INTRODUCTION:Cognitive impairment remains underdetected in clinical practice, with prevalence estimates exceeding the official statistics. Most existing screening tools rarely extend beyond cognitive performance to capture the broader context of individual ageing, thus increasing the risk of misdiagnosis. Riga Cognitive Screening Task (RiTa) was developed to address these gaps. METHODS:RiTa development and evaluation were conducted in three phases. The item development phase combined a literature review, exploratory factor analysis, and analysis of cognitive screening tools. Content validity was assessed by three experts, and face validity was assessed with nine older adults. 134 older adults (aged 51-92, M = 68.34, 35.8% male) participated in the pilot study. Cognition and protective factors were assessed with RiTa, while Montreal Cognitive Assessment (MoCA) was used for convergent validity. A subset of participants (n=107) underwent structural MRI. RESULTS:Expert evaluations and participant interviews supported the content and face validity of RiTa. The Cognitive Assessment scale differentiated between diagnostic groups in most tasks, with the overall group effect remaining significant after adjustment for age and education. It also demonstrated strong convergent validity with MoCA. ROC analyses indicated solid discrimination between normal cognition and MCI and near-perfect discrimination for MNcI. Criterion validity was supported by strong correlations with medial temporal atrophy scores. The Protective Factors scale showed an emerging conceptual structure, but no significant association with cognitive performance in this pilot sample. CONCLUSION:RiTa demonstrates encouraging validity as a multidomain screening tool. Further refinement of the Protective Factor scale and validation in larger samples are warranted.
INTRODUCTION:Cognitive impairment is a major source of disability in Parkinsonian disorders, yet biomarkers that distinguish cognitive status from cognitive decline remain limited. DNA methylation-based epigenetic aging (EA) measures capture complementary dimensions of biological aging, but it remains unclear whether they primarily reflect stable between-person differences in cognitive performance or longitudinal cognitive change. METHODS:We examined associations between EA measures and global cognition in the Parkinson's Progression Markers Initiative (PPMI) cohort. Seven EA measures were derived from peripheral blood DNA methylation data, and cognition was assessed longitudinally using the Montreal Cognitive Assessment (MoCA). Linear mixed-effects models included baseline-plus-change-from-baseline, within-person versus between-person decomposition, baseline clock-by-time interaction, and decline-focused sensitivity models. RESULTS:Higher EA was consistently associated with lower overall MoCA scores. In baseline-plus-change-from-baseline models, the analytic-baseline component showed the dominant signal, whereas the change-from-baseline terms were not significant after false discovery rate correction. In decomposition models, associations were concentrated in the between-person component, while within-person deviation terms were not significant. Secondary analyses were consistent with this pattern. CONCLUSION:Blood-based EA measures may be more informative as markers of cognitive status than as markers of short-term cognitive progression. Larger studies with longer follow-up and more detailed domain-specific cognitive phenotyping are needed to clarify their longitudinal relevance.
BACKGROUND:Frontotemporal Dementia (FTD) is a progressive neurodegenerative disorder marked by early-onset behavioral and cognitive impairments with no current disease-specific treatment. As traditional pharmacologic interventions provide only symptomatic relief and carry significant limitations, nonpharmacologic strategies such as physical activity (PA) are gaining attention as potential disease-modifying approaches. SUMMARY:This narrative review synthesizes emerging evidence on the neuroprotective effects of PA in FTD, including its possible relationship to neurotrophic signaling, neuroinflammation, mitochondrial function, and axonal integrity. Relevant literature was identified through a review of preclinical and clinical studies of PA and FTD. KEY MESSAGES:Preclinical and clinical studies suggest that PA may be associated with slower symptom progression and mild behavioral and cognitive improvements in patients with FTD. Although limited by small sample sizes, observational studies, and variability in study design, preliminary data suggest that further studies on PA and FTD are warranted, including mechanistic investigations. Randomized controlled trials are needed to establish guidelines for exercise prescriptions that can be tailored to FTD patients. Until then, supervised PA in FTD care may be considered a potential adjunct pending further validation due to its accessibility, low risk, and potential for broad therapeutic benefit.
INTRODUCTION:Social cognition (SC) is often impaired by dementia, contributing to difficulties with relationships and social isolation. Additionally, people with dementia frequently have impaired awareness of their impairments, which may worsen distress for them, their family, and friends. We investigated SC in people with Alzheimer's disease (PwAD), awareness of SC, and whether PwAD overestimate SC abilities compared to healthy controls (HC). METHODS:Participants completed the Interpersonal Reactivity Index perspective-taking subscale (IRI-PT), a self-report measure of SC, and The Awareness of Social Inference Test (short form) (TASIT-S), a task-based measure of SC. Insight was evaluated by comparing self-assessment with TASIT-S performance. The Addenbrooke's Cognitive Examination (version 3; ACE-III) measured general cognition. RESULTS:We recruited 70 PwAD (mean age = 78.13; mean ACE-III = 71.80) and 17 HC (mean age = 71.53; mean ACE-III = 96.65). PwAD self-reported lower theory of mind (ToM) (IRI-PT = -2.16, 95% CI = -0.33 to 4.64, p = 0.09) and performed worse on TASIT-S emotion recognition (-2.04, 95% CI = -2.89 to -1.20, p < 0.001), sarcasm recognition (-0.91, 95% CI = -1.66 to -0.16, p = 0.02), and ToM assessments (-1.42, 95% CI = -2.27 to -0.57, p = 0.001). There was no significant relationship between IRI-PT and TASIT-S ToM in either group, nor in the participant group as a whole. We categorised "under-estimators" (low IRI-PT, high TASIT-S ToM), "over-estimators" (high IRI-PT, low TASIT-S ToM), and "congruent-estimators" and found that lower ACE-III was associated with ToM over-estimation. CONCLUSION:Differences in self-reported and task-assessed SC were observed between PwAD and HC, but self-estimated and task-assessed ToM were not associated, suggesting that SC self-estimation is unreliable in PwAD and possibly in healthy older adults.
Introduction: Frontotemporal dementia (FTD) comprises a heterogeneous group of neurodegenerative syndromes characterized by diverse behavioural, cognitive, and language profiles. Longitudinal data describing its clinical course progression using FTD-specific instruments remain limited. This study aimed to characterize the functional, cognitive, and behavioural trajectories of FTD clinical syndromes in a Spanish cohort, including assessments performed remotely during the COVID-19 pandemic. Methods: Sixty-seven patients diagnosed with behavioural variant FTD (bvFTD), non-fluent variant primary progressive aphasia, or semantic variant PPA (svPPA) were prospectively followed at Hospital Universitario 12 de Octubre (Madrid, Spain). Functional and neuropsychiatric status were assessed with the Frontotemporal Dementia Rating Scale (FTD-FRS), the Interview for Deterioration in Daily Activities in Dementia (IDDD), the Neuropsychiatric Inventory (NPI), and the telephone Mini-Mental State Examination (t-MMSE). Thirty-three assessments were conducted remotely during pandemic restrictions. Results: Over a mean follow-up of 3.1 years, significant declines were observed in FTD-FRS, IDDD, and t-MMSE (p < 0.001), whereas NPI scores remained stable. The svPPA group exhibited the greatest cognitive and functional decline, while bvFTD showed more heterogeneous progression. Twelve participants (18%) died during follow-up, predominantly older men with poorer baseline performance. Conclusion: Functional and cognitive decline in FTD varies across clinical variants, with the semantic subtype showing the most rapid progression in our cohort. Remote assessments are feasible and represent a valid approach for longitudinal monitoring.
BACKGROUND:Accurate evaluation of quality of life (QoL) is essential for optimal dementia management, yet notable discrepancies exist between patient self-rated and proxy-rated QoL. This study aimed to analyse the discrepancies and agreement between self-rated and proxy-rated QoL and identify their independent predictors among community-dwelling persons with mild dementia (PwMD). METHODS:This cross-sectional study included 129 PwMD and their primary caregivers. Assessments included sociodemographic information, the QoL-Alzheimer's Disease scale, Mini-Mental State Examination, Geriatric Depression Scale, Activities of Daily Living, Functional Activities Questionnaire and Neuropsychiatric Inventory Questionnaire. Differences and agreement were analyzed using Wilcoxon tests, Spearman correlations, and intraclass correlation coefficients (ICC). Independent predictors were identified through multiple linear regression. RESULTS:Patients rated their QoL significantly higher than their caregivers did, with poor-to-fair agreement at the total, dimensional and item levels (ICC = 0.11-0.50). Higher depressive symptoms (β = -0.354, p = 0.001), lower severity of elation (β = 0.214, p = 0.013), and greater disinhibition (β = -0.174, p = 0.041) independently predicted poorer self-rated QoL. By contrast, greater neuropsychiatric symptom severity (β = -0.283, p < 0.001), poorer Activities of Daily Living function (β = -0.230, p = 0.006), and polypharmacy (β = -0.208, p = 0.009) predicted lower proxy-rated QoL. CONCLUSION:Self- and proxy-rated QoL reflect distinct evaluative perspectives in PwMD. Self-reports are influenced by emotional and psychological states, whereas proxy ratings are shaped by observable symptoms, functional dependency and treatment burden. These findings suggest the need to integrate both assessment perspectives in clinical practice.
INTRODUCTION:This study evaluated the psychometric properties of the Farsi version of the Saint Louis University Mental Status (SLUMS) examination, marking the first such investigation. METHODS:The sample comprised 200 participants: 75 with normal cognition, 74 with mild cognitive impairment (MCI), and 51 with dementia. Concurrent validity was assessed using the MMSE and NUCOG; divergent validity employed the GDS-15. RESULTS:Exploratory factor analysis showed a unidimensional structure. Internal consistency (Cronbach's α = 0.719) and test-retest reliability (intraclass correlation coefficient = 0.717) were satisfactory. SLUMS correlated highly with MMSE (r = 0.787) and NUCOG (r = 0.861), but moderately with GDS-15 (r = -0.376). It effectively discriminated dementia from MCI but showed limited ability to differentiate normal cognition from MCI. CONCLUSION:The Farsi SLUMS is a suitable screening tool for detecting dementia, though caution is advised when distinguishing MCI from normal cognition.
Introduction: Early methods for screening and monitoring Alzheimer’s disease and other dementias are being developed in response to emerging interventions that target preclinical disease stages. This study aimed to determine adults’ willingness to be screened for dementia risk, and the extent to which privacy of results relative to medical or insurance providers impacted their decision. Methods: Amazon MTurk was used to survey 527 adults nationwide. Results: Logistic regression and random forest models identified that, overall, participants were willing to take such a test, with older age being associated with increased willingness. However, non-white participants were over 3 times more likely than white participants to agree to be screened only if their results were not shared with a medical provider/insurer. Conclusion: Findings suggest that more inclusive and affordable methods for dementia risk screening and monitoring need to be developed for real-world at-home use without engaging medical providers or insurance.
INTRODUCTION:Limitations in activities of daily living represent a crucial risk factor for cognitive decline, while the role of caregiving models in this process remains unclearly elucidated. To examine the correlation between different caregiving models and cognitive decline of people aged 45 and above with basic activity of daily living (BADL)/instrumental activities of daily living (IADL) limitations. METHODS:Data were derived from the China Health and Retirement Longitudinal Study database covering the period 2011-2020. Using multiple linear regression models and linear mixed effect models (LMM), the association between different nursing models and cognitive function trajectories was systematically evaluated, and subgroup analyses were conducted to test the robustness and heterogeneity of the results. RESULTS:Multiple regression analysis indicated that spousal care was negatively associated with Mini-Mental State Examination (MMES) scores (OR = 0.68, 95% CI: 0.12-1.24, p = 0.017), whereas care provided by children, other relatives, and hired caregivers notably improved MMSE scores (p < 0.05), with hired care yielding the greatest improvement (OR = 4.61, 95% CI: 2.08-7.14, p < 0.001). The LMM further revealed that, compared to no care, all other care types were substantially related to the rate of change in MMSE scores over time. Subgroup analysis demonstrated pronounced interactions in sex and chronic disease subgroups (P for interaction <0.05). CONCLUSION:This work provides empirical evidence for optimizing long-term care services, highlighting the importance of integrating professional care support to delay cognitive decline among individuals aged 45 and older with BADL/IADL limitations.
INTRODUCTION:The relationship between cognitive defects and missing teeth has drawn increasing research attention in recent years. However, little research has specifically demonstrated the correlation between mild cognitive impairment (MCI) and missing teeth, and existing findings remain inconsistent. Thus, we conducted a systematic review synthesizing current evidence on tooth loss and MCI, aiming to address this gap. METHODS:The reviewers searched Embase, Scopus, and PubMed for relevant studies published up to May 2025. An updated search was conducted in December 2025. Dual-independent literature reviewing was performed at all stages, with conflicts resolved by consensus. RESULTS:From an initial pool of 2,709 articles, 113 underwent full-text reading, and 10 met the inclusion criteria. Our findings suggest that missing teeth, including the number of teeth lost, the number of functional teeth remaining, categorized tooth loss, and the rate of tooth loss, are significantly associated with MCI. Potential mechanisms may involve periodontal inflammation triggering neuroinflammation, reduced chewing-related neural stimulation, impaired nutrient intake, and social isolation. CONCLUSIONS:Although limited evidence suggests an association between tooth loss and MCI, offering potential avenues for MCI prevention through oral health interventions, the overall quality of the research remains low. Further high-quality studies will be needed to validate these findings.
INTRODUCTION:Adverse childhood experiences (ACEs) may have long-term effects on cognitive and motor function in later life. This study examined the association between ACEs and motoric cognitive risk (MCR) syndrome among older adults in China and investigated whether depression and chronic pain mediate this relationship. METHODS:This cross-sectional study analyzed 3,983 adults aged ≥60 years from the China Health and Retirement Longitudinal Study (CHARLS). Twelve ACE indicators were assessed across conventional, expanded, and new categories. MCR was diagnosed based on cognitive complaints and slow gait speed. Depression was evaluated using the 10-item Center for Epidemiologic Studies Depression Scale, and chronic pain through standardized questionnaires. Multivariable logistic regression models and parallel mediation analyses examined associations between ACEs and MCR. RESULTS:The study included 3,983 older adults with a median age of 66 years (interquartile range: 63-71), of whom 59.3% were male. MCR was identified in 12.9% (n = 512) of participants, with emotional neglect (40.1%) and physical abuse (30.7%) being the most common ACEs. Participants with 1-3 ACEs (adjusted odds ratio [OR] = 1.41, 95% confidence interval [CI]: 1.05-1.93) and ≥4 ACEs (adjusted OR = 1.69, 95% CI: 1.19-2.43) showed significantly higher odds of MCR compared to those without ACEs. Depression and chronic pain mediated 14.3% and 21.4% of the total effect, respectively. CONCLUSION:ACEs demonstrated dose-dependent associations with MCR in Chinese older adults, partially mediated through depression and chronic pain. These findings suggest that screening for ACE exposure and addressing mental and physical health may be critical for preventing cognitive-motor decline in later life.
INTRODUCTION:This study evaluates the clinical validity of the Korean Computerized Cognitive Function Test (CFT-S) by comparing its domain-specific scores with those of the Seoul Neuropsychological Screening Battery-II (SNSB-II) in patients with mild cognitive impairment (MCI) or Alzheimer's disease (AD). METHODS:A total of 300 participants (MCI: n = 163; AD: n = 137) from Severance Hospital completed both CFT-S and SNSB-II assessments within a 2-week interval, along with brain MRI and APOE genotyping. Pearson correlations and multiple regression analyses examined relationships between cognitive scores and biomarker variables. Receiver operating characteristic curves assessed diagnostic accuracy. Bland-Altman plots evaluated agreement across five shared cognitive domains. RESULTS:CFT-S index scores showed significant positive correlations with SNSB-II in attention, language, visuospatial, and executive domains (r = 0.59-0.71, p < 0.001). The memory domain showed a lower correlation in AD patients (r = 0.28), reflecting limitations under severe impairment. Hippocampal volume was positively associated with MMSE (r = 0.54), CFT-S Memory (r = 0.50), and SNSB Memory Scores (r = 0.52). Education correlated with MMSE (r = 0.32) but not with CFT-S or SNSB, suggesting minimal education bias. APOE-ε4 carriers had smaller hippocampal volumes, higher FBB-PET BAPL scores, and poorer cognitive outcomes. The Bland-Altman plots demonstrated acceptable agreement at the group level between CFT-S and SNSB-II across all cognitive domains, with small mean biases and symmetric distributions despite relatively wide limits of agreement. CONCLUSION:CFT-S index scores and Bland-Altman plot analysis demonstrated validity relative to SNSB-II, with significant associations to hippocampal atrophy and genetic risk factors. The findings support CFT-S as a viable and efficient cognitive assessment tool for diagnosing MCI and AD.
INTRODUCTION:With the aging global population, effective screening tools for age-related cognitive disorders are urgently needed. Mild cognitive impairment (MCI), a transitional stage between normal aging and dementia, requires early detection for timely intervention. METHODS:The current research developed an innovative electronic assessment tool designed with three task modules targeting executive function, memory binding, and spatial navigation to quickly screen for MCI in older adults. A validation study was conducted with 271 older participants, aged 56 to 89, comprising 138 individuals with MCI and 133 cognitively normal controls. An independent dataset from a community hospital was used for further confirmation. RESULTS:The validation study indicated excellent reliability and validity, achieving 72% accuracy in distinguishing MCI from cognitively normal individuals, with excellent screening power (AUC = 0.807; 95% CI: 0.756-0.858). This performance surpasses that of the paper-and-pencil Mini-Mental State Examination (MMSE). The independent dataset from a community hospital further confirmed that the tool achieved a good accuracy rate of 93% (26/28) in predicting MCI. CONCLUSION:These results provide strong tool support for the early identification of MCI, enhancing the effective management of cognitive decline in at-risk elderly individuals.
INTRODUCTION:Behavioral and psychological symptoms of dementia (BPSD) substantially contribute to functional decline and caregiver burden, yet culturally validated assessment tools remain limited in Vietnam. This study aimed to translate, culturally adapt, and assess the reliability and selected aspects of construct validity of the Vietnamese version of the Neuropsychiatric Inventory (V-NPI). METHODS:A cross-sectional study was conducted among 399 individuals with dementia and their caregivers in Hai Duong province. The V-NPI was administered alongside the Clinical Dementia Rating (CDR), Geriatric Depression Scale-15 (GDS-15), and Pittsburgh Sleep Quality Index (PSQI). Internal consistency, domain-level associations, and convergent and discriminant validity were assessed. RESULTS:The V-NPI demonstrated excellent internal consistency for both the severity (Cronbach's α = 0.91) and caregiver distress (Cronbach's α = 0.93) subscales. Domain-total correlations ranged from 0.44 to 0.64, indicating moderate internal convergence alongside meaningful heterogeneity across symptom domains. The depression domain showed a modest correlation with the GDS-15, and the night-time disturbances domain showed a weak but statistically significant correlation with the PSQI, supporting domain-level construct validity. Neuropsychiatric symptoms were highly prevalent, with night-time disturbances (71.2%), apathy/indifference (60.2%), and depression/dysphoria (59.6%) being the most frequently reported domains. CONCLUSION:The V-NPI appears to be a reliable and culturally appropriate instrument for assessing BPSD and caregiver distress among older adults with dementia in Vietnam, supporting its use in both clinical practice and research.
INTRODUCTION:Elevated total tau protein (t-τ) in the cerebrospinal fluid (CSF) is routinely used as a marker of Creutzfeldt-Jakob disease (CJD). We hypothesized that CSF t-τ and patients' age may anticipate survival time (ST) also in subjects with familial CJD (f-CJD) as has been shown previously in sporadic CJD (s-CJD). METHODS:We analyzed data from the Israeli National CJD Registry from 1991 to 2022. The data included cases of both f-CJD and s-CJD in whom demographic data and CSF t-τ levels were measured, and the date of death was available. Using X-tile software, we determined the optimal cut-off points for continuous variables in survival analysis and found the cut-points for t-τ level and patients' age. RESULTS:We analyzed data on 183 sequential CJD patients. The data included definite (n = 9), probable (n = 165), and possible (n = 9) CJD cases of whom 120 (61 males) were f-CJD (65.6%) and 63 (35 males) patients were s-CJD (34.4%). The cut-off value of CSF t-τ level was found to be 1,226 pg/mL. It separated ST into two groups, 105 days (interquartile ranges [IQR]: 59-305) in the lower group vs. 59 days (IQR: 29.5-147.5) in the higher, p = 0.0005. Cox analyses showed that for every 100 pg/mL increase in CSF t-τ, ST shortened by 3% in days (Exp β = 1.0003; 95% confidence interval: 1.0001-1.0005). Age had no direct prognostic value but correlated with CSF t-τ levels (rho = 0.243, p < 0.001). CONCLUSIONS:Age and CSF t-τ levels above the cut-off value predict ST shortening in patients with both f-CJD and s-CJD.
Introduction: Global variation in dementia incidence reflects demographic and socioeconomic forces, yet the role of staple dietary patterns remains less defined. While population ageing is a key determinant of dementia burden, differences in cereal consumption, particularly rice, wheat, and maize, have received limited attention. This ecological study examined whether national cereal consumption patterns are associated with dementia incidence across countries independent of confounding factors. Methods: Country-level data from 204 nations were compiled, with complete case analyses conducted in 184 countries. Alzheimer’s disease and other dementias incidence in 2021 served as the outcome variable. Predictors included per capita consumptions of total cereals, rice, wheat, and maize, alongside genetic predisposition, economic affluence, urban living, ageing indexed by life expectancy at age sixty, and meat consumption. Pearson and partial correlations, principal component analysis, and stepwise multiple regression were applied. Results: Wheat consumption was positively associated with dementia incidence, affluence, and longevity, whereas rice and maize consumption showed inverse associations. Partial correlations confirmed a persistent inverse association for rice consumption and a weaker inverse association for total cereal consumption after adjustment. Principal component analysis identified a socioeconomic component aligned with wheat consumption and ageing, while rice and maize loaded inversely. Stepwise regression demonstrated that ageing was the strongest predictor of dementia incidence, while rice and total cereal consumption retained small independent inverse associations. Conclusions: Global dementia incidence is driven primarily by population ageing and socioeconomic development. Cereal type reflects distinct developmental contexts, with rice-based patterns associated with a modestly lower dementia burden.
INTRODUCTION:Differentiating frontotemporal lobar degeneration (FTLD) from Alzheimer's disease (AD), particularly when presenting with overlapping behavioural symptoms, remains clinically challenging. This study assessed the utility of Addenbrooke's Cognitive Examination-III (ACE-III)-derived ratios in distinguishing these conditions. METHODS:A retrospective cohort of 115 patients (n = 52 biomarker-confirmed AD, n = 63 FTLD) with overlapping behavioural symptoms was analysed. ACE-III scores and behavioural profiles were examined, and novel ratios were tested. RESULTS:The novel Phonemic Fluency/Orientation-Memory (PFOM) ratio outperformed existing ACE-III metrics, achieving an area under the curve of 0.85 (sensitivity 84.1%, specificity 73.1%) for differentiating FTLD from AD. Notably, longer symptom duration in AD, but not in FTLD, was associated with worsening frontal and cognitive symptoms. Patients with AD were significantly older than those with FTLD. CONCLUSION:These novel ratios showed robust diagnostic performance, regardless of disease duration, and better reflect FTLDs cognitive profile. They may offer improved clinical utility over traditional ACE-III measures.
INTRODUCTION:Neuropsychiatric symptoms (NPS) are highly prevalent in dementia and represent a major driver of functional decline, caregiver burden, and mortality. When symptoms become severe or refractory to non-pharmacological measures, antipsychotics are frequently introduced despite ongoing safety concerns. Their impact on survival in community-dwelling patients with NPS, however, remains uncertain. This study aimed to examine the association between antipsychotic use and all-cause mortality in older adults with dementia and NPS. METHODS:This analysis was registered in PROSPERO (CRD42024621462), conducted in accordance with the Cochrane Handbook, and reported following PRISMA 2020 guidelines. Eligible observational studies included community-dwelling adults aged ≥65 years with dementia and documented NPS, reporting adjusted hazard ratios (aHRs) for antipsychotic use and all-cause mortality. Pooled estimates were derived using fixed-effects models. RESULTS:Five observational cohort studies including 14,183 participants were analyzed. Antipsychotic use was not significantly associated with all-cause mortality (pooled aHR = 1.06; 95% CI: 0.97-1.16; p = 0.21; I2 = 43%). Subgroup analyses showed aHR = 0.79 (95% CI: 0.62-1.01) for typical antipsychotics and aHR = 1.23 (95% CI: 0.97-1.56) for atypical agents, with a significant difference between classes (p = 0.03). CONCLUSIONS:In community-dwelling older adults with dementia and NPS, no statistically significant association between antipsychotic use and all-cause mortality was observed. However, the available evidence is limited and imprecise, resulting in substantial uncertainty. These findings should therefore be interpreted with caution. This study is a secondary analysis of a previously published systematic review and meta-analysis [O'Hara-Veintimilla et al. Am J Geriatr Psychiatry. 2025;23(25):S1064-7481].
INTRODUCTION:Post-stroke cognitive impairment is associated with increased mortality and healthcare costs. However, its characteristics in patients with large vessel occlusion after mechanical thrombectomy (MT) remain unclear. In this study, we aimed to evaluate the feasibility of administering the Montreal Cognitive Assessment (MoCA) in the acute phase after MT and examine its association with long-term cognitive outcomes. METHODS:We retrospectively analyzed patients with acute ischemic stroke (AIS) who underwent MT and completed MoCA within 5 days of admission, using data from a prospective registry. Patients were classified into acute MoCA feasible and non-feasible groups. Clinical characteristics and cognitive outcomes were compared between the groups, including MoCA and modified Rankin Scale (mRS) scores post-MT. RESULTS:In total, 161 patients were enrolled: 77 (median age, 73 years; 56 men) in the feasible group and 84 (median age, 77 years; 50 men) in the non-feasible group. Multivariate analysis showed that higher National Institute of Health Stroke Scale score on admission (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.03-1.14; p < 0.01) and left-sided occlusion (OR 2.17, 95% CI 2.17-4.00, p = 0.01) were independently associated with MoCA feasibility. Among 51 patients assessed at 6 months, over 80% had persistent cognitive impairment. The chronic MoCA score in the feasible group was 24 and in the non-feasible group was 17. Both groups achieved a favorable functional outcome (mRS score ≤2). CONCLUSION:Over 80% of patients with AIS who underwent MT experienced chronic cognitive impairment, even among those with favorable functional outcomes.
INTRODUCTION:The Mini-Mental State Examination (MMSE) is widely utilized in clinical settings for cognitive screening, yet its diagnostic accuracy is often influenced by demographic factors such as educational attainment. This study investigates the educational gradient in MMSE performance and evaluates whether uniform cutoff scores adequately distinguish cognitively normal (CN), mild cognitive impairment (MCI), and Alzheimer's disease (AD) patients across different educational strata. METHODS:A total of 300 older adults (CN = 100; MCI = 100; AD = 100) were retrospectively recruited from the Severance Hospital memory clinic, intentionally balanced to ensure statistical power and avoid class-imbalance bias across diagnostic groups. All participants completed the Korean version of MMSE and the Seoul Neuropsychological Screening Battery-II (SNSB-II) and underwent 3T brain MRI for hippocampal volumetry. Education level was categorized as low (≤6 years), medium (7-12 years), and high (≥13 years). MMSE diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curve analyses stratified by education. Interaction effects were tested via multiple linear regression, and correlations with hippocampal volume were assessed. RESULTS:MMSE scores showed a significant educational gradient, with higher education associated with higher performance (p < 0.001). MMSE scores demonstrated a pronounced educational gradient, with particularly reduced performance in individuals with low educational attainment, suggesting potential overestimation of cognitive impairment when uniform MMSE cutoffs are applied. ROC analyses revealed only moderate diagnostic accuracy of MMSE in the higher education groups (area under the curve [AUC] = 0.83 and 0.78). The AUC was 0.73 (95% CI: 0.58-0.88) in the low-education group; the AUC was 0.83 (95% CI: 0.75-0.91) in the middle-education group and 0.78 (95% CI: 0.70-0.87) in the high-education group, suggesting only moderate diagnostic accuracy of MMSE. Conversely, lower education groups showed underperformance potentially unrelated to pathology. Regression models confirmed that education and diagnosis had additive but noninteracting effects on MMSE scores. MMSE correlated strongly with hippocampal volume (r = 0.739, p < 0.001), validating its general neuroanatomical relevance. CONCLUSION:MMSE performance is substantially modulated by education, with uniform cutoffs yielding differential diagnostic validity across educational strata. We suggest education-adjusted interpretation of MMSE and emphasize the need for integrative diagnostic approaches combining cognitive testing with neuroimaging biomarkers.
