Cognitive function in late-life depression after modified electroconvulsive therapy: A stratified analysis.

ObjectiveThis study aimed to investigate the relationship between white matter hyperintensities (WMH) and perivascular spaces (PVS) on magnetic resonance imaging (MRI) with Montreal Cognitive Assessment (MoCA) scores in patients referred for possible lecanemab therapy based on clinical suspicion of Alzheimer’s disease (AD) prior to biomarker confirmation.Materials and methodsIn this retrospective review, 149 consecutive patients with suspected AD between November 2023 and June 2024 who were evaluated for possible lecanemab therapy were identified. All underwent brain MRI and had valid MoCA scores. WMH were graded using the Fazekas scale (0-3). PVS were visually graded (1-4) in the basal ganglia and centrum semiovale on T2-weighted images. Generalized linear models assessed the association between imaging markers and MoCA, adjusting for age, sex, hypertension (HTN), hyperlipidemia (HLD), and diabetes mellitus (DM).ResultsThe mean MoCA score was 19.56, reflecting mild to moderate cognitive impairment. The mean Fazekas score was 1.37, indicating mild to moderate WMH burden, while the mean PVS scores for basal ganglia and centrum semiovale were 1.99 and 2.37, respectively. There is no significant correlation between age and MoCA scores in our patient population. A negative association of -0.1 between the Fazekas score and MoCA score was observed after controlling for the effects of PVS. In contrast, PVS did not significantly correlate with MoCA score.ConclusionIn patients evaluated for possible lecanemab therapy, a higher WMH burden was negatively associated with global cognition, whereas PVS demonstrated no significant relationship with MoCA scores. These findings suggest that WMH may be an imaging marker of vascular pathology in those suspected of AD.

Obstructive Sleep Apnea (OSA) is a chronic condition associated with cognitive impairment and various comorbidities. This prospective study evaluated cognitive deficits in OSA patients and identified clinical factors affecting cognitive function. Seventy-two participants were assessed using polysomnography (PSG) and the Montreal Cognitive Assessment (MoCA). Findings revealed significantly lower MoCA scores in severe OSA patients compared to those with mild or moderate OSA. Severe OSA patients had a median MoCA score of 23.5 (20.0-25.0), indicating more significant cognitive impairment, while those with normal OSA severity had the highest median score of 28.5 (27.8-29.2). Mild and moderate OSA patients had median scores of 26.5 (21.0-28.0) and 25.0 (23.80-26.0), respectively (p < 0.008). Logistic regression showed that ex-smoking status negatively impacted MoCA scores more in the unadjusted model (p = 0.003) than in the adjusted one (p = 0.018). Forced Vital Capacity (FVC) positively correlated with MoCA scores, stronger in the unadjusted model (p < 0.001 vs. p < 0.03). Higher Oxygen Desaturation Index (ODI) correlated with higher MoCA scores while increasing Apnea-Hypopnea Index (AHI) severity correlated with lower MoCA scores in both models. A significant negative correlation was found between age and MoCA score (r = -0.473, p < 0.001), and between MoCA score and AHI (r = -0.350, p < 0.003). This study highlights the need for sensitive cognitive screening tools like MoCA inevaluating OSA patients, linking cognitive impairment closely with OSA severity and other clinical factors.

Cognitive decline in elderly patients with type 2 diabetes is associated with glycated albumin, ratio of Glycated Albumin to glycated hemoglobin, and concentrations of inflammatory and oxidative stress markers

BackgroundMini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are validated and frequently used screening tools for cognitive function.AimsTo present MMSE and MoCA scores by sex, age and education among community-dwelling older adults.MethodsThis is a post-hoc observational analysis using data from the DO-HEALTH trial, which included generally healthy adults (≥ 70 years) from Switzerland, Germany, Austria, France, and Portugal who scored at least 24 points on the MMSE at baseline. We present MMSE and MoCA scores overall and by country, sex, age (70–74 years, ≥ 75 years), education (≤ and > median education years).Results2151 DO-HEALTH participants (mean age 74.9 years, 57% aged 70–74 years, 62% women) were included. The median (IQR) years of education was 12 (10–15), median MMSE score was 29 (28–30) and median MoCA score was 26 (23–28) points. In subgroups by sex, age, and education, the median MMSE score remained 29 for all subgroups, except for participants with shorter education (≤ 12 years) and higher age (≥ 75), who scored 28 points. For MoCA, the median score in subgroups ranged from 24 to 27 points. Participants with shorter education (≤ 12 years) and higher age (≥ 75) had lowest scores (men 24, women 25 points).ConclusionsWe provide MMSE and MoCA scores for generally healthy, community-dwelling older adults from Switzerland, Germany, Austria, France and Portugal. The median MMSE and MoCA scores differed with age and education, and – less consistently – with sex.Trial registrationInternational Trials Registry (clinicaltrials.gov; registration ID: NCT01745263), registered December 2012.

The Montreal Cognitive Assessment (MoCA) score is a convenient and promising tool for estimating alcoholic patients' global cognitive functioning, a major challenge for all specialized alcohol treatment centers. However, whether or not the score should be corrected for education level and whether the proposed cutoff is relevant in patients with alcohol use disorders (AUD) should be determined. We compared the MoCA scores in patients hospitalized for AUD with and without cognitive impairment assessed by a battery of neuropsychological (NP) tests. Sensitivity, specificity, and cutoff of the MoCA score were analyzed using receiver operating characteristic curve analysis. Thirty-one patients with and 25 without cognitive impairment were included in the study. There were 40 men and 16women, with a mean age of 49.5years. The mean uncorrected MoCA score was 23.1±3.3 in those with and 27.0±1.9 in those without cognitive impairment. NP tests were significantly correlated with the MoCA score. Uncorrected MoCA scores identified more than 80% of the patients with a cutoff score equal to 26, to obtain similar accuracy with the corrected score required using a cutoff score equal to 27. Our results confirm that the MoCA test is a convenient and reliable screening tool to measure cognition defects in alcoholic patients. As using the 1-point education adjustment increases the cutoff score by 1 point, it is suggested to use the noncorrected score and the usual cutoff, that is, 26. Being easy to administer and only moderately time-consuming, the MoCA score should be used extensively in addiction treatment centers.

To explore the association between obesity and cognition impairment in patients with moderate-to-severe obstructive sleep apnea-hypopnea syndrome (OSAHS). A total of 425 eligible patients with moderate-to-severe OSAHS were screened for this retrospective study at Sleep Center, Second Affiliated Hospital, Soochow University from January 2008 to January 2013. Based on body mass index (BMI), they were categorized into normal weight (18.5 ≤ BMI<24, n = 67), mild overweight (24 ≤ BMI<26, n = 100), severe overweight (26 ≤ BMI<28, n = 134) and obese (BMI ≥ 28, n = 124) groups. They were examined by overnight polysomnography (PSG). And cognitive functions were assessed by the Montreal Cognitive Assessment (MoCA) questionnaires. MoCA scores, clinical and polysomnographic variables were compared between the groups. And the correlations between MoCA scores and clinical and PSG parameters were further evaluated by stepwise multivariate regression. Two-way analysis of variance (two-way ANOVA) was performed to examine the effects of obesity and OSAHS on MoCA score. The scores of MoCA progressively decreased across the spectrum from mild overweight to obese groups. The highest BMI group (obese group) had the lowest MoCA score (25.45 ± 2.35 vs 26.26 ± 2.01, 26.29 ± 2.60, 26.05 ± 2.51, P = 0.030, 0.010, 0.048). The evaluations of MoCA subdomains further revealed selective reductions. Compare to normal weight group, the score of visuospatial and executive function, memory/delayed recall significant decreased in obese and severe overweight groups (visuospatial and executive function: 4.48 ± 0.63 vs 4.07 ± 0.94, 4.13 ± 1.04, P = 0.022, 0.048; memory/delayed recall: 3.54 ± 0.90 vs 2.77 ± 1.20, 2.87 ± 1.30, P = 0.001, 0.004). Stepwise multivariate regression analysis demonstrated that MoCA scores were correlated significantly with apnea-hypopnea index (AHI), BMI, age and years of education. Two-way ANOVA revealed that both obesity and OSAHS had independent effects on MoCA score (P = 0.004). The interactions between the effect of obesity and OSAHS on cognitive score were insignificant. It indicated that the effect of BMI on cognitive function did not change with AHI. In OSAHS patients, obesity aggravates cognitive impairment independently of AHI. And obesity is one of the most important influencing factors of cognitive function.

BackgroundA number of studies have shown that COPD, particularly in its later and more severe stages, is associated with various cognitive deficits. Thus, the primary goal of the present study was to elucidate the extent of cognitive impairment in patients with long-term oxygen therapy-dependent (LTOTD) COPD. In addition, this study aimed to determine the effectiveness of two cognitive screening tests, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), for COPD patients and the ability of oxygen therapy to mitigate COPD-related deficits in cognitive function.MethodsThe present study enrolled 45 subjects: 24 nonuser and 21 regular-user LTOTD-COPD patients. All subjects had a similar grade of education, and there were no significant differences regarding age or sex. The MoCA (cutoff: <26 points) and MMSE (cutoff: ≤24 points) scores were compared between these two groups.ResultsThe nonuser LTOTD-COPD group had a significantly lower MoCA score than that of the regular-user LTOTD-COPD group (19.38±2.99 vs 21.68±2.14, respectively) as well as a significantly lower MMSE score. Moreover, the absence of supplemental oxygen therapy increased the risk of cognitive impairment (MoCA, P=0.007 and MMSE, P=0.014), and the MoCA and MMSE scores significantly correlated with the number of emergency admissions and the number of hospitalizations in the last year.ConclusionIn the present study, the nonuser LTOTD-COPD group exhibited a significant decrease in cognitive status compared with the regular-user LTOTD-COPD group. This suggests that the assessment of cognitive function in nonuser LTOTD-COPD patients and the use of protective strategies, such as continuous supplemental oxygen treatment, should be considered during the management of COPD in this population. In addition, the MoCA score was superior to the MMSE score for the determination of cognitive impairment in the nonuser LTOTD-COPD patients.

To understand the relationship between scores on two standardized measures of cognition, the Montreal Cognitive Assessment (MoCA) and the cognitive subscale of the Functional Independence Measure (FIMCog), and whether these scores can predict functional outcomes in rehabilitation. Retrospective data analysis was conducted on all inpatients admitted to a general rehabilitation unit within a 6-month period (N = 477). The average age of patients was 74 years. The Functional Independence Measure (FIM) was completed for all patients on admission and discharge. The MoCA was administered to patients on clinical suspicion of cognitive impairment. The MoCA was completed with 116 patients. Cognitive status was assessed using FIMCog and MoCA. The motor subscale of FIM was used to assess functional status in calculating the motor Rehabilitation Functional Gain (mRFG) and motor Rehabilitation Functional Efficiency (mRFE) scores. Discharge destination was also used as an outcome measure. There was a moderate correlation between FIMCog and MoCA scores on admission (r = 0.49, P < 0.001). Higher FIMCog and MoCA scores were associated with higher mRFG and mRFE scores. There was an indication that patients with higher MoCA scores were more likely to be discharged to a private residence (adjusted odds ratio 1.11; 95% confidence interval: 0.99, 1.25, P = 0.072). Cut-off points of <25 on the MoCA (sensitivity 88.9%, specificity 48.9%), and <29 on the FIMCog (sensitivity 77.8%, specificity 53.3%) predicted those patients who were less likely to discharge to a private residence. FIMCog and MoCA scores on admission were moderately correlated, and strongly correlated with functional rehabilitation outcomes. The FIMCog and MoCA had moderately high utility in predicting discharge destination. Geriatr Gerontol Int 2020; 20: 336-342.

Purpose: To characterize and predict early post-stroke cognitive impairment by describing cognitive changes in stroke patients 4–8 weeks post-infarct, determining the relationship between cognitive ability and functional status at this early time point, and identifying the in-hospital risk factors associated with early dysfunction.Materials and Methods: Data were collected for 214 patients with ischemic stroke and 39 non-stroke controls. Montreal Cognitive Assessment (MoCA) exams were administered at post-hospitalization clinic visits approximately 4–8 weeks after infarct. MoCA scores were compared for patients with: no stroke, minor stroke [NIH Stroke Scale (NIHSS) < 5], and major stroke. Ordinal logistic regression was performed to assess the relationship between MoCA score and functional status [modified Rankin Scale score (mRS)] at follow-up. Predictors of MoCA < 26 and < 19 (cutoffs for mild and severe cognitive impairment, respectively) at follow-up were identified by multivariable logistic regression using variables available during hospitalization.Results: Post stroke cognitive impairment was common, with 66.8% of patients scoring < 26 on the MoCA and 22.9% < 19. The average total MoCA score at follow-up was 18.7 (SD 7.0) among major strokes, 23.6 (SD 4.8) among minor strokes, and 27.2 (SD 13.0) among non-strokes (p = <0.0001). The follow-up MoCA score was associated with the follow-up mRS in adjusted analysis (OR 0.69; 95% C.I. 0.59–0.82). Among patients with no prior cognitive impairment (N = 201), a lack of pre-stroke employment, admission NIHSS > 6, and left-sided infarct predicted a follow-up MoCA < 26 (c-statistic 0.75); while admission NIHSS > 6 and infarct volume > 17 cc predicted a MoCA < 19 (c-statistic 0.75) at follow-up.Conclusion: Many patients experience early post-stroke cognitive dysfunction that significantly impacts function during a critical time period for decision-making regarding return to work and future independence. Dysfunction measured at 4–8 weeks can be predicted during the inpatient hospitalization. These high-risk individuals should be identified for targeted rehabilitation and counseling to improve longer-term post-stroke outcomes.

IntroductionWe determined the effect of baseline low density lipoprotein (LDL) and triglyceride (TG) concentrations on cognitive decline, in patients with symptomatic high grade intracranial stenosis.MethodsWe analyzed a cohort of stroke patients who had baseline and 4 months follow‐up Montreal Cognitive Assessment (MoCA) scores. MoCA score worsening after 4 months was the outcome of interest, defined as worsening of ≥ 2 points from baseline. Baseline LDL and TG concentrations (mg/dl) were assessed, and univariate and multivariate analysis using logistic regression were performed to identify predictors of worsening MoCA scores.ResultsA total of 349 patients were analyzed. 313 and 315 patients had baseline LDL and TG, respectively. 61 (17%) had a worsening of MoCA scores. The mean baseline LDL was 97.3 (39.1) in the worsening group, compared to 110.6 (44.8) in those with no worsening (p = 0.014). 23% of patients with LDL < 100 had worsening in MoCA score compared to 11% of patients with LDL ≥ 100 (p< 0.006). The mean baseline TG was 145.7 (102.2) in the worsening group, compared to 170.7 (135.4) (p = 0.053). On multivariate analysis, higher age (p = 0.014) and lower baseline LDL (p = 0.046) were predictors of worsening MoCA scores.ConclusionsPatients who did not undergo any worsening MoCA scores had higher LDL and TG levels at baseline, and only older age and lower baseline LDL scores predicted worsening scores at 4 months. Presumably, the patients with high baseline lipid levels were treated more aggressively with dietary modifications and statins, which could have led to cognitive protective effect regardless of serum lipid profile.

Autoimmune epilepsy is an under-recognized condition, and the mechanisms of antibody-mediated epileptogenesis are unknown. The N-methyl-D-aspartate (NMDA) receptor subunit 3 peptide B (NR3B) modulates Mg2+ sensitivity and Ca2+ mobilization of glutamate responses in the central nervous system (CNS). The levels of antibodies against NR3B (NR3B Ab's) in the cerebrospinal fluid (CSF) and the correlations between NR3B Ab's and cognitive comorbidities of epilepsy patients remain unclear. CSF samples were collected from 36 patients with consecutive epilepsy and 17 healthy controls. The levels of NR3B Ab's in the CSF were measured by ELISA. The cognitive function was assessed by Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). The results showed that the levels of NR3B Ab's were significantly higher in patients with epilepsy than those in the controls (p<0.01). Thirteen of 36 patients had higher levels of NR3B Ab's exceeding mean+ 2SD of all patients, and the scores of MMSE and MoCA of these 13 patients were significantly lower than the other 23 patients and controls (p<0.01; p<0.001). However, there were no significant differences in the scores of MMSE and MoCA between the 23 patients and the controls. Correlation analysis indicated a significant negative correlation between the levels of NR3B Ab's and the scores of MMSE (correlation coefficient: r=-0.543; p<0.01) or the scores of MoCA (correlation coefficient: r=-0.548; p<0.01). We suggest that some patients with epilepsy may have immune process after onset and the presence of NR3B Ab's may be associated with cognitive comorbidities in patients with epilepsy.

AimThis study aimed to investigate the alterations in whole‐brain gray matter density in early stage type 2 diabetes mellitus (T2DM) patients with cognitive impairment using magnetic resonance imaging.MethodsThirty‐six cases of early stage T2DM patients with cognitive impairment (T2DM‐CI), 34 cases of early stage T2DM patients without cognitive impairment (T2DM) and 30 cases of healthy controls (HC) were enrolled. Montreal Cognitive Assessment (MoCA) and Mini‐Mental State Examination (MMSE) scores were used to identify the cognitive impairment. The whole‐brain gray matter density was analyzed using 3D‐T1 BRAVO imaging, using the voxel‐based morphometry method on T1 structure imaging of two groups.ResultsThe correlation analysis of total gray matter density with MMSE and MoCA scores in the T2DM‐CI group was performed. There were no significant differences in MMSE and MoCA scores between the HC and T2DM groups. However, the MMSE and MoCA scores in the T2DM‐CI group were significantly reduced compared with the T2DM group. There were no significant differences in age, gender, education, body mass index (BMI) or blood pressure among the three groups. Voxel‐based morphometry (VBM) results showed that the density of left triangle part of inferior frontal gyrus, orbital part of inferior frontal gyrus and opercular part of inferior frontal gyrus and left insula in the T2DM‐CI group decreased compared with the T2DM group. Correlation analysis results showed that there was a significant positive correlation between total gray matter density and scores of MMSE and MoCA scores in the T2DM‐CI group.ConclusionIn conclusion, total gray matter density is positively correlated with the scores of MMSE and MoCA in T2DM patients, which may be an early sign of cognitive impairment in patients with T2DM.

Objective To explore the diagnostic value of Alzheimer-associated neuronal thread protein(AD7C-NTP)and olfactory function in the differentiation of three types of dementia, and to evaluate their clinical application value. Methods Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA)were applied to evaluate cognitive function of all subjects with Alzheimer disease(AD), frontotemporal dementia(FTLD), or mixed dementia(MD). Enzyme-linked immunosorbent assay(ELISA)was used to detect the expression levels of AD7c-NTP in urine.T&T test method was applied to detect the olfactory function.Spearman rank correlation was used to evaluate the correlation of urine AD7c-NTP with MMSE and MoCA scores. Results There was no significant difference in the demographic profile(except age)among three types of dementia of AD, FTLD and MD(F=4.05, P=0.02). Among the three dementia groups, the mean age of the MD group was highest.The statistically significant difference in MMSE scores was found among the three groups(F=3.79, P=0.03), while there was no significant difference in MoCA and NPI scores among the three dementia groups.The levels of the urine AD7c-NTP were different among the three dementia groups, but without statistical significance(H=1.25, P=0.53). Additionally, the FTLD group had the highest urine AD7c-NTP level.Spearman rank correlation analysis showed no correlation of AD7c-NTP with MMSE and MoCA(r=0.18, P=0.25; r=0.14, P=0.39, respectively). No differences in olfactory function of the recognition domain(H=3.40, P=0.18)and in the detection domain(H=2.07, P=0.36)were found among three dementia groups of AD, FTLD and MD. Conclusions The level of urine AD7c-NTP is not of clinical significance in differentiating three types of dementia, and it is not correlated with the MMSE and MoCA scores.This study fails to find the clinical value of olfactory function test for distinguishing three types of dementia. Key words: Dementia; Alzheimer-associated neuronal thread protein; Olfactory function

Emotional-affective disorders often accompany vascular cognitive impairment. Currently, there is insufficient data on the impact of non-drug treatment of cognitive impairment on the emotional sphere. The aim of the study was to evaluate the effect of non-drug methods (meal planning, exercise, cognitive training) on anxiety and depression in patients with mild cognitive impairment of vascular etiology. Material and methods. The study included 60 patients aged 45 to 88 years (mean age 63.9 ± 9.7, 26 males and 34 females) with mild cognitive impairment of vascular etiology. 30 patients (study group, 18 women, 12 men, mean age 63.7 ± 8.8 years, Montreal Cognitive Assessment (MoCA) score 22.5 ± 2.4) received a set of non-drug methods for 1 month, including cognitive training, detailed recommendations on physical activity and meal planning. Patients in the control group (n = 30, 16 women, 14 men, mean age — 64.2 ± 10.7 years, MoCA score — 21.7 ± 2.4 points) were once informed by the attending physician about the expediency of a physically and cognitively active lifestyle and the basic principles diets, however, systematic training with them was not carried out. Anxiety and depression were assessed at the stage of inclusion in the study, after 1 month, after 6 months, and one year after the start of observation using the Beck Depression Scale, the Spielberger–Khanin Anxiety Scale. Results. 1 month after the start of the study, along with a significant (p &lt; 0.05) improvement in cognitive functions according MoCA, a significant decrease in the severity of anxiety was noted in the study group (p &lt; 0.05). In patients with mild and moderate depression (n = 13), a significant (p &lt; 0.05) regression in the severity of depression was recorded after a month of using non-drug methods. However, in the process of long-term follow-up (1 year), the differences with the initial visit for these indicators lost statistical significance. In the control group, a month after the start of the study, there were no significant differences in the MoCA test (p &gt; 0.05), while the indicators of anxiety and depression worsened throughout the entire observation period. The study group significantly (p &lt; 0.05) outperformed the control group in the MoCA test immediately after treatment and after 6 months. Differences of anxiety level were significant only immediately after treatment. Conclusion. A complex of non-drug methods is effective in the treatment of vascular MCI and reduces anxiety in patients. In patients with mild and moderate depression decrease of depression symptoms was observed also. However the effect of the monthly course was not stable.

Alzheimer's disease (AD) is the most common cause of dementia. Global field synchronization (GFS) can measure functional synchronization in frequency-domain electroencephalogram (EEG) data. The aim of this study is to explore GFS values and its clinical significance for severity of cognitive decline in AD. EEGs were recorded from 37 AD patients and 37 age-matched healthy individuals. GFS values were calculated in delta, theta, alpha, beta 1, beta 2, beta 3, gamma, and full frequency bands. The Montreal Cognitive Assessment (MoCA) and Clinical Dementia Rating scale (CDR) were employed to assess symptom severity in AD patients. Correlation analysis, clustering analysis, and concordance analysis were performed to analyze the relationship between GFS values and MoCA scores in AD patients. GFS values of the beta 1, beta 2, beta 3, and full bands were lower in AD patients than in healthy individuals, and positively correlated with MoCA and CDR scores in the combined group (AD patients and healthy individuals). GFS values were positively correlated with MoCA socres in 3 beta bands and full bands, and with CDR scores in the delta band. There was a good concordance between K-means clustering algorithm calculating of GFS values and MoCA scoring (κ = .913, P < .001). In conclusion, the present results indicated that GFS can serve as an indicator of cognitive decline or impairment in AD patients. Furthermore, the GFS method of EEG holds considerable promise to distinguish mild cognitive impairment from serious cognitive impairment in patients with AD.