Evaluation of the non-auditory neurocognitive test MoCA-HI for hearing-impaired

BackgroundSince hearing loss and cognitive decline often co-occur among older adults, a cognitive screening test suitable for hearing-impaired people is of high clinical relevance. We report the first evaluation of a German language version of the Montreal Cognitive Assessment—Hearing Impaired version (MoCA-HI).ObjectiveThe aim of the present study was to compare cognitively healthy participants with and without hearing loss, to examine the impact of age, sex, educational level and degree of hearing impairment on the German MoCA-HI performance, and to develop normative data.Material and methodsThe German MoCA-HI was tested in 94 participants with normal or mild hearing impairment (group 1: 4PTA ≤ 40 dB on the better hearing ear) and 81 participants with moderate to profound hearing loss (group 2: 4PTA > 40 dB on the better hearing ear). Additionally, all participants performed the standard MoCA (version 8.2).ResultsNo significant group difference between group 1 and 2 was found in the MoCA-HI total score (p = 0.05). In contrast, group 1 performed significantly better than group 2 on the standard MoCA (p < 0.001). There was no difference between the MoCA and the MoCA-HI performance in group 1 (p = 0.12), whereas individuals of group 2 performed significantly better on the MoCA-HI than on the standard MoCA (p < 0.001). Test-retest reliability of the MoCA-HI was high (p < 0.001). Higher age (p < 0.001), male sex (p = 0.009) and lower education (p < 0.001) were associated with a lower overall MoCA-HI score. Based on the demographic data normative data were developed by a regression-based approach.ConclusionThe MoCA-HI is a cognitive screening test which is suitable for people with hearing impairment

Social robots as psychometric tools for cognitive assessment: a pilot test

Recent research demonstrated the benefits of employing robots as therapeutic assistants and caregivers, but very little is known on the use of robots as a tool for psychological assessment. Socially capable robots can provide many advantages to diagnostic practice: engage people, guarantee standardized administration and assessor neutrality, perform automatic recording of subject behaviors for further analysis by practitioners. In this paper, we present a pilot study on testing people’s cognitive functioning via social interaction with a humanoid robot. To this end, we programmed a social robot to administer a psychometric tool for detecting Mild Cognitive Impairment, a risk factor for dementia, implementing the first prototype of robotic assistant for mass screening of elderly population. Finally, we present a pilot test of the robotic procedure with healthy adults that show promising results of the robotic test, also compared to its traditional paper version

Is it feasible to deliver a complex intervention to improve the outcome of falls in people with dementia? A protocol for the DIFRID feasibility study

Background: People with dementia (PWD) experience ten times as many incident falls as people without dementia. Little is known about how best to deliver services to people with dementia following a fall. We used an integrated, mixed-methods approach to develop a new intervention which combines theory generated via a realist synthesis and data on current provision and pathways, gathered through a prospective observational study as well as qualitative interviews, focus groups, and ethnographic observation. This intervention is to be tested in a feasibility study in the UK National Health Service. Methods: People living with dementia in one of three geographical areas will be eligible for the study if they experience a fall requiring healthcare attention and have an informal carer. Potential participants will be identified by community services (primary care, paramedics, telecare), secondary care (ED; facilitated discharge services; rehabilitation outreach teams) and research case registers. Participants will receive a complex multidisciplinary intervention focused on their goals and interests for up to 12 weeks. The intervention will be delivered by occupational therapists, physiotherapists and rehabilitation support workers. Feasibility outcomes will include recruitment and retention, suitability and acceptability of outcome measures and acceptability, feasibility and fidelity of intervention components. PWD outcome measures will include number of falls, Montreal Cognitive Assessment (MOCA), European Quality of Life Instrument (EQ-5D-5L), Quality of Life–Alzheimer’s Disease Scale (QOL-AD), Modified Falls Efficacy Scale (MFES) and Goal Attainment Scaling (GAS). PWD outcome measures completed by an informal carer will include Disability Assessment for Dementia (DAD), EQ-5D-5L Proxy, QoL-AD Proxy and a Health Utilisation Questionnaire (HUQ), The carer outcome measure will be the Zarit Burden Interview (ZBI). An embedded process evaluation will explore barriers and facilitators to recruitment and intervention delivery. Discussion: The study results will inform whether and how a larger multicentre RCT should be undertaken. A full RCT would have the potential to show how outcomes can be improved for people with dementia who have fallen. Ethics and dissemination: The National Research Ethics Service Committee Newcastle and North Tyneside 2 approved the feasibility study. Trial registration: International Standard Randomised Controlled Trial Registry Registration number: ISRCTN41760734 Date of registration: 16/11/201

Montreal Cognitive Assessment Memory Index Score (MoCA-MIS) as a predictor of conversion from mild cognitive impairment to Alzheimer\u27s disease

OBJECTIVES: To assess the usefulness of the Montreal Cognitive Assessment (MoCA) total score (MoCA-TS) and Memory Index Score (MoCA-MIS) in predicting conversion to Alzheimer\u27s disease (AD) in individuals with mild cognitive impairment (MCI). DESIGN: Retrospective chart review. SETTING: Community-based memory clinic. PARTICIPANTS: Individuals meeting Petersen\u27s MCI criteria (N = 165). MEASUREMENTS: Baseline MoCA scores at MCI diagnosis were collected from charts of eligible individuals with MCI, and MoCA-TS, MoCA-MIS, and a cognitive domain index score were calculated to assess their prognostic value in predicting conversion to AD. RESULTS: One hundred fourteen participants progressed to AD (MCI-AD), and 51 did not (nonconverters; MCI-NC); 90.5% of participants with MCI with a MoCA-TS less than 20/30 and a MoCA-MIS less than 7/15 at baseline converted to AD within the average follow-up period of 18 months, compared with 52.7% of participants with MCI above the cutoffs on both scores. Individuals with multiple-domain amnestic MCI had the highest AD conversion rates (73.9%). CONCLUSION: Identifying individuals with MCI at high risk of conversion to AD is important clinically and for selecting appropriate subjects for therapeutic trials. Individuals with MCI with a low MoCA-TS and a low newly devised memory index score (MoCA-MIS) are at greater risk of short-term conversion to AD

The Montreal Cognitive Assessment-Basic: A Screening Tool for Mild Cognitive Impairment in Illiterate and Low-Educated Elderly Adults

OBJECTIVES: To assess the validity of a newly developed cognitive screening tool, the Montreal Cognitive Assessment-Basic (MoCA-B), in screening for mild cognitive impairment (MCI) in elderly adults with low education and varying literacy. DESIGN: Cross-sectional. SETTING: Community hospital in Bangkok, Thailand. PARTICIPANTS: Cognitively normal controls (n = 43) and individuals with MCI according to the National Institute on Aging-Alzheimer\u27s Association work group criteria (n = 42) aged 55 to 80 with less than 5 years of education. MEASUREMENTS: MoCA-B scores. RESULTS: Mean MoCA-B scores were 26.3 ± 1.6 for illiterate controls and 21.3 ± 3.8 for illiterate participants with MCI (P \u3c .001) and 26.6 ± 2.0 for literate controls and 23.0 ± 2.1 for literate participants with MCI (P \u3c .001). MoCA-B scores did not differ significantly according to literacy, and multiple regression suggested no association with age or education. The optimal cutoff score of 24 out of 25 yielded 81% sensitivity and 86% specificity for MCI (area under the receiver operating characteristic curve = 0.90, P \u3c .001). Test-retest reliability was 0.91 (P \u3c .001), and internal consistency was 0.82. Administration time was 15 to 21 minutes. CONCLUSION: The MoCA-B appears to have excellent validity and addresses an unmet need by accurately screening for MCI in poorly educated older adults regardless of literacy

Vascular retinal biomarkers improves the detection of the likely cerebral amyloid status from hyperspectral retinal images

ABSTRACT: Introduction This study investigates the relationship between retinal image features and β-amyloid (Aβ) burden in the brain with the aim of developing a noninvasive method to predict the deposition of Aβ in the brain of patients with Alzheimer's disease. Methods Retinal images from 20 cognitively impaired and 26 cognitively unimpaired cases were acquired (3 images per subject) using a hyperspectral retinal camera. The cerebral amyloid status was determined from binary reads by a panel of 3 expert raters on 18F-florbetaben positron-emission tomography (PET) studies. Image features from the hyperspectral retinal images were calculated, including vessels tortuosity and diameter and spatial-spectral texture measures in different retinal anatomical regions. Results Retinal venules of amyloid-positive subjects (Aβ+) showed a higher mean tortuosity compared with the amyloid-negative (Aβ−) subjects. Arteriolar diameter of Aβ+ subjects was found to be higher than the Aβ− subjects in a zone adjacent to the optical nerve head. Furthermore, a significant difference between texture measures built over retinal arterioles and their adjacent regions were observed in Aβ+ subjects when compared with the Aβ−. A classifier was trained to automatically discriminate subjects combining the extracted features. The classifier could discern Aβ+ subjects from Aβ− subjects with an accuracy of 85%. Discussion Significant differences in texture measures were observed in the spectral range 450 to 550 nm which is known as the spectral region known to be affected by scattering from amyloid aggregates in the retina. This study suggests that the inclusion of metrics related to the retinal vasculature and tissue-related textures extracted from vessels and surrounding regions could improve the discrimination performance of the cerebral amyloid status