Accuracy of the Short-Form Montreal Cognitive Assessment Chinese Versions.

Background: There is a strong need for short and effective methods to screen for cognitive impairment. Recent studies have created short forms of the Montreal Cognitive Assessment (s-MoCA) in English-speaking populations. It is also important to develop a validated Chinese short version to detect cognitive impairment. Methods: Item response theory and computerized adaptive testing analytics were used to construct abbreviated MoCAs across a large neurological sample comprising 6,981 community-dwelling Chinese veterans. Results: Six MoCA items with high discrimination and appropriate difficulty were included in the s-MoCA. The Chinese short versions (sensitivity 0.89/0.90, specificity 0.72/0.77) are similar in performance to the full MoCA in identifying cognitive impairment (sensitivity 0.91, specificity 0.82). Conclusions: These short variants of the MoCA may serve as quick and effective instruments when the original MoCA cannot be feasibly administered in clinical services with a high patient burden and limited cognitive testing resources.

The Epoch Effect on Cognitive Function Requires Regular Updating of Cognitive Screening Tests.

BACKGROUND: Over time, improved cognitive abilities in elderly individuals lead to an overall increase in performance on widely used cognitive screening tests (e.g., Mini-Mental State Examination, MMSE) and impact screening efficacy. OBJECTIVE: We aimed to examine the epoch effect on cognitive function measured using MMSE, in addition to the influence of demographic characteristics on MMSE. We also evaluated the ability of the MMSE in detecting dementia and examined the discrimination ability and measurement precision of the MMSE. METHODS: In a cross-sectional survey, Chinese veterans aged ≥60 years were interviewed. Multiple linear regression analysis was applied to explore the factors affecting the MMSE. The expected MMSE score was calculated to examine the epoch effect. The diagnostic accuracy of the MMSE was determined via receiver operating characteristic curve analyses. Item response theory methods were implemented using Stata 16.0. RESULTS: The MMSE score increased with higher education and decreased with advancing age. The observed MMSE score in this study (26.9) was higher than the expected MMSE score (24.9). It demonstrated 78.3% /84.1% /89.9% sensitivity and 85.8% /79.5% /66.8% specificity in detecting dementia using the cut-off score 25/26/27. The MMSE showed reduced discrimination and provided little information for ability level of -1 and above. CONCLUSION: Improved cognitive ability over time may increase the performance on cognitive screening tests (e.g., MMSE). This impact of epoch in cognitive function emphasizes the importance of regularly updating cognitive screening tests.

The impact of methods to handle missing data on the estimated prevalence of dementia and mild cognitive impairment in a cross-sectional study including non-responders.

OBJECTIVE: Although several statistical methods for adjusting for missing data have been developed and are widely applied in research, few studies have investigated these methods in adjusting for missingness in datasets that aim to estimate the prevalence of dementia. We attempted to develop a more feasible approach for handling missingness in a cross-sectional study among elderly. METHODS: Five methods of estimating prevalence, including stratified weighting (SW), inverse-probability weighting (IPW), hot deck imputation (HDI), ordinal logistic regression (OLR) and multiple imputation (MI), were applied to handle the missing data yielded by a dataset that include 2231 non-responders. RESULTS: Compared with the results of the complete case analysis, the differences in the prevalence rates of dementia and mild cognitive impairment (MCI) calculated by the prevalence-estimating methods after adjusting for non-responders were less than 7% and 6%, respectively. In contrast to the results of other methods, the estimated prevalence of dementia and MCI calculated by MI increased when more predictive factors were included, and the lowest rate of missing data was achieved using MI. Using the participants' ages, the cognitive screening sores and activity of daily life sores as predictive variables when correcting for missingness induced relatively larger effects on the estimated dementia prevalence. CONCLUSIONS: When adjusting for missingness while estimating the prevalence of dementia in cross-sectional studies, a simple method, such as SW, is recommended when limited information is available, whereas MI is the preferred method when additional information is available. Further simulation studies are needed to determine the optimal approach.

Characteristics of participants' and caregivers' influence on non-response in a cross-sectional study of dementia in an older population.

OBJECTIVE: The issue of non-response in dementia epidemiological studies, which may result in the underestimation of the prevalence of dementia, has attracted little attention. We aimed to explore the causes and related factors of non-response in a dementia survey among Chinese veterans. METHODS: A two-phase, cross-sectional study investigated the prevalence of dementia and mild cognitive impairment in Chinese veterans aged ≥ 60 years. We collected the socio-demographic data and prior medical history, evaluated the health status of veterans and their caregivers, assessed the cognitive status of veterans, and evaluated the care burden of caregivers by Caregiver Burden Inventory (CBI). RESULTS: Of 9676 eligible participants, 525 (5.4%) veterans in phase 1 and 1706 (35.0%) veterans among 4875 veterans in phase 2 did not respond. Illness, hospitalization and death accounted for 63.0% and 75.5% non-response in phases 1 and 2, respectively. Non-participation in social activities, self-perceived poor health status, worsened health changes, self-reported need for life care, and history of hearing loss or glaucoma independently predicted non-response in phase 1 or 2. The heavy care burden, suggested by the higher CBI scores and self-reported health deterioration of the primary caregivers, predicted non-response in phase 1 or 2. CONCLUSIONS: The negative factors from both the participants and their caregivers independently predicted the non-response in the dementia study in an older population. Preventative strategies from the perspectives of the participants and caregivers should be developed to improve the response rates in both phases in a cross-sectional study.

Awareness Status of Chronic Disabling Neurological Diseases among Elderly Veterans.

BACKGROUND: The awareness, treatment and prevention of chronic diseases are generally poor among the elderly population of China, whereas the prevention and control of chronic diseases in elderly veteran communities have been ongoing for more than 30 years. Therefore, investigating the awareness status of chronic disabling neurological diseases (CDND) and common chronic diseases (CCD) among elderly veterans may provide references for related programs among the elderly in the general population. METHODS: A cross-sectional survey was conducted among veterans ≥60 years old in veteran communities in Beijing. The awareness of preventive strategies against dementia, Alzheimer's disease (AD), Parkinson's disease (PD), sleep disorders, cerebrovascular disease (CVD) and CCD such as hypertension, and the approaches used to access this information, including media, word of mouth (verbal communication among the elderly) and health care professionals, were investigated via face-to-face interviews. RESULTS: The awareness rates for CCD and CVD were approximately 100%, but that for AD was the lowest at <10%. The awareness rates for sleep disorders, PD and dementia, were 51.0-89.4%. Media was the most commonly selected mode of communication by which veterans acquired knowledge about CCD and CVD. Media was used by approximately 80% of veterans. Both health care professionals and word of mouth were used by approximately 50% of veterans. With respect to the source of information about CDND excluding AD, the rates of the use of health care professionals, word of mouth and media were 10.6-28.2%, 56.5-76.5%, and approximately 50%, respectively. CONCLUSIONS: The awareness of CDND among elderly veterans was significantly lower than that of CCD. More information about CDND should be disseminated by health care professionals. Appropriate guidance will promote the rapid and extensive dissemination of information about the prevention of CDND by media and word-of-mouth peer education.

Physical activity as a protective factor against depressive symptoms in older Chinese veterans in the community: result from a national cross-sectional study.

BACKGROUND: Physical activity is generally considered to be effective in reducing the prevalence of depression and promoting remission of its symptoms. However, large-scale epidemiological research on this issue is lacking in older Chinese adults. We performed a nationwide epidemiological survey to determine the relationship between physical activity and depressive symptoms in older Chinese veterans in the community, with adjustment for potential confounders. METHODS: A cross-sectional study was conducted in a representative sample of 9,676 community-dwelling older Chinese veterans. Depressive symptoms were identified using the Center for Epidemiological Studies Depression Scale. Physical activity was self-reported using a one-year physical activity questionnaire. Information about covariates was obtained by questionnaire-based interview. Relationships between study variables and symptoms of depression were estimated using unadjusted and adjusted analyses. RESULTS: The median age was 82.29 (interquartile range 80.25-84.60) years. In total, 81.84% of the study participants engaged in physical activity that was predominantly light in intensity. In unadjusted analyses, physical activity was associated with a significantly decreased likelihood of depressive symptoms (5.43% versus 18.83%, P<0.0001). Multivariate logistic regression with adjustment and controlling for confounders, physical activity was still inversely associated with depressive symptoms and was the only independent protective factor (odds ratio 0.57, 95% confidence interval 0.44-0.72, P<0.0001) among the associated factors in this study. In a univariate general linear model, there was a significant difference in Center for Epidemiological Studies Depression Scale score between subjects participating in active physical activity and those who did not (F=59.07, P<0.0001). CONCLUSION: This study found an inverse relationship between physical activity and symptoms of depression in older Chinese veterans in the community. It was also indicated that the antidepressant effect of physical activity probably extended to the oldest-old, and the light-intensity physical activity was probably available for the same protective effect. This information could be used to devise further interventions to prevent or ameliorate symptoms of depression.

Optimal cutoff scores for dementia and mild cognitive impairment of the Montreal Cognitive Assessment among elderly and oldest-old Chinese population.

BACKGROUND: All versions of the Montreal Cognitive Assessment (MoCA) lack population-based data of 80-plus individuals. The norms and cut-off scores for mild cognitive impairment (MCI) and dementia of the MoCA are different among five Chinese versions. OBJECTIVE: To provide the cut-off scores in detecting MCI and dementia of the Peking Medical Union College Hospital version of the MoCA (MoCA-P). METHODS: In a cross-sectional survey, Chinese veterans aged ≥60 years completed the MoCA-P and the Mini-Mental State Examination (MMSE). RESULTS: Among 7,445 elderly veterans, 5,085 (68.30%) were aged ≥80 years old, 2,621 (35.20%) had 6 years of education or less, 6,847 (91.97%) were male, and 2,311 (31.04%) and 984 (13.22%) veterans were diagnosed as having MCI and dementia, respectively. Adding two points and one point to the MoCA scores for the primary and middle school groups, respectively, can fully adjust for the notable impact of education but cannot compensate for the effect of age. In the three age groups (60-79, 80-89, and ≥90 years old), the optimal MoCA-P cut-off scores for detecting MCI were ≤25, ≤24, and ≤23, respectively, and for detecting dementia were ≤24, ≤21, and ≤19, respectively, which demonstrated relatively high sensitivities and specificities. The areas under the curves for the MoCA-P for detecting MCI and dementia (0.937 and 0.908, respectively) were greater than those for the MMSE (0.848 and 0.892, respectively). CONCLUSION: Compared with the MMSE, the MoCA-P is significantly better for detecting MCI in the elderly, particularly in the oldest old population, and it also displays more effectiveness in detecting dementia.

Burden, anxiety and depression in caregivers of veterans with dementia in Beijing.

Dementia is the most common neurodegenerative disease in the elderly. The number of Chinese dementia patients reached 5 million in 2001 and will grow rapidly by 314-336% in 2040. Caring for patients with dementia is a stressful experience, which can cause the physical and mental problems in caregivers. According to the protocol, we evaluated the burden, depression and anxiety of caregivers by Clinical Dementia Rating (CDR) Scale, Caregiver Burden Inventory (CBI), Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS). 90 caregivers of dementia patients and 90 caregivers of nondementia patients with other chronic diseases from 24 military communities in Beijing were enrolled in this investigation. The scores of burden, depression and anxiety increased from nondementia to severe dementia groups. There were associations between patient's CDR score and CBI score, as well as the average daily care time and CBI score. In addition, the scores of SDS and SAS were both positive correlated to CBI score. Comparing to general community, the caregivers of dementia veterans had lower scores in SDS and SAS. Therefore, we should pay more attentions to the caregivers of severe dementia patients. Reduction of daily care time is a possible way to releasing the burden of caregivers. Better general supports are beneficial to reducing depression and anxiety when caregivers confront the heavy burden.

[A cross-sectional study of neurological disease in the veterans of military communities in Beijing].

OBJECTIVE: To investigate the prevalence of cognitive and motor disorders as well as emotional and sleep abnormality in the veterans from military communities in Beijing. METHODS: The participants underwent a comprehensive in-person evaluation including detailed neuropsychological testing, Hospital Anxiety and Depression Scale and special questionnaires for movement and sleep disorders. RESULTS: The overall prevalence of cognitive impairment, extrapyramidal diseases was 32.7%, 8.8%. The prevalence of mild cognitive impairment, dementia, Parkinson disease, essential tremor, anxiety and depression was 26.2%, 6.5%, 2.0%, 6.1%, 1.4% and 4.1% respectively. Prevalence of all kinds of sleep disorders ranged from 10.3% to 53.9%. The prevalence of cognitive impairment had no significant difference of sex, but were correlated to age and education, the correlation coefficient was 0.326 and -0.221 (P<0.01). CONCLUSION: Veterans from military communities had higher prevalence of cognitive impairment, extrapyramidal diseases and sleep disorders and lower that of anxiety and depression relatively.

Cognitive stimulation therapy in the treatment of neuropsychiatric symptoms in Alzheimer's disease: a randomized controlled trial.

OBJECTIVE: to determine the efficacy of cognitive stimulation therapy (CST) in the treatment of neuropsychiatric symptoms in patients with Alzheimer's disease. DESIGN: a randomized, controlled, rater-blind clinical trial. SETTING: the military sanatorium. SUBJECTS: thirty-two patients with mild to moderate Alzheimer's disease exhibiting marked neuropsychiatric symptoms were included in the study. INTERVENTION: all 32 patients were randomly assigned to a cognitive stimulation therapy group (n = 16) or a control group (n = 16) for 10 weeks. MAIN MEASURE: the efficacy measures included the Mini Mental State Examination and the Neuropsychiatric Inventory. RESULTS: patients receiving cognitive stimulation therapy showed a greater improvement in the Neuropsychiatric Inventory total score (mean change - 2.06 points versus 0.00 points, t = -4.766, P<0.001) and in the Mini Mental State Examination total score (mean change 0.81 points versus -0.19 points, t =3.106, P =0.004) compared to control at week 10. Analysis of the individual Neuropsychiatric Inventory domains revealed a statistically significant benefit for cognitive stimulation therapy-treated patients in the areas of apathy (mean change -1.06 points versus -0.31 points, P =0.017) and depression/dysphoria (mean change -0.50 points versus 0.06 points, P =0.047). There were no statistically significant benefits for cognitive stimulation therapy-treated patients in the other individual Neuropsychiatric Inventory domains or in the caregiver distress score. CONCLUSIONS: cognitive stimulation therapy has significant efficacy in lowering apathy and depression symptomatology and in the Mini Mental State Examination in patients with mild to moderate Alzheimer's disease.

[A case-control study of risk factors in mild cognitive impairment].

OBJECTIVE: To explore the risk factors of mild cognitive impairment (MCI). METHODS: A case-control study including 97 MCI patients and 143 cognitive normal controls (NC) in Chinese PLA General Hospital was conducted. The cases and controls were matched for age, gender and occupation. The relationship between MCI and various factors was analysed by univariate and multivariate analysis. RESULTS: Results data from univariate analysis showed that the history of coronary heart diseases, stroke, anaemia, and the education level had significant differences between NC and MCI patients. Multivariate analysis confirmed that the history of coronary heart diseases, stroke, anaemia and the education level were significantly related to MCI and their ORs (95% confidence interval) were 2.21 (1.18 - 4.14), 2.18 (1.20 - 3.98), 4.63 (1.79 - 11.97), 0.75 (0.58 - 0.97) respectively. CONCLUSION: The history of coronary heart diseases, stroke and anaemia were independent risk factors of MCI and high education level seemed to be a protective factor of MCI.