Elevated Serum Amyloid A Is Associated With Cognitive Impairment in Ischemic Stroke Patients

Background and PurposeThe impact of serum amyloid A on cognitive impairment after ischemic stroke is unclear. We aimed to investigate the association between serum amyloid A (SAA) levels and post-stroke cognitive impairment (PSCI) at 3 months after ischemic stroke.MethodsOne hundred and ninety-eight patients were enrolled prospectively from June 2020 to April 2021. The SAA concentrations were measured using a commercially available enzyme-linked immunosorbent assay kit after admission. Cognitive function was assessed using the Montreal Cognitive Assessment score at 3 months after the symptom onset. We defined a Montreal Cognitive Assessment score <25 as cognitive impairment.ResultsDuring 3-month follow-up, 80 patients (40.4%) were diagnosed as having PSCI. As compared with patients with cognitively normal ischemic stroke, those with PSCI were older, more likely to have diabetes and white matter lesions, and had a higher baseline National Institutes of Health stroke score and SAA levels. After adjustment for age, the National Institutes of Health stroke score and other covariates, the OR for the highest quartile of SAA compared with the lowest quartile was 5.72 (95% CI, 2.17–15.04, P = 0.001) for PSCI. Also, ordinal logistic regression analysis showed that higher SAA concentrations were associated with increased risk of PSCI severity (OR, 4.31; 95% CI, 1.81–10.33, P = 0.001). Similar results were found when the SAA levels were analyzed as a continuous variable.ConclusionsThis present study demonstrated that increased SAA levels might be associated with PSCI at 3 months after ischemic stroke.

The relationship between fatigue severity and mild cognitive impairment in Saudi patients with type 2 diabetes mellitus

Type 2 Diabetes Mellitus (T2DM) is a major health issue in Saudi Arabia, with a prevalence of 23.7% in 2015. Several factors contribute to the occurrence of Mild Cognitive Impairment (MCI) and its progression to Alzheimer's disease in patients with T2DM. This study assesses MCI and fatigue severity and their relationship in patients with T2DM. Out of the 160 Saudi adults interviewed at the King Khalid University Hospital in Riyadh from October 2019 till March 2020, 80 were known cases of T2DM while the rest were non-diabetic individuals. The Montreal Cognitive Assessment (MoCA) test, Mini Mental State Exam (MMSE) and Fatigue Severity Score (FSS) were used to evaluate MCI and fatigue severity, respectively. According to the MoCA scale, 68.7% diabetic individuals as against 42.5% from the non-diabetic group had MCI. While the FSS showed that 40% of the diabetic group vs 26.3% of the non-diabetic were fatigued. In conclusion, patients with T2DM are at a higher risk of developing MCI. Keywords: Type 2 diabetes mellitus, Mild cognitive impairment, Fatigue, Mini mental state exam, Montreal Cognitive Assessment, Saudi Arabia.

Validation of the Visual Cognitive Assessment Test (VCAT) for the Early Diagnosis of Cognitive Impairment in Multilingual Population in Malaysia

As Malaysia undergoes a demographic transformation of population aging, the prevalence of dementia is expected to rise, posing a major public health threat issue. Early screening to detect cognitive impairment is important to implement appropriate clinical interventions. The Visual Cognitive Assessment Test (VCAT) is a language-neutral cognitive assessment screening tool suitable for multilingual populations. This study was aimed to validate the VCAT screening tool for the detection of cognitive impairment amongst the population of Malaysia. A total of 184 participants were recruited, comprising 79 cognitively healthy participants (CHP), 46 mild cognitive impairment (MCI) patients, and 59 mild dementia (Alzheimer’s disease and Vascular Dementia) patients from five hospitals between May 2018 and December 2019 to determine the usefulness of VCAT. Diagnostic performance was assessed using area under the curve (AUC), and receiver operating characteristic (ROC) analysies was performed to determine the recommended cutoff scores. ROC analyses for the VCAT was comparable with that of MoCA (Montreal Cognitive Assessment) in differentiating between CHP, MCI, and mild dementia (AD and VaD) participants. The findings of this study suggest the following optimal cutoff score for VCAT: Dementia 0–19, MCI 20–23, Normal 24–30. The mean ± SD time to complete the VCAT was 10.0 ± 2.75 min in the CHP group and 15.4 ± 4.52 min in the CI group. Results showed that 76.0% of subjects thought that the instructions in VCAT were similar or easier to understand compared with MoCA. This study showed that the VCAT is a valid and useful screening tool for patients with cognitive impairment in Malaysia and is feasible to be used in the clinical settings.

Developing guidelines for the translation and cultural adaptation of the Montreal Cognitive Assessment: scoping review and qualitative synthesis

Background Ethnic minorities in countries such as the UK are at increased risk of dementia or minor cognitive impairment. Despite this, cognitive tests used to provide a timely diagnosis for these conditions demonstrate performance bias in these groups, because of cultural context. They require adaptation that accounts for language and culture beyond translation. The Montreal Cognitive Assessment (MoCA) is one such test that has been adapted for multiple cultures. Aims We followed previously used methodology for culturally adapting cognitive tests to develop guidelines for translating and culturally adapting the MoCA. Method We conducted a scoping review of publications on different versions of the MoCA. We extracted their translation and cultural adaptation procedures. We also distributed questionnaires to adaptors of the MoCA for data on the procedures they undertook to culturally adapt their respective versions. Results Our scoping review found 52 publications and highlighted seven steps for translating the MoCA. We received 17 responses from adaptors on their cultural adaptation procedures, with rationale justifying them. We combined data from the scoping review and the adaptors’ feedback to form the guidelines that state how each question of the MoCA has been previously adapted for different cultural contexts and the reasoning behind it. Conclusions This paper details our development of cultural adaptation guidelines for the MoCA that future adaptors can use to adapt the MoCA for their own languages or cultures. It also replicates methods previously used and demonstrates how these methods can be used for the cultural adaptation of other cognitive tests.

Assessing Cognitive Function in Multiple Sclerosis With Digital Tools: Observational Study

Background Cognitive impairment (CI) is one of the most prevalent symptoms of multiple sclerosis (MS). However, it is difficult to include cognitive assessment as part of MS standard care since the comprehensive neuropsychological examinations are usually time-consuming and extensive. Objective To improve access to CI assessment, we evaluated the feasibility and potential assessment sensitivity of a tablet-based cognitive battery in patients with MS. Methods In total, 53 participants with MS (24 [45%] with CI and 29 [55%] without CI) and 24 non-MS participants were assessed with a tablet-based cognitive battery (Adaptive Cognitive Evaluation [ACE]) and standard cognitive measures, including the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT). Associations between performance in ACE and the SDMT/PASAT were explored, with group comparisons to evaluate whether ACE modules can capture group-level differences. Results Correlations between performance in ACE and the SDMT (R=–0.57, P<.001), as well as PASAT (R=–0.39, P=.01), were observed. Compared to non-MS and non-CI MS groups, the CI MS group showed a slower reaction time (CI MS vs non-MS: P<.001; CI MS vs non-CI MS: P=.004) and a higher attention cost (CI MS vs non-MS: P=.02; CI MS vs non-CI MS: P<.001). Conclusions These results provide preliminary evidence that ACE, a tablet-based cognitive assessment battery, provides modules that could potentially serve as a digital cognitive assessment for people with MS. Trial Registration ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618

The Effect of Psychological Factors on Cognitive Functions in Stroke Patients With Chronic Fatigue

Background and Objectives: Cognitive and psychological impairments are among the disabling consequences of chronic stroke. Despite the high prevalence of these impairments in patients with chronic stroke and the significant impact of psychological factors on cognitive factors in other neurological diseases, no study was found to investigate the relationship between psychological factors and cognitive factors in chronic stroke patients with chronic fatigue. Therefore, this study aimed to investigate the relationship between psychological factors and cognitive functions in chronic stroke patients with chronic fatigue Methods: A total of 85 chronic stroke patients with chronic fatigue visited the Rehabilitation Centers of Tehran, Iran, were selected through the simple non-probability sampling method and enrolled in this correlational study. The Fatigue Severity Scale, Beck Depression Inventory, and Beck Anxiety Inventory were used to measure the levels of the fatigue, depression, and anxiety of patients with strokes, respectively. Besides, the cognitive functions of the participants were assessed using the Mini-Mental State Examination, the Montreal Cognitive Assessment, and the Pain Visual Analog Scale. Results: Based on the regression models, the Mini-Mental State Examination and the Montreal Cognitive Assessment explained up to 24.2% and 39.6% of the variance of cognitive functions, respectively. In all step-by-step models, the variables of anxiety, education level, and depression were the strongest predictors of cognitive functions. Conclusion: According to the clinical findings, psychological impairments, such as anxiety can adversely affect cognitive factors in chronic stroke patients with chronic fatigue. Therefore, therapeutic interventions focused on psychological factors may considerably improve the cognitive skills of these patients.