Predictores de riesgo de deterioro cognitivo leve en una población de hipertensos / Predictors of Mild Cognitive Impairment in a Hypertensive Population

RESUMEN Introducción. El estatus cognitivo es considerado un biomarcador del daño vascular encefálico en la hipertensión arterial (HTA). Es fundamental en pacientes con HTA la pesquisa del deterioro cognitivo leve (DCL). Objetivos . Valorar la presencia de factores predictores de DCL en pacientes hipertensos. Material y métodos . Estudio observacional, transversal, en el periodo 2015-2023. Se incluyeron pacientes mayores de 18 años, asistidos en policlínica que hubieran realizado la Evaluación Cognitiva de Montreal (MoCA). Se consideró valor de MoCA alterado uno < 24. Se excluyeron pacientes con dificultades motoras, sensoriales, enfermedad psiquiátrica, analfabetismo. Las variables cualitativas se presentan como frecuencias absolutas y relativas, y para el estudio de asociación se utilizó test de Chi cuadrado. Las variables cuantitativas se presentan como media y desviación estándar, y el estudio de diferencias se realizó con test T de Student para muestras independientes. En el análisis de regresión logística múltiple se colocaron aquellas variables significativas en el análisis univariado por el método Forward. Nivel de significación alfa = 0,05. Resultados . 129 pacientes, mujeres: hombres 2:1; edad promedio 60 años. El 79,1 % tenía HTA grado 3, 30,4 % presentaban más de 20 años de evolución de HTA. El 52,7% tenía escolarización primaria. Un 89,4 % presentaba sobrepeso-obesidad, el 36,4 % tabaquismo, 29,7 % dislipidemia mixta. Un 65,1% presentó un valor de MoCA ≥ 24 y el 34,9 % un valor < 24. En el modelo predictor logístico, las variables evolución en años de HTA, dislipidemia mixta, y enfermedad cerebrovascular fueron predictoras de riesgo de MoCA alterado. El nivel educativo terciario fue factor protector. Conclusión . La identificación de factores predictores de daño cognitivo es prioritaria para una acción preventiva. En este estudio las variables tiempo de evolución de la HTA, dislipidemia mixta, enfermedad cerebrovascular y nivel educativo permitieron predecir mayor riesgo de DCL.

ABSTRACT Background . Cognitive status is considered a biomarker of vascular brain damage caused by hypertension (HTN). Screening for mild cognitive impairment (MCI) is essential in patients with HTN. Objectives . The aim of this study was to evaluate the presence of predictors of MCI in hypertensive patients. Methods . We conducted an observational and cross-sectional study between 2015 and 2023. All the patients > 18 years treated in a clinic and who were evaluated with the Montreal Cognitive Assessment (MoCA) were included. A score < 24 in the MoCA test was considered abnormal. Patients with motor or sensory impairment, psychiatric disorders, or illiteracy were excluded. Qualitative variables are presented as absolute frequencies and percentages, and the chi-square test was used to analyze their association. Quantitative variables are expressed as mean ± standard deviation and were compared with the independent samples t-test. All the variables with statistical significance in the univariate analysis through forward selection were included in the multiple logistic regression analysis. A p value < 0.05 was considered statistically significant. Results . A total of 129 patients were included (women-to-men ratio 2:1; mean age 60 years); 79.1% had stage 3 HTN, time from HTN diagnosis was > 20 years in 30.4%, 52.7% had complete primary education, 89.4% had overweight/obesity, 36.4% were smokers and 29.7% had mixed dyslipidemia. A score ≥ 24 in the MoCA was present in 65.1% and 34.9% had a score < 24. The logistic predictor model identified time from HTN diagnosis, mixed dyslipidemia and cerebrovascular disease as predictors of abnormal MoCA. A tertiary educational level had a protective effect. Conclusion . Identifying predictors of cognitive impairment is a priority to take preventive actions. In this study, time from HTN diagnosis, mixed dyslipidemia, cerebrovascular disease and educational level were associated with cognitive impairment.

Exploration of remote cognitive assessment and rehabilitation guidance / 中华神经科杂志

With rapid global growth of the older population, it has been increasingly important for screening, early diagnosis, treatment and daily monitoring of cognitive function in the elderly population. Given the limited effects of pharmacological treatments, cognitive rehabilitation has the potential to improve meaningful outcomes for older people and thus comes into sight. Traditional cognitive assessment and rehabilitation require face-to-face interview, while patients with cognitive impairment are mostly elderly with difficulties in access to medical care, usually needed to be accompanied by caregivers and having other co-morbidities with limited mobility. This contradiction is especially prominent in the context of COVID-19 pandemic, which may even exacerbate cognitive decline of patients. Therefore, remote cognitive assessment and rehabilitation based on information and communication technologies have become new options. This paper introduces the widely used and validated means of remote assessment and its guiding use in cognitive rehabilitation, which can be implemented through the Internet, applications, video and telephone. The advantages of being fast, convenient and geographically agnostic lead to a wider use in large community and safeguard the health of patients with cognitive impairment.

Tiaoshen acupuncture for primary insomnia: a pilot randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effects of Tiaoshen (regulating the spirit) acupuncture on cognitive function and sleep quality in patients with primary insomnia (PI).@*METHODS@#Sixty patients with PI were randomly divided into an observation group (30 cases, 2 cases dropped off) and a control group (30 cases, 2 cases dropped off, 1 case was excluded). The patients in the observation group were treated with acupuncture at Baihui (GV 20), Shenting (GV 24), Sishencong (EX-HN 1), and bilateral Benshen (GB 13), Shenmen (HT 7), Neiguan (PC 6), Sanyinjiao (SP 6). The patients in the control group were treated with shallow needling at non-effective points. Each treatment was provided for 30 min, once every other day, 3 treatments per week for 4 weeks. The Montreal cognitive assessment (MoCA), digit span test (DST), trail making test (TMT)-A, Pittsburgh sleep quality index (PSQI), and fatigue scale-14 (FS-14) were used to assess cognitive function and sleep quality before and after treatment, as well as in follow-up of 4-week after treatment completion. Correlation analysis was conducted between the differences in PSQI scores and differences in MoCA scores before and after treatment in the observation group.@*RESULTS@#Compared with before treatment, the total score, visuospatial and executive function score and delayed memory score of MoCA as well as DST backward score were increased (P<0.01), while TMT-A time, PSQI and FS-14 scores were significantly reduced (P<0.01) after treatment and in follow-up in the observation group. Compared with before treatment, the PSQI score in the control group was reduced (P<0.01, P<0.05). After treatment and in follow-up, the observation group had significantly higher total score, visuospatial and executive function score, delayed memory score of MoCA, and DST backward score compared to the control group (P<0.05, P<0.01). In the observation group, the TMT-A time was significantly shorter than that in the control group (P<0.05, P<0.01), and the PSQI and FS-14 scores were significantly lower than those in the control group (P<0.01). In the observation group, there was a negative correlation between the difference in PSQI scores (post-treatment minus pre-treatment) and the difference in MoCA scores (post-treatment minus pre-treatment) (r=-0.481, P<0.01). A similar negative correlation was found between the difference in PSQI scores (follow-up minus pre-treatment) and the difference in MoCA scores (follow-up minus pre-treatment) (r=-0.282, P<0.05).@*CONCLUSION@#Tiaoshen acupuncture could improve cognitive function, enhance sleep quality, and alleviate daytime fatigue in patients with PI. The improvement in cognitive function in patients with PI is correlated with the improvement in sleep quality.

Cognitive profile in mild cognitive impairment with Lewy bodies

INTRODUCTION@#This study aimed to elucidate the cognitive profile of patients with mild cognitive impairment with Lewy bodies (MCI-LB) and to compare it to that of patients with mild cognitive impairment due to Alzheimer's disease (MCI-AD).@*METHODS@#Subjects older than 60 years with probable MCI-LB (n = 60) or MCI-AD (n = 60) were recruited. All patients were tested with Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) to assess their global cognitive profile.@*RESULTS@#The MCI-AD and MCI-LB patients did not differ in total MMSE and MoCA scores. However, some sub-items in MMSE and MoCA were shown to be screening markers for differentiating MCI-LB from MCI-AD. In the visuoconstructive test, the total score and hands subitem score in the clock-drawing test were significantly lower in MCI-LB than in MCI-AD. As for the executive function, the 'animal fluency test', 'repeat digits backward test' and 'take paper by your right hand' in MMSE all showed lower scores in MCI-LB compared with MCI-AD. As for memory, 'velvet' and 'church' in MoCA and 'ball' and 'national flag' in MMSE had lower scores in MCI-AD than in MCI-LB.@*CONCLUSION@#This study presents the cognitive profile of patients with MCI-LB. In line with the literature on Dementia with Lewy bodies, our results showed lower performance on tests for visuoconstructive and executive function, whereas memory remained relatively spared in the early period.

Effect of aluminum-fluoride interactions on overall cognitive function of aluminum plant workers / 环境与职业医学

Background Aluminum and fluoride are neurotoxic, and aluminum exposure alone is closely related to the overall cognitive function of operational workers. It is unclear about the effect of aluminum and fluoride interactions on cognitive function. Objective To evaluate a potential interaction effect of blood aluminum and urinary fluoride on the overall cognitive function of workers working in an aluminum plant. Methods Using cluster sampling, 230 workers in the electrolysis workshop of an aluminum group company in Shanxi Province were selected, and plasma aluminum concentrations were determined by inductively coupled plasma mass spectrometry (ICP-MS) and urinary fluoride by ion-selective electrode. The study participants were divided into a low blood aluminum group and a high blood aluminum group according to the median (M) of blood aluminum concentration, and a low urinary fluoride group and a high urinary fluoride group by a predetermined cutoff point (2.160 mg·L−1). The Montreal Cognitive Assessment-Beijing (MoCA-BJ) was used to assess overall cognitive function of the workers. Logistic regression model was used to analyze the relationship between blood aluminum, urinary fluoride, and mild cognitive impairment (MCI), including multiplicative interaction analysis and correlation analysis; R language was used to fit an additive interaction model of blood aluminum and urinary fluoride on MCI and to calculate synergy index (S), relative excess risk due to interaction (RERI), and attributable proportion due to interaction (API). Results Among the 230 operational workers, the median blood aluminum concentration (P25, P75) was 40.11 (25.16, 58.89) µg·L−1, and there were 104 cases of abnormal urinary fluoride, with an abnormality rate of 45.2%. There was a multiplicative interaction (OR=7.783, 95%CI: 1.377, 43.991) and no additive interaction (RERI=0.030, 95%CI: −0.498, 0.559; API=0.018, 95%CI: −0.279, 0.316; S=1.049, 95%CI: 0.519, 2.118) for the effect between blood aluminum and urinary fluoride on overall cognitive function of the workers. The logistic regression analysis showed that the risk of MCI was 12.105 (95%CI: 2.802, 52.287) times higher in workers with both high blood aluminum and high urinary fluoride than in those with low blood aluminum and low urinary fluoride, after adjusting for selected influencing factors. Conclusion Occupational exposure related high blood aluminum and high urinary fluoride are risk factors for cognitive dysfunction, and the coexistence of both indicators increases the risk of MCI in workers with occupational aluminum exposure, with a multiplicative interaction.

Revisión de las pruebas cognitivas breves para pacientes con sospecha de demencia / Review of brief cognitive tests for patients with suspected dementia

RESUMEN NTRODUCCIÓN: Para ser útiles, las pruebas cognitivas breves (PCB) deben ser rápidas, sensibles, fáciles de realizar y no necesitar de un gran entrenamiento para hacerlo. Las pruebas cognitivas breves comúnmente utilizadas incluyen el Mini Examen del Estado Mental (MMSE) y la Evaluación Cognitiva de Montreal (MoCA). OBJETIVO: Brindar una descripción de las PCB disponibles y sus propiedades psicométricas para la detección de la demencia. MÉTODOS: Revisión narrativa RESULTADOS: El MMSE le otorga un gran peso a la orientación, la memoria, la visuo-espacialidad y el lenguaje, y, en consecuencia, puede ser sensible a los déficits cognitivos encontrados en la demencia tipo Alzheimer. MoCA es una prueba breve más compleja que evalúa una gama más amplia de dominios cognitivos, especialmente funciones ejecutivas, proporcionando una mayor sensibilidad para detectar el deterioro cognitivo leve y otros tipos de demencia, no solo la demencia tipo Alzheimer. CONCLUSIONES: Las PCB son parte del arsenal necesario para ayudar a confirmar la sospecha de la demencia. La escolaridad tiene un impacto importante en el desempeño de las PCB y puede sesgar la interpretación de los resultados obtenidos.

ABSTRACT INTRODUCTION: To be useful, Brief Cognitive Tests (BCTs) must be fast, sensitive, easy to perform, and not require extensive training to do so. Commonly used brief cognitive tests include the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). OBJECTIVE: To provide a description of the available BCTs and their psychometric properties for the detection of dementia. METHODS: Narrative review RESULTS: The MMSE places great weight on orientation, memory, visuospatiality, and language, and, consequently, may be sensitive to the cognitive deficits found in Alzheimer's dementia. MoCA is a more complex brief test that assesses a broader range of cognitive domains, especially executive functions, providing greater sensitivity for detecting mild cognitive impairment and other types of dementia, not just Alzheimer's dementia. CONCLUSIONS: BCTs are part of the arsenal needed to help confirm suspected dementia. Schooling has an important impact on the performance of BCTs and can bias the interpretation of the results obtained.

Characteristics of the cognitive domains of the montreal cognitive assessment scale in the elderly from the perspective of structural equation modeling / 中华老年医学杂志

Objective:To analyzed the characteristics of the cognitive domains of the montreal cognitive assessment(MOCA)scale in cognitively impaired or normal elderly people from the perspective of structural equation modeling(SEM).Methods:There were 335 old individuals in this study, including 166 cognitively normal individuals, 130 patients with mild cognitive impairment(MCI)and 39 individuals with dementia.The average age of the individuals was 81.5±9.0.Data on the Montreal cognitive assessment(MoCA, Beijing version)were gathered.Following exploratory factor analysis and selection of latent and manifest variables, a structural equation model was established.After assessment of data from the domains of the scale in the elderly, participants were divided into a normal group and a patient group, which formed the basis of the model.Results:The KMO value of the data calculated by exploratory factor analysis was 0.762.The dimensions measured by the scale were divided into four main latent variables: memory, visuospatial execution, language ability and attention.The CMIN value of the overall model was 44.039 and the P value was 0.168.The parameters of the overall model and individual dimensions all indicated a good fit.The model showed that visuospatial execution had the largest impact on cognitive function, with a path coefficient of 0.742, and language ability had the least impact, with a path coefficient of only 0.091.As a latent variable, attention had path coefficients of 0.372 and 0.236 for memory, 1.663 and 1.102 for visuospatial execution, and 1.090 and 0.798 for language ability, respectively, for the two groups, with clear statistically significant differences between the groups(all P<0.05). Conclusions:SEM can improve researchers' overall understanding of the impacts of the individual components of the scale and their use and interpretation of the scale.

Influence of tomoxetine hydrochloride on the cognitive processing of children with attention deficit hyperactivity disorder / 中华行为医学与脑科学杂志

Objective:To explore the influence of tomoxetine hydrochloride on the cognitive processing of children with attention deficit hyperactivity disorder (ADHD).Methods:From January 2018 to July 2021, 62 ADHD children who were treated with tomoxetine hydrochloride for the first time for(8±4) weeks were selected as the ADHD group.And 62 healthy children matched with age and sex were selected as the healthy control group.Pre-test and post-test by the Das-Naglieri: Cognitive Assessment System(DN: CAS) were performed to evaluate the cognitive function of all individuals.The differences of cognitive processing in pre-treatment and post-treatment of ADHD group were compared with those in healthy control group.The difference between before and after treatment of ADHD group was also compared.SPSS 26.0 statistical software was adopted for statistical analysis.The scores of ADHD group pre-treatment and post-treatment were compared by paired sample t-test, and the scores of ADHD group pre-treatment and post-treatment were compared with those of healthy control group by independent sample t-test. Results:Compared with healthy control group, there were lower of planning score((18.77±5.92) vs (28.56±5.55)), attention score((22.24±5.93) vs (29.56±6.16)), simultaneous processing ((34.21±7.75) vs (37.61±6.29)), successive processing((30.37±7.12) vs (33.74±5.43)), and the total scores((105.60±21.29) vs (134.84±22.87)) in ADHD group before treatment, and there were significant differences( t=9.49, 6.74, 2.68, 2.96, 7.36, all P<0.05). Compared with healthy control group, there were lower of planning score ((22.13±5.99)s), attention score((25.26±7.11) with significant difference( t=6.20, 3.60, both P<0.05) in ADHD group after treatment.And there was no significant difference in the simultaneous processing test and the successive processing test after treatment compared with the healthy control group(both P>0.05). In ADHD group, the scores of planning, simultaneous processing, attention, successive processing and the total score were significantly higher after treatment than those before treatment and there were significant differences( t=-6.03, -4.13, -4.77, -5.48, -8.59, all P<0.05). (2) Compared with the healthy control group, there were lower of matching number score and other 8 sub-test scales in DN: CAS test in ADHD group before treatment, and the differences were statistically significant (all P<0.05). Meanwhile, there were still lower of matching number score and other 4 sub-test scales in DN: CAS test in ADHD group after treatment, and the differences were statistically significant (all P<0.05). The matching number score and other 10 sub-test scales in DN: CAS test in ADHD group after treatment were all higher than those of before treatment(all P<0.05). Conclusion:The planning, attention, simultaneous processing, successive processing and total cognitive function of ADHD children were significantly improved after treatment with tomoxetine hydrochloride, special for simultaneous processing and successive processing.

Correlation analysis of total cerebrovascular disease burden and cognitive impairment in patients with acute basal ganglia infarction / 中国神经精神疾病杂志

Objective To investigate the correlation between total burden of cerebral small vessel disease (CSVD) and cognitive impairment in patients with acute basal ganglia infarction. Methods Patients with acute basal ganglia infarction for the first time were enrolled, and the general data of the enrolled patients were collected. Patients were assessed by Montreal cognitive assessment (MoCA). Based on MoCA assessment, patients were then divided into cognitive impairment (CI) group and non-cognitive impairment (NCI) group. CSVD total load scores were conducted afterwards in order to analyze the correlation between the total load of different degrees of cerebral small vessel disease and cognitive impairment. Results A total of 178 patients were enrolled in this study: 135 in the CI group and 43 in the NCI group. There were significant differences in age (t=4.11, P=0.04) but not in high-density lipoprotein (t=2.92, P=0.09), and glycosylated hemoglobin C (t=3.02, P=0.08) between the two groups. The infarct volume was larger in the CI group (CI group: 424.72±36.55, NCI group: 227.02±34.62, t=4.022, P=0.046). There were significant differences in a sing1e lentiform nucleus (χ2=19.08, P<0.01), caudal Nucleus(χ2=9.97, P<0.01), infarction at the site of internal capsule(χ2=3.85, P=0.05), the infarct site involved lentiform nucleus, internal capsule and caudate nucleus at(χ2=4.30, P=0.04), and numbers of patients with moderate-to-severe internal carotid artery stenosis (χ2=4.14, P=0.04) as well as numbers of patients with moderate-to-severe intracranial artery stenosis (χ2=4.19, P=0.04). Similarly, there were significant differences in CSVD total burden (t=3.62, P<0.01), deep white matter hyperintensity (t=9.02, P<0.01), and cerebral microbleeds (t=5.54, P=0.02) between CI group and NCI group. The comparisons on MoCA score, visuospatial and execution, attention, language, generalization and abstraction, memory and orientation but not naming were statistically significant between the two groups. The logistic regression equation showed that CSVD total burden (OR=0.316, 95%Cl: 0.185~0.541, P<0.001), age (OR=0.924, 95%Cl: 0.884~0.967, P=0.001) and infarct volume (OR=0.924, 95%Cl: 0.884~0.967, P=0.001), (95%Cl: 1.000~1.003, P=0.047) was significantly associated with cognitive impairment in patients with acute basal ganglia infarction. Conclusion High CSVD total load score, older age and larger infarct volume may be risk factors for cognitive impairment in patients with acute basal ganglia infarction.

Efficacy of the Mini-Mental State Examination versus the Montreal Cognitive Assessment in screening cognitive impairment in patients with lacunar cerebral infarction / 中国基层医药

Objective:To investigate the efficacy of the Mini-Mental State Scale (MMSE) versus the Montreal Cognitive Assessment Scale (MoCA) in screening cognitive impairment in patients with a lacunar cerebral infarction. Methods:138 eligible patients who received treatment in the Affiliated Hospital of Shanxi Datong University from January 2018 to October 2019 were recruited for this study. They received cognitive function evaluation by the MMSE and MoCA. These patients were grouped according to the median number of age or the median number of years of education. The sensitivity and consistency of the MMSE versus MoCA in screening cognitive impairment in patients with a lacunar cerebral infarction were analyzed using the χ2 test. The total cognitive scores of the MMSE and MoCA, and the scores of each cognitive domain such as memory, execution, visual space, attention, language, and orientation, were compared between groups using multiple linear regression analysis. Results:The sensitivity of MoCA in screening for cognitive impairment in low-age, high-age, low-year-education, and high-year-education groups and the whole population of patients with a lacunar cerebral infarction was 76.5%, 75.7%, 74.2%, 77.8%, 76.1%, respectively, which were significantly higher than those of MMSE (44.1%, 65.7%, 60.6%, 50.0%, 55.1%, χ2 = 12.17, 13.13, 9.33, 15.75, 23.86, all P < 0.01). The Kappa coefficients of low-age, high-age, low-year-education and high-year-education groups were 0.336, 0.391, 0.358, 0.389, and 0.373, respectively, all of which were less than 0.4 (all P < 0.01). These findings suggest that the consistency of the two scales in screening cognitive impairment is poor. The cognitive impairment detection rate by the MMSE was significantly higher in the high-age group than in the low-age group (65.7% vs. 44.1%, χ2 = 6.50, P < 0.05). The total cognitive scores of MMSE and MoCA and the scores of memory, execution, visual space, attention, language, and orientation in patients with a lacunar cerebral infarction were significantly lower in the high-age group or low-year-education group than in the low-age group ( tMMSE = 3.61, 2.49, 3.12, 4.26, 1.70, 3.69, 2.24, all P < 0.01; tMoCA = 3.83, 1.75, 3.28, 3.80, 2.21, 4.08, 2.52, all P < 0.05) or high-year-education group ( tMMSE = -2.87, -2.32, -0.85, -2.54, -0.73, -2.57, -2.96, all P < 0.01; tMoCA = -2.95, -1.12, -3.39, -1.54, -1.52, -3.09, -3.02, all P < 0.05). Conclusion:Combined application of MMSE and MoCA has a high clinical value in screening cognitive impairment in patients with a lacunar cerebral infarction. High-age patients with a lacunar cerebral infarction who receive low-year education have memory, execution, visual space, attention, language, and orientation impairments.

Correlation between lesion volume ratio and cognitive function in ischemic leukoaraiosis / 中国医师进修杂志

Objective:To investigate the relationship between the volume ratio of ischemic leukoaraiosis (LA) and cognitive level and arterial perfusion.Methods:Fifty-four patients, who was hospitalized in Dalian Central Hospital and diagnosed as LA clinically during the time of March to December in 2012, were selected to collect the information of the volume ratio of white matter disease, MoCa score and the average flow rate of carotid artery. The correlation between the volume ratio of white matter disease and MoCa score, cognitive impairment and the average flow rate of carotid artery were analyzed.Results:The volume ratio of LA lesions was negatively correlated with MOCA score ( r = -0.59, P<0.01); the volume ratio of LA lesions was negatively correlated with the mean flow rate of internal carotid artery ( r = -0.37, P<0.01). Quantity order of the area under receiver operating characteristic (ROC) curve of MoCA cognitive subgroup was as following: delayed memory (1.000)> visual space/executive function (0.970) = abstract force (0.970)> language ability (0.960)> attention (0.888). Conclusions:The larger the volume ratio of leukopathy in LA patients, the more serious the cognitive impairment, especially the cognitive impairment of impairment of memory delay, visual space/executive function, abstract ability and language ability.

Preliminary evidence for the Matrix Matching Test as a valid and reliable measure of general cognitive ability / Evidencia preliminar para el uso del Matrix Matching Test como una medida válida y confiable de habilidad cognitiva general en adolescentes

Abstract Introduction: In research, a simple measure of general cognitive ability is often required. One method is the Matrix Matching Test, a brief, free-to-use, language-free assessment of general cognitive ability or intelligence in adults, which taps both fluid and crystalized processes. We investigated its reliability and validity with adolescent participants. Method: The Matrix Matching Test was administered to 111 participants, aged 12 to 17 (46% female). Subsamples also completed two standard measures of cognitive ability: Vocabulary (crystalized) and Matrix Reasoning (fluid) tests from the Wechsler Intelligence Scale for Children IV (WISC-IV). Results: The Matrix Matching Test was found to have acceptable internal consistency and good retest reliability. Criterion validity was indicated by its ability to distinguish between psychosocially deprived participants living in foster care (n = 40) and controls, and by its positive correlation with grade point average. There were large positive correlations between the Matrix Matching Test and the standard measures of Vocabulary, and Matrix Reasoning, suggesting convergent validity. Conclusions: Our preliminary evidence suggests that The Matrix Matching Test is a reliable and valid measure of general cognitive ability for ages 12 to 17.

Resumen Introducción: En ámbitos de investigación, el uso de una herramienta de medición general de habilidad cognitiva es comúnmente requerido. Una de estas herramientas es el Matrix Matching Test, una evaluación de habilidad cognitiva o inteligencia para adultos que es corta, de uso gratuito y no tiene impedimentos de lenguaje. Esta herramienta evalúa los procesos fluidos, así como los procesos cristalizados de la inteligencia adulta. Investigamos la confiabilidad y la validez de esta herramienta con participantes adolescentes. Método: Se administró la herramienta Matrix Matching Test a 111 participantes de edades entre 12 y 17 años (46 % mujeres). Los subgrupos además completaron dos medidas de habilidad cognitiva del más alto estándar obtenidos de la Escala de inteligencia de Wechsler para Niños IV (WISC-IV): Vocabulario (cristalizada) y Matrices (fluida). Resultados: Se encontró que el Matrix Matching Test tiene una consistencia interna aceptable y buena confiabilidad retest. Se indicó el criterio de validez por su capacidad para distinguir entre participantes habitantes en hogares sustitutos (n = 40) y participantes del grupo control. Asimismo, existe una correlación positiva con el GPA. Además, se encontró correlaciones positivas fuertes entre el Matrix Matching Test y las mediciones de más alto estándar de Vocabulario y Matrices, lo que sugiere una validez convergente. Conclusiones: Nuestra evidencia preliminar sugiere que el Matrix Matching Test es una medida confiable y válida para las habilidades cognitivas generales en edades de 12 a 17 años.

Evidence of the validity of a novel version of the computerized cognitive screening battery CompCog / Evidência de validade de uma nova versão da bateria computadorizada de rastreio cognitivo CompCog

ABSTRACT Although the availability of the computer-based assessment has increased over the years, neuropsychology has not carried out a significant paradigm shift since the personal computer's popularization in the 1980s. To keep up with the technological advances of healthcare and neuroscience in general, more efforts must be made in the field of clinical neuropsychology to develop and validate new and more technology-based instruments, especially considering new variables and paradigms when compared to paper and pencil tests. Objective: This study's objective was to produce concurrent validity evidence of the novel version of the computerized cognitive screening battery CompCog. Methods: Participants performed a traditional paper and pencil neuropsychological testing session and another session where CompCog was administrated. The data of a total of 50 young adult college students were used in the analyses. Results: Results have shown moderate and strong correlations between CompCog's tasks and their equivalents considering paper and pencil tests. Items clustered in agreement with the subtest division in a principal component analysis. Conclusions: The findings suggest that CompCog is valid for measuring the cognitive processes its tasks intend to evaluate.

RESUMO Embora a disponibilidade de instrumentos computadorizados para avaliação tenha aumentado ao longo dos anos, a neuropsicologia não passou por uma mudança significativa de paradigma desde a popularização do computador pessoal nos anos 1980. Para acompanhar os avanços tecnológicos da saúde e da neurociência em geral, mais esforços devem ser feitos no campo da neuropsicologia clínica para desenvolver e validar novos instrumentos de base mais tecnológica, especialmente considerando novas variáveis e paradigmas quando comparados aos testes de lápis e papel. Objetivo: O objetivo deste estudo foi produzir evidências de validade concorrente da nova versão da bateria computadorizada de rastreio cognitivo CompCog. Métodos: Os participantes passaram por uma sessão de avaliação neuropsicológica com testes tradicionais de lápis e papel e de outra sessão em que o CompCog foi administrado. Os dados do total de 50 jovens adultos universitários foram utilizados nas análises. Resultados: Os resultados mostraram correlações moderadas e fortes entre as tarefas do CompCog e seus equivalentes nos testes tradicionais. Uma análise de componentes principais mostrou que os itens formaram fatores em concordância com a divisão de subtestes da bateria. Conclusões: Os resultados sugerem que o CompCog é válido para medir os processos cognitivos que suas tarefas pretendem avaliar.

Associação entre classes funcionais da insuficiência cardíaca com fração de ejeção preservada e comprometimento cognitivo / Association between the functional classification of heart failure with preserved fraction ejection and cognitive impairment

INTRODUÇÃO: A insuficiência cardíaca (IC) é uma síndrome resultante de defeitos estruturais e funcionais da bomba cardíaca, mais de 80% dos pacientes são idosos, com diversas comorbidades associadas. A demência é definida por qualquer desordem onde o declínio significativo do nível prévio de cognição do paciente interfere em sua independência e funcionamento social, doméstico ou ocupacional. A relação entre o comprometimento cognitivo leve e a IC já é bem estabelecida na literatura, porém estudos recentes apontam uma possível relação da IC na patogênese e no agravo da demência. OBJETIVOS: Classificar a limitação funcional de voluntários com IC com fração de ejeção preservada (FEp) e realizar o teste Montreal Cognitive Assessment (MoCA) de memória para analisar se há associação entre as limitações funcionais da IC e o deterioramento cognitivo do paciente. MÉTODOS: Trata-se de um estudo observacional transversal, foram avaliados 27 pacientes com história de ICFEp no ambulatório de Insuficiência Cardíaca do Hospital da Universidade Luterana do Brasil. RESULTADOS: Foram avaliados 27 pacientes, com idade média de 72.4 anos, sendo 18 (66.6%) do sexo feminino, 24 (88.8%) obtiveram escore no MoCA inferior a 26, sendo a média da escala 20.4. Entre os 27 pacientes, quatro apresentavam classe funcional NYHA I, 15 NYHA II, 3 NYHA III e 5 NYHA IV. CONCLUSÃO: O estudo mostra uma tendência de pior desempenho no MoCA entre pacientes com pior classe funcional de IC (NYHA I-II: MoCA 21.4 +/- 4.9 e NYHA III-IV MoCA: 18 +/- 4.2 p:0. 0.087)

INTRODUCTION: Heart failure (HF) is a syndrome resulting from structural and functional defects of cardiac pump, more than 80% of the patients are elderly with diverse associated comorbidities. The dementia is defined by any disorder where the significant decline of the previous cognition level of the patient intervene on his independence and social, domestic or occupational functioning. The link between light cognitive impairment and HF is already well documented in literature, however recent studies point a possible relation of HF in pathogenesis and deteriorating of dementia. OBJETIVE: Rank functional limitation of volunteers with HF with preserved ejection fraction and to apply the Montreal Cognitive Assessment (MoCA) memory test to analyse if there is a association between HF functional limitations and dementia onset/worsening. METHODS: Transversal observational study, 27 patients with HF with preserved ejection fraction were assessed in Universidade Luterana do Brasil's heart failure clinic. RESULTS: Assessing 27 patients, with average age of 72.4 years (+/-7.3), being 18 (66.6%) female, we found 24 (88.8%) with MoCA score lower to 26, being the average score 20.4. Between the 27 patients, 4 had functional class NYHA I, 15 NYHA II, 3 NYHA III and 5 NYHA IV. CONCLUSION: The present study shows a tendency to lower performance in MoCA on patients with worse HF functional classification (NYHA I-II: MoCA 21.4 +/- 4.9 e NYHA III-IV MoCA: 18 +/- 4.2 p:0. 0.087)

Análisis bibliométrico de las funciones ejecutivas de adultos mayores en Iberoamérica / Bibliometric analysis of executive functions of older adults in Ibero-America

RESUMEN Objetivos: a) Verificar la cantidad de estudios efectuados en Iberoamérica sobre función ejecutiva (FE) en adultos mayores; b) Identificar los instrumentos utilizados para medir las FE en adultos mayores durante los años 2009-2018. Material y métodos: Se efectuó un estudio bibliométrico sobre las FE en adultos mayores de Iberoamérica. La búsqueda de información se hizo en las base de datos Scopus y Scielo. Se consideraron estudios iberoamericanos publicados en idioma español y portugués, utilizándose ocho palabras clave y cinco indicadores registrados. Resultados: Se identificaron un total de 12 investigaciones originales en seis países iberoamericanos (España, Argentina, Chile, Colombia, Cuba, y Perú). La mayor cantidad de investigaciones relacionadas con FE en asultos mayores tuvo lugar en los periodos 2009-2010 y 2013-2014. En estos estudios, se han utilizado varios instrumentos con el Trail Making Test (TMT) y la Frontal Assessment Battery (FAB) como los de uso más frecuente. Conclusiones: Parece existir un interés limitado por investigar las FE en adultos mayores de Iberoamérica. La mayoría de los estudios idntificados en esta indagación utilizaron como tests cognitivos el TMT y la FAB.

SUMMARY Objectives: a) To verify the number of studies on executive functions (EF) in older adults carried out in Ibero-America; b) To identify the instruments used to measure EF in older adults during the years 2009-2018. Material and methods: A bibliometric study on EF in older adults in Latin America was carried out through the Scopus and Scielo databases. Studies published in Spanish and Portuguese languages using eight keywords and five registered indicators. Results: Between 2009 and 2018, a total of 12 original investigations have been carried out in six Iberoamerican countries (Spain, Argentina, Chile, Colombia, Cuba, and Peru). Most EF-related investigations were reported duing the 2010-2009 and 2013-2014 periods. Several instruments were used, the Trail Making Test and the Frontal Assessment Battery being the most frequent. Conclusions: There seems to be a limited interest in investigating EF in older adults in Ibero-America. Most of these studies identified in this inquiry used the TMT and the FAB as cognitive tests.

Evaluation of sensitivity and specificity of the INECO Frontal Screening and the Frontal Assessment Battery in mild cognitive impairment / Avaliação da sensibilidade e especificidade do teste de rastreio frontal do ineco e da bateria de avaliação frontal no comprometimento cognitivo leve

ABSTRACT. The Frontal Assessment Battery (FAB) and the INECO Frontal Screening (IFS) are two instruments frequently used to explore cognitive deficits in different diseases. However, studies reporting their use in patients with mild cognitive impairment (MCI) are limited. Objective: To compare the sensitivity and specificity of FAB and IFS in mild cognitive impairment (multiple-domain amnestic MCI subtype — md-aMCI). Methods: IFS and FAB were administered to 30 md-aMCI patients and 59 healthy participants. Sensitivity and specificity were investigated using the Receiver Operating Characteristic (ROC) analysis. Results: The area under the ROC curve (AUC) of IFS for MCI patients was .82 (sensitivity=0.96; specificity=0.76), whereas the AUC of FAB was 0.74 (sensitivity=0.73; specificity=0.70). Conclusions: In comparison to FAB, IFS showed higher sensitivity and specificity for the detection of executive dysfunctions in md-aMCI subtype. The use of IFS in everyday clinical practice would allow detecting the frontal dysfunctions in MCI patients with greater precision, enabling the early intervention and impeding the transition to more severe cognitive alterations.

RESUMO. A Bateria de Avaliação Frontal (FAB) e o teste de rastreio frontal do INECO (IFS) são dois instrumentos frequentemente utilizados para explorar déficits cognitivos em diferentes doenças. No entanto os estudos que relatam seu uso em pacientes com comprometimento cognitivo leve (MCI) são limitados. Objetivo: Comparar a sensibilidade e especificidade da FAB e IFS em comprometimento cognitivo leve (subtipo amnéstico de múltiplos domínios [md-aMCI]). Métodos: O IFS e FAB foram administrados a 30 pacientes md-aMCI e 59 participantes saudáveis. A sensibilidade e a especificidade foram exploradas usando a análise ROC. Resultados: A área sob a curva ROC (AUC) do IFS para pacientes com MCI foi de 0,82 (sensibilidade=0,96; especificidade=0,76), enquanto a AUC de FAB foi de 0,74 (sensibilidade=0,73; especificidade=0,70). Conclusões: Em comparação com o FAB, o IFS apresentou maior sensibilidade e especificidade para detecção de disfunções executivas no subtipo md-aMCI. O uso do INECO Frontal Screening (IFS) na prática clínica cotidiana, permitiria detectar com maior precisão as disfunções frontais em pacientes com deficiência cognitiva leve, possibilitando a intervenção precoce, impedindo a transição para alterações cognitivas mais graves.

Interactive scalp acupuncture for cognitive dysfunction after stroke: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the efficacy of interactive scalp acupuncture, scalp acupuncture alone and scalp acupuncture plus cognitive training for cognitive dysfunction after stroke.@*METHODS@#A total of 660 patients with cognitive dysfunction after stroke were randomly divided into an interactive scalp acupuncture group (218 cases, 18 cases dropped off), a scalp acupuncture group (220 cases, 20 cases dropped off) and a scalp acupuncture plus cognitive training group (222 cases, 22 cases dropped off). All the patients were treated with routine medication and exercise rehabilitation training. The interactive scalp acupuncture group was treated with scalp acupuncture on the parietal midline, and contralateral anterior parietal temporal oblique line and posterior parietal temporal oblique line at the same time of cognitive training; the scalp acupuncture group was treated with scalp acupuncture alone, and the scalp acupuncture plus cognitive training group was treated with scalp acupuncture and cognitive training in the morning and afternoon respectively. All the treatments were given once a day, 6 times a week for 8 weeks. Montreal cognitive assessment (MoCA) scale score was used to evaluate the cognitive function before treatment, 4 weeks and 8 weeks into treatment.@*RESULTS@#Compared before treatment, the total score of MoCA was increased after 4-week treatment and 8-week treatment in the three groups (@*CONCLUSION@#The interactive scalp acupuncture could significantly improve the cognitive function in patients with cognitive dysfunction after stroke, and the efficacy is superior to scalp acupuncture alone and scalp acupuncture plus cognitive training.

A lexical decision task to measure crystallized-verbal ability in Spanish / Una tarea de decisión léxica para medir la capacidad verbal cristalizada en español

Abstract A classical distinction in cognitive science is between fluid and crystalized abilities. Fluid ability is captured by many common executive function and intelligence tests. Crystalized ability, on the other hand, can be measured quite simply via lexical decision tasks including the English-language Spot-the-Word Test. However, no similar Spanish-language test has been available up to now. This paper presents a Spanish-language Lexical Decision Task that is quick to administer and was tested on sample of 139 normal adult participants. Results indicate that the new test has good internal consistency and test-retest reliability. An analysis of the correlations between this new test and demographic variables, as well as with the subtests of the Wechsler Adult Intelligence Scale suggest that it is a valid measure of crystalized-verbal ability. It also appears to be a brief but valid assessment of intelligence in general, and its positive correlation with academic achievement establishes predictive validity. The new test has the potential to be a useful research tool to rapidly measure reading ability, crystalized-verbal ability, and intelligence in Spanish speaking adults.

Resumen Una distinción clásica en la ciencia cognitiva es entre las habilidades fluidas y cristalizadas. La habilidad fluida es medida por muchas funcionas ejecutivas y tests de inteligencia. Por otro lado, la habilidad cristalizada puede ser medida sencillamente mediante una tarea de decisión léxica, como en la versión en inglés conocida como Spot-the-Word Test. Sin embargo, hasta ahora no ha habido una versión similar de este test en español. Aquí les presento una Tarea de Decisión Léxica en español que es de rápida aplicación. Esta fue aplicada en una muestra de 139 participantes, adultos normales. Los resultados indican que este nuevo test tiene buena consistencia interna y confiabilidad test-retest. Los análisis de las correlaciones entre este nuevo test y las variables demográficas, al igual que con las sub pruebas de las Escala de Inteligencia de Wechsler para Adultos, sugiere que es una medida confiable de la habilidad verbal cristalizada. También parece ser una breve, pero válida evaluación de inteligencia en general, con validez predictiva establecida por sus correlaciones positivas con el logro académico. Este nuevo test tiene potencial para ser una herramienta útil para medir rápidamente habilidad de lectura, habilidad verbal cristalizada e inteligencia en adultos hispanohablantes.

Prognostic value of Montreal Cognitive Assessment in heart failure patients / 中华心血管病杂志

Objective: To explore the occurrence of cognitive impairment in Chinese heart failure (HF) patients and it's impact on prognosis. Methods: In this prospective observational study, a total of 990 HF patients were enrolled from 24 hospitals in China during December 2012 to November 2014. All patients were administrated with the interview-format Montreal Cognitive Assessment (MoCA), according to which they were divided into MoCA<26 (with cognitive impairment) group and MoCA≥26 (without cognitive impairment) group. Baseline data were collected and a 1-year follow up was carried out. Univariate and multivariate logistic or Cox regression were performed for 1-year outcomes. Results: Cognitive impairment was evidenced in 628 patients (63.4%) and they were more likely to be older, female, and with higher proportion of New York Heart Association(NYHA) class Ⅲ-Ⅳ, chronic obstructive pulmonary disease (COPD), ischemic heart disease, while body mass index (BMI), education level, and medical insurance rate were lower (all P<0.05) as compared to patients in MoCA≥26 group. The rate of percutaneous intervention, device implantation, cardiac surgery and evidence-based medications were significantly lower in MoCA<26 group than in MoCA≥26 group (all P<0.05). During the 1-year follow up, patients in the MoCA<26 group had higher all-cause mortality (10.2%(64/628) vs. 2.2%(8/362), P<0.01), cardiovascular mortality (5.9%(37/628) vs. 0.8%(3/362), P<0.01) and major adverse cardiac and cerebrovascular events (MACCE) (9.6%(60/628) vs. 2.5%(8/362), P<0.01) than patients in the MoCA≥26 group. In univariate regression, MoCA<26 was associated with increased all-cause mortality (HR(95%CI):4.739(2.272-9.885), P<0.01), cardiovascular mortality (HR(95%CI):7.258(2.237-23.548), P=0.001) and MACCE (OR(95%CI):4.143(2.031-8.453), P<0.01). After adjustment by multivariate regression, MoCA<26 was indicated as an independent risk factor for all-cause mortality (HR(95%CI): 6.387(2.533-16.104), P<0.01), cardiovascular mortality (HR(95%CI): 10.848(2.586-45.506), P=0.001) and MACCE (OR(95%CI): 4.081(1.299-12.816), P=0.016), while not for re-hospitalization for HF (OR(95%CI):1.010(0.700-1.457), P=0.957). Conclusions: Cognitive impairment is common in HF patients,and it is an independent prognostic factor for 1-year outcomes. Routine cognitive function assessment and active intervention are thus recommended for HF patients.

Clinical effect of electroacupuncture at Baihui and Shuigou points in treatment of brain injury in patients with sepsis-associated encephalopathy / 针刺研究

OBJECTIVE: To investigate the clinical effect of electroacupuncture at Baihui (GV20) and Shuigou (GV26) points in the treatment of brain injury in patients with sepsis-associated encephalopathy(SAE). METHODS: A total of 70 patients with SAE were randomly divided into control group and treatment group, with 35 patients in each group. The patients in the control group were given routine western medicine treatment, including anti-infective therapy, nerve nutrition, and mechanical ventilation, and those in the treatment group were given electroacupuncture at GV20 and GV26 in addition to the treatment in the control group. The course of treatment was 1 week for both groups. Serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), and neuron-specific enolase (NSE) were measured for both groups, the Montreal Cognitive Assessment (MoCA) scale was used to assess the change in cognitive function, and Glasgow Coma Scale (GCS) score was determined before and after treatment and was used to evaluate treatment outcome after treatment. RESULTS: Both groups had significant reductions in the serum levels of CRP, IL-6, and NSE after 24 h and one week of treatment (P<0.05), and compared with the control group, the treatment group had significant reductions in the levels of CRP, IL-6 and NSE after treatment (P<0.05). The treatment group had significant increases in the total score of MoCA and the scores of all dimensions except attention after one week of treatment (P<0.05), and the treatment group had significantly higher scores than the control group after treatment (P<0.05). Both groups had a significant increase in GCS score after one week of treatment (P<0.05), and the treatment group had a significantly higher GCS score than the control group after treatment (P<0.05). The treatment group had a significantly higher total effective rate than the control group ［88.6% (31/35) vs 57.1% (20/35), P<0.05］. CONCLUSION: Electroacupuncture at GV20 and GV26 can effectively improve brain injury and effective rate in SAE patients.