Cláudia Memória

Brief screening for mild cognitive impairment: validation of the Brazilian version of the Montreal cognitive assessment

The Montreal Cognitive Assessment (MoCA) is a brief cognitive schedule that has been developed for the screening of patients with Mild Cognitive Impairment (MCI). MCI is recognized as a high‐risk state for Alzheimers disease. The aim of the present study is to examine the reliability and validity of the Brazilian version of the MoCA test (MoCA‐BR) in a sample of older individuals with at least 4 years of education.

Diagnostic transitions in mild cognitive impairment subtypes

BACKGROUND At least for a subset of patients, the clinical diagnosis of mild cognitive impairment (MCI) may represent an intermediate stage between normal aging and dementia. Nevertheless, the patterns of transition of cognitive states between normal cognitive aging and MCI to dementia are not well established. In this study we address the pattern of transitions between cognitive states in patients with MCI and healthy controls, prior to the conversion to dementia. METHODS 139 subjects (78% women, mean age, 68.5 +/- 6.1 years; mean educational level, 11.7 +/- 5.4 years) were consecutively assessed in a memory clinic with a standardized clinical and neuropsychological protocol, and classified as cognitively healthy (normal controls) or with MCI (including subtypes) at baseline. These subjects underwent annual reassessments (mean duration of follow-up: 2.7 +/- 1.1 years), in which cognitive state was ascertained independently of prior diagnoses. The pattern of transitions of the cognitive state was determined by Markov chain analysis. RESULTS The transitions from one cognitive state to another varied substantially between MCI subtypes. Single-domain MCI (amnestic and non-amnestic) more frequently returned to normal cognitive state upon follow-up (22.5% and 21%, respectively). Among subjects who progressed to Alzheimers disease (AD), the most common diagnosis immediately prior conversion was multiple-domain MCI (85%). CONCLUSION The clinical diagnosis of MCI and its subtypes yields groups of patients with heterogeneous patterns of transitions between one given cognitive state to another. The presence of more severe and widespread cognitive deficits, as indicated by the group of multiple-domain amnestic MCI may be a better predictor of AD than single-domain amnestic or non-amnestic deficits. These higher-risk individuals could probably be the best candidates for the development of preventive strategies and early treatment for the disease.

Psychometric characteristics of the Rivermead Behavioural Memory Test (RBMT) as an early detection instrument for dementia and mild cognitive impairment in Brazil.

BACKGROUND The Rivermead Behavioural Memory Test (RBMT) assesses everyday memory by means of tasks which mimic daily challenges. The objective was to examine the validity of the Brazilian version of the RBMT to detect cognitive decline. METHODS 195 older adults were diagnosed as normal controls (NC) or with mild cognitive impairment (MCI) or Alzheimers disease (AD) by a multidisciplinary team, after participants completed clinical and neuropsychological protocols. RESULTS Cronbachs alpha was high for the total sample for the RBMT profile (PS) and screening scores (SS) (PS = 0.91, SS = 0.87) and for the AD group (PS = 0.84, SS = 0.85), and moderate for the MCI (PS = 0.62, SS = 0.55) and NC (PS = 0.62, SS = 0.60) groups. RBMT total scores, Appointment, Pictures, Immediate and Delayed Story, Immediate and Delayed Route, Delayed Message and Date contributed to differentiate NC from MCI. ROC curve analyses indicated high accuracy to differentiate NC from AD patients, and, moderate accuracy to differentiate NC from MCI. CONCLUSIONS The Brazilian version of the RBMT seems to be an appropriate instrument to identify memory decline in Brazilian older adults.

Transcranial Magnetic Stimulation to Address Mild Cognitive Impairment in the Elderly: A Randomized Controlled Study

Transcranial magnetic stimulation (TMS) is a noninvasive brain stimulation technique with potential to improve memory. Mild cognitive impairment (MCI), which still lacks a specific therapy, is a clinical syndrome associated with increased risk of dementia. This study aims to assess the effects of high-frequency repetitive TMS (HF rTMS) on everyday memory of the elderly with MCI. We conducted a double-blinded randomized sham-controlled trial using rTMS over the left dorsolateral prefrontal cortex (DLPFC). Thirty-four elderly outpatients meeting Petersens MCI criteria were randomly assigned to receive 10 sessions of either active TMS or sham, 10 Hz rTMS at 110% of motor threshold, 2,000 pulses per session. Neuropsychological assessment at baseline, after the last session (10th) and at one-month follow-up, was applied. ANOVA on the primary efficacy measure, the Rivermead Behavioural Memory Test, revealed a significant group-by-time interaction (p = 0.05), favoring the active group. The improvement was kept after one month. Other neuropsychological tests were heterogeneous. rTMS at 10 Hz enhanced everyday memory in elderly with MCI after 10 sessions. These findings suggest that rTMS might be effective as a therapy for MCI and probably a tool to delay deterioration.

Hypertension Severity Is Associated With Impaired Cognitive Performance

Background Most evidence of target‐organ damage in hypertension (HTN) is related to the kidneys and heart. Cerebrovascular and cognitive impairment are less well studied. Therefore, this study analyzed changes in cognitive function in patients with different stages of hypertension compared to nonhypertensive controls. Methods and Results In a cross‐sectional study, 221 (71 normotensive and 150 hypertensive) patients were compared. Patients with hypertension were divided into 2 stages according to blood pressure (BP) levels or medication use (HTN‐1: BP, 140–159/90–99 or use of 1 or 2 antihypertensive drugs; HTN‐2: BP, ≥160/100 or use of ≥3 drugs). Three groups were comparatively analyzed: normotension, HTN stage 1, and HTN stage 2. The Mini–Mental State Examination, Montreal Cognitive Assessment, and a validated comprehensive battery of neuropsychological tests that assessed 6 main cognitive domains were used to determine cognitive function. Compared to the normotension and HTN stage‐1, the severe HTN group had worse cognitive performance based on Mini–Mental State Examination (26.8±2.1 vs 27.4±2.1 vs 28.0±2.0; P=0.004) or Montreal Cognitive Assessment (23.4±3.7 vs 24.9±2.8 vs 25.5±3.2; P<0.001). On the neuropsychological tests, patients with hypertension had worse performance in language, processing speed, visuospatial abilities, and memory. Age, hypertension stage, and educational level were the best predictors of cognitive impairment in patients with hypertension in different cognitive domains. Conclusions Cognitive impairment was more frequent in patients with hypertension, and this was related to hypertension severity.

Higher arterial stiffness is associated with lower cognitive performance in patients with hypertension

Cognitive impairment and elevated arterial stiffness have been described in patients with arterial hypertension, but their association has not been well studied. We evaluated the correlation of arterial stiffness and different cognitive domains in patients with hypertension compared with those with normotension. We evaluated 211 patients (69 with normotension and 142 with hypertension). Patients were age matched and distributed according to their blood pressure: normotension, hypertension stage 1, and hypertension stage 2. Cognitive function was assessed using the Mini‐Mental State Examination, Montreal Cognitive Assessment, and a battery of neuropsychological evaluations that assessed six main cognitive domains. Pulse wave velocity was measured using a Complior device, and carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. The hypertension stage 2 group had higher arterial stiffness and worse performance either by Mini‐Mental State Examination (26.8±2.1 vs 27.3±2.1 vs 28.0±2.0, P=.003) or the Montreal Cognitive Assessment test (23.4±3.5 vs 24.9±2.9 vs 25.6±3.0, P<.001). On multivariable regression analysis, augmentation index, intima‐media thickness, and pulse wave velocity were the variables mainly associated with lower cognitive performance at different cognitive domains. Cognitive impairment in different domains was associated with higher arterial stiffness.

Preliminary Results: Transcranial magnetic stimulation improves memory and attention in elderly with cognitive impairment no-dementia (CIND)—A controlled study

Background:Normal aging is associated with cognitive impairments, often overlooked in medical practice, especially in milder forms, with significant impact on quality of life. Such cognitive decline has not, up to date, specific treatment approach, leaving a gap in the therapeutic arsenal of both specialist and general practitioner. Repetitive transcranial magnetic stimulation (rTMS) is a promising noninvasive and painless technique. It has the potential to improve cognition in elderly activating neural networks, and provides an attractive option as strategy to enhance cognitive abilities, especially memory, in older subjects. The objective of this study is to assess the effects of high frequency rTMS to the dorsolateral prefrontal cortex (DLPFC) on global cognition of functionally independent elderly with subjective complaints of memory impairment. Methods: Clinical trial. Nineteen (8 male and 11 female) elderly, aged between 60 and 74 years old (mean age 1⁄4 64.5 6 3.8), independent for instrumental activities of daily living (IADL) with subjective memory complaints and evidence of some impairment in neuropsychological assessment, characterizing cognitive impairment no-dementia. The MoCA test was used for screening. For each patient, a brain magnetic resonance Table 2 Reversal of scopolamine induced amnesia by Ageratum conyzoides of EPM model in young mice

Brief screening for mild cognitive impairment: initial validation of the Montreal cognitive assessment (MoCA) in Brazilian elderly

were analyzed. Results: A 3 (group) x 2 (trial) analysis of variance (ANOVA), with repeated measures on the last factor, was conducted on the semantic clustering scores. The significant main effects of group [F(2,138)1⁄431.06, p < 0.01] and trial [F(1, 138)1⁄454.76, p < 0.01] were modified by a significant interaction [F(2, 138)1⁄416.60, p < 0.01]; clustering increased from learning to the long delay in healthy controls [t(52)1⁄4 8.00, p < 0.01] and to a lesser degree in MCI [t(55)1⁄43.54, p < 0.01], but not inAD [t(31)1⁄41.54, p> 0.05]. For the recall data, a similar analysis found significant main effects of group [F(2,138)1⁄488.47, p < 0.01] and trial [F(1, 138)1⁄4196.34, p< 0.01] that were modified by a significant interaction [F(2, 138)1⁄412.13, p < 0.01]; still, all three groups showed better trial 5 performance than delayed free recall (all t’s > 6.13, all p’s < 0.01). Conclusions: These results indicate that healthy controls exhibit increased strategy use even after information is already learned. Individuals with MCI show this increase in strategy use, but to a lesser degree, while persons with AD show no change in clustering. These findings were not mirrored by the recall data, in which all groups showed declines in performance from the last learning trial to delayed free recall. Our findings suggest that changes in strategy use are reflective of early cognitive difficulties in MCI.

Impact of hypertension severity on arterial stiffness, cerebral vasoreactivity, and cognitive performance

ABSTRACT. Aging, hypertension (HTN), and other cardiovascular risk factors contribute to structural and functional changes of the arterial wall. Objective: To evaluate whether arterial stiffness (AS) is related to cerebral blood flow changes and its association with cognitive function in patients with hypertension. Methods: 211 patients (69 normotensive and 142 hypertensive) were included. Patients with hypertension were divided into 2 stages: HTN stage-1 and HTN stage-2. The mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA) and a battery of neuropsychological (NPE) tests were used to determine cognitive function. Pulse wave velocity was measured using the Complior®. Carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. Middle cerebral artery flow velocity was measured by transcranial Doppler ultrasonography. Results: Both arterial stiffness parameters and cerebral vasoreactivity worsened in line with HTN severity. There was a negative correlation between breath holding index (BHI) and arterial stiffness parameters. Cognitive performance worsened in line with HTN severity, with statistical difference occurring mainly between the HTN-2 and normotension groups on both the MMSE and MoCA. The same tendency was observed on the NPE tests. Conclusion: Hypertension severity was associated with higher AS, worse BHI, and lower cognitive performance.

Impact of hypertension on cognitive performance in individuals with high level of education

Education is considered to provide a cognitive and neurological reserve through neuronal changes or increased efficacy of processing networks. The hypothesis of cognitive reserve asserts that older individuals with greater experiential resources exhibit better cognitive functioning and are able to tolerate higher levels of brain pathology before displaying clinical symptoms. Hypertension is linked to cognitive impairment. We evaluated the impact of hypertension on cognitive performance in hypertensive patients with high level of education. In a cross-sectional study 163 patients (61 normotensive and 102 hypertensive) with 9 or higher schooling years were comparatively evaluated. Hypertension was defined as blood pressure (BP) levels ≥140/90 mmHg or use of antihypertensive drugs. The mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA), and a validated comprehensive battery of neuropsychological tests that assessed 6 main cognitive domains were used to determine cognitive function. Hypertension group had higher weigh, BMI and lower education level and family income. Hypertension group performed worse either on MMSE (27.7 ± 1.9 vs 28.3 ± 1.7, p=0.049) or MoCA (25.2 ± 2.6 vs 26.1 ± 2.5, p=0.022); similar poorer performance in hypertensive group were also seen at different domains on neuropsychological evaluation. We concluded that even in those with high level of education, patients with hypertension have poorer cognitive performance compared to control pairs. Correspondence to: Henrique CS Muela. Department of Physiology, Faculty of Medicine, Agostinho Neto University, Luanda, Angola. POX: 116, Tel: +244 925141398. E-mail: henrimuela@hotmail.com