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Background: Detecting cognitive impairment in Parkinson's disease (PD) is challenging due to diverse manifestations and outdated diagnostic criteria. Cognitive screening tools, as Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), are adopted worldwide, but despite several cutoffs has been proposed for PD, no consensus has been reached, hindered by limited sample sizes, lack of validation, and inconsistent age- and education-adjustments., Objectives: Determine the optimal MMSE and MoCA cutoffs in a large PD cohort, spanning from normal cognition (PD-NC), mild cognitive impairment (PD-MCI) to dementia (PDD), and develop a decision tree model to assist physicians in cognitive workups., Methods: Our retrospective Italian multicenter study involves 1780 PD, cognitively diagnosed with a level-II assessment: PD-NC(n = 700), PD-MCI(n = 706), and PDD(n = 374). Optimal cutoffs (for raw scores) were determined through ROC analysis. Then, a machine learning approach-decision trees-was adopted to validate and analyze the possible inclusion of other relevant clinical features., Results: The decision tree model selected as primary feature a MMSE cutoff ≤24 to predict dementia, and a score ≤ 27 for PD-MCI. To enhance PD-MCIvs.PD-NC accuracy, it also recommends including a MoCA score ≤ 22 for PD-MCI, and > 22 for PD-NC. Age and education were not selected as relevant features for the cognitive workup. Both MoCA and MMSE cutoffs exhibited high sensitivity and specificity in detecting PD cognitive statues., Conclusions: For the first time, a clinical decision tree model based on robust MMSE and MoCA cutoffs has been developed, allowing to diagnose PD-MCI and/or PDD with a high accuracy and short administration time., Competing Interests: Declaration of competing interest The authors declare no competing financial interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: . The present study aimed at deriving regression-based reliable change indices (RCIs) for the Montreal Cognitive Assessment (MoCA) in an Italian cohort of non-demented Parkinson's disease (PD) patients., Methods: N = 33 consecutive, non-demented PD patients were followed-up at a 5-to-8-month interval (M = 6.6; SD = 0.6) with the MoCA. Practice effects and test-retest reliability were assessed via dependent-sample t-tests and intra-class correlation (ICC) coefficients, respectively. RCIs were derived separately for raw and demographically adjusted MoCA scores according to a standardized regression-based approach by accounting for both baseline confounders (i.e., demographics, disease duration and Unified Parkinson's Disease Rating Scale scores) and retest interval., Results: No practice effects were found (t(32) = 0.29; p = .778), with acceptable test-retest reliability being detected (ICC = 0.67). MoCA scores at T0 proved to be the only significant predictor of T1 MoCA performances within both the model addressing raw scores and that addressing adjusted scores (ps < 0.001)., Conclusions: The present study provides Italian practitioners and researchers with regression-based RCIs for the MoCA in non-demented PD patients, which can be reliably adopted for retest interval ≥ 5 and ≤ 8 months without encountering any practice effect., (© 2024. The Author(s).)

Informant report dementia severity staging measures, such as the Quick Dementia Rating System (QDRS) offer clinicians useful diagnostic and staging information. These measures also potentially avoid many of the pitfalls inherent in mental status examinations (e.g., cultural bias, educational bias, floor and ceiling effects). We derive cut points for the QDRS and comprehensively examine their classification accuracy in a large, diagnostically heterogeneous, rural, memory disorder clinic sample. Our findings suggest the QDRS may be helpful when used in the context of a comprehensive diagnostic and staging evaluation. When used in isolation, the QDRS is insufficiently accurate for diagnosis and staging of dementia.

Objectives: To evaluate the reliability and validity of the computer-aided cognitive test (CACT)., Methods: 219 Subjects of Tongji Hospital's Brain Health cohort (115 cases of Mild Cognitive Impairment (MCI) patients and 104 cases of normal controls) were enrolled, of which 24 cases received a retest after 2 weeks. Finally, the reliability and validity of the scale were tested and analyzed., Results: (1) Reliability: (a) the internal consistency reliability of the total score of the scale was 0.645; (b) the retest reliability correlation coefficient of the total score of the scale was 0.900; (c) the Guttman Split-Half coefficient was 0.631; (2) Validity: (a) construct validity analysis showed that the correlation coefficient between each section score was between 0.036 and 0.408, and the correlation coefficient between each section score and the total score was between 0.468 and 0.781; (b) criterion validity analysis showed that the correlation coefficient between the total score of CACT and that of the Mini Mental State Examination (MMSE) was 0.733, and the coefficient between the total score of CACT and that of the basic version of the Montreal Cognitive Assessment (MoCA) was 0.763; (c) the area under the ROC curve of the CACT to distinguish between MCI patients and controls was 0.920, with an optimal diagnostic threshold of 20, a sensitivity of 88.5%, and a specificity of 80.9%., Conclusion: The CACT is little influenced by education level. It has good reliability and validity, which can be used for early clinical screening of cognitive dysfunction.

Objective: The objective of this study was the measurement of the test-retest reliability of n-back in Chinese stroke patients., Methods: Seventy-five sub-acute stroke patients performed n-back twice in three days. The test-retest reliability of n-back was analyzed by correlation coefficient., Results: The n-back had excellent test-retest reliability in stroke patients. Pearson or Spearman coefficients ranged from 0.81 to 0.88. The intra-class correlation coefficients ranged from 0.72 to 0.87. The Chinese version of Montreal Cognitive Assessment-Basic (MoCA-BC) score was significantly correlated with the performance of n-back. MoCA-BC and n-back accuracy were significantly related in the Mild Cognitive Impairment (MCI) group ( r  = 0.60 in 1-back, p  = .002; r  = 0.43 in 2-back, p  = .040). However, MoCA-BC was correlated with reaction time (RT) in the Cognitively Normal (CN) group ( r = -0.44 in 1-back, p  = .003; r = -0.36 in 2-back, p  = .018). The test-retest reliability of CN group was mostly higher than that of MCI group RT: 0.71-0.76 in MCI, 0.80-0.88 in CN; accuracy: 0.80-0.85 in MCI, 0.75-0.86 in CN). The practice effect was observed in the CN group instead of the MCI group., Conclusions: This study indicated that the test-retest reliability of n-back was high in stroke patients. N-back was correlated with cognition. It was preferable to conduct subgroup analyses according to the level of cognitive assessment of patients with stroke.

A previous study that evaluated the ability of the Bender Gestalt Test (BGT) to discriminate between dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) suggested that a total score of 98 is the optimal cutoff value for discriminating between these two diseases and that DLB tends to exhibit unique errors; i.e., "element deformation" and "gestalt destruction." The objectives of the present study were: (1) to examine the sensitivity and specificity of a total BGT score of 98 as a cutoff value in greater numbers of DLB patients than in the previous study, (2) to set a new cutoff value if a cutoff value of 98 is not optimal, and (3) to clarify the frequency of element deformation and gestalt destruction in DLB patients. The participants were 133 DLB patients, 65 AD patients, and 30 cognitively normal elderly people. All of the participants underwent the Mini-Mental State Examination, BGT, and brain magnetic resonance imaging. As a result, the total BGT score cutoff value of 98 showed low sensitivity (0.58), and a cutoff value of 84 was indicated to be the optimal cutoff value for discriminating between DLB and AD. In addition, 32 out of 133 DLB patients and one out of 65 AD patients exhibited element deformation or gestalt destruction. This study suggested that the BGT is a useful neuropsychological test for differentiating DLB from AD. In addition, the need to evaluate the spatial and perceptual difficulties of DLB patients with various types of visual stimulation is also discussed.

Purpose: Dementia includes all the symptoms associated with declining mental and cognitive skills, resulting in an inability to perform daily activities., Objectives: We aimed to translate and adapt the Montréal Cognitive Assessment (MoCA) test into the Moroccan cultural context. We compared the sensitivity and specificity between MoCA and Mini-Mental State of Folstein (MMS) in the screening of dementia., Materials and Methods: The participants in this study were residents in the Fez-Meknes region and over 50 years old. We performed translation and adaptation of the English MoCA 8.1 version into all Moroccan languages: Darija, Tamazight in its three variants (Tachelhit, Tarifit, Atlas Tamazight), and Arabic. We validated Moroccan MoCA according to the Beaton et al. instructions., Results: The sensitivity, specificity, and alpha Cronbach of the MoCA test were 88.5, 93.8%, and 0.87, while they were 90.2, 90.8%, and 0.79 for the MMS test., Conclusion: The Moroccan MoCA test had high sensitivity, specificity, and internal reliability compared to the MMS test. The availability of the MoCA in the Moroccan language will be helpful in the screening of dementia and research studies in Morocco and other countries.

This article explores the diagnosis of Mild Cognitive Impairment (MCI) in general practice. It examines the subtypes of MCI and their specific diagnostic criteria for different neurodegenerative conditions such as Alzheimer's disease, Parkinson's disease, fronto-temporal dementia and cerebrovascular disorders. It highlights the preferential use of the Montreal Cognitive Assessment (MoCA) over the Mini-Mental State Examination (MMSE) for detecting MCI. A MoCA score below the norm (< 26 points) warrants a more thorough diagnostic work-up, including a full neuropsychological assessment and possibly brain imaging., Competing Interests: les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) questionnaires are commonly used to measure global cognition in clinical trials. Because these scales are discrete and bounded with ceiling and floor effects and highly skewed, their analysis as continuous outcomes presents challenges. Normality assumptions of linear regression models are usually violated, which may result in failure to detect associations with variables of interest., Methods: Alternative approaches to analyzing the results of these cognitive batteries include transformations (standardization, square root, or log transformation) of the scores in the multivariate linear regression (MLR) model, the use of nonlinear beta-binomial regression (which is not dependent on the assumption of normality), or Tobit regression, which adds a latent variable to account for bounded data. We aim to empirically compare the model performance of all proposed approaches using four large randomized controlled trials (ORIGIN, TRANSCEND, COMPASS, and NAVIGATE-ESUS), and using as metrics the Akaike information criterion (AIC). We also compared the treatment effects for the methods that have the same unit of measure (i.e., untransformed MLR, beta-binomial, and Tobit)., Results: The beta-binomial consistently demonstrated superior model performance, with the lowest AIC values among nearly all the approaches considered, followed by the MLR with square root and log transformations across all four studies. Notably, in ORIGIN, a substantial AIC reduction was observed when comparing the untransformed MLR to the beta-binomial, whereas other studies had relatively small AIC reductions. The beta-binomial model also resulted in a significant treatment effect in ORIGIN, while the untransformed MLR and Tobit regression showed no significance. The other three studies had similar and insignificant treatment effects among the three approaches., Conclusion: When analyzing discrete and bounded outcomes, such as cognitive scores, as continuous variables, a beta-binomial regression model improves model performance, avoids spurious significance, and allows for a direct interpretation of the actual cognitive measure., Trials Registration: ORIGIN (NCT00069784). Registered on October 1, 2003; TRANSCEND (NCT00153101). Registered on September 9, 2005; COMPASS (NCT01776424). Registered on January 24, 2013; NAVIGATE-ESUS (NCT02313909). Registered on December 8, 2014., (© 2024. The Author(s).)

Background and Purpose: The aim of this study was to examine the discriminative validity of the Brief Assessment of Impaired Cognition (BASIC) case-finding instrument in a general practice (GP) setting and compare it with other widely used brief cognitive instruments., Methods: Patients aged ≥70 years were prospectively recruited from 14 Danish GP clinics. Participants were classified as having either normal cognition (n = 154) or cognitive impairment (n = 101) based on neuropsychological test performance, reported instrumental activities of daily living, and concern regarding memory decline. Comparisons involved the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Rowland Universal Dementia Assessment Scale (RUDAS), the Mini-Cog, the 6-item Clock Drawing Test (CDT-6) and the BASIC Questionnaire (BASIC-Q)., Results: BASIC demonstrated good overall classification accuracy with an area under the receiver operating characteristic curve (AUC) of 0.88 (95% confidence interval [CI] 0.84-0.92), a sensitivity of 0.72 (95% CI 0.62-0.80) and a specificity of 0.86 (95% CI 0.79-0.91). Pairwise comparisons of the AUCs of BASIC, MMSE, MoCA and RUDAS produced non-significant results, but BASIC had significantly higher classification accuracy than Mini-Cog, BASIC-Q and CDT-6. Depending on the pretest probability of cognitive impairment, the positive predictive validity of BASIC varied from 0.83 to 0.36, and the negative predictive validity from 0.97 to 0.76., Conclusions: BASIC demonstrated good discriminative validity in a GP setting. The classification accuracy of BASIC is equivalent to more complex, time-consuming instruments, such as the MMSE, MoCA and RUDAS, and higher than very brief instruments, such as the CDT-6, Mini-Cog and BASIC-Q., (© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Background: Cognitive screening tools enable the detection of cognitive impairment, facilitate timely intervention, inform clinical care, and allow long-term planning. The Montreal Cognitive Assessment for people with hearing impairment (MoCA-H) was developed as a reliable cognitive screening tool for people with hearing loss. Using the same methodology across four languages, this study examined whether cultural or linguistic factors affect the performance of the MoCA-H., Methods: The current study investigated the performance of the MoCA-H across English, German, French, and Greek language groups (n = 385) controlling for demographic factors known to affect the performance of the MoCA-H., Results: In a multiple regression model accounting for age, sex, and education, cultural-linguistic group accounted for 6.89% of variance in the total MoCA-H score. Differences between languages in mean score of up to 2.6 points were observed., Conclusions: Cultural or linguistic factors have a clinically significant impact on the performance of the MoCA-H such that optimal performance cut points for identification of cognitive impairment derived in English-speaking populations are likely inappropriate for use in non-English speaking populations. To ensure reliable identification of cognitive impairment, it is essential that locally appropriate performance cut points are established for each translation of the MoCA-H., (© 2024 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Background: The Clinical Dementia Rating (CDR) scale allows to detect the presence of dementia and to assess its severity, however its evaluation requires a significant time (45 min). We evaluated the agreement between two methods of collection of the CDR: face-to-face interview or based on the information available in the patient's medical record., Methods: The CLIMER study was conducted among patients attending a memory center. The CDR scale was evaluated during face-to-face interviews between neuropsychologists and patients and their caregivers and based on blind analysis of the information of the patients' medical record by neuropsychologists. The agreement of the CDR sum of boxes (CDR-SB), the 5-point scale CDR and the different domains of the CDR evaluated between the different methods was measured using intraclass correlation (ICC) coefficient, Bland and Altman method, and linearly weighted Kappa., Results: The study included 139 patients (means ± SD age 80.1 ± 6, 58.3% women, 71.9% with dementia). The ICC for the CDR-SB score assessed by face-to-face and with all the information available in the patient's medical record was 0.95 (95% CI: 0.93-0.97). The mean difference between the CDR-SB score assessed by face-to-face and with the medical record was 0.098 ± 1.036, and 92.4% of the patients lay within the 95% limits of agreement. The ICC for the 5-point scale CDR assessed by face-to-face and with the patient's medical record was 0.92 (95% CI: 0.88-0.95) when all the available information of the patient's medical record was used. The linear weighted Kappa coefficients was 0.79 (95% CI: 0.68-0.91) for the 5-point scale CDR comparison between the two evaluation methods. The analysis by domain of the CDR showed ICC ranging from 0.65 to 0.91 depending of the domains and the methods of evaluation., Conclusion: This study showed an excellent level of agreement of the evaluation of the CDR- SB and the 5-point scale CDR when using all the information of the patient's medical record compared to the face-to-face interview., Trial Registration: https//clinicaltrials.gov/ct2/show/NCT04763941 Registration Date 02/17/2021., (© 2024. The Author(s).)

Introduction: Despite the Rowland Universal Dementia Assessment Scale (RUDAS) having significant advantages as a cognitive screening tool, particularly for minority populations, the Mini-Mental State Examination (MMSE) test is the most widely used test for cognitive screening in Alzheimer's disease (AD). This study aimed to develop a conversion table to predict MMSE scores from observed RUDAS scores, allowing an easy-to-use method to compare both screening tests., Methods: The equipercentile equating method was used to develop the conversion table using a training sample consisting of cognitively intact participants and individuals with early-stage AD. The resulting conversion table was validated in two samples, comprising participants from majority and minority populations assessed in Spanish., Results: The conversion table demonstrated excellent reliability with intraclass correlation coefficients of.92 in both validation samples., Conclusion: This study provides a conversion table between RUDAS and MMSE scores, improving the comparability of these cognitive screening tools for use in clinical and research purposes., (© 2024 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.)

Background and Objective: The Mild Behavioral Impairment-Checklist (MBI-C) was developed to detect and standardize neuropsychiatric symptoms. The objective of this study was to evaluate the Turkish adaptation, validity, and reliability of the MBI-C., Methods: The sample of our study consisted of 80 patients with cognitive impairment and a control group with 113 participants whose cognitive impairment was not detected in standard tests. Participants were evaluated with the Standardized Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale-15 (GDS-15), MBI-C and Neuropsychiatric Inventory (NPI)., Results and Conclusion: In the reliability analysis, the Cronbach-alpha value for MBI-C was found to be .810. In the ROC analysis performed with the total MBI-C score, the area under the curve (AUC) was calculated as .821 and the cut-off score was determined as 8.5; sensitivity was calculated as .77 and specificity as .83. A strong positive correlation was found between test-retest MBI-C scores (r = .886, P < .0019). A strong positive correlation was found between MBI-C and NPI scores (r = .964, P < .001). MBI-C scores were significantly negatively correlated with MMSE and MoCA scores and positively correlated with GDS-15 scores. The results of our study showed that the Turkish version of the MBI-C is a valid and reliable measurement., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Despite its wide use in dementia diagnosis on the basis of cut-off points, the inter-rater variability of the Addenbrooke's Cognitive Examination-Third Edition (ACE-III) has been poorly studied., Methods: Thirty-one healthcare professionals from an older adults' mental health team scored two ACE-III protocols based on mock patients in a computerised form. Scoring accuracy, as well as total and domain-specific scoring variability, were calculated; factors relevant to participants were obtained, including their level of experience and self-rated confidence administering the ACE-III., Results: There was considerable inter-rater variability (up to 18 points for one of the cases), and one case's mean score was significantly higher (by nearly four points) than the true score. The Fluency, Visuospatial and Attention domains had greater levels of variability than Language and Memory. Higher scoring accuracy was not associated with either greater levels of experience or higher self-confidence in administering the ACE-III., Conclusions: The results suggest that the ACE-III is susceptible to scoring error and considerable inter-rater variability, which highlights the critical importance of initial, and continued, administration and scoring training.

Introduction: Consensus definitions of meaningful within-patient change (MWPC) on the Clinical Dementia Rating-Sum of Boxes (CDR-SB) are needed. Existing estimates use clinician-rated anchors in clinically diagnosed Alzheimer's disease (AD) populations. Incorporating the care partner perspective offers important insights, and evaluating biomarker-confirmed cohorts aligns estimates with ongoing trials., Methods: Anchor-based analyses were conducted to evaluate MWPC on the CDR-SB in early AD (Tauriel; NCT03289143) using Caregiver Global Impression of Change in memory or daily activities., Results: Across time points and anchors, mean CDR-SB changes associated with the "somewhat worse" category ranged from 1.50 to 2.12 in early AD, 1.07 to 2.06 in mild cognitive impairment-AD, and 1.79 to 2.25 in mild AD., Discussion: The proposed ranges are appropriate to define meaningful progression on the CDR-SB in similar cohorts and support the interpretation of treatment benefit through MWPC analyses. Thresholds should be calibrated to the context of use; lower/higher thresholds may be applicable in studies of earlier/later disease over shorter/longer durations., Highlights: Within-patient CDR-SB change thresholds are provided using caregiver-rated anchors. 1.5 to 2.5 points may be an appropriate range in early AD trials of similar durations. Cumulative distribution function plots illustrate the benefit of a given treatment. When selecting thresholds, the target population and study design should be considered., (© 2024 The Author(s). Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Early detection of cognitive impairment is of paramount importance in clinical settings, with several brief screening tools having been developed for that purpose. The present study sought to evaluate the clinical utility of the Saint Louis University Mental Status examination (SLUMS) at identifying examinees with normal cognition, mild cognitive impairment, or dementia syndrome using the criterion of a comprehensive neuropsychological assessment. Two hundred sixty-three examinees ( M age = 67.84 ± 12.72; 59.3% female; 81.4% white) were referred for comprehensive neuropsychological evaluation at a private, Mid-Atlantic medical center. Using original cutoff scores, the SLUMS correctly classified just over half (55.1%) of examinees. Classification statistics suggested modified cutoff scores for mild cognitive impairment (≤24) and dementia (≤17) with strong discriminability between cognitive status groups (AUCs ranged from .834 to .986). These proposed revised cutoff scores improved overall concordance between SLUMS and diagnostic conclusions from comprehensive clinical neuropsychological testing, correctly classifying nearly two-thirds of examinees (65.4%). The SLUMS and its revised cutoff scores appear to have clinical utility for cognitive screening in primary care and neurological settings to inform treatment plans and appropriate referrals for comprehensive neuropsychological assessment.

Performance validity tests are susceptible to false positives from genuine cognitive impairment (e.g., dementia); this has not been explored with the short form of the California Verbal Learning Test II (CVLT-II-SF). In a memory clinic sample, we examined whether CVLT-II-SF Forced Choice Recognition (FCR) scores differed across diagnostic groups, and how the severity of impairment [Clinical Dementia Rating Sum of Boxes (CDR-SOB) or Mini-Mental State Examination (MMSE)] modulated test performance. Three diagnostic groups were identified: subjective cognitive impairment (SCI; n  = 85), amnestic mild cognitive impairment (a-MCI; n  = 17), and dementia due to Alzheimer's Disease (AD; n  = 50). Significant group differences in FCR were observed using one-way ANOVA; post-hoc analysis indicated the AD group performed significantly worse than the other groups. Using multiple regression, FCR performance was modeled as a function of the diagnostic group, severity (MMSE or CDR-SOB), and their interaction. Results yielded significant main effects for MMSE and diagnostic group, with a significant interaction. CDR-SOB analyses were non-significant. Increases in impairment disproportionately impacted FCR performance for persons with AD, adding caution to research-based cutoffs for performance validity in dementia. Caution is warranted when assessing performance validity in dementia populations. Future research should examine whether CVLT-II-SF-FCR is appropriately specific for best-practice testing batteries for dementia.

Objective: To compare the test-retest reliabilities and minimal detectable change (MDC) of the Short Portable Mental State Questionnaire (SPMSQ) and the Montreal Cognitive Assessment (MoCA) in patients with stroke., Methods: 63 patients were recruited from 1 medical center. The SPMSQ and MoCA were administered twice, 2 weeks apart., Results: Both measures showed high intraclass correlation coefficients (SPMSQ: 0.87; MoCA: 0.89) and acceptable MDC%s (SPMSQ: 14.8%; MoCA: 19.6%). A small correlation ( r = 0.30) was found between the absolute difference and average in each pair of assessments in the SPMSQ, which was close to the criterion of heteroscedasticity. A small practice effect was observed in the MoCA (Cohen's d = 0.30)., Conclusion: The SPMSQ demonstrated smaller random measurement error and an absence of practice effect. When comparing the psychometric properties of the SPMSQ and MoCA as outcome measures for assessing cognitive function in patients with stroke, the SPMSQ appears to be a more suitable choice than the MoCA., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Cognitive screening tools are widely used in clinical practice to screen for age-related cognitive impairment and dementia. These tools' test scores are known to be influenced by age and education, leading to routine correction of raw scores for these factors. Despite these corrections being common practice, there is evidence suggesting that corrected scores may perform worse in terms of discrimination than raw scores., Objective: To address the ongoing debate in the field of dementia research, we assessed the impact of the corrections on discrimination, specificity, and sensitivity of the Montreal Cognitive Assessment test in Italy, both for the overall population and across age and education strata., Methodology: We created a realistic model of the resident population in Italy in terms of age, education, cognitive impairment and test scores, and performed a simulation study., Results: We confirmed that the discrimination performance was higher for raw scores than for corrected scores in discriminating patients with cognitive impairment from individuals without (areas under the curve of 0.947 and 0.923 respectively). With thresholds determined on the overall population, raw scores showed higher sensitivities for higher-risk age-education groups and higher specificities for lower-risk groups. Conversely, corrected scores showed uniform sensitivity and specificity across demographic strata, and thus better performance for certain age-education groups., Conclusion: Raw and corrected scores show different performances due to the underlying causal relationships between the variables. Each approach has advantages and disadvantages, the optimal choice between raw and corrected scores depends on the aims and preferences of practitioners and policymakers., Competing Interests: Declarations Competing interests Hans-Aloys Wischmann worked for Philips in various healthcare research and innovation management roles, up to April 2021. Outside of the submitted work, Giancarlo Logroscino reports having received speaking honoraria from Lilly, GE Healthcare, Lundbeck and being an associate editor of Neuroepidemiology/Karger. Outside of the submitted work, Tobias Kurth reports receiving research grants from the Gemeinsamer Bundesausschuss (G-BA Federal Joint Committee, Germany) and the Bundesministerium für Gesundheit (BMG—Federal Ministry of Health, Germany). He further reports having received personal compensation from Eli Lilly and Company, Novartis, the BMJ, and Frontiers. Marco Piccininni reports having received partial funding from Novartis Pharma and being awarded a research grant from the Center for Stroke Research Berlin (private donations), both outside of the submitted work. Ethical approval and Informed consent Ethical approval was not required for this research as all analyzed data were simulated based on publicly available statistics, and no human participants were involved., (© 2024. The Author(s).)

Objective: The Montreal Cognitive Assessment (MoCA) is among the most frequently administered cognitive screening tests, yet demographically diverse normative data are needed for repeated administrations., Method: Data were obtained from 18,410 participants using the National Alzheimer's Coordinating Center Uniform Data Set. We developed regression-based norms using Tobit regression to account for ceiling effects, explored test-retest reliability of total scores and by domain stratified by age and diagnosis with Cronbach's alpha, and reported the cumulative change frequencies for individuals with serial MoCA administrations to gage expected change., Results: Strong ceiling effects and negative skew were observed at the total score, domain, and item levels for the cognitively normal group, and performances became more normally distributed as the degree of cognitive impairment increased. In regression models, years of education was associated with higher MoCA scores, whereas older age, male sex, Black and American Indian or Alaska Native race, and Hispanic ethnicity were associated with lower predicted scores. Temporal stability was adequate and good at the total score level for the cognitively normal and cognitive disorders groups, respectively, but fell short of reliability standards at the domain level., Conclusions: MoCA total scores are adequately reproducible among those with cognitive diagnoses, but domain scores are unstable. Robust regression-based norms should be used to adjust for demographic performance differences, and the limited reliability, along with the ceiling effects and negative skew, should be considered when interpreting MoCA scores., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Verbal fluency (VF) tasks are known as suitable for detecting cognitive impairment (CI) in Parkinson's disease (PD). This study thus aimed to evaluate the psychometrics and diagnostics of the Alternate Verbal Fluency Battery (AVFB) by Costa et al. (2014) in an Italian cohort of non-demented PD patients, as well as to derive disease-specific cut-offs for it., Methods: N = 192 non-demented PD patients were screened with the Montreal Cognitive Assessment (MoCA) and underwent the AVFB-which includes phonemic, semantic and alternate VF tests (PVF; SVF; AVF), as well as a Composite Shifting Index (CSI) reflecting the "cost" of shifting from a single- to a double-cued VF task. Construct validity and diagnostics were assessed for each AVFB measure against the MoCA. Internal reliability and factorial validity were also tested., Results: The MoCA proved to be strongly associated with PVF, SVF and AVF scores, whilst moderately with the CSI. The AVFB was internally consistent and underpinned by a single component; however, an improvement in both internal reliability and fit to its factorial structure was observed when dropping the CSI. Demographically adjusted scores on PVF, SVF and AVF tests were diagnostically sound in detecting MoCA-defined cognitive impairment, whilst this was not true for the CSI. Disease-specific cut-offs for PVF, SVF and AVF tests were derived., Discussion: In conclusion, PVF, SVF and AVF tests are reliable, valid and diagnostically sound instruments to detect cognitive impairment in non-demented PD patients and are therefore recommended for use in clinical practice and research., (© 2024. The Author(s).)

Objective: Cognitive assessment is based on performance in different tests. However, this performance might be hindered by lack of effective effort on the one hand, and by too much stress on the other hand. Despite their known impact, there are currently no effective tools for measuring cognitive effort or stress effect during cognitive assessment. We developed real-time electrophysiological markers for cognitive effort and for stress effect, which could be used during cognitive assessment., Methods: We assessed these markers during the use of the Montreal Cognitive Assessment (MoCA) before and after cardiac surgery, which is known to involve cognitive decline in up to 30%-50% of elderly patients., Results: The major findings of the study, for the largest group of patients, with preoperative MoCA in the intermediate range, were that the decline is significantly associated (1) with higher preoperative cognitive effort and (2) with higher postoperative stress effect during the test., Conclusions: These findings, as well as preliminary additional ones, suggest a potential importance for monitoring cognitive effort and stress effect during assessment in general, and specifically during perioperative assessment., Significance: Easy-to-use markers could improve the efficacy of cognitive assessment and direct treatment generally, and specifically for perioperative decline., (© 2024 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.)

Objective: This study evaluated the diagnostic performance of a widely available cognitive screener, the Montreal cognitive assessment (MoCA), to detect cognitive impairment in older patients (age ≥ 55) with epilepsy residing in the US, using the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) as the gold standard., Methods: Fifty older adults with focal epilepsy completed the MoCA and neuropsychological measures of memory, language, executive function, and processing speed/attention. The IC-CoDE taxonomy divided participants into IC-CoDE Impaired and Intact groups. Sensitivity and specificity across several MoCA cutoffs were examined. Spearman correlations examined relationships between the MoCA total score and clinical and demographic variables and MoCA domain scores and individual neuropsychological tests., Results: IC-CoDE impaired patients demonstrated significantly lower scores on the MoCA total, visuospatial/executive, naming, language, delayed recall, and orientation domain scores (Cohen's d range: 0.336-2.77). The recommended MoCA cutoff score < 26 had an overall accuracy of 72%, 88.2% sensitivity, and 63.6% specificity. A MoCA cutoff score < 24 yielded optimal sensitivity (70.6%) and specificity (78.8%), with overall accuracy of 76%. Higher MoCA total scores were associated with greater years of education (p = 0.016) and fewer antiseizure medications (p = 0.049). The MoCA memory domain was associated with several standardized measures of memory, MoCA language domain with category fluency, and MoCA abstraction domain with letter fluency., Significance: This study provides initial validation of the MoCA as a useful screening tool for older adults with epilepsy that can be used to identify patients who may benefit from comprehensive neuropsychological testing. Further, we demonstrate that a lower cutoff (i.e., <24) better captures cognitive impairment in older adults with epilepsy than the generally recommended cutoff and provides evidence for construct overlap between MoCA domains and standard neuropsychological tests. Critically, similar efforts in other regions of the world are needed., Plain Language Summary: The Montreal cognitive assessment (MoCA) can be a helpful tool to screen for cognitive impairment in older adults with epilepsy. We recommend that adults 55 or older with epilepsy who score less than 24 on the MoCA are referred to a neuropsychologist for a comprehensive evaluation to assess any changes in cognitive abilities and mood., (© 2024 The Author(s). Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)

Objective: Cognitive impairment is now recognized as an impending public health crisis. About one-third of adults are concerned about their cognition, and the prevalence of objective cognitive impairment is much higher among those with neurological disorders. Existing screening tools are narrowly focused on detecting dementia in older adults and must be clinician-administered and scored, making them impractical for many neurology practices. This study examined the utility of a brief, self-administered, computerized cognitive screening tool, the Brief Assessment of Cognitive Health (BACH), in identifying cognitive impairment in adults., Methods: 912 adults (ages 18-84) completed BACH and a neuropsychological battery. Multivariable models were developed to provide a BACH index score reflecting the probability of cognitive impairment for individual patients. Predictive accuracy was compared to that of the Montreal Cognitive Assessment (MoCA) in a subset of 160 older adults from a Memory Disorders clinic., Results: The final multivariable model showed good accuracy in identifying cognitively impaired individuals (c = 0·77). Compared to MoCA, BACH had superior predictive accuracy in identifying older patients with cognitive impairment (c = 0·79 vs. 0·67) as well as differentiating those with MCI or dementia from those without cognitive impairment (c = 0·86 vs. c = 0·67)., Conclusions: Results suggest that cognitive impairment can be identified in adults using a brief, self-administered, automated cognitive screening tool, and BACH provides several advantages over existing screeners: self-administered; automatic scoring; immediate results in health record; easily interpretable score; utility in wide range of patients; and flags for treatable factors that may contribute to cognitive complaints (i.e., depression, sleep problems, and stress)., (© 2024. The Author(s).)

Background: The need for cognitive testing is increasing with the aging population and the advent of new Alzheimer disease therapies. To respond to the increased demand, the XpressO was developed as a self-administered digital cognitive prescreening tool that will help distinguish between populations of subjective and objective cognitive impairment according to the Montreal Cognitive Assessment (MoCA)., Methods: This is a prospective validation study. XpressO is composed of tasks that assess memory and executive functions. It is validated compared to the digital MoCA as a gold standard. Out of 118 participants screened from the MoCA Clinic and a family practice clinic, 88 met inclusion criteria, two participants had missing data due to incomplete tasks, 86 participants were included in the analysis; the mean age was 70.34 years. A logistic regression model was built, and its accuracy was evaluated by the sensitivity, specificity, and Area Under the Curve (AUC) of the Receiver Operating Characteristic., Results: Analysis showed strong correlation between (1) XpressO memory tasks scores and the MoCA Memory Index Score (p-values < 0.001), and between (2) XpressO sub-test scores and MoCA total score (p-values < 0.005). The AUC for predicting MoCA performance is 0.845. To classify individuals with normal and abnormal MoCA scores, two threshold values were introduced for the total XpressO scores: sensitivity of 91% at a cutoff of 72, specificity of 90% at a cutoff of 42, and an undetermined range in between., Conclusion: XpressO demonstrated high AUC, high sensitivity and specificity to predict cognitive performance compared to the digital MoCA. It may provide efficient cognitive prescreening by identifying individuals who would benefit from further clinical assessments, potentially reducing waiting times and high burden on healthcare clinics., (© 2024 MoCA Test Inc. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Background: Montreal cognitive assessment (MoCA) is a tool that is widely accepted across the world to measure mild cognitive impairment (MCI). The original cut-off score of MoCA falsely screens a large population of Indians as having MCI., Objective: The aim of this study was to develop the normative data for MoCA for the older population of Kerala, South India., Material and Methods: We conducted the study among 959 cognitively normal older individuals of Kalliyoor village of Thiruvananthapuram district, Kerala. The validated Malayalam version of MoCA [MoCA-M] was administered by trained volunteers. The mean, median, and 10th percentile of the scores [domain-specific and total] were calculated in various age and educational groups., Results: The mean (SD) MoCA score was 19.4 (7.3). The 10th percentile for the total MoCA score was 9. The 10th percentile for all domains was zero, except for orientation. As age advanced, MoCA scores significantly reduced. The mean total MoCA scores dropped from 20.1 (7) [for ages between 65 and 75 years] to 7.4 (1.6) [for ages above 85 years]. We also obtained a significant improvement in scores among subjects with higher educational standards., Conclusion: The study throws light into the performance of MoCA among the Indian population. This study defines the norms for the Indian population and suggests redefining the threshold for positively screening for MCI using MoCA-M., (Copyright © 2024 Copyright: © 2024 Neurology India, Neurological Society of India.)

Objective The objective was to explore the validity and reliability of the Picture-Based Memory Impairment Screen (PMIS) assessment tool in stroke patients and to provide an objective basis for its application in China. Methods: A total of 30 stroke patients in the Department of Rehabilitation Medicine were assessed using the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the PMIS. The results were evaluated by content validity, simultaneous validity, consistency test of instruments of assessment, inter-scorer reliability, and retest reliability. Results: The correlation coefficient between each item score and total score of PMIS was between 0.422 and 0.778 ( p  < 0.05), showing good content validity. The total score of PMIS was moderately positively correlated with the MMSE short-term memory score ( p  < 0.001), highly positively correlated with the MMSE long-term memory score and retrospective memory score ( p  < 0.001), and highly positively correlated with the MoCA long-term memory score, memory index and total score ( p < 0.001), indicating good criterion validity. The consistency test of the two instruments of assessment showed that a PMIS ≤ 5 was used as the demarcation score for dementia, and it was tested for consistency with the MMSE dementia score of stroke patients, and the Kappa value was 0.81 ( p  < 0.001). The inter-scorer reliability and retest reliability were good (inter-scorer reliability intra-group correlation coefficient (ICC) >0.95; retest reliability ICC 0.904). Conclusion: The PMIS was a reliable and valid assessment tool, which can be used as memory impairment screening tool for stroke patients in China.

Introduction: The Mini-Mental State Examination (MMSE) is widely used for dementia screening. The purpose of this study was twofold. First, to cross-culturally adapt the Moroccan Arabic version of MMSE (MA-MMSE) to screen dementia among literate and illiterate elderly Moroccans, and second to analyze its psychometric properties., Methods: The MA-MMSE was administered to 80 elderly patients, 28 were females and 52 were males. Among all the participants, 22 showed evidence of dementia. Receiver Operator Characteristic (ROC), internal consistency, and test-retest reliability were investigated. The test-retest reliability was assessed by Spearman correlation analysis. Cronbach's α coefficients for internal consistency between total scores and subscores of the test were calculated., Results: Areas under the ROC curve in literate and illiterate elderly Moroccans participants corresponded to 0.932 and 0.936, respectively. The cutoff point of 21/22 on the MA-MMSE in literate elderly had the highest sensitivity (85.7%), specificity (94.7%), and a positive likelihood ratio of (16.29%), whereas the cutoff point of 18/19 of the screening test in illiterate elderly yielded the highest sensitivity (92.9%), specificity (95.0%), and a positive likelihood ratio of (18.57%). The Cronbach's α values of the MA-MMSE for literate and illiterate elderly Moroccans were higher than 0.7. Thirty subjects were randomly selected for participation in the test-retest protocol. Participants were retested after an interval of 4-6 weeks. The test-retest reliability for total scores was significant 0.78 ( p  < 0.01)., Conclusion: The findings provide preliminary evidence that the MA-MMSE is a feasible instrument for dementia screening.

The Mini-Mental State Examination (MMSE) is a long-established test to screen for dementia, estimate the severity and monitor the progression of cognitive impairment. The MMSE total score is dependent upon demographic factors, particularly education, but little is known about how education influences the 6 distinct MMSE cognitive domains. The present study aims to understand how the performances in the MMSE cognitive domains reflect clinical diagnosis and educational level. The study recruited 1043 participants, comprising 388 healthy controls, 360 patients with Mild Cognitive Impairment (MCI) and 295 patients with dementia. The association of the MMSE cognitive domains scores with clinical diagnosis (healthy, MCI, dementia) and educational level (primary education, middle school, high school and university/college) was analyzed with a multivariate ordinal regression model. The scores in all MMSE domains were generally higher in healthy controls as compared to patients with MCI, and higher in these as compared to patients with dementia. The MMSE domain Constructional ability was associated to the education level, the domains Orientation , Recall and Language were associated to diagnosis, Attention and calculation was associated to both education level and diagnosis, and Registration was not associated to either education or diagnosis. In conclusion, impairment in specific MMSE domains pinpoints cognitive decline, probably indicating brain areas affected by neurodegeneration, and impairment in others reflects lower education levels and the lack of acquisition of relevant schooling abilities.

Objective: Modified Mini-Mental State Examination (3MSE) is often used to screen for dementia, but little is known about psychometric validity in American Indians., Methods: We recruited 818 American Indians aged 65-95 for 3MSE examinations in 2010-2013; 403 returned for a repeat examination in 2017-2019. Analyses included standard psychometrics inferences for interpretation, generalizability, and extrapolation: factor analysis; internal consistency-reliability; test-retest score stability; multiple indicator multiple cause structural equation models., Results: This cohort was mean age 73, majority female, mean 12 years education, and majority bilingual. The 4-factor and 2nd-order models fit best, with subfactors for orientation and visuo-construction (OVC), language and executive functioning (LEF), psychomotor and working memory (PMWM), verbal and episodic memory (VEM). Factor structure was supported for both research and clinical interpretation, and factor loadings were moderate to high. Scores were generally consistent over mean 7 years. Younger participants performed better in overall scores, but not in individual factors. Males performed better on OVC and LEF, females better on PMWM. Those with more education performed better on LEF and worse on OVC; the converse was true for bilinguals. All differences were significant, but small., Conclusion: These findings support use of 3MSE for individual interpretation in clinic and research among American Indians, with moderate consistency, stability, reliability over time. Observed extrapolations across age, sex, education, and bilingual groups suggest some important contextual differences may exist.

Objective: To develop a combined index using cognitive function and instrumental activities of daily living (IADL) to discriminate between Clinical Dementia Rating (CDR) scores of 0.5 and 1 in the clinical setting, and to investigate its optimal cutoff values and internal and external validities., Methods: We included outpatients aged 65-89 years with CDR scores of 0.5 or 1. The optimal cutoff values and internal validity were verified using Japanese memory clinic-based datasets between September 2010 and October 2021 [National Center for Geriatrics and Gerontology (NCGG) datasets]. Cognitive function and IADL were assessed using the Mini-Mental State Examination (MMSE) and Lawton Index (LI), respectively. The optimal cutoff values were defined using the Youden Index. To verify internal validity, sensitivity and specificity were calculated using stratified 5-fold cross-validation. To verify external validity, sensitivity and specificity of the optimal cutoff values were assessed in the Organized Registration for the Assessment of dementia on Nationwide General consortium toward Effective treatment (ORANGE) Registry dataset between July 2015 and March 2022, which has multicenter clinical data., Results: A total of 800 (mean age, 77.53 years; men, 50.1%) and 1494 (mean age, 77.97 years; men, 43.3%) participants comprised the NCGG and ORANGE Registry datasets, respectively. The optimum cutoff values for men and women were determined as MMSE < 25 and LI < 5 and MMSE < 25 and LI < 8, respectively; such a combined index showed good discriminative performance in internal (sensitivity/specificity: men, 92.50/73.52; women, 88.57/65.65) and external validities (men, 81.43/77.62; women, 77.64/74.67)., Conclusion: The index developed is useful in discriminating between CDR scores of 0.5 and 1 and should be applicable to various settings, such as memory clinics and clinical research., (© Copyright 2024 Physicians Postgraduate Press, Inc.)

Background: This systematic review aims to comprehensively assess the diagnostic accuracy of cognitive screening tools validated for older adults in Iran, providing evidence-based recommendations for clinicians and researchers., Methods: A comprehensive search in March 2023 across Web of Science, PubMed, Scopus, ScienceDirect, SID, IranMedex, and IranDoc, enhanced by hand-searching references and Google Scholar, identified cross-sectional studies on cognitive screening in Iranian seniors. We assessed diagnostic accuracy, cognitive domains, and test strengths and weaknesses. A bivariate random-effects meta-analysis provided summary estimates and 95% confidence intervals, illustrated in forest plots., Results: Our review, derived from an initial screening of 38 articles, focused on 17 studies involving 14 cognitive screening tools and participant counts from 60 to 350, mostly from specialized clinics. The MMSE was the only tool examined in at least three studies, prompting a meta-analysis revealing its sensitivity at 0.89 and specificity at 0.77 for dementia detection, albeit amidst significant heterogeneity (I^2 > 80%). ACE-III demonstrated the highest diagnostic accuracy for MCI and dementia, while MoCA's performance was deemed adequate for MCI and excellent for dementia. High bias risk in studies limits interpretation., Conclusion: This review identifies key cognitive tools for dementia and MCI in Iranian older adults, tailored to educational levels for use in primary and specialized care. It emphasizes the need for further validation to enhance diagnostic precision across diverse settings, within a concise framework prioritizing brevity and accuracy for clinical applicability., (© 2024. The Author(s).)

Objective Due to the increasing elderly population and number of dementia patients, the current number of psychiatrists and neurologists remains insufficient to treat dementia in Japan. Therefore, a simple method for accurately performing a dementia diagnosis, including that of primary care physicians, is sought in clinical practice. Methods A retrospective study was conducted on patients who made their first visit due to amnesia between October 2020 and October 2022. The sensitivities and specificities of four spatial recognition and planning ability evaluation methods [fox finger imitation test, pentagon-copying test (PCT), cube-copying test (CCT), and clock-drawing test (CDT)] were calculated. The difference between the Mini-mental State Examination (MMSE) scores, as an evaluation of memory and language impairment, and CDT scores were assessed using the Mann-Whitney U test. Patients Fifty-one patients with dementia and 6 patients without dementia were examined in this study. Results The sensitivity and specificity were 31.4% and 100% for the fox finger imitation tests, 29.4% and 100% for PCT, 62% and 83.3% for CCT, and 72.5% and 100% for CDT, respectively. The sensitivity increased to 78.4% when the CCT and CDT results were combined. Spearman's rank correlation coefficient between the MMSE and CDT scores of the 51 patients with dementia showed a significantly positive correlation (r=0.62, p<0.001). Comparing Alzheimer's disease (AD) and dementia with Lewy bodies (DLB), the difference between the MMSE and CDT scores was significantly greater in patients with DLB. Conclusion To quickly screen for dementia, a combination of CCT and CDT is recommended for the highest sensitivity (78.4%). In addition, the difference between the CDT and MMSE scores is considered to be useful for differentiating DLB from AD.

Objective: The purpose of this study is to provide evidence that supports the validity and reliability of the Colombian version of the Addenbrooke's Cognitive Examination Revised (ACE-R) in comparison to the MMSE at assessing and finding patients with Mild Cognitive Impairment (MCI). Additionally, the study aims to determine the optimal cut-off scores based on the age of a population with a low education level., Method: This study included 314 individuals (235 participants diagnosed with MCI and 79 cognitively healthy) who live in two different rural departments (states) in Colombia. The participants were recruited for this study through community clubs for the older adults. Most of the individuals were female (236), the average age was 65.95 years of age (SD= 7.8), and the average education level was of 3.78 years (SD = 1.79). It is important to note that the sample only included people with a maximum of 6 years of schooling., Results: A ROC analysis indicated that the ACE-R is more effective than the MMSE at evaluating and finding MCI individuals within the three groups. The cut-off points for the Under 60 years of age group was 83.50 (sensitivity 0.880% and specificity 0.632%); 61-69 years of age 80.50 (sensitivity 0.714% and specificity 0.677%); and Over 70 years of age was 79.50 (sensitivity 0.750% and specificity 0.659%). The internal consistency analysis with MacDonald's Ω determined reliability indicators ≥70 in the ACE-R, except for the age range of 61 to 69 years., Conclusion: The Colombian version of the ACE-R demonstrates to be a valid and reliable global cognitive screening tool. It is effective at discerning MCI individuals from healthy within a group of participants with a low education level.

Objective: Although neurocognitive disorders (NCD) are common post-stroke, many populations do not have adapted cognitive screens and cut-offs. We therefore reviewed the appropriateness of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Oxford Cognitive Screen (OCS) for diagnosing NCD in culturally diverse stroke populations. Method: Using an extensive search string, diagnostic accuracy studies for MMSE, MoCA and OCS in the stroke population were retrieved from four databases. We compared translations and adaptations, adjustments in scores and cut-offs, and their diagnostic accuracy. Results: The search resulted in 28 MMSE, 39 MoCA and 5 OCS-studies in 13 western, educated, industrialized, rich and democratic (WEIRD) and 4 other countries. There was a lack of studies on South-American, African, and non-Chinese-Asian populations. All three tests needed adaptation for less WEIRD populations and populations with languages with non-Latin features. Optimal MMSE and OCS subtest cut-offs were similar across WEIRD and less WEIRD populations, whereas optimal MoCA cut-offs appeared lower for less WEIRD populations. The use of adjusted scores resulted in different optimal cut-offs or similar cut-offs with better accuracy. Conclusions: MoCA, MMSE and OCS are promising tools for diagnosing post-stroke-NCD. For culturally diverse populations, translation, adaptation and adjusted scores or cut-offs are necessary for diagnostic accuracy. Available studies report scarcely about their sample's cultural background and there is a lack of diagnostic accuracy studies in less WEIRD or culturally diverse populations. Future studies should report more cultural characteristics of their sample to provide better insight into the tests' accuracy in culturally diverse populations.

Background: In the era of disease-modifying therapies, empowering the clinical neuropsychologist's toolkit for timely identification of mild cognitive impairment (MCI) is crucial., Objective: Here we examine the clinimetric properties of the Montreal Cognitive Assessment (MoCA) for the early diagnosis of MCI due to Alzheimer's disease (MCI-AD)., Methods: Data from 48 patients with MCI-AD and 47 healthy controls were retrospectively analyzed. Raw MoCA scores were corrected according to the conventional Nasreddine's 1-point correction and demographic adjustments derived from three normative studies. Optimal cutoffs were determined while previously established cutoffs were diagnostically reevaluated., Results: The original Nasreddine's cutoff of 26 and normative cutoffs (non-parametric outer tolerance limit on the 5th percentile of demographically-adjusted score distributions) were overly imbalanced in terms of Sensitivity (Se) and Specificity (Sp). The optimal cutoff for Nasreddine's adjustment showed adequate clinimetric properties (≤23.50, Se = 0.75, Sp = 0.70). However, the optimal cutoff for Santangelo's adjustment (≤22.85, Se = 0.65, Sp = 0.87) proved to be the most effective for both screening and diagnostic purposes according to Larner's metrics. The results of post-probability analyses revealed that an individual testing positive using Santangelo's adjustment combined with a cutoff of 22.85 would have 84% post-test probability of receiving a diagnosis of MCI-AD (LR+ = 5.06)., Conclusions: We found a common (mal)practice of bypassing the applicability of normative cutoffs in diagnosis-oriented clinical practice. In this study, we identified optimal cutoffs for MoCA to be allocated in secondary care settings for supporting MCI-AD diagnosis. Methodological and psychometric issues are discussed.

Background: The Mini-Mental State Examination (MMSE) is one of the most widely used tests to assess the global cognitive deterioration of older adults. There are many versions of this Test in Spanish. A validation study was previously conducted in Chile, but to date, no standards computed from a large population sample are available., Aim: to develop normative scores according to age and educational level for older people living in Chile., Method: Data were collected from a sample of 1199 subjects between 50 and 91 years of age from various research centers., Results: We present the normative scores in percentiles calculated according to age (50-64, 65-74, 75-91 years of age) and educational level (1-12 years and more than 13 years of formal schooling)., Conclusion: This article provides normative scores for the MMSE that should be useful in clinical practice as they may help better interpret the performances of Chilean older adults who seek consultation for cognitive impairment.

Purpose: Fellows and residents provide inpatient consultations. Though consults vary considerably, measuring the associated cognitive load (CL) is key to guiding faculty on how to optimize learning during consults. However, existing CL instruments, such as the unidimensional Paas scale, cannot separate the 3 components of CL and may miss the nuances of consult CL. Therefore, the authors developed the Consult Cognitive Load (CCL) instrument to measure the 3 CL components during consults., Method: In 2018-2019, the authors developed the CCL at the University of California, San Francisco, using Wilson's constructive approach to measurement. To generate content and response process validity evidence, the authors consulted the literature and experts to generate construct maps, items, and a scoring rubric and conducted cognitive interviews. They administered the CCL to internal medicine and psychiatry trainees across 5 University of California campuses and used Rasch family and linear regression models to assess internal structure validity and relationships to key predictor variables. They compared the CCL with the Paas scale using Wright maps and used latent correlations to support separating CL into 3 components., Results: Analysis revealed appropriate fit statistics, appropriate mean respondent location increases across all levels, threshold banding, and expected relationships with key predictor variables. The CCL provided more coverage of the 3 CL components compared with the Paas scale. Correlations among the 3 CL components were not strong, suggesting that the CCL offers more nuance than a unidimensional measure of CL in the context of consults., Conclusions: This study generated initial validity evidence to support the CCL's use as a measure of consult CL and supports measuring the 3 CL components separately rather than as a single construct in the context of consults. Learners and faculty could compare learner CCL scores with reference scores to promote reflection, metacognition, and coaching., (Copyright © 2021 by the Association of American Medical Colleges.)

Objective: To link the Activity Measure for Post-Acute Care (AM-PAC) Applied Cognition to the Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive Function, allowing for a common metric across scales., Design: Cross-sectional survey study., Setting: Outpatient rehabilitation clinics., Participants: Consecutive sample of 500 participants (N=500) aged ≥18 years presenting for outpatient therapy (physical, occupation, speech)., Interventions: Not applicable., Main Outcome Measures: AM-PAC Medicare and Generic Cognition short forms and PROMIS Cognitive Function items representing the PROMIS Cognitive Function item bank., Results: The calibration of 25 AM-PAC cognition items with 11 fixed PROMIS cognitive function item parameters using item-response theory indicated that items were measuring the same underlying construct (cognition). Both scales measured a wide range of functioning. The AM-PAC Generic Cognitive assessment showed more reliability with lower levels of cognition, whereas the PROMIS Cognitive Function full-item bank was more reliable across a larger distribution of scores. Data were appropriate for a fixed-anchor item response theory-based crosswalk and AM-PAC Cognition raw scores were mapped onto the PROMIS metric., Conclusions: The crosswalk developed in this study allows for converting scores from the AM-PAC Applied Cognition to the PROMIS Cognitive Function scale., (Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: Sleep disturbances in Parkinson's disease (PD) are common. Non -motor symptoms including sleep disturbance have gender difference in PD. The objective is to determine gender differences in PD in relation to the sleep quality., Patients and Methods: 156 patients with PD with males (n = 119) and females (n = 37) were included. The sleep quality and sleep disturbances were assessed using Pittsburgh sleep quality index (PSQI), Parkinson's disease Sleep Scale (PDSS) and Epworth Sleep Scale (ESS)., Results: Females with PD had higher frequency with insomnia (56.7%) as compared to males with PD (44.5%) (p = 0.05), nightmares (32.4%) as compared to males with PD (16.8%) (p = 0.04), greater PSQI component score of habitual sleep efficiency (p = 0.008), sleep disturbance (p = 0.03) and daytime dysfunction (p = 0.02), greater global PSQI score (p = 0.03), higher percentage of patients with global PSQI score > 5 (64.8%) than males with PD (41.1%) (p = 0.01), suggesting poor quality of sleep in females with PD. Higher total ESS score (p = 0.03), higher frequency of females with PD with total ESS score > 10 (45.9%) than in males with PD (26.9%) (p = 0.02), and lower total PDSS score (p = 0.009). On correlation analysis, the global PSQI score in females with PD had strong positive correlation with duration of PD, HAM-A and HAM-D scores and negative correlation with MMSE scores., Conclusions: Females with PD had a poor sleep quality with higher frequency of insomnia, nightmares, and daytime sleepiness. The longer duration of PD, higher scores of anxiety and depression scale and lower MMSE scores are associated with poor sleep quality in females with PD., (© 2020. Belgian Neurological Society.)

Aim: To examine whether education adjusted cut-off points of the Thai version of the ACE-III improve diagnostic accuracy in the detection of mild cognitive impairment (MCI) and dementia. Materials & methods: There were 172 participants consisting of 70 normal controls, 49 people with MCI and 53 patients with dementia. Results: To screen for MCI, the adjusted for education method yielded greater accuracy for the area under the receiver operating characteristic curve (AuROC) than the unadjusted method (0.9-0.92 vs 0.86). For the detection of dementia, when applying the education correction, AuROC increased from 0.87 (unadjusted) to 0.91 for the education >6 group, but there was no improvement for education ≤6 group (AuROC 0.86). Conclusion: The use of adjusted cut-off score for education level could increase the diagnostic accuracy of the test.

Background: The diagnosis of Alzheimer's disease dementia and other dementias relies on clinical assessment. There is a high prevalence of cognitive disorders, including undiagnosed dementia in secondary care settings. Short cognitive tests can be helpful in identifying those who require further specialist diagnostic assessment; however, there is a lack of consensus around the optimal tools to use in clinical practice. The Mini-Cog is a short cognitive test comprising three-item recall and a clock-drawing test that is used in secondary care settings., Objectives: The primary objective was to determine the accuracy of the Mini-Cog for detecting dementia in a secondary care setting. The secondary objectives were to investigate the heterogeneity of test accuracy in the included studies and potential sources of heterogeneity. These potential sources of heterogeneity will include the baseline prevalence of dementia in study samples, thresholds used to determine positive test results, the type of dementia (Alzheimer's disease dementia or all causes of dementia), and aspects of study design related to study quality., Search Methods: We searched the following sources in September 2012, with an update to 12 March 2019: Cochrane Dementia Group Register of Diagnostic Test Accuracy Studies, MEDLINE (OvidSP), Embase (OvidSP), BIOSIS Previews (Web of Knowledge), Science Citation Index (ISI Web of Knowledge), PsycINFO (OvidSP), and LILACS (BIREME). We made no exclusions with regard to language of Mini-Cog administration or language of publication, using translation services where necessary., Selection Criteria: We included cross-sectional studies and excluded case-control designs, due to the risk of bias. We selected those studies that included the Mini-Cog as an index test to diagnose dementia where dementia diagnosis was confirmed with reference standard clinical assessment using standardised dementia diagnostic criteria. We only included studies in secondary care settings (including inpatient and outpatient hospital participants)., Data Collection and Analysis: We screened all titles and abstracts generated by the electronic database searches. Two review authors independently checked full papers for eligibility and extracted data. We determined quality assessment (risk of bias and applicability) using the QUADAS-2 tool. We extracted data into two-by-two tables to allow calculation of accuracy metrics for individual studies, reporting the sensitivity, specificity, and 95% confidence intervals of these measures, summarising them graphically using forest plots., Main Results: Three studies with a total of 2560 participants fulfilled the inclusion criteria, set in neuropsychology outpatient referrals, outpatients attending a general medicine clinic, and referrals to a memory clinic. Only n = 1415 (55.3%) of participants were included in the analysis to inform evaluation of Mini-Cog test accuracy, due to the selective use of available data by study authors. There were concerns related to high risk of bias with respect to patient selection, and unclear risk of bias and high concerns related to index test conduct and applicability. In all studies, the Mini-Cog was retrospectively derived from historic data sets. No studies included acute general hospital inpatients. The prevalence of dementia ranged from 32.2% to 87.3%. The sensitivities of the Mini-Cog in the individual studies were reported as 0.67 (95% confidence interval (CI) 0.63 to 0.71), 0.60 (95% CI 0.48 to 0.72), and 0.87 (95% CI 0.83 to 0.90). The specificity of the Mini-Cog for each individual study was 0.87 (95% CI 0.81 to 0.92), 0.65 (95% CI 0.57 to 0.73), and 1.00 (95% CI 0.94 to 1.00). We did not perform meta-analysis due to concerns related to risk of bias and heterogeneity., Authors' Conclusions: This review identified only a limited number of diagnostic test accuracy studies using Mini-Cog in secondary care settings. Those identified were at high risk of bias related to patient selection and high concerns related to index test conduct and applicability. The evidence was indirect, as all studies evaluated Mini-Cog differently from the review question, where it was anticipated that studies would conduct Mini-Cog and independently but contemporaneously perform a reference standard assessment to diagnose dementia. The pattern of test accuracy varied across the three studies. Future research should evaluate Mini-Cog as a test in itself, rather than derived from other neuropsychological assessments. There is also a need for evaluation of the feasibility of the Mini-Cog for the detection of dementia to help adequately determine its role in the clinical pathway., (Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Background: Alzheimer's disease and other forms of dementia are becoming increasingly common with the aging of most populations. The majority of individuals with dementia will first present for care and assessment in primary care settings. There is a need for brief dementia screening instruments that can accurately detect dementia in primary care settings. The Mini-Cog is a brief, cognitive screening test that is frequently used to evaluate cognition in older adults in various settings., Objectives: To determine the accuracy of the Mini-Cog for detecting dementia in a primary care setting., Search Methods: We searched the Cochrane Dementia and Cognitive Improvement Register of Diagnostic Test Accuracy Studies, MEDLINE, Embase and four other databases, initially to September 2012. Since then, four updates to the search were performed using the same search methods, and the most recent was January 2017. We used citation tracking (using the databases' 'related articles' feature, where available) as an additional search method and contacted authors of eligible studies for unpublished data., Selection Criteria: We only included studies that evaluated the Mini-Cog as an index test for the diagnosis of Alzheimer's disease dementia or related forms of dementia when compared to a reference standard using validated criteria for dementia. We only included studies that were conducted in primary care populations., Data Collection and Analysis: We extracted and described information on the characteristics of the study participants and study setting. Using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria we evaluated the quality of studies, and we assessed risk of bias and applicability of each study for each domain in QUADAS-2. Two review authors independently extracted information on the true positives, true negatives, false positives, and false negatives and entered the data into Review Manager 5 (RevMan 5). We then used RevMan 5 to determine the sensitivity, specificity, and 95% confidence intervals. We summarized the sensitivity and specificity of the Mini-Cog in the individual studies in forest plots and also plotted them in a receiver operating characteristic plot. We also created a 'Risk of bias' and applicability concerns graph to summarize information related to the quality of included studies., Main Results: There were a total of four studies that met our inclusion criteria, including a total of 1517 total participants. The sensitivity of the Mini-Cog varied between 0.76 to 1.00 in studies while the specificity varied between 0.27 to 0.85. The included studies displayed significant heterogeneity in both methodologies and clinical populations, which did not allow for a meta-analysis to be completed. Only one study (Holsinger 2012) was found to be at low risk of bias on all methodological domains. The results of this study reported that the sensitivity of the Mini-Cog was 0.76 and the specificity was 0.73. We found the quality of all other included studies to be low due to a high risk of bias with methodological limitations primarily in their selection of participants., Authors' Conclusions: There is a limited number of studies evaluating the accuracy of the Mini-Cog for the diagnosis of dementia in primary care settings. Given the small number of studies, the wide range in estimates of the accuracy of the Mini-Cog, and methodological limitations identified in most of the studies, at the present time there is insufficient evidence to recommend that the Mini-Cog be used as a screening test for dementia in primary care. Further studies are required to determine the accuracy of Mini-Cog in primary care and whether this tool has sufficient diagnostic test accuracy to be useful as a screening test in this setting., (Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Cross-sectional studies suggest a correlation between alterations in dream content reports and executive dysfunction tests in Parkinson's disease (PD), but this has not been assessed in longitudinal studies. Our objective was to assess the predictive value of dream content for progression of cognitive dysfunction in PD. We prospectively addressed all consecutive, non-demented patients with PD attending an outpatient clinic during a 1-year period. Dream reports were collected at baseline by means of a dream diary and analysed according to the Hall and Van de Castle system. Patients were assessed at baseline for rapid eye movement sleep behaviour disorder, motor stage, mood disorder and psychosis. The Montreal Cognitive Assessment (MoCA) was applied at baseline and 4 years later. Linear regression analysis was used to the test the relation between each dream index (predictors), demographic and other motor and non-motor variables (covariates), and change in MoCA scores (dependent variable). In all, 58 patients were assessed at both time points and 23 reported at least one dream (range 1-27, total 148). Aggression, physical activities, and negatively toned content predominated in dream reports. The MoCA scores decreased significantly from baseline to follow-up. In the multivariate model, negative emotion index was the strongest predictor of cognitive decline. We found a significant positive association between negative emotions in dreams at baseline and subsequent reduction in MoCA scores. These findings suggest that some dream content in patients with PD could be considered a predictor of cognitive decline, independent of other factors known to influence either dream content or cognitive deterioration., (© 2020 European Sleep Research Society.)

Objectives: This study aimed to investigate the distribution of cognitive function in people with systemic lupus erythematosus (SLE) by objective and self-report measures and associations between cognition and participation among people with SLE., Methods: Fifty-five volunteers with SLE (age: 39.7 ± 12.7yrs, female: 92.7%) completed the Montreal Cognitive Assessment (MoCA) to measure cognitive ability objectively, the Cognitive Symptom Inventory (CSI) and PROMIS Cognitive Function 8a (CF) to assess self-reported everyday cognition, and PROMIS-43 Profile to assess self-reported ability to participate in social roles and activities (participation) and other disease-associated symptoms (e.g., depression, pain, fatigue)., Results: The average MoCA score was 25.3 ± 3.1, with 47.3% of participants scoring <26, which is indicative of cognitive impairment. Group average CSI (35.8 ± 7.9), CF (T-score = 45.0 ± 8.5), and participation (T-score = 46.9 ± 11.2) scores suggest mildly impaired functional cognition and participation compared to normative data. Participation correlated with self-reported everyday cognition measures (r ≥ 0.56, p < 0.01) but not with MoCA (r = 0.25, p = 0.06). In hierarchical linear regression analysis, CSI, fatigue, and pain were each significant independent predictors of participation (R2 = 0.78, p < 0.01)., Conclusions: We found that cognitive dysfunction is common among people with SLE. Along with pain and fatigue, reduced everyday cognitive function contributes to reduced participation in social, leisure, work, and family-related activities.

Background/objectives: Virtual (i.e., telephone or videoconference) care was broadly implemented because of the COVID-19 pandemic. Our objectives were to compare the diagnostic accuracy of virtual to in-person cognitive assessments and tests and barriers to virtual cognitive assessment implementation., Design: Systematic review and meta-analysis., Setting: MEDLINE, EMBASE, CDSR, CENTRAL, PsycINFO, and gray literature (inception to April 1, 2020)., Participants and Interventions: Studies describing the accuracy or reliability of virtual compared with in-person cognitive assessments (i.e., reference standard) for diagnosing dementia or mild cognitive impairment (MCI), identifying virtual cognitive test cutoffs suggestive of dementia or MCI, or describing correlations between virtual and in-person cognitive test scores in adults., Measurements: Reviewer pairs independently conducted study screening, data abstraction, and risk of bias appraisal., Results: Our systematic review included 121 studies (15,832 patients). Two studies demonstrated that virtual cognitive assessments could diagnose dementia with good reliability compared with in-person cognitive assessments: weighted kappa 0.51 (95% confidence interval [CI] 0.41-0.62) and 0.63 (95% CI 0.4-0.9), respectively. Videoconference-based cognitive assessments were 100% sensitive and specific for diagnosing dementia compared with in-person cognitive assessments in a third study. No studies compared telephone with in-person cognitive assessment accuracy. The Telephone Interview for Cognitive Status (TICS; maximum score 41) and modified TICS (maximum score 50) were the only virtual cognitive tests compared with in-person cognitive assessments in >2 studies with extractable data for meta-analysis. The optimal TICS cutoff suggestive of dementia ranged from 22 to 33, but it was 28 or 30 when testing was conducted in English (10 studies; 1673 patients). Optimal modified TICS cutoffs suggestive of MCI ranged from 28 to 31 (3 studies; 525 patients). Sensory impairment was the most often voiced condition affecting assessment., Conclusion: Although there is substantial evidence supporting virtual cognitive assessment and testing, we identified critical gaps in diagnostic certainty., (© 2021 The American Geriatrics Society.)

Objective: To document dementia-relevant state assisted living regulations and their changes over time as they pertain to licensed care settings., Data Sources: For all states, current directories of licensed assisted living communities and state regulations for each year, 2007-2018, were obtained from state agency websites and Nexis Uni, respectively., Study Design: We identified multiple types of regulatory classifications for each state and documented the presence or absence of specific dementia care provisions in the regulations for each type by study year. Maps and summary statistics were used to compare results to previous research and document change longitudinally., Data Collection/extraction Methods: We used a policy analysis approach to connect communities listed in directories to applicable regulatory text. Then, we employed policy surveillance and question-based coding to record the presence or absence of specific policies for each classification and study year., Principal Findings: Our team empirically documented provisions requiring dementia-specific training for administrators and direct care staff, and cognitive impairment screening for each study year. We found that 23 states added one or more of these requirements for one or more license types, but the states that had these provisions for all types of licensed assisted living declined from four to two., Conclusions: We identified significant, previously undocumented, within-state policy variation for assisted living licensed settings between 2007 and 2018. Using the regulatory classification instead of the state as the unit of analysis revealed that many policy adoptions were limited to dementia-designated settings. This suggests that people living with dementia in general assisted living are not afforded the same protections. We call our approach health services regulatory analysis and argue that it has the potential to identify gaps in existing policies, an important endeavor for health services research in assisted living and other care settings., (© Health Research and Educational Trust.)

To determine the relationship between sleep spindle characteristics (density, power and frequency), executive functioning and cognitive decline in older adults, we studied a convenience subsample of healthy middle-aged and older participants of the Brain in Motion study. Participants underwent a single night of unattended in-home polysomnography with neurocognitive testing carried out shortly afterwards. Spectral analysis of the EEG was performed to derive spindle characteristics in both central and frontal derivations during non-rapid eye movement (NREM) Stage 2 and 3. Multiple linear regressions were used to examine associations between spindle characteristics and cognitive outcomes, with age, body mass index (BMI), periodic limb movements index (PLMI) and apnea hypopnea index (AHI) as covariates. NREM Stage 2 total spindle density was significantly associated with executive functioning (central: β = .363, p = .016; frontal: β = .408, p = .004). NREM Stage 2 fast spindle density was associated with executive functioning (central: β = .351, p = .022; frontal: β = .380, p = .009) and Montreal Cognitive Assessment score (MoCA, central: β = .285, p = .037; frontal: β = .279, p = .032). NREM Stage 2 spindle frequency was also associated with MoCA score (central: β = .337, p = .013). Greater spindle density and fast spindle density were associated with better executive functioning and less cognitive decline in our study population. Our cross-sectional design cannot infer causality. Longitudinal studies will be required to assess the ability of spindle characteristics to predict future cognitive status., (© 2020 European Sleep Research Society.)