed to deal with the uncertain information which exists in the processes of cognitive pattern classification in HCR.First,an evaluation panel was constructed based on expert opinions and processing including setting corresponding anchor points and qualitative indicators of different cognitive patterns,and mapping them to fuzzy numbers and unit intervals.Second,based on the evaluation panel,different analysts judge the cognitive pattern types of actual specific events and provide the level of confidence he or she has in the judgments.Finally,the evaluation opinions of multiple analysts were expressed and fused based on the Dempster-Shafer Evidence Theory(DSET),and the fused results were applied to the HCR model to obtain the Human Error Probability(HEP).A case study was used to demonstrate the procedure and effectiveness of the proposed method.

Evaluation of the Tokyo Cognitive Assessment for Predicting Cognitive Impairment in Rehabilitation Users

[Purpose] This study aimed to evaluation of the Tokyo cognitive assessment (Toca) for predicting cognitive impairment in rehabilitation users. [Method] The variables of age, BMI, educational background, Toca for 36 rehabilitation users and 22 healthy elder were assessed. We compared cognitive functions in rehabilitation users who need support and healthy elders. [Results] Of the Toca 1 to 11 trials, there was a significant difference other than 9, 10 rials. The Toca scores with 8 points higher were significantly higher in healthy elders than in rehabilitation users. The area under the receiver-operator curve (AUC) for predicting mild cognitive impairment (MCI) by the Toca was 0.874. Using a cut-off point of 19/20, the Toca demonstrated a sensitivity of 83.9% and a sensitivity of 85.0% in diagnosing MCI. [Conclusion] The Toca is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in rehabilitation users.

AB033.The impact of visual impairment on the Montreal Cognitive Assessment

Background:Cognitive assessments,such as the Montreal Cognitive Assessment(MoCA),use components that assume intact sensory abilities,however,adults show concomitant decreases in visual acuity with increasing age.Scores on cognitive assessments are typically lower for individuals with visual impairments compared to individuals with normal/corrected to normal vision.But it is not clear if lowers scores on cognitive assessments are due to the assessments relying on visual stimuli,or if individuals with visual impairments are actually more likely to have cognitive impairments.Therefore we simulated visual impairments,i.e.,reduced visual acuity and contrast sensitivity,in young healthy adults to determine how this impacts their scores on a measure of cognitive ability,i.e.,the MoCA.Methods:Participants(n=19)completed one of the three version of the MoCA under three conditions(20/20,simulated 20/80,simulated 20/200).The MoCA was administered following the clinical protocols.Only participants that scored>26(i.e.,normal cognitive function)at 20/20 were included in the analysis.For comparison,we included MoCA data from a sample of older adults with normal vision(n=19,Mage=74,Acuity M=0.04 logMAR,SD=0.16)or visual impairment(n=19,Mage=79,Acuity M=0.35 logMAR,SD=0.3).Results:Acuity of participants at 20/20(M=0.06 LogMAR,SD=0.1),simulated 20/80(M=0.63,SD=0.18)and simulated 20/200(M=0.88,SD=0.19)showed that the participants experienced simulated acuity loss with the goggles.For the MoCA scores,we found a main effect of acuity(F=16.22,P<0.001,η2=0.375,BF10=5,618).Planned post hoc comparisons showed a significant difference between scores with a 20/20 acuity(M=27.26,SD=0.93)and 20/80(M=24.74,SD=1.66,t=5.62,ptukey<0.001,d=1.88),and between 20/20 and 20/200(M=25.63,SD=1.46,t=3.63,ptukey=0.002,Cohen’s d=1.33).However,no difference was observed between 20/80 and 20/200(t=−1.99,ptukey=0.125,d=0.572).The MoCA scores in older adults with normal vision(M=27.32,SD=2.41)and with visual impairment(M=26.68,SD=2.52),did not differ significantly(t36=−0.787,P=0.436,d=0.26,BF10=0.4).Conclusions:Our findings show that simulated reductions in visual acuity and contrast sensitivity lead to lower scores on measures of cognitive ability,specifically the MoCA.However,it appears that older adults with actual visual impairments may have developed compensatory strategies to adapt to this loss in visual acuity as there were no significant differences in scores of older adults with and without visual impairments.Therefore,we would recommend that when assessing an individual with visual impairments to conduct the cognitive test by re-scoring it without the visual components,e.g.,the MoCA Blind,to magnify the visual components,or to substitue the visual component when possible using auditory alternatives,e.g.,the oral trail making task.

Sensitizing a Gifted Child with Autism Spectrum Disorder towards Social Cognition: From Assessment to Treatment

Social cognition difficulties are well documented in children with Autism Spectrum Disorder (ASD). This clinical case study reports on social cognition assessment and treatment of a gifted child, SC (9 years), with ASD and an extraordinarily high verbal IQ (146). The assessment of theory of mind, emotion recognition and pragmatic abilities showed some weaknesses in these areas. The 4-month treatment was divided into 14 sessions and was aimed at helping SC to improve his abilities to recognize emotions and comprehend mental states. The main technique used in the intervention was “social reading” with video clips. The initial assessment was repeated after the treatment and in a follow up session. The results of this case study suggest that “social reading” can be considered as a beneficial technique for children with high-functioning ASD, and especially in giftedness conditions.

Cognitive Ability in Elderly in a City in Northeastern Brazil: An Analytical Study

To analyze the cognitive ability of elderly people assisted by the Family Health Strategy (FHS) in a northeastern Brazilian city, a cross-sectional, analytical study was conducted with 406 elderly assisted by the FHS in Mossoro-RN, Brazil, from March to May 2014. The data were collected through two validated questionnaires. For the data analysis, the Alpha Cronbach’s, Kruskal-Wallis test, chi-square and Pearson correlation statistical tests were applied. There was a predominance of women (67.98%) in the survey. Among the respondents, 50% had an index of up to 27 points in Pfeffer Instrument, identifying greater degree of dependence in performing instrumental daily activities related to mobility in the community (39.7%) and financial management (57.1%). On Mini-Mental State Examination (MMSE), 75% of seniors had an index above 27 points, with the scores classification as standard (50.99%), mild (25.12%), moderate (22.66%) and severe (1.23%). Although changes have been identified in cognitive performance and independence of elderly people in some areas, these difficulties do not completely affect the lives and daily activities of the elderly.

Fluoxetine ameliorates cognitive impairments induced by chronic cerebral hypoperfusion via down-regulation of HCN2 surface expression in the hippocampal CA1 area

Aim To investigate whether tluoxetine, a selective serotonin reuptake inhibitor（ SSRI） , could amelio- rate cognitive impairments induced by chronic cerebral hypopeffusion in rats and to clarify the underlying mecha- nisms of its efficacy. Methods Rats were subjected to permanent bilateral occlusion of the common carotid arteries （two-vessel occlusion, 2VO）. Two weeks later, rats were treated with 30 mg · kg^-1 fluoxetine （intragastric injec- tion, i. g. ） for 6 weeks. Cognitive function was evaluated by Morris water maze （MWM） and novel objects recog- nition （NOR） test. Long-term potentiation （LTP） was used to address the underlying synaptic mechanisms. West- ern blot was used to quantify the protein levels. Results Fluoxetine treatment significantly improved the cognitive 2VO impairments caused by 2VO, accompanied with a reversion of 2VO-induced inhibitory of LTP. Furthermore, caused an up-regulation of hyperpolarization-activated cyclic nueleotide-gated channel 2 （HCN2） surface expres- sions in the hippocampal CA1 area and fluoxetine also effectively recovered the up-regulation of HCN2 surface ex- pressions. Conclusion Fluoxetine can ameliorate cognitive impairments induced by chronic cerebral hypopeffusion and a possible mechanism may via down-regulating HCN2 surface expression in the Hippocampal CA1 area.

CA-30,an active fraction derived from Liuwei Dihuang Decoction,ameliorates cognitive deterioration via intestinal microbiome

Alzheimer disease(AD)is the leading cause of dementia that affects millions of elderly people worldwide.The currently available therapies have limited efficacy.Liuwei Dihuang formula(LW),a classical traditional Chinese medicine(TCM)prescription,has long been used to treat various diseases,including dementia.A great number of pharmacological studies have showed that LW and its active fractions had beneficial effects on AD associated cognitive impairments.Our recent study found that LW,especially its oligosaccharide fraction CA-30,could improve the gastrointestinal microbiota dysbiosis in senescence-accelerated mouse prone 8(SAMP8),an AD mouse model.Here,we sought to determine the effects of CA-30 on the composition and function of the intestinal microbiome in SAMP8 mice.Administration with CA-30 decreased the degree of senescence,increased the nest building and locomotor activity,ameliorated the impairments in object recognition,spatial learningand memory behavour,and decreased the active avoidance response in SAMP8 mice.Meanwhile,CA-30 improvedthe cytokine and hormone secretion and lymphocyte subset dysregulation in SAMP8 mice.Moreover,we found that CA-30 altered the abundance of 4 genera and 10 newborn genera.Advantageous changes in carbohydrate-active enzymes of SAMP8 mice following CA-30 treatment,especially GH85,were also noted.We further found that 7 genera were significantly correlated with the NIM network and cognitive performance.CA-30 influenced the relative abundance of these intestinal microbiomes in SAMP8 mice and restored them to SAMR1 mouse levels.CA-30 ameliorated the intestinal microbiome,rebalanced the NIM network,improved the AD-like cognitive impairments in SAMP8,and might thus be a potential therapeutic agent for AD.

Clinical Study of Endovascular Treatment of Severe Middle Cerebral Artery Stenosis or Occlusion and Vascular Cognitive Impairment

It is very important to study the factors affecting the incidence,progress and prognosis of patients with vascular dementia.50 cases of severe middle cerebral artery stenosis or occlusion underwent endovascular treatment(25 cases of mild cognitive dysfunction,25 cases of moderate cognitive dysfunction)were divided into two groups,where a medical drug treatment group and a control group established with 25 cases in each group.The cognitive function of each group of patients was evaluated before operation,7 days after operation,30 days after operation,and 180 days after operation.CTP was used to compare the hemodynamic changes in patients before and after operation.The severe stenosis or occlusion of the middle cerebral artery in patients can be improved,and the intracranial blood supply of patients with poorly compensated medial cranial circulation and hypoperfusion can be restored to a certain extent.Meanwhile,improvement of cognitive function was definitive in some patients with cognitive dysfunction.To guide the formulation of treatment plans for patients with severe middle cerebral artery stenosis or occlusion.

D-N:CAS和PREP的应用进展

该文简要的介绍了以新的智力理论—PASS理论为基础的Das-Naglieri认知评估系统(D-N:CAS),以及和其相配套的"基于认知加工的阅读增强方案"(the Process-Based Reading Enhancement Program PREP)构成,同时综述了D-N:CAS和PREP国内外的应用现状。

4例轻度智力障碍儿童认知能力的CAS测评分析

以CAS认知评估系统测试随班就读和培智学校的4名轻度智力障碍儿童,探讨其认知特点,结果发现:4名轻度智力障碍儿童均存在认知薄弱性,注意是他们认知过程中的最薄弱环节;但其认知过程并不均衡,有某项认知能力并不迟滞的情况;在普小随班就读的轻度智障儿童4项认知分数均高于培智学校中的轻度智障儿童。教育者可先行诊断,针对每个个体的薄弱环节制定补救计划。

基于CAS理论的智能指控系统防空作战效能评估仿真研究

防空作战指挥控制模型复杂,为评估分析智能指控系统对防空作战效果的影响,本文从战场全局出发,对作战要素进行简化,将作战双方分为攻守两方,作战要素分为:进袭飞机、指控系统和地空导弹等三类作战主体Agent。通过NetLogo4.0软件时防空作战系统进行仿真实验,分析了在其它作战条件一定的情况下,指控系统智能化水平高低对现代防空作战效果的影响。

基于多源遥感数据的疏勒河上游山区流域VIC-CAS模型积雪模拟效果评估

积雪积累和消融过程是冰冻圈水文模型的重要组成部分,利用多源遥感数据对水文模型模拟的积雪分布和深度进行评估是进一步增强融雪过程模拟的物理基础,也是提高模拟可靠性的重要手段。基于2002—2013年疏勒河上游山区流域MODIS地表反射率数据集和中国雪深长时间序列数据集,对VIC-CAS模型模拟的逐日积雪覆盖度和雪深进行了综合评估。结果表明:从不同降雪年份来看,VICCAS模型可以较好地模拟多雪年(2008年)疏勒河上游山区流域积雪的覆盖度,在平雪年(2004年)和少雪年(2013年)模型模拟精度相对较低。从不同海拔的模拟结果来看,在流域占比最高的4 000~5 000m高程带精度最高,2 000~3 000m高程带精度最低;对比模拟雪深与中国雪深产品发现,多雪年的一致性较高,平雪年和少雪年的一致性较低。这表明VIC-CAS模型对疏勒河上游日尺度的积雪覆盖度和雪深的模拟精度相对较低,特别在低海拔处和薄雪情况下,其原因可能是对积雪再分布和风吹雪过程的模拟算法和参数化存在较大的不确定性,需要进一步改进。