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Background: We aimed to examine the discriminant validity of a brief self-administered cognitive screening test, the Test Your Memory (TYM) and a brief neuropsychological test, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), supplemented with executive and language tests (Color Trail Test [CTT] and modified Boston Naming Test [mBNT], respectively), in detecting cognitive impairment (CI) in a one-stop memory clinic in Singapore. Methods: Ninety patients ≥50 years old with a diagnosis of no cognitive impairment, mild cognitive impairment, and mild Alzheimer disease were recruited from memory clinic. They received the TYM, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), RBANS, CTT, mBNT, and a gold-standard formal neuropsychological test battery. Results: The TYM had a significantly larger area under the curve (AUC) than MMSE (0.96 vs 0.88, P = .03) and was equivalent to MoCA in detecting CI (0.96 vs 0.95, P = .80). At the optimal cutoff points, the TYM (Conclusion: The self-administered TYM is superior to MMSE and equivalent to MoCA in detecting CI and could be implemented routinely. The RBANS supplemented with CTT and mBNT is more sensitive in detecting CI than RBANS alone therefore could be used for diagnostic purposes.

Background: Studies report varying rates and predictors of mild cognitive impairment (MCI) progression and reversion. Methods: We determined MCI reversion and progression among 473 community-living adults aged ≥55 years in the Singapore Longitudinal Ageing Study with an average of 6 years of follow-up and estimated association with baseline variables. Results: A total of 208 MCI participants reverted to normal cognition (44.0%) and 19 progressed to dementia (4.0%). In a model adjusted for age, gender, education, ethnicity, cardiovascular risk factors/diseases, APOE ε4 status, depressive symptoms, leisure-time activities (LTA), and baseline Mini-Mental State Examination (MMSE), we found that LTA score (OR = 1.07, 95% CI 1.02–1.13), MMSE score (OR = 1.21, 95% CI 1.11–1.31), and subjective memory complaint (OR = 1.83, 95% CI 1.16–2.90) significantly predicted MCI reversion. Controlling for all variables, age (OR = 1.09, 95% CI 1.02–1.17), lower education (OR = 3.26, 95% CI 1.01–10.49), and the metabolic syndrome (OR = 3.13, 95% CI 1.12–8.77) significantly predicted MCI progression. Controlling for age, sex, ethnicity, and education, diabetes significantly predicted MCI progression (OR = 3.19, 95% CI 1.23–8.26), but the presence of other cardiometabolic factors reduced this association to an OR of 2.18 (95% CI 0.72–6.60). Conclusion: In this relatively younger population, there were higher rates of MCI reversion and lower rates of MCI progression which were predicted by the positive effects of LTA and a higher MMSE score as well as by the deleterious effect of the metabolic syndrome and diabetes.

Convergent evidences have revealed that schizophrenia is associated with brain dysconnectivity, which leads to abnormal network organization. However, discrepancies were apparent between the structural connectivity (SC) and functional connectivity (FC) studies, and the relationship between structural and functional deficits in schizophrenia remains largely unknown. In this study, resting-state functional magnetic resonance imaging and structural diffusion tensor imaging were performed in 20 patients with schizophrenia and 20 matched healthy volunteers (patients/controls = 19/17 after head motion rejection). Functional and structural brain networks were obtained for each participant. Graph theoretical approaches were employed to parcellate the FC networks into functional modules. The relationships between the entries of SC and FC were estimated within each module to identify group differences and their correlations with clinical symptoms. Although five common functional modules (including the default mode, occipital, subcortical, frontoparietal, and central modules) were identified in both groups, the patients showed a significantly reduced modularity in comparison with healthy participants. Furthermore, we found that schizophrenia-related aberrations of SC-FC coupling exhibited complex patterns among modules. Compared with controls, patients showed an increased SC-FC coupling in the default mode and the central modules. Moreover, significant SC-FC decoupling was demonstrated in the occipital and the subcortical modules, which was associated with longer duration of illness and more severe clinical manifestations of schizophrenia. Taken together, these findings demonstrated that altered module-dependent SC-FC coupling may underlie abnormal brain function and clinical symptoms observed in schizophrenia and highlighted the potential for using new multimodal neuroimaging biomarkers for diagnosis and severity evaluation of schizophrenia. Hum Brain Mapp 38:2008-2025, 2017. © 2017 Wiley Periodicals, Inc.

Previous research on older adults with superior cognitive abilities (super-cognition) has typically examined cognition using a single domain approach, which may not adequately capture the multidimensional nature of successful cognitive aging. Furthermore, the lifestyle factors associated with super-cognition have not been studied adequately. The current study examined the cognitive profiles and lifestyle factors associated with super-cognition. Community-dwelling older adults (

ObjectiveTo explore the additive effect of neurodegenerative diseases, measured by atrophy, on neurocognitive function in Asian dementia-free elderly with cerebrovascular disease (CeVD).MethodsThe present study employed a cross-sectional design and was conducted between 2010 and 2015 among community-dwelling elderly participants recruited into the study. Eligible participants were evaluated with an extensive neuropsychological battery and neuroimaging. The weighted CeVD burden scale comprising markers of both small- and large-vessel diseases was applied, with a score of ≥2, indicating significant CeVD burden. Cortical atrophy (CA) and medial temporal atrophy (MTA) were graded using the global cortical atrophy scale and Schelten’s scale, respectively. Global and domain-specific (attention, executive function, language, visuomotor speed, visuoconstruction, visual memory, and verbal memory) neurocognitive performance was measured using a locally validated neuropsychological battery (Vascular Dementia Battery, VDB).ResultsA total of 819 dementia-free participants were included in the analysis. Among none-mild CeVD subjects, there was no significant difference in the global cognitive performance across atrophy groups (no atrophy, CA, and CA+MTA). However, in moderate-severe CeVD subjects, CA+MTA showed significantly worse global cognitive performance compared with those with CA alone (mean difference=−0.35, 95% CI −0.60 to −0.11, p=0.002) and those without atrophy (mean difference=−0.46, 95% CI −0.74 to −0.19, pConclusions and relevanceAtrophy and moderate-severe CeVD burden showed an additive effect on global and domain-specific cognitive performance. This study highlights the importance of investigating the mechanisms of clinico-pathological interactions between neurodegenerative processes and vascular damage, particularly in the pre-dementia stage.

Background The neurotoxic hypothesis suggests that psychosis is toxic to the brain leading to clinical consequences. In this study, we hypothesized that a longer duration of untreated psychosis (DUP) in first episode schizophrenia (FES) patients is associated with poorer cognitive functioning, and that higher premorbid intelligence buffers against DUP-related cognitive impairment. Method Eighty-one FES patients completed a neuropsychological battery, the Brief Assessment of Cognition in Schizophrenia (BACS). Composite scores of the BACS, which were normalized to a matched healthy control of seventy-three subjects, were used as an index of general cognition. A median split using the Wide Range Achievement Test–Reading Test scores was used to divide the patients into low versus high premorbid IQ groups. Hierarchical linear regression was performed to examine predictors of general cognition, including DUP. Results Longer DUP was found to be a significant predictor of poorer general cognition. In addition, DUP predicted general cognition in the low premorbid IQ group but not in the high premorbid IQ group. Conclusions Our findings demonstrate that longer DUP in FES patients is associated with worse cognitive scores, and that this association is more pronounced in a subgroup of patients who have lower premorbid intelligence. Our results suggest the importance of earlier identification and management of patients with low premorbid IQ, given that their cognition may be more vulnerable to the toxicity of psychosis.

The co-occurrence of sleep problems, cognitive impairment, and depression among the elderly suggests that these three conditions are likely to be interrelated. Recent findings suggest that depressive symptoms moderate the relationship between sleep problems and cognitive impairment in elderly people but methodological problems have led to inconsistent conclusions. The present study aims to better understand the relationship between sleep quality, depressive symptoms, and cognitive function.We administered the Repeatable Battery for the Assessment of Neuropsychological Status and self-report measures of sleep quality and depression to 380 elderly participants (Mage = 68 years, SD= 5.7). Bootstrapped moderation analyses were conducted to examine the role of depressive symptoms in the relationship between sleep and various aspects of cognitive function.This moderation effect was significant in the domains of delayed memory (ΔR(2) = .01, F = 4.5, p = .04), language (ΔR(2) = .01, F = 4.6, p = .035), and general cognitive status (ΔR(2) = .01, F = 5.3, p = .02). However, unlike previous studies, higher sleep quality corresponded to better outcomes in delayed memory, language abilities, and general cognitive status in participants with low levels of depressive symptoms. No significant relationship between sleep quality and any cognitive function was observed among participants with high levels of depressive symptoms.Among individuals who reported low levels of depressive symptoms, sleep quality was positively related to cognitive performance in the domains of delayed recall, language, and general cognitive status. However, sleep quality was not significantly associated with cognitive abilities in these domains among participants with elevated levels of depressive symptoms; participants had relatively poor outcomes in these cognitive domains regardless of their sleep quality.

Aims: To examine the diagnostic utility of the National Institute of Neurological Disorders and Stroke and the Canadian Stroke Network (NINDS-CSN) neuropsychological battery in memory clinics comparing controls with patients with no cognitive impairment (NCI), patients with cognitive impairment-no dementia (CIND) at varying severity levels (mild/moderate), and patients with dementia. Methods: A total of 405 participants with NCI, CIND or dementia were assessed with the NINDS-CSN battery. The discriminatory properties of all three protocols (5, 30 and 60 min) before and after education stratification (none/primary vs. secondary/above) were examined by receiver operating characteristic curves. Results: Overall, the shorter protocols are equivalent to the longer protocol in diagnosing dementia, regardless of education. To discriminate between nondementia groups, before education stratification, the 5-min protocol showed varied discriminatory properties between different diagnostic/severity groups. After stratification, the 5-min protocol was broadly equivalent to the longer protocols in lower-education groups [area under the curve (AUC) range: 0.77-0.87] but was less accurate in the higher-education groups (AUC range: 0.68-0.78). The 30- and 60-min protocol constantly showed moderate-to-excellent differentiating capacities regardless of education (AUC range: 0.80-0.90). Conclusion: The NINDS-CSN neuropsychological battery can be applied in memory clinics and effectively discriminate between cognitively intact individuals and those with cognitive impairments of varying severity. Furthermore, level of education should be taken into consideration when choosing protocols with different lengths for cognitive assessment.

To examine the relationships between tea consumption habits and incident neurocognitive disorders (NCD) and explore potential effect modification by gender and the apolipoprotein E (APOE) genotype.Population-based longitudinal study.The Singapore Longitudinal Aging Study (SLAS).957 community-living Chinese elderly who were cognitively intact at baseline.We collected tea consumption information at baseline from 2003 to 2005 and ascertained incident cases of neurocognitive disorders (NCD) from 2006 to 2010. Odds ratio (OR) of association were calculated in logistic regression models that adjusted for potential confounders.A total of 72 incident NCD cases were identified from the cohort. Tea intake was associated with lower risk of incident NCD, independent of other risk factors. Reduced NCD risk was observed for both green tea (OR=0.43) and black/oolong tea (OR=0.53) and appeared to be influenced by the changing of tea consumption habit at follow-up. Using consistent non-tea consumers as the reference, only consistent tea consumers had reduced risk of NCD (OR=0.39). Stratified analyses indicated that tea consumption was associated with reduced risk of NCD among females (OR=0.32) and APOE ε4 carriers (OR=0.14) but not males and non APOE ε4 carriers.Regular tea consumption was associated with lower risk of neurocognitive disorders among Chinese elderly. Gender and genetic factors could possibly modulate this association.

Emerging evidence suggests that schizophrenia is associated with brain dysconnectivity. Nonetheless, the implicit assumption of stationary functional connectivity (FC) adopted in most previous resting-state functional magnetic resonance imaging (fMRI) studies raises an open question of schizophrenia-related aberrations in dynamic properties of resting-state FC. This study introduces an empirical method to examine the dynamic functional dysconnectivity in patients with schizophrenia. Temporal brain networks were estimated from resting-state fMRI of 2 independent datasets (patients/controls = 18/19 and 53/57 for self-recorded dataset and a publicly available replication dataset, respectively) by the correlation of sliding time-windowed time courses among regions of a predefined atlas. Through the newly introduced temporal efficiency approach and temporal random network models, we examined, for the first time, the 3D spatiotemporal architecture of the temporal brain network. We found that although prominent temporal small-world properties were revealed in both groups, temporal brain networks of patients with schizophrenia in both datasets showed a significantly higher temporal global efficiency, which cannot be simply attributable to head motion and sampling error. Specifically, we found localized changes of temporal nodal properties in the left frontal, right medial parietal, and subcortical areas that were associated with clinical features of schizophrenia. Our findings demonstrate that altered dynamic FC may underlie abnormal brain function and clinical symptoms observed in schizophrenia. Moreover, we provide new evidence to extend the dysconnectivity hypothesis in schizophrenia from static to dynamic brain network and highlight the potential of aberrant brain dynamic FC in unraveling the pathophysiologic mechanisms of the disease.

Objective: There is no established minimum clinically important difference (MCID) for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) index and total scale scores. This study aimed to estimate the MCID for the RBANS index scores and total scale score. Method: Participants included 1,856 ethnic Chinese, older adults. Distribution- and anchor-based methods were used to estimate values for the MCID. Distribution-based estimates were calculated as the standard error of measurement (SEM) and .5 standard deviations (SD). For anchor-based estimates, we compared RBANS scores between the clinical dementia rating (CDR) scale no dementia and very mild dementia groups and between the clinical assessment of dementia (CAD) cognitively normal and mild cognitive impairment groups using regression models adjusting for demographic characteristics. Results: Estimates from the CDR anchor were 7.79, 8.63, 10.74, 9.74, 5.61, and 3.77 for the total scale score, language, immediate memory, delayed memory, visuospatial/constructional, and the attention index, respectively. Estimates from the distribution-based methods were similar to the estimates based on the CDR, except for the language and attention indexes. Estimates from the CAD anchor were larger. Conclusions: We estimated the MCID for the total scale score, language, immediate memory, delayed memory, visuospatial/constructional, and attention indexes of the RBANS as 8, 9, 10, 10, 6, and 4 points, respectively. These estimates are best suited to discriminate between patient groups, for example, in a clinical trial setting. Further research is needed using longitudinal data to assess their applicability to assess within patient differences.

Background and Purpose— The present study sought to examine the association between the burden of cerebrovascular disease (CeVD) as assessed by multimodal magnetic resonance imaging and neurocognitive function. Methods— Cognitively impaired patients and controls were tested on an extensive neuropsychological battery and underwent multimodal brain magnetic resonance imaging. CeVD markers determined from magnetic resonance imaging included the presence of multiple lacunes, multiple cerebral microbleeds, and moderate or severe white matter hyperintensities as markers for small-vessel disease and cortical stroke and intracranial stenosis as markers for large-vessel disease. A weighted CeVD burden score was constructed, and its association with global and domain-specific cognitive performance was investigated. Results— A total of 305 cases and 94 controls were included in the analysis. A graded association of CeVD burden with neurocognitive function was found. Moreover, a clear threshold of CeVD burden was associated with severe impairment. White matter hyperintensities was associated with global neurocognitive deficits, whereas microbleeds were associated with domain-specific impairments. Conclusions— The weighted CeVD burden score comprising markers of both small- and large-vessel diseases were associated with deficits in both global and domain-specific neurocognitive function. Additional studies are needed to validate the use of this CeVD burden score for the prediction of dementia.

Background: The Montreal Cognitive Assessment (MoCA) was developed as a screening instrument for mild cognitive impairment (MCI). We evaluated the MoCA's test performance by educational groups among older Singaporean Chinese adults. Method: The MoCA and Mini-Mental State Examination (MMSE) were evaluated in two independent studies (clinic-based sample and community-based sample) of MCI and normal cognition (NC) controls, using receiver operating characteristic curve analyses: area under the curve (AUC), sensitivity (Sn), and specificity (Sp). Results: The MoCA modestly discriminated MCI from NC in both study samples (AUC = 0.63 and 0.65): Sn = 0.64 and Sp = 0.36 at a cut-off of 28/29 in the clinic-based sample, and Sn = 0.65 and Sp = 0.55 at a cut-off of 22/23 in the community-based sample. The MoCA's test performance was least satisfactory in the highest (>6 years) education group: AUC = 0.50 (p = 0.98), Sn = 0.54, and Sp = 0.51 at a cut-off of 27/28. Overall, the MoCA's test performance was not better than that of the MMSE. In multivariate analyses controlling for age and gender, MCI diagnosis was associated with a 2 = 0.010), but lower (1-6 years) and no education was associated with a 3- to 5-point decrement (η2 = 0.115 and η2 = 0.162, respectively). Conclusion: The MoCA's ability to discriminate MCI from NC was modest in this Chinese population, because it was far more sensitive to the effect of education than MCI diagnosis.

Background Schizophrenia is associated with diverse white matter (WM) brain abnormalities. In this study, we sought to examine the WM microstructural findings which underlie clinical psychopathology clusters in schizophrenia and hypothesized that these symptom clusters are associated with common and unique WM tracts. Methods Overall, 76 healthy controls (HC), and 148 patients with schizophrenia (SZ) were recruited and severity of symptomatology in schizophrenia was assessed using the Positive and Negative Syndrome Scale. WM fractional anisotropy (FA) values were extracted from their diffusion tensor images. Psychopathology clusters were first determined using factor analysis and the relationship between these symptom factors and FA values were then assessed with structural equation modelling, which included covariates such as age, sex, duration of illness and medications prescribed. Results Patients with schizophrenia had reduced FA in the genu of corpus callosum (gCC) compared to HC. A three-factor model, namely Positive, Negative, Disorganised factors, was determined as the best fit for the data. All three psychopathology factors were associated with decreased FA in the gCC and bilateral cingulate gyrus. Higher Negative factor scores were uniquely associated with decreased FA in the right sagittal striatum and right superior longitudinal fasciculus. Conclusions This study found shared and specific WM changes and their associations with specific symptom clusters, which potentially allows for monitoring of such white matter findings associated with clinical presentations in schizophrenia over treatment and illness course.

Background: The schizotypal construct has been postulated to be on the continuum of psychosis. It has also been hypothesized to be part of the genetic diathesis where elevated schizotypal traits have been found in nonaffected relatives. Early evidence show high schizotypal traits, discriminated between schizophrenia and bipolar disorder and depression, and increased risk of developing psychosis.

To provide normative values for the healthy ethnic Chinese Singaporean population and a large sample of patients with schizophrenia for the Continuous Performance Task-Identical Pairs (CPT-IP). Participants Data were collected on 1011 healthy ethnic Chinese and 654 patients diagnosed with schizophrenia, all between 21 and 55 years of age.Data were stratified by age and gender. The effects of age, gender and education were explored in patients and controls. Performance indices were assessed in their ability to predict group inclusion. Controls' performance was compared with that reported in a US sample.Performance was affected by age, sex, and education, with youth, male sex and higher education providing a performance advantage. Patients' performance was lower than controls' by more than 1 standard deviation, with the 3-digit d' score most significantly discriminating between controls and patients. The effects of socio-demographic factors on performance were in line with those conducted in the US and previously reported in the literature.This is the largest norming study ever conducted on the CPT-IP. It will enable investigators and clinicians to select appropriate indices to assess severity of cognitive decline and/or evaluate cognitive remediation therapy outcomes after taking into account age, gender and education factors.

Asia will experience a surge in dementia prevalence within the next 20 – 40 years, but there is a dearth of well-normed neuropsychological tests that could assist with dementia diagnosis. Here, we report normative data for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in Elderly ethnic Chinese Singaporeans aged 55 – 91 years of age. A total of 1,165 male and female community-dwelling, cognitively normal elderly Chinese persons in Singapore, with varying levels of education and range of languages, were tested with the RBANS version A. The effects of age, education, language and gender on RBANS performance were examined. Negative effects of increased age and positive effects of education on the RBANS subtests, Index and Total Scale scores were found suggesting differential associations between age-related cognitive decline and education that vary according to the specific cognitive ability measured. The findings indicate that unique cultural and educational profile of elderly Chinese should be considered when applying the RBANS in this population.

Background.Elucidating the cognitive architecture of schizophrenia promises to advance understanding of the clinical and biological substrates of the illness. Traditional cross-sectional neuropsychological approaches differentiate impaired from normal cognitive abilities but are limited in their ability to determine latent substructure. The current study examined the latent architecture of abnormal cognition in schizophrenia via a systematic approach.Method.Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were carried out on a large neuropsychological dataset including the Brief Assessment of Cognition in Schizophrenia, Continuous Performance Test, Wisconsin Card Sorting Test, Benton Judgment of Line Orientation Test, and Wechsler Abbreviated Scale of Intelligence matrix reasoning derived from 1012 English-speaking ethnic Chinese healthy controls and 707 schizophrenia cases recruited from in- and out-patient clinics.Results.An initial six-factor model fit cognitive data in healthy and schizophrenia subjects. Further modeling, which accounted for methodological variance between tests, resulted in a three-factor model of executive functioning, vigilance/speed of processing and memory that appeared to best discriminate schizophrenia cases from controls. Factor analytic-derived g estimands and conventionally calculated g showed similar case–control discrimination. However, agreement analysis suggested systematic differences between both g indices.Conclusions.Factor structures derived in the current study were broadly similar to those reported previously. However, factor structures between schizophrenia subjects and healthy controls were different. Roles of factor analytic-derived g estimands and conventional composite score g were further discussed. Cognitive structures underlying cognitive deficits in schizophrenia may prove useful for interrogating biological substrates and enriching effect sizes for subsequent work.

Background Mixed dementia (MD), i.e., the coexistence of Alzheimer's disease (AD) and cerebrovascular disease (CVD), is a common dementia subtype. Few studies have attempted to establish the cognitive profiles of mild–moderate MD and compare it to the profiles of AD using a comprehensive neuropsychological test battery. We aimed to establish the neuropsychological profile of mild–moderate MD in relation to mild–moderate AD. Methods Patients with consensus diagnoses of MD and AD of mild–moderate severity (Clinical Dementia Rating score of 1–2) were recruited from a memory clinic. Cognitive performance was measured by a formal neuropsychological battery covering domains of attention, language, verbal and visual memory, visuoconstruction, visuomotor speed and executive function. Cognitive domain scores are z-scores calculated using the mean and SDs of the AD group. ANCOVAs with age and education as covariates were employed to examine differences in mean score difference of cognitive domains and subtests between patients with MD and AD. Results 151 patients were recruited with the majority of AD (n = 96, 63.6%) and a minority of MD (n = 55, 36.4%). There were no significant differences in the demographic characteristics of patients with MD and AD. However, patients with MD were significantly more impaired than AD patients in global cognitive composite, attention and visuoconstruction (global cognitive composite: − 0.32 ± 0.98 vs 0 ± 1, p = 0.011; attention: − 0.32 ± 0.90 vs 0 ± 1, p = 0.013; visuoconstruction: − 0.27 ± 0.99 vs 0 ± 1, p = 0.024, respectively). Conclusion The neuropsychological profile of patients with MD of mild–moderate severity is characterized by a poorer global performance, as well as attention and visuoconstruction than those with AD of mild–moderate severity.

Objective Silent lacunar infarct (SLI) is associated with cognitive decline and linked to an increased risk of stroke and dementia. We examined the association of SLI with MRI measures of cortical thickness, subcortical and lateral ventricular shapes and cognition in 285 ethnic Chinese elderly. Methods SLI, cortical thickness, shapes of subcortical and ventricular structures were quantified using MRI. The cognitive performance was assessed using comprehensive neuropsychological tests. Linear regression was used to examine associations among SLI, brain measures and cognition. Results SLI was associated with atrophy in multiple subcortical structures, ventricular enlargement and widespread cortical thinning. Both SLI and atrophy were independently related to poorer performance in attention, memory and language domains. Only SLI was associated with visuomotor speed and executive function, while atrophy mediated the association between SLI and visuoconstruction. Conclusions Our findings support a vascular contribution to neurodegeneration and cognitive impairment.

There is a dearth of non-Western normative data for neuropsychological batteries designed to measure cognitive deficits in schizophrenia. Here, we provide normative data for English-speaking ethnic Chinese on the widely used Brief Assessment of Cognition in Schizophrenia acquired from 595 healthy community participants between ages 14 and 55. Means and standard deviations of subtests and composite scores were stratified by age group and sex. We also explored linear regression approaches to generate continuous norms adjusted for age, sex, and education. Notable differences in subtest performances were found against a Western comparison sample. Normative data established in the current sample are essential for clinical and research purposes as it serves as a reference source of cognition for ethnic Chinese.

The MATRICS Consensus Cognitive Battery (MCCB) was developed to provide a reliable, valid, and standard battery for clinical trials on cognitive enhancers in schizophrenia. In this study we tested the applicability of the MCCB to Singapore's English speakers. Healthy ethnic Chinese, Malay, and Indian English speakers (N = 171) of both genders were recruited within three age groups and three levels of education to match as closely as possible the US norming sample, and were administered the MCCB. Descriptive data, T scores, age, gender, education, and ethnicity effects on performance were explored and compared with the US norming study. Age, education, and ethnicity affected the battery's composite scores, with young and highly educated participants generally outperforming the old, less-educated ones. Male participants outperformed their female counterparts in two out of seven cognitive domains. Although generally lower when compared to the US norming sample, Singaporean scores reflected the same relationship with age, education, and gender, with the exception of a substantially worse performance in the social cognition domain. Differences among the ethnic groups in Singapore-and the poorer performance measured in these groups with respect to the US sample-call for the necessity of an extended norming study in Singapore.

Metabolic syndrome (MetS) is reported to be associated with cognitive decline and dementia, in particular vascular dementia. However, the evidence linking MetS to Alzheimer's disease (AD) and amnestic mild cognitive impairment (aMCI), a precursor of AD, is inconsistent and limited. This study examined the association of MetS and its components with aMCI and how APOE-ee4 and younger age influenced this association. Participants with aMCI (n = 98) and cognitively normal controls (n = 802) were identified from baseline data in a second wave cohort of older subjects aged 55 and over in the Singapore Longitudinal Ageing Study-2 (SLAS-2) in 2009/2010. The associations of MetS and its individual components with aMCI were analyzed using logistic regression controlling for age, gender, education, current smoking, alcohol drink, leisure time activities score, Geriatric Depression Scale score, APOE-e4, and heart disease or stroke. The analysis was repeated for associations stratified by age and APOE-e4 status. In multivariate analysis, MetS was associated with an elevated risk of aMCI (OR = 1.79; 95% CI 1.15-2.77). Among MetS components, central obesity showed a significant association with aMCI (OR = 1.77; 95% CI 1.11-2.82). The association between MetS and aMCI remained significant on repeated analysis among subjects free of heart disease and stroke. This association was particularly stronger among participants with APOE-e4 allele (OR = 3.35; 95% CI, 1.03-10.85) and younger (

The direct impact of external carotid-internal carotid (EC-IC) bypass surgery on cognition of patients with severe steno-occlusive disease of internal carotid (ICA) or middle cerebral artery (MCA) is unknown. In this pilot study, we evaluated changes in cerebral hemodynamic and cognition in these patients.Patients with severe steno-occlusive disease and impaired cerebral vasodilatory reserve (CVR) with transcranial Doppler (TCD) breath holding index (BHI) and acetazolamide-challenged HMPAO-Single Photon Emission Tomographic (SPECT) imaging were offered EC-IC bypass surgery. CVR and cognitive performance using a formal neuropsychological battery were evaluated before and 3-6 months after surgery.Nine patients and 9 matched controls were recruited. Significant CVR improvement from TCD-BHI [median 0 (Inter-quartile range IQR 0.45) to 1.10 (IQR 0.73), p0.001] and SPECT (p0.001) was observed in surgery patients. EC-IC bypass patients had significant improvement in verbal memory (p=0.037) and executive function (p=0.043) and a trend of improvement in visual memory (p=0.052) compared to controls.EC-IC bypass surgery in carefully selected patients could improve cerebral hemodynamics and verbal memory and executive function.

Clinical neuropsychology in Asia has emerged from the interactions of multiple processes, including the development of psychology and its subdisciplines worldwide, the entering of psychology into Asia and ongoing intellectual influences from outside of Asia, indigenous responses to those external forces, and homegrown initiatives in studying brain-behavior relationships prior to and since the beginnings of modern neuropsychology. This chapter reviews the history of neuropsychology in China, Hong Kong, Singapore, and other Asian regions. With globalization and increasing ease of information exchange, neuropsychological practice in Asia will continue to be shaped by influence from the West interacting with the indigenization process to shape the development of neuropsychology in Asia. Rapid development of neuroscience leads to cutting-edge findings and discovery of brain-behavior relationships, which has and will continue to be one of the rich sources of information that guides and shapes neuropsychological practice in Asia and worldwide.

Convergent evidences have revealed that schizophrenia is associated with brain dysconnectivity, which leads to abnormal network organization. However, discrepancies were apparent between the structural connectivity (SC) and functional connectivity (FC) studies, and the relationship between structural and functional deficits in schizophrenia remains largely unknown. In this study, resting‐state functional magnetic resonance imaging and structural diffusion tensor imaging were performed in 20 patients with schizophrenia and 20 matched healthy volunteers (patients/controls = 19/17 after head motion rejection). Functional and structural brain networks were obtained for each participant. Graph theoretical approaches were employed to parcellate the FC networks into functional modules. The relationships between the entries of SC and FC were estimated within each module to identify group differences and their correlations with clinical symptoms. Although five common functional modules (including the default mode, occipital, subcortical, frontoparietal, and central modules) were identified in both groups, the patients showed a significantly reduced modularity in comparison with healthy participants. Furthermore, we found that schizophrenia‐related aberrations of SC–FC coupling exhibited complex patterns among modules. Compared with controls, patients showed an increased SC–FC coupling in the default mode and the central modules. Moreover, significant SC–FC decoupling was demonstrated in the occipital and the subcortical modules, which was associated with longer duration of illness and more severe clinical manifestations of schizophrenia. Taken together, these findings demonstrated that altered module‐dependent SC–FC coupling may underlie abnormal brain function and clinical symptoms observed in schizophrenia and highlighted the potential for using new multimodal neuroimaging biomarkers for diagnosis and severity evaluation of schizophrenia. Hum Brain Mapp 38:2008–2025, 2017. © 2017 Wiley Periodicals, Inc.

Background A total cerebrovascular disease (CeVD) burden scale was previously constructed and an inverse association of CeVD burden and cognition was found. However, the generalizability of the CeVD scale has not been examined. Objective The objective was to validate the previously constructed total CeVD burden scale by establishing its association with cognitive function and dementia diagnosis in a community sample. Methods Eligible participants were assessed on an extensive neuropsychological battery and underwent MRI scans. The total CeVD scale, comprising markers of both small- and large-vessel diseases, was derived according to previously described criteria. Association of total CeVD burden with global and domain-based cognitive performance and dementia diagnostic utility of the scale was established. Results A total of 863 participants were included in the analysis. A stepwise association of CeVD burden score with global and domain-specific cognitive function was found. Per score increase on the total CeVD burden scale was associated with 3.6 (95% CI = 2.1-6.4) times higher odds of dementia compared to dementia-free. Discussion The total CeVD burden scale is associated with cognition and dementia in a community sample. Longitudinal studies are required to establish the predictive ability of this scale.

Neuropsychological testing is key to diagnosing and assessing for dementia but there is a dearth of normative neuropsychological data for ethnic Chinese older persons, particularly for non-English-speaking individuals with low education. The aim of this study was to establish a set of age-specific, education-specific, and culture-appropriate norms on measures of cognitive function for a population of cognitively normal community-dwelling Chinese elderly, and explore the effects of age and education on test performance. Results showed decreasing test performances with increasing age and very poor performance in the most poorly educated strata. However, the age-associated decline in test performance was not uniform across different education groups, indicating a more complex association. The present findings highlight a need for normative data that are applicable to lower educated elderly people as this group makes up a substantial proportion of the Asian elderly.

When attention is oriented to a peripheral visual event, observers respond faster to stimuli presented at a cued location than at an uncued location. Following initial reaction time facilitation responses are slower to stimuli subsequently displayed at the cued location, an effect known as inhibition of return (IOR). Both facilitatory and inhibitory effects have been extensively investigated in two-dimensional space. Facilitation has also been documented in three-dimensional space, however the presence of IOR in 3D space is unclear, possibly because IOR has not been evaluated in an empty 3D space. Determining if IOR is sensitive to the depth plane of stimuli or if only their bi-dimensional location is inhibited may clarify the nature of the IOR. To address this issue, we used an attentional cueing paradigm in three-dimensional (3D) space. Results were obtained from fourteen participants showed IOR components in 3D space when binocular disparity was used to induce depth. We conclude that attentional orienting in depth operates as efficiently as in the bi-dimensional space. © 2012 Elsevier B.V.

Research on long-term exposure to electromagnetic fields on cognition is lacking. We investigated the associations between frequent digital mobile phone use and global and domain-specific cognitive changes in older persons, a vulnerable group experiencing age-associated cognitive decline. We assessed 871 non-demented Chinese participants in the Singapore Longitudinal Ageing Studies cohort on the frequency of digital mobile phone use, neurocognitive performance and confounding variables at baseline, and neurocognitive performance at the 4-year follow-up. Findings showed that digital mobile phone users were typically self-selected to possess characteristics favoring better cognitive functioning and concomitantly demonstrate better performance on cognitive tasks. There was evidently no significant deleterious effect of digital mobile phone use on cognitive functioning in older people. Findings suggest, however, that digital mobile phone use may have an independent facilitating effect on global and executive functioning. Bioelectromagnetics 33:176–185, 2012. © 2011 Wiley Periodicals, Inc.

Studies that have examined schizotypal personality traits using self-reported measures have found gender differences in the expression and degree of schizotypy. Despite the reported presence of schizotypal traits in Asian populations, putative gender differences have been almost entirely derived from studies of Western populations. This study examined the gender effect of schizotypy in a broad sample of the Chinese population in Singapore using the Schizotypal Personality Questionnaire (SPQ). The questionnaire was administered to 538 (308 males and 230 females) subjects (age range of 21–55). As with previous studies, gender differences were related to the presence of negative schizotypal personality traits, namely No Close Friends and Constricted Affect. The spectrum of differences in schizotypy was also extended to the psychosocial sphere as marital status and years of education were significantly associated with several SPQ domains. The findings suggest that there are common elements in Asian and Caucasian populations and that psychosocial risk is an important correlate of schizotypy. The implications of gender differences in the aetiology of schizophrenia spectrum disorders are discussed.

Sex differences in the onset, epidemiology, clinical presentation and neuropathology of schizophrenia suggest that sexual dimorphism in brain development may be relevant to pathogenesis. Sex hormones, in particular testosterone, are considered to be crucial in brain development, but few investigations have examined the potential role of prenatal testosterone in schizophrenia. In this study, we examined a retrospective marker of prenatal testosterone release - 2D:4D finger length ratio (2D:4D), the relative length of 2nd to 4th digit, in 64 Asian patients with schizophrenia and 64 sex-matched controls. No significant difference in mean finger lengths was present, however 2D:4D ratio was significantly different between patients and controls. The effect was primarily seen in males consistent with a 'less masculinised' pattern and hypotheses suggesting that schizophrenia may be associated with an abnormality in prenatal circulating testosterone.

Dichotic listening (DL) impairments, in particular the loss or reduction of right ear advantage (REA) in people with schizophrenia have been variously interpreted as both a state and trait marker for schizophrenia. To date, there has been no comprehensive investigation of dichotic language impairments in relation to the structural integrity of the temporal cortex - the likely neural substrate for such impairments. In this study of 39 early onset patients and matched controls we used a dichotic listening procedure and examined the findings in relation to MRI measurements of gross and regional cerebral volumes. No overall group difference in ear advantage was found between patients and controls but patients who showed absence of REA also demonstrated an accompanying reduction of left temporal lobe volume compared with patients who showed normal ear advantage and controls. The findings suggest that impaired DL performance is a correlate of structural change in the temporal lobe and that this is apparent in early onset cases.

Primary objective: To illustrate the clinical course of a patient with a marked amnestic syndrome resulting from a closed head injury that had significant effects on frontal and thalamic memory structures. Methods and procedures: The patient underwent a series of brain imaging investigations (CT and MRI) and neuropsychological investigations to determine the severity and course of behavioural and cognitive impairments. Results: Three months post-injury, the patient demonstrated dense retrograde and anterograde amnesia for auditory-verbal and visuo-spatial information, disorientation and confabulation. In contrast, memory for faces appeared unimpaired. One month later the patient’s behaviour, orientation and spatial memory had improved with no concomitant improvement in auditory-verbal memory. Conclusions: The findings indicate that injury to the diencephalon manifests in a verbal amnesic syndrome that is anterograde in nature if localized in the region of the anterior left thalamus, but leaves a relatively intact visual memory. Furthermore, injuries to the frontal and temporal lobes and their projections to the diencephalon may be more important in the emergence and resolution of retrograde amnesia and disturbances in autobiographical recall than previously appreciated.

Despite convergent evidence indicating a variety of regional abnormalities of hemispheric asymmetry in schizophrenia, patterns of wider neural network asymmetry remain to be determined. In this study, we investigated alterations in hemispheric white matter topology in schizophrenia and their association with clinical manifestations of the illness. Weighted hemispheric brain anatomical networks were constructed for each of 116 right-handed patients with schizophrenia and 66 matched healthy participants. Graph theoretical approaches were then employed to estimate the hemispheric topological properties. We found that although small-world properties were preserved in the hemispheric network, a significant hemispheric-independent deficit of global integration was found in schizophrenia. Furthermore, a significant group-by-hemisphere interaction was revealed in the characteristic path length and global efficiency, attributing to significantly reduced hemispheric asymmetry of global integration in patients compared with healthy controls. Specifically, we found reduced asymmetric nodal efficiency in several frontal regions and the hippocampus. Finally, the abnormal hemispheric asymmetry of brain anatomical network topology was associated with clinical features (duration of illness and psychotic psychopathology) in patients. Our findings provide new insights into lateralized nature of hemispheric dysconnectivity and highlight the potential for using brain network measures of hemispheric asymmetry as neural biomarkers for schizophrenia and its clinical features.

Objective: Chinese is the most commonly spoken language in the world. The availability of Chinese translations of assessment scales is useful for research in multi-ethnic and multinational studies. This study aimed to establish whether each of the Chinese translations (Mandarin, Hokkien, Teochew, and Cantonese) of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) achieved measurement equivalence to the English version.Method: Participants included 1856 ethnic Chinese, older adults. The RBANS was administered in the language/dialect according to the participants’ preference by interviewers who were fluent in that language/dialect. Multiple regression analysis was used to adjust for demographic and clinical differences between participants who spoke different languages/dialects. Equivalence (practical equivalence) was declared if the 90% confidence interval for the adjusted mean difference fell entirely within the pre-specified equivalence margin, ±.2 (±.4) standard deviations.Results: The delayed memory index was at least practically equivalent across languages. The Mandarin, Hokkien, and Teochew versions of the immediate memory, language, and total scale score were practically equivalent to the English version; the Cantonese version showed small differences from the English version. Equivalence was not established for the Hokkien and Teochew versions of the visuospatial/constructional index. The attention index was different across languages.Conclusions: Data from the English and Chinese versions for the total scale score, language, delayed, and immediate memory indexes may be pooled for analysis. However, analysis of the attention and visuospatial/constructional indexes from the English and Chinese versions should include a covariate that represents the version in the statistical adjustment.

Despite convergent neuroimaging evidence indicating a wide range of brain abnormalities in schizophrenia, our understanding of alterations in the topological architecture of brain anatomical networks and how they are modulated over time, is still rudimentary. Here, we employed graph theoretical analysis of longitudinal diffusion tensor imaging data (DTI) over a 5-year period to investigate brain network topology in schizophrenia and its relationship with clinical manifestations of the illness. Using deterministic tractography, weighted brain anatomical networks were constructed from 31 patients experiencing schizophrenia and 28 age- and gender-matched healthy control subjects. Although the overall small-world characteristics were observed at both baseline and follow-up, a scan-point independent significant deficit of global integration was found in patients compared to controls, suggesting dysfunctional integration of the brain and supporting the notion of schizophrenia as a disconnection syndrome. Specifically, several brain regions (e.g., the inferior frontal gyrus and the bilateral insula) that are crucial for cognitive and emotional integration were aberrant. Furthermore, a significant group-by-longitudinal scan interaction was revealed in the characteristic path length and global efficiency, attributing to a progressive aberration of global integration in patients compared to healthy controls. Moreover, the progressive disruptions of the brain anatomical network topology were associated with the clinical symptoms of the patients. Together, our findings provide insights into the substrates of anatomical dysconnectivity patterns for schizophrenia and highlight the potential for connectome-based metrics as neural markers of illness progression and clinical change with treatment.

Sexual dimorphism in the brain maturation during childhood and adolescence has been repeatedly documented, which may underlie the differences in behaviors and cognitive performance. However, our understanding of how gender modulates the development of structural connectome in healthy adults is still not entirely clear. Here we utilized graph theoretical analysis of longitudinal diffusion tensor imaging data over a five-year period to investigate the progressive gender differences of brain network topology. The brain networks of both genders showed prominent economical “small-world” architecture (high local clustering and short paths between nodes). Additional analysis revealed a more economical “small-world” architecture in females as well as a greater global efficiency in males regardless of scan time point. At the regional level, both increased and decreased efficiency were found across the cerebral cortex for both males and females, indicating a compensation mechanism of cortical network reorganization over time. Furthermore, we found that weighted clustering coefficient exhibited significant gender-time interactions, implying different development trends between males and females. Moreover, several specific brain regions (e.g., insula, superior temporal gyrus, cuneus, putamen, and parahippocampal gyrus) exhibited different development trajectories between males and females. Our findings further prove the presence of sexual dimorphism in brain structures that may underlie gender differences in behavioral and cognitive functioning. The sex-specific progress trajectories in brain connectome revealed in this work provide an important foundation to delineate the gender related pathophysiological mechanisms in various neuropsychiatric disorders, which may potentially guide the development of sex-specific treatments for these devastating brain disorders.

Australia is a diverse country comprising people from many different backgrounds, races and ethnic groups including immigrant and indigenous cultures. The mental health needs of Australian society reflect the composition of the Australian population and the particular issues faced by the various sectors of the society. In conjunction with greater understanding of the significant burdens that illnesses such as dementia, depression, schizophrenia, suicide and anxiety disorders place on all levels of Australian society, there is a changing view of the priorities for mental health research. In this article we summarize current, emerging and future mental health challenges confronting Australia and review the efforts that Australian researchers are making to meet these challenges.Declaration of interest: The first author (S.L.C.) is a consultant for Cogtest Ltd, London and the second author (D.L.C.) has received Research funding from Eli Lilly and is a consultant for Novartis and Bristol-Myers Squibb.

Lateral biases in visual perception have been demonstrated in normal individuals and in patients with unilateral brain lesions. It has been suggested that the absence of structural and functional asymmetries in schizophrenia could be due to a failure in lateralisation that may be most pronounced in those patients whose illness onset is at an early age. Here we examined lateral biases in patients with schizophrenia of an early onset (N = 21) and a late onset.(N = 19), and their respective age-matched control groups, using the greyscales task, a sensitive measure of asymmetries in visual processing. The stimuli consisted of two rectangles, one above the other, shaded in opposite directions and matched overall for darkness. Participants judged which of the two rectangles looked darker overall. Previous studies using this task in healthy participants have reported a reliable bias, such that the rectangle with the darker end on the left is selected preferentially. Whereas the late-onset patients in this study exhibited a perceptual bias of similar direction and magnitude to that of controls, this was not the case for the early-onset patients, who exhibited significantly less bias than their control group. The reduced perceptual bias seen in the early-onset group, but not the late-onset group, suggests an attenuation of right hemisphere mechanisms dedicated to processing vistiospatial information. The attenuated perceptual asymmetry in the early-onset group only may be consistent with the view that (i) an earlier illness onset reflects a greater loss of hemispheric differentiation and (ii) reduced functional asymmetries in the early-onset group are a manifestation of a failure to allocate functions to one or the other hemisphere.

Background: Schizotypy provides an opportunity to study the continuum of psychosis. Recent evidence demonstrates polygenicity in schizophrenia and the potential value of neurocognition as an intermediate phenotype. The current study re-examines the neurocognitive structure across the schizophrenia spectrum.

Background:An association between metabolic syndrome (MetS) and disturbances in neurocognitive function has been identified in Caucasians but the nature and extent of impaired cognition in Asian MetS patients, who may be at greater risk of degenerative cognitive decline, remains unspecified.Methods:A cross-sectional study was conducted at the National University Hospital of Singapore. Participants were recruited from a diabetes clinic at the National University Hospital. Fifty-three patients who met MetS criteria and 44 clinical controls were recruited. All participants were 55 years and above and community ambulant. Neurocognitive function was assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB). CANTAB performances between MetS and control groups were examined with analysis of variance (ANOVA) and the relative contributions of vascular risk, and intrademographic factors on CANTAB scores were dilineated with stepwise regression analyses.Results:Participants with MetS consistently performed significantly worse than controls across all CANTAB subtests. Education and Chinese race were found to be potential protective factors.Conclusions:Executive and memory impairment is present in Asian patients with midlife MetS who may be particularly vulnerable to the detrimental impact of MetS in midlife.

Background:The Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were compared with and without the addition of a brief processing speed test, the symbol digit modalities test (SDMT), for vascular cognitive impairment (VCI) screening at three to six months after stroke.Methods:Patients with ischemic stroke and transient ischemic attack were assessed with MoCA and MMSE, as well as a formal neuropsychological battery three to six months after stroke. VCI was defined by impairment in any cognitive domain on neuropsychological testing. The area under the receiver operating characteristic curve (AUC) was used to compare test discriminatory ability.Results:One hundred and eighty-nine patients out of 327 (58%) had VCI, of whom 180 (95%) had vascular mild cognitive impairment (VaMCI), and nine (5%) had dementia. The overall AUCs of the MoCA and MMSE scores and performance at their respective cut-off points were equivalent in detecting VCI (AUCs: 0.87 (95% CI 0.83–0.91) vs. 0.84 (95% CI 0.80–0.88), p = 0.13; cut-offs: MoCA (≤23) vs. MMSE (≤26), sensitivity: 0.78 vs. 0.71; specificity: 0.80 vs. 0.82; positive predictive value: 0.84 vs. 0.84; negative predictive value: 0.72 vs. 0.67; and correctly classified 78.6% vs. 75.5%; p = 0.42). The AUCs of MMSE and MoCA were improved significantly by the SDMT (AUCs: MMSE+SDMT 0.90 (95% CI 0.87–0.93), p p < 0.02).Conclusions:The MoCA and MMSE are equivalent and moderately sensitive, and can be supplemented with the SDMT to improve their accuracy in VCI screening.

Meta-analyses in adult-onset schizophrenia report loss of normal planum temporale (PT) asymmetry, posited to relate to language and symptoms, but are inconclusive regarding global "cerebral torque". PT asymmetry has been reported unchanged in childhood onset schizophrenia. Here the discrepancy is examined in adolescence. Unbiased PT asymmetry and torque measures were obtained on 35 adolescents with schizophrenia or schizoaffective disorder and 31 adolescent controls. Patients had less PT asymmetry than controls, but torque was unchanged. Taken with previous reports, these results in adolescent onset psychosis suggest that local disturbance of cerebral asymmetry increases with patient age; it could indicate that differential rate of change at the cortical surface in the two hemispheres is the mechanism of symptom generation.

BackgroundAbnormalities in the corpus callosum have been reported in patients with schizophrenia for over 30 years but the influence of inter-individual differences and illness characteristics remains to be fully elucidated.AimsTo examine the influence of individual and illness characteristics on the corpus callosum in Chinese Singaporean patients with schizophrenia.MethodUsing magnetic resonance and diffusion tensor imaging, mean corpus callosum area, volume and fractional anisotropy were investigated in 120 Chinese Singaporean patients (52 with chronic and 68 with first-episode schizophrenia) and compared with data from 75 matched healthy controls.ResultsBoth area and volume were significantly reduced in patients relative to controls but no significant differences in corpus callosum existed between genders in either patients or controls. Differences in area and volume of the corpus callosum were greatest in patients whose condition was chronic relative to patients with a first episode and controls. Anterior callosum in patients, regardless of chronicity, was no different to that of controls.ConclusionsMorphological abnormalities in the corpus callosum may increase with illness progression.

Objectives To investigate the prognostic value of the neurocognitive status measured by screening instruments, the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE), individually and in combination with the stroke severity scale, the National Institute of Health Stroke Scale (NIHSS), obtained at the subacute stroke phase or the baseline (≤2 weeks), for functional outcome 3–6 months later. Design Prospective observational study. Setting Tertiary stroke neurology service. Participants 400 patients with a recent ischaemic stroke or transient ischaemic attack (TIA) received NIHSS, MoCA and MMSE at baseline and were followed up 3–6 months later. Primary outcome measures At 3–6 months following the index event, functional outcome was measured by the modified Rankin Scale (mRS) scores. Results Most patients (79.8%) had a mild ischaemic stroke and less disability (median NIHSS=2, median mRS=2 and median premorbid mRS=0), while a minority of patients had TIA (20.3%). Baseline NIHSS, MMSE and MoCA scores individually predicted mRS scores at 3–6 months, with NIHSS being the strongest predictor (NIHSS: R2 change=0.043, p2), baseline MoCA and MMSE had a significant and moderately large incremental predictive value to the baseline NIHSS for mRS scores at 3–6 months (MMSE: R2 changes=0.021, p=0.010; MoCA: R2 changes=0.017, p=0.021). Conclusions Cognitive screening at the subacute stroke phase can predict functional outcome independently and improve the predictive value of stroke severity scores for functional outcome 3–6 months later, particularly in patients with more severe stroke.