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This study aimed to explore the association between serum non-high-density lipoprotein cholesterol (non-HDL-C) and cognitive dysfunction risk in patients with acute ischemic stroke (AIS). This cross-sectional study enrolled 583 AIS patients. Biochemical markers and lipid profile were collected after admission. AIS patients were classified into high group (non-HDL-C ≥3.4 mM) and normal group (non-HDL-C <3.4 mM). Mini-Mental State Examination scale (MMSE), Montreal Cognitive Assessment scale (MoCA), Activities of Daily Living (ADL) scale, Neuropsychiatric Inventory (NPI), and Hamilton Depression scale 21 version (HAMD-21) were applied on the third day after admission. Compared with the control group, patients of the high group had higher body mass index and higher frequency of intracranial artery stenosis, and exhibited higher levels of non-HDL-C, total cholesterol, triglycerides, low-density lipoprotein cholesterol, homocysteine, fasting blood glucose, and glycosylated hemoglobin (HbA1c), and lower levels of high-density lipoprotein cholesterol (all P<0.05). Compared with the control group, patients of the high group had significantly lower MMSE and MoCA scores (MMSE: 26.01±4.17 vs 23.12±4.73, P<0.001; MoCA: 22.28±5.28 vs 20.25±5.87, P<0.001) and higher scores on the NPI and HAMD-21 (both P<0.001). MMSE (r=-0.306, P<0.001) and MoCA scores (r=-0.251, P<0.001) were negatively associated with non-HDL-C level. Multivariate regression analysis revealed that non-HDL-C level (OR=1.361, 95%CI: 1.059-1.729, P=0.016) was independently associated with the presence of cognitive dysfunction after adjusting for confounding factors. High serum non-HDL-C level might significantly increase the risk of cognitive dysfunction after AIS.
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Humans , Male , Female , Middle Aged , Aged , Brain Ischemia/complications , Cognitive Dysfunction/etiology , Activities of Daily Living , Cross-Sectional Studies , Risk Factors , Ischemic Stroke/complications , Cholesterol, HDLABSTRACT
Background: Cognitive impairment in the elderly is a common condition and, in most instances, primary care providers are the first point of contact for a patient and family. This study was aimed to find out the association between socio-demographic profile and severity of cognitive impairment in elder patients presenting with new onset of psychiatric symptoms.Methods: A cross sectional study was done among elder subjects (≥60 years of age) presented with new onset of psychiatric symptoms during one year period. A structured questionnaire was used to assess the socio-demographic details such as age, sex, education, occupation, socio-economic status and marital status. Mini International Neuropsychiatric interview and Montreal Cognitive Assessment scale were used for psychiatric diagnosis and severity of cognitive impairment grading, respectively. Association between socio-demographic data and cognitive impairment was statistically analyzed.Results: Among the 67 subjects included in the study, 76.2% had cognitive impairment. Majority of the subjects were females (56.7%) in the age group of 66-70 years. The association between cognitive impairment and sex (p=0.006), education (p=0.002) and occupation (p=0.015) were significant. But no significant association between cognitive impairment and marital status (p=0.0137) or socioeconomic status (p=0.400) was evidenced.Conclusions: Females in the age group of 66-70 years were more prevalent to cognitive impairment. The association between sex, education, occupation and severity of cognitive impairment was significant. No significant association between severity of cognitive impairment score and marital status or socioeconomic status was found.
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Background: Neuropsychiatric impairments play significant roles throughout the course of cognitive decline mainly in older adults with dementia or mild cognitive impairment (MCI). This study was aimed to find the association between psychiatric comorbidities and severity of cognitive impairment in elder patients presented with new onset of Psychiatric Symptoms.Methods: A cross sectional study was done among elder subjects (≥60 years of age) presented with new onset of psychiatric symptoms during one year period. Mini International neuropsychiatric interview and Montreal Cognitive Assessment scale were used for psychiatric diagnosis and severity of cognitive impairment grading, respectively. Association between psychiatric comorbidities and MCI was statistically analyzed.Results: Total 67 subjects were included in the study. Analysis of the psychiatric diagnosis revealed that major depressive episode (52.2%) was the most prevalent psychiatric disorder among the study population followed by Psychotic disorders (23.9%). Generalized anxiety disorder contributed to 19.4% of the total study population. Significant association (p<0.002) was identified between the severity of cognitive impairment and the psychiatric comorbidities.Conclusions: A significant association was identified between the severity of MCI and the psychiatric comorbidities. Major depressive episode was the most prevalent psychiatric disorder followed by psychotic disorders and generalized anxiety disorder.
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Objective To investigate the characteristics of cognitive impairment in critical patients, and to explore the role of early cognitive intervention training in improving cognitive impairment in critical patients. Methods A prospective cohort study was conducted. 133 patients in conscious and normal intelligence admitted to intensive care unit (ICU) of Hefei Second People's Hospital from January 2015 to June 2018 were enrolled. The patients were divided into control group (n = 66) and cognitive intervention group (n = 67) according to random number table based on chronological number for entry into the study. Cognitive function was assessed by Montreal cognitive assessment scale (MoCA scale) within 24 hours after ICU admission. The patients in the cognitive intervention group received a series of scientifically designed cognitive training sessions (playing electronic musical keyboard, learning simple Spanish, clock-drawing, psychological intervention) for 2 months, and follow-up was completed if the patient was discharged from ICU. While the patients in the control group did not undertake any cognitive training. After 2 months, the cognitive function of patients in both groups were assessed with MoCA scale. Subgroup analysis was conducted according to different age groups (20-40 years old, 41-60 years old, 61-80 years old) to explore the effect of cognitive intervention training in different age groups. According to the subjective evaluation of the patient's ability to live 2 months after cognitive intervention by the patient or his relatives, receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of the total score of MoCA for patients' ability to live after cognitive intervention. Results 133 critical patients were enrolled in the final analysis. There was no significant difference in gender, age, education, complications, ICU hospitalization, sedative or analgesic drug usage between the two groups, indicating that the data of the two groups were balanced and comparable. No significant difference in MoCA scale total score or sub-item cognitive domain score within 24 hours of ICU admission was found between the two groups. After 2 months of intervention, the incidence of cognitive impairment in the cognitive intervention group was significantly lower than that in the control group [38.8% (26/67) vs. 60.6% (40/66), χ2 = 6.321, P = 0.015]. The total score of MoCA scale and four sub-item cognitive domain scores including visual space and execution power, protection of memory, attention execution, and orientation in the cognitive intervention group were significant higher than those in the control group (MoCA scale total score: 26.73±1.92 vs. 24.95±2.26, visual space and executive power score: 4.39±0.70 vs. 3.95±0.88, protection of memory score: 8.91±1.03 vs. 8.24±1.37, attention execution score: 5.21±0.77 vs. 4.79±1.00, orientation score: 5.67±0.53 vs. 5.44±0.68, all P < 0.05), but no significant difference was found in verbal skills score (2.55±0.56 vs. 2.53±0.56, P > 0.05). Subgroup analysis showed that the total MoCA scale score of the younger sample (20-40 years old, n = 20) was recovered by 2.10±1.55 in the cognitive intervention group after 2 months of cognitive intervention, which was significantly higher than that in the control group (n = 21; 0.24±2.76, P < 0.05). In the middle-aged and the older population [aged 41-60 years old (n = 20) and 61-80 years old (n = 27)], the total MoCA scale scores were recovered slightly after cognitive intervention as compared with those in the younger sample (0.43±1.47, -1.91±2.20 vs. 2.10±1.55, both P < 0.05), which were significantly lower than those in the control group [aged 41-60 years old (n = 21) and 61-80 years old (n = 24), -0.78±1.38, -4.41±2.17,both P < 0.01]. It was suggested that cognitive intervention training played an active role in the recovery of cognitive function in young critical patients. It was shown by ROC curve analysis that the area under ROC curve (AUC) of MoCA scale total score for predicting daily life ability after cognitive intervention was 0.732 with 95% confidence interval (95%CI) of 0.646-0.819. When the best cut-off value was 24.5, the sensitivity was 89.3%, the specificity was 60.2%, the positive predictive value was 85.7%, and the negative predictive value was 80.8%. Conclusions Early cognitive intervention could efficiently abate the deterioration of cognitive function in critical patients in ICU and had significant effects on the visual space and executive power, protection of memory, attention execution and orientation. Cognitive intervention exerted significantly positive effects on the recovery of cognitive function in the younger sample population (aged 20-40 years old).
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OBJECTIVE@#To observe the clinical efficacy of acupuncture method for mild cognitive impairment in the elderly.@*METHODS@#A total of 96 patients were randomly divided into an observation group, a control group and a waiting group, 32 cases in each group. The patients in the observation group were treated with acupuncture at Baihui (GV 20), Shenting (GV 24), Yintang (GV 29) and Sishencong (EX-HN 1), etc, while the patients in the control group were treated with nonpenetrating sham acupuncture at the same acupoints as the observation group. The treatment was given once every other day, three times a week for 8 weeks. The patients in the waiting group only received health guidance for 8 weeks. Montreal cognitive assessment scale (MoCA) and mini-mental state examination (MMSE) were used before and after 8-week treatment in all three groups. The observation group and the control group were followed up for 2 months and evaluated with MoCA and MMSE.@*RESULTS@#The MoCA scores in the observation group after treatment and during follow-up were higher than before treatment (0.05). The MoCA scores in the control group after treatment and during follow-up were higher than before treatment (0.05). The difference before and after treatment in the observation group was higher than the control group and waiting group (0.05). The MMSE scores after treatment and during follow-up were higher than before treatment in the control group (0.05). The difference before and after treatment the observation group and control group was not significant (>0.05), and those in the two groups were higher than the waiting group (<0.01). The difference between follow-up and before treatment in the observation group was higher than the control group (<0.01), and the difference between follow-up and after treatment was lower than the control group (<0.01).@*CONCLUSION@# acupuncture method could improve cognitive impairment in elderly patients with mild cognitive impairment.
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Aged , Female , Humans , Male , Acupuncture Points , Acupuncture Therapy , Cognitive Dysfunction , Therapeutics , Mental Status and Dementia Tests , Treatment OutcomeABSTRACT
Objective To assess the psychometric potential of the Montreal Cognitive Assessment Scale-Beijing (MoCA-BJ) as a screening instrument for mild cognitive impairment (MCI) in older adults in Wuhan communities of central China. Methods MoCA-BJ and Mini-Mental State Examination (MMSE) were adopted to assess the MCI of 381 older adults from 13 communities in Wuhan in 2015. Confirmatory factor analysis was conducted to evaluate the construct validity of MoCA-BJ, and the relationship between all aspects of cognitive function and MoCA different dimensions. Results MoCA-BJ had acceptable reliability (w=0.76), and MoCA-BJ and MMSE estimation results were highly correlated (r=0.73, P＜0.01). By comparing three measurement models through confirmatory factor analysis, we found that the MoCA-BJ scale had two factors (F1: visual space executive function, F2: memory-based other cognitive functions) in model 3, fit degree of which was higher than model 1 by one factor, and there was a statistically significant difference in the number of factors between model 1 and model 3 (χ2dif=8.73,P＜0.01). Conclusions The MoCA-BJ has two underlying factors that respectively represent two highly correlated but distinct factors, cognition and visual-spatial. Uninformative items should be revised with culturally sensitive items and the cut-off point for mild impairment should also be altered.
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Objective To understand the cognitive function of the patientwith acquired immune deficiency syndrome (AIDS) in Guangxi are.MethodEighty caseof AIDconfirmed by laboratory in the Nanning Fourth People′Hospital were selected athe patientgroup ;athe same time 88 individualwithouthe dangeroubehaviorwithin 3 monthwhich could cause human im-munodeficiency virus(HIV) infection and with negative anti-HIV antibody detection were selected from the accompanying family memberathe control group .The Chinese translation version of the Montreal cognitive assessmenscale (MoCA) waadopted to conducthe investigation and evaluation on the cognition function in the two group.ResultThe total score span in the patientgroup wa2-29 pointwith the average of (20 .04 ± 6 .13) point,of normal cognitive function and 48 cases(60 .00% ) of cognitive impairmen;the total score span in the control group wa17-29 pointwith the average of (25 .02 ± 2 .98) point,of normal cogni-tive function and 6 cases(6 .82% ) of cognitive impairmen.The scoreof MoCtotal score ,visual and execution ,naming ,delayed recall ,attention ,abstraction and orientation in the patientgroup were lowethan those in the control group ,the differencebetween the two groupwere statistically significan(P＜0 .01) .The personnel distribution and proportion in the variouscore segmenta-tionhad statistical differencebetween the two group(P＜0 .05) .The factorof gende,age and educational level were performed the Logistiregression analysi,the resultshowed thaonly the educational level wathe influencing facto.Conclusion Differendegreeof cognitive impairmenexisin the AIDpatientand the educational level may be factoaffecting the scale score .
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Objective To investigate relationship between different degrees of asymptomatic carotid artery stenosis and cognitive impairment. Methods The cognitive function were evaluated with the montreal cognitive assessment scale (MoCA) in 80 patients with asymptomatic carotid artery stenosis and 56 controls, the total MoCA scores and subprojects scores were compared between the patients with different degrees of ACS and controls. Results The total MoCA score, visual space and executive function, attention and delayed recall had significant difference among the mild, moderate, severe ACS patients and control group (all P 0.05). The total MoCA score and the scores of visual space and executive function , attention and delayed recall in moderate and severe ACS patients were significantly lower than the control group and mild ACS patients (P < 0.05). Furthermore, the severe ACS patients, compared with the moderate ACS patients , performed worse on the cognitive tasks which involved visual space and executive function, attention and delayed recall (P < 0.05). Conclusions Cognitive function is impaired in the patients with moderate and severe ACS,the neuropsychological characteristics are mainly impaired in visual space and executive function, attention and delayed recall.
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Objective To observe the effects of computer assisted training combined with the actual environment training on vascular cognitive impairment with no dementia (VCIND) after stoke.Methods Sixty elderly patients with VCIND after stroke were randomly divided into a research group and a control group,each of 30.All patients were given routine medication and rehabilitation training,while the research group was additionally provided with computer assisted training and the actual environment training lasting two months.All patients' cognitive function and activities of daily life (ADL) in both groups were assessed using the Montreal cognitive assessment scale(MoCA) and modified Barthel index(MBI) before and after treatment.Results After two months of treatment,the total score of MoCA (22.80 ± 4.63) and the scores of seven subprojects including visual space (4.00 ± 0.93),naming (2.67±0.62),attention(4.13 ±0.74),language(2.33 ±0.62),abstract thinking(1.60± 0.83),delayed memory(2.93 ±0.70) and orientation(5.13 ± 1.19) in the research group were significantly higher than those before treatment and those of the control group.However,in the control group,only the total score and the scores of naming,language and delayed memory in the control group significantly were higher than those before treatment.After treatment,the scores of MBI in both group were significantly promoted,reaching (61.53 ± 7.13) and (52.20 ± 4.93) for the research and control group respectively,with the former improving more significantly than the latter.Conclusion The computer assisted training combined with the actual environment training helps to improve cognitive function and ADL for patients with VCIND after stoke.Such combined therapy is worth of promoting in clinical practice.
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La esquizofrenia es un trastorno mental que posee múltiples dimensiones sintomáticas y las alteraciones cognitivas son características cardinales en la evolución del trastorno. El uso de clinimetría para evaluar dichas deficiencias puede aportar información en la investigación en este campo. Objetivo Determinar la validez y confiabilidad de la Escala de Evaluación Cognitiva Montreal (MoCA) para la evaluación del déficit cognitivo en pacientes con el diagnóstico de esquizofrenia. Material y métodos Se evaluaron cien pacientes con diagnóstico de esquizofrenia reclutados en la Clínica de Esquizofrenia del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz. Se aplicaron las escalas de MoCA, MMSE y PANSS para la valoración de las funciones cognitivas. Se estableció la confiabilidad del MoCA con el Alfa de Cronbach y se estableció su validez concurrente con el MMSE y la subescala cognitiva de la PANSS. Resultados De acuerdo al MMSE (con ajuste de escolaridad) el 8% de los pacientes fueron clasificados con deterioro cognitivo en contraste con el puntaje total del MoCA que reporto 69% de la muestra con deterioro cognitivo. La escala MoCA obtuvo una confiabilidad (Alfa de Cronbach=0.71) similar a la observada por el MMSE (a=0.70) y adecuada validez concurrente. Conclusiones La MoCA es un instrumento confiable y válido para establecer la presencia de deterioro cognitivo leve en pacientes con esquizofrenia, sencillo y de fácil aplicación en la práctica clínica psiquiátrica cotidiana...
Schizophrenia is a severe mental disorder characterized by complex symptoms and impaired cognitive function, which has been considered a core feature. Research into cognition and schizophrenia over the past years has taken several different approaches including psychometric assessments. Objective The Montreal Cognitive Assessment (MoCA) has been proven useful in detecting cognitive impairment in patients with several forms of dementia. Our aim was to assess its validity as a screening instrument for cognitive impairment in schizophrenic patients. Material and methods One hundred patients with diagnosis of schizophrenia were recruited at the Schizophrenia Clinic of the National Institute of Psychiatry in Mexico. The MoCA and MMSE were used to assess cognitive functions in these patients. For the concurrent validity, the MoCA, MMSE and PANSS were used, and existing methods were utilized to determine reliability and validation. Results According to the MMSE-education adjusted cut-off scores, only 8% of the patients in our sample were found with cognitive impairment in contrast with 69% of the total score obtained from the MoCA. The MoCA was tested for reliability with a Cronbach's alpha=0.71 similar to the one reported for MMSE (a=0.70) showing appropriate concurrent validity. Conclusions The MoCA is a cognitive tool with adequate psychometric properties as a screening instrument for the detection of mild cognitive impairment in schizophrenia. It also promises to fill an urgent unmet need for a brief screening tool capable of detecting patients with MCI and schizophrenia...
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Objective To investigate the value of the Changsha version of the Montreal Cognitive Assessment Scale (MoCA) in the assessment of vascular cognitive impairment after cerebral infarction .Methods 112 cases of clinically diagnosed cerebral infarc-tion were selected and divided into the normal cognition (NC) group and vascular cognitive impairment(VCI) group .The Changsha version of MoCA and the mini-mental state examination(MMSE) were adopted to detect the cognitive function ,the correlation of two scales was analyzed and the cutoff values of the Changsha version of MoCA were preliminarily studied .Results The total scores of the Changsha version of MoCA and MMSE in the VCI group were 15 .12 ± 4 .60 and 20 .44 ± 3 .22 respectively ,which were lower than 22 .75 ± 1 .79 and 25 .21 ± 1 .74 in the NC group ,the difference had statistical significance (P< 0 .05);the total scores of the Changsha version of MoCA was positively correlated with the total scores of MMSE (r=0 .84 ,P<0 .01);the best cut-off value of the Changsha version of MoCA was 20/21 ,the sensitivity and specificity were 92% and 95% respectively .Conclusion The Changsha version of MoCA can screen VCI well and has a high screening value ,and its optimal cutoff value is 20/21 .
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Objective To investigate the relationship between the cerebral microbleeds (CMBs) and changes of cognitive function,and the possible mechanism of cognitive impairment caused by CMBs.Methods Sixty-eight micro-hemorrhage patients on susceptibility weighted imagine (SWI) sequences composed positive group,and sixty-eight patients selected without micro-hemorrhage in the SWI sequence and meeting the selection criteria as control group.At the same time,both two groups were assessed by MoCA and CDT scale inspection.Results CDT scores of CMBs group (2.00±0.88) were significantly lower than those of control group (3.76±0.53),and there was significantly different in the two groups (t=-3.27,P=0.00).At the same time,MoCA total scores and executive functions,naming,calculation,language,abstraction,recall scores of CMBs group were significantly lower than those of control group,and all of the groups were significantly different (t=-5.48,P=0.00; t=-4.36,P=0.00; t=-2.35,P=0.01 ; t=-2.49,P=0.02; t=-4.09,P=0.00; t=-4.63,P=0.00).CDT scores,MoCA total scores,executive functions,language,abstraction,memory scores between CMBs groups and control group were significantly different at all levels (P＜0.05).Executive functions,languages and calculated inter-group of mild CMBs,moderate CMBs,severe CMBs were significantly different (P＜0.05).The number of CMBs was negative correlation with total scores,executive function,language,and abstract (r=-0.675,P=0.000; r=-0.689,P=0.000; r=-0.536,P=0.000; r=-0.636,P=0.000).Conclusion The existence of CMBs and the number of CMBs are closely related to cognitive dysfunction.The more of CMBs,the more of obvious cognitive impairment.