Cancer-related cognitive impairment and associated factors in a sample of older male oral-digestive cancer survivors.

OBJECTIVE: This study examines the demographic and clinical variables associated with cancer-related cognitive impairment (CRCI) in a sample of older, male, oral-digestive cancer survivors at VA Medical Centers in Boston and Houston. METHODS: A two-time point, longitudinal design was used, with cognitive assessment conducted at 6 and 18 months post-diagnosis. Using ANCOVA, the cognitive functioning of 88 older adults with head and neck, esophageal, gastric, or colorectal cancers was compared with that of 88 healthy controls. Paired t-tests examined cognitive change over time in the cancer group. Hierarchical linear regression examined variables potentially associated with cognitive impairment at 18 months. RESULTS: Forty-eight percent of cancer patients exhibited cognitive impairment 6 months post-cancer diagnosis, and 40% at 18 months. Cancer survivors were impaired relative to controls on measures of sustained attention, memory, and verbal fluency at 18 months, controlling for age. Older age, low hemoglobin, and cancer-related PTSD were associated with worse cognition at 18 months. CONCLUSIONS: CRCI is more frequent in older adults than reported in studies of younger adults and may be more frequent in men. Potential areas of intervention for CRCI include psychotherapy for cancer-related PTSD, treatment of anemia, and awareness of particularly vulnerable cognitive domains such as sustained attention, memory, and verbal fluency.

Validation of Montreal Cognitive Assessment, MoCA, Alternate French Versions.

UNLABELLED: Objective background: The Montreal Cognitive Assessment (MoCA) is a questionnaire that has been developed to help physicians around the world diagnose a patient's cognitive ability. Available in multiple languages and for use in multiple countries worldwide, the goal of this study was to validate the alternate versions 2 and 3 of the French MoCA test to assist physicians in the detection of mild cognitive impairment (MCI), while decreasing the learning effect upon frequent testing. METHODS: A validation study was conducted at the MoCA Clinic and Institute in Québec, Canada. The subject population consisted of 25 patients diagnosed with MCI meeting Petersen criteria and 25 healthy subjects serving as the normal control (NC) group. Three MoCA test versions were administered in the French language in random order within one session. Scores obtained in all three versions in MCI and NC groups were assessed for reliability and consistency from one version to the next. RESULTS: On average, scores obtained in each subject group (MCI and NC) fell within their corresponding diagnostic ranges (score above 26 points for NC patients versus scores below 26 points for MCI patients). Difference in scores observed between the original French MoCA version and the two alternate versions in each subject cohort were minimal and not considered clinically significant. CONCLUSIONS: All three test versions of the French MoCA are considered equivalent in diagnostic reliability and consistency and contribute to decreasing the potential learning effect when patients are required to repeat the test frequently.

Montreal Cognitive Assessment 5-minute protocol is a brief, valid, reliable, and feasible cognitive screen for telephone administration.

BACKGROUND AND PURPOSE: The National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization working group proposed a brief cognitive protocol for screening of vascular cognitive impairment. We investigated the validity, reliability, and feasibility of the Montreal Cognitive Assessment 5-minute protocol (MoCA 5-minute protocol) administered over the telephone. METHODS: Four items examining attention, verbal learning and memory, executive functions/language, and orientation were extracted from the MoCA to form the MoCA 5-minute protocol. One hundred four patients with stroke or transient ischemic attack, including 53 with normal cognition (Clinical Dementia Rating, 0) and 51 with cognitive impairment (Clinical Dementia Rating, 0.5 or 1), were administered the MoCA in clinic and a month later, the MoCA 5-minute protocol over the telephone. RESULTS: Administration of the MoCA 5-minute protocol took 5 minutes over the telephone. Total score of the MoCA 5-minute protocol correlated negatively with age (r=-0.36; P<0.001) and positively with years of education (r=0.41; P<0.001) but not with sex (ρ=0.03; P=0.773). Total scores of the MoCA and MoCA 5-minute protocol were highly correlated (r=0.87; P<0.001). The MoCA 5-minute protocol performed equally well as the MoCA in differentiating patients with cognitive impairment from those without (areas under receiver operating characteristics curve for MoCA 5-minute protocol, 0.78; MoCA=0.74; P>0.05 for difference; Cohen d for group difference, 0.80-1.13). It differentiated cognitively impaired patients with executive domain impairment from those without (areas under receiver operating characteristics curve, 0.89; P<0.001; Cohen d=1.7 for group difference). Thirty-day test-retest reliability was excellent (intraclass correlation coefficient, 0.89). CONCLUSIONS: The MoCA 5-minute protocol is a free, valid, and reliable cognitive screen for stroke and transient ischemic attack. It is brief and highly feasible for telephone administration.

Montreal Cognitive Assessment (MoCA) XpressO: Validation of a digital self-administered cognitive prescreening tool.

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

A cross-cultural study of the Montreal Cognitive Assessment for people with hearing impairment.

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

Vascular cognitive impairment: most useful subtests of the Montreal Cognitive Assessment in minor stroke and transient ischemic attack.

BACKGROUND/AIMS: Cognitive impairment is frequent in cerebrovascular disease but often remains undetected. The Montreal Cognitive Assessment (MoCA) has been proposed in this context. Our aim was to evaluate the MoCA and its subtests in cerebrovascular disease. METHODS: We assessed 386 consecutive patients with minor stroke (National Institutes of Health Stroke Score <4) or transient ischemic attack at 3 months. The MoCA and the modified Rankin Scale (mRS) were administered. Computed tomography (CT) scans were assessed for stroke and white matter changes. An unfavorable functional outcome was defined as mRS >1. RESULTS: The prevalence of cognitive impairment (cutoff of 26) was 55% using the MoCA and 13% using the MMSE. In a multivariate analysis, MoCA <26 was associated with the outcome (OR 3.00, CI 1.78-5.03), as were remote lacunar stroke on CT and white matter changes of at least moderate severity. Five subtests (5-word recall, word list generation, trail-making, abstract reasoning and cube copy) formed an optimal short MoCA with 6/10 or less showing a sensitivity of 91% and a specificity of 83%. CONCLUSION: This study extends the utility of the MoCA to milder forms of cerebrovascular disease. The MoCA is associated with the 3-month functional outcome. Five subtests may constitute an optimal brief tool in vascular cognitive impairment.

The Early Diagnosis of Alzheimer's Disease: A Patient-Centred Conversation with the Care Team.

Alzheimer's disease (AD) is a neurodegenerative disorder which accounts for 60-80% of dementia cases, affecting approximately 10 million people in Europe. Neuroimaging techniques and cerebrospinal fluid biomarkers used in combination with cognitive assessment tools open the door to early diagnosis of AD. However, these tools present some challenges that need to be overcome, such as low sensitivity or specificity, high cost, limited availability or invasiveness. Thus, low-cost and non-invasive alternatives, such as plasma biomarkers, have the potential to drive changes in AD screening and diagnosis. In addition to the technical aspects, organisational challenges as well as ethical concerns need to be addressed. In many countries, there is an insufficient number of specialists to recognise, evaluate and diagnose dementia and the waiting times to see a specialist are long. Given that there is currently no cure for AD, it is important to consider the potential psychological impact of an early diagnosis. In addition, counselling before biomarker sampling and during diagnosis disclosure is vital to guarantee that the patients have all the information necessary and their queries are addressed in a sensitive manner. Here, we illustrate (using a clinical vignette) current challenges of diagnosis and discuss some of the benefits and challenges of early diagnosis in AD including the value of biomarkers in combination with clinical evaluation. Lastly, some guidelines for disclosing early diagnosis of AD are provided based on our experiences.

Validation of the German Montreal-Cognitive-Assessment-H for hearing-impaired.

Background: Hearing loss and dementia are highly prevalent in older age and often co-occur. Most neurocognitive screening tests are auditory-based, and performance can be affected by hearing loss. To address the need for a cognitive screening test suitable for people with hearing loss, a visual version of the Montreal-Cognitive-Assessment was developed and recently validated in English (MoCA-H), with good sensitivity and specificity for identifying cases of dementia. As the MoCA is known to perform differently across languages, revalidation of the German MoCA-H was necessary. The aim of the present study was to assess the diagnostic accuracy of the German MoCA-H among those with normal cognition, mild cognitive impairment (MCI) and dementia and to determine an appropriate performance cut- off. Materials and methods: A total of 346 participants aged 60-97 years (M = 77.18, SD = 9.56) were included; 160 were cognitively healthy, 79 with MCI and 107 were living with dementia based on the GPCOG and a detailed medical questionnaire as well as a comprehensive examination by a neurologist in case of cognitive impairment. Performance cut-offs for normal cognition, MCI and dementia were estimated for the MoCA-H score and z-scores using the English MoCA-H cut-off, the balanced cut-off and the Youden's Index. Results: A mean score of 25.49 (SD = 3.01) points in the German MoCA-H was achieved in cognitively healthy participants, 20.08 (SD = 2.29) in the MCI and 15.80 (SD = 3.85) in the dementia group. The optimum cut-off for the detection of dementia was ≤21 points with a sensitivity of 96.3% and a specificity of 90%. In the MCI group, a cut-off range between 22 and 24 points is proposed to increase diagnostic accuracy to a sensitivity and specificity of 97.5 and 90%, respectively. Conclusion: The German MoCA-H seems to be a sensitive screening test for MCI and dementia and should replace commonly used auditory-based cognitive screening tests in older adults. The choice of a cut-off range might help to better reflect the difficulty in clinical reality in detecting MCI. However, screening test batteries cannot replace a comprehensive cognitive evaluation.

Development and validation of the Montreal cognitive assessment for people with hearing impairment (MoCA-H).

BACKGROUND: Hearing impairment is common among older adults and affects cognitive assessments for identification of dementia which rely on good hearing function. We developed and validated a version of the Montreal Cognitive Assessment (MoCA) for people with hearing impairment. METHODS: We adapted existing MoCA 8.1 items for people with hearing impairment by presenting instructions and stimuli in written rather than spoken format. One Attention domain and two Language domain items required substitution by alternative items. Three and four candidate items respectively were constructed and field-tested along with the items adapted to written form. We used a combination of individual item analysis and item substitution to select the set of alternative items to be included in the final form of the MoCA-H in place of the excluded original items. We then evaluated the performance and reliability of the final tool, including making any required adjustments for demographic factors. RESULTS: One hundred and fifty-nine hearing-impaired participants, including 76 with normal cognition and 83 with dementia, completed the adapted version of the MoCA. A further 97 participants with normal hearing completed the standard MoCA as well as the novel items developed for the MoCA-H to assess score equivalence between the existing and alternative MoCA items and for independence from hearing impairment. Twenty-eight participants were retested between 2-4 weeks after initial testing. After the selection of optimal item set, the final MoCA-H had an area under the curve of 0.973 (95% CI 0.952-0.994). At a cut-point of 24 points or less sensitivity and specificity for dementia was 92.8% and 90.8%, respectively. The intraclass correlation for test-retest reliability was 0.92 (95%CI 0.78-0.97). CONCLUSION: The MoCA-H is a sensitive and reliable means of identifying dementia among adults with acquired hearing impairment.

Alternate-form reliability of the Montreal cognitive assessment screening test in a clinical setting.

AIMS: The Montreal Cognitive Assessment (MoCA) has gained recognition for its validity in detecting cognitive impairment in several clinical populations. For serial assessments, alternate forms are needed to overcome possible practice effects. Our objective was to investigate the reliability of two German MoCA alternate forms for longitudinal assessment applications. METHODS: The original and one of two alternate forms of the MoCA were administered within a 60-min interval of a clinical interview in a counterbalanced order to 100 healthy elderly controls, 30 patients with mild cognitive impairment (MCI) and 30 patients with Alzheimer's disease (AD). The diagnosis of the majority of patients was supported by in vivo AD pathology biomarkers. RESULTS: There was a strong correlation between the alternate forms and the original MoCA in all groups, but particularly in the clinical samples. Total mean scores did not differ significantly between the MoCA versions, even taking into account the presentation order. As in previous studies, age and education influenced performance in the MoCA. The same pattern of group differences (controls > MCI > AD) was observed for each of the versions. CONCLUSION: All three forms can be reliably and interchangeably used in serial cognitive assessment, confirming the MoCA's applicability in research and clinical longitudinal approaches.

Psychometrics of the Montreal Cognitive Assessment (MoCA) and its subscales: validation of the Taiwanese version of the MoCA and an item response theory analysis.

BACKGROUND: The Montreal Cognitive Assessment (MoCA) is an instrument for screening mild cognitive impairment (MCI). This study examined the psychometric properties and the validity of the Taiwan version of the MoCA (MoCA-T) in an elderly outpatient population. METHODS: Participants completed the MoCA-T, Mini-Mental State Examination (MMSE), and the Chinese Version Verbal Learning Test. The diagnosis of Alzheimer's disease (AD) was made based on the NINCDS-ADRDA criteria, and MCI was diagnosed through the criteria proposed by Petersen et al. (2001). RESULTS: Data were collected from 207 participants (115 males/92 females, mean age: 77.3 ± 7.5 years). Ninety-eight participants were diagnosed with AD, 71 with MCI, and 38 were normal controls. The area under the receiver operator curves (AUC) for predicting AD was 0.98 (95% confidence interval [CI] = 0.97-1.00) for the MMSE, and 0.99 (95% CI = 0.98-1.00) for the MoCA-T. The AUC for predicting MCI was 0.81 (95% CI = 0.72-0.89) using the MMSE and 0.91 (95% CI = 0.86-1.00) using the MoCA-T. Using an optimal cut-off score of 23/24, the MoCA-T had a sensitivity of 92% and specificity of 78% for MCI. Item response theory analysis indicated that the level of information provided by each subtest of the MoCA-T was consistent. The frontal and language subscales provided higher discriminating power than the other subscales in the detection of MCI. CONCLUSION: Compared to the MMSE, the MoCA-T provides better psychometric properties in the detection of MCI. The utility of the MoCA-T is optimal in mild to moderate cognitive dysfunction.

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

Background: Since 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). Objective: The 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 methods: The 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). Results: No 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. Conclusion: The MoCA-HI is a cognitive screening test which is suitable for people with hearing impairment.

MoCA 7.1: Multicenter Validation of the First Italian Version of Montreal Cognitive Assessment.

Background: The early detection of neurocognitive disorders, especially when mild, is a key issue of health care systems including the Italian Dementia National Plan. The Mini-Mental State Examination (MMSE), i.e., the reference screening tool for dementia in Italian Memory Clinics, has low sensitivity in detecting mild cognitive impairment (MCI) or mild dementia. Objective: Availability of a 10-minute screening test sensitive to MCI and mild dementia, such as the Montreal Cognitive Assessment (MoCA), is relevant in the field. This study presents initial validity and reliability data for the Italian version of MoCA 7.1 that is being collected as part of a large ongoing longitudinal study to evaluate the rate of incident MCI and dementia in older adults. Methods: MoCA 7.1 and MMSE were administered to cognitive impaired patients (n = 469; 214 with MCI, 255 with dementia; mean age: 75.5; 52% females,) and healthy older adults (n = 123, mean age: 69.7, 64 % females). Results: Test-retest (0.945, p < 0.001) and inter-rater (0.999, p < 0.001) reliability of MoCA 7.1, assessed on randomly selected participants with normal cognition, MCI, dementia, were significant. MoCA 7.1 showed adequate sensitivity (95.3%) and specificity (84.5%) in detecting MCI compared to MMSE (sensitivity: 53.8%; specificity: 87.5%). The Area Under the Curve of MoCA 7.1 was significantly greater than that of MMSE (0.963 versus 0.742). MoCA 7.1 showed similar results in detecting both MCI and dementia. Conclusion: MoCA 7.1 is a reliable and useful tool that can aid in the diagnosis of MCI and dementia in the Italian population.

Association between regional tau pathology and neuropsychiatric symptoms in aging and dementia due to Alzheimer's disease.

BACKGROUND: Neuropsychiatric symptoms (NPS) are frequent in aging and Alzheimer's disease (AD). Here we study the relationship between NPS and AD pathologies in vivo. METHOD: Two hundred and twenty-one individuals from the TRIAD cohort (143 cognitively unimpaired, 52 mild cognitive impairment, and 26 AD) underwent [18F]MK6240-tau-positron emission tomography (PET), [18F]AZD4694-amyloid-PET, magnetic resonance imaging, and neuropsychological evaluations. Spearman correlations and voxel-based regression models evaluated the relationship between Neuropsychiatric Inventory Questionnaire (NPI-Q) scores, and tau-PET, amyloid-PET, and voxel-based morphometry. RESULTS: Fifty percent of individuals presented NPS; these correlated with tau, not amyloid beta or neurodegeneration. Associations between NPI-Q score and tau-PET were stronger in the parietal association area, superior frontal, temporal, and medial occipital lobes. NPI-Q domains associated with distinct patterns of tau uptake. CONCLUSIONS: NPS are predominantly related to tau in aging and dementia. Regions affected are part of the behavioral circuits, and vulnerable to early AD pathology. Domain-specific analyses showed NPS are related to the AD pathophysiological processes in a symptom-specific manner.

Topographic Distribution of Amyloid-ß, Tau, and Atrophy in Patients With Behavioral/Dysexecutive Alzheimer Disease.

OBJECTIVE: To determine the associations between amyloid-PET, tau-PET, and atrophy with the behavioral/dysexecutive presentation of Alzheimer disease (AD), how these differ from amnestic AD, and how they correlate to clinical symptoms. METHODS: We assessed 15 patients with behavioral/dysexecutive AD recruited from a tertiary care memory clinic, all of whom had biologically defined AD. They were compared with 25 patients with disease severity- and age-matched amnestic AD and a group of 131 cognitively unimpaired (CU) elderly individuals. All participants were evaluated with amyloid-PET with [18F]AZD4694, tau-PET with [18F]MK6240, MRI, and neuropsychological testing. RESULTS: Voxelwise contrasts identified patterns of frontal cortical tau aggregation in behavioral/dysexecutive AD, with peaks in medial prefrontal, anterior cingulate, and frontal insular cortices in contrast to amnestic AD. No differences were observed in the distribution of amyloid-PET or atrophy as determined by voxel-based morphometry. Voxelwise area under the receiver operating characteristic curve analyses revealed that tau-PET uptake in the medial prefrontal, anterior cingulate, and frontal insular cortices were best able to differentiate between behavioral/dysexecutive and amnestic AD (area under the curve 0.87). Voxelwise regressions demonstrated relationships between frontal cortical tau load and degree of executive dysfunction. CONCLUSIONS: Our results provide evidence of frontal cortical involvement of tau pathology in behavioral/dysexecutive AD and highlight the need for consensus clinical criteria in this syndrome.

The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease.

BACKGROUND/AIMS: To evaluate the psychometric properties of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease (SVD). METHODS: 40 SVD patients and 40 matched controls were recruited. Concurrent and criterion validity, inter-rater and test-retest reliability, internal consistency of the HK-MoCA were examined and clinical observations were made. RESULTS: Performance on the HK-MoCA was significantly predicted by both executive (beta = 0.23, p = 0.013) and non-executive (beta = 0.64, p < 0.001) composite scores. It differentiated SVD patients from controls (area under the curve = 0.81, p < 0.001) with an optimal cutoff at 21/22. Reliability, internal consistency and clinical utility were good. CONCLUSION: The HK-MoCA is a useful cognitive screening instrument for use in SVD patients.

Protocol for the development of versions of the Montreal Cognitive Assessment (MoCA) for people with hearing or vision impairment.

INTRODUCTION: Hearing and vision impairments are highly prevalent among older adults and impact commonly used cognitive assessment tools for the identification of dementia. Adaptations of such tests for people with hearing or vision impairment have not been adequately validated among populations with such sensory impairment. METHODS AND ANALYSIS: We will develop two versions of the Montreal Cognitive Assessment (MoCA) for people with acquired hearing impairment (MoCA-H) or vision impairment (MoCA-V). The MoCA-H and MoCA-V will exclude the existing MoCA items that are presented in spoken or visual format, respectively, and include new suitably adapted items. Participants (n=792) with combinations of hearing, vision and cognitive impairment will complete standard or adapted versions of the MoCA across three language sites (English, French and Greek). Development of the MoCA-H and the MoCA-V will be based on analysis of adapted and standard MoCA items following model-based development to select the combination of items for the MoCA-H and MoCA-V that provide optimal sensitivity and specificity for detection of dementia. ETHICS AND DISSEMINATION: The study has received ethical approval from respective centres in the UK, France, Greece and Cyprus. The results of the study will be disseminated through peer-reviewed publication, conference presentations, the study website (https://www.sense-cog.eu/), the SENSE-Cog Twitter account (@sense_cog) and the MoCA test website (https://www.mocatest.org/). The main outputs of the study will be versions of the MoCA that are appropriate for use with adults with acquired hearing or vision impairment and will contribute significantly to the clinical care of older people.

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

INTRODUCTION: This study investigates the relationship between retinal image features and ß-amyloid (Aß) burden in the brain with the aim of developing a noninvasive method to predict the deposition of Aß 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 (Aß+) showed a higher mean tortuosity compared with the amyloid-negative (Aß-) subjects. Arteriolar diameter of Aß+ subjects was found to be higher than the Aß- 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 Aß+ subjects when compared with the Aß-. A classifier was trained to automatically discriminate subjects combining the extracted features. The classifier could discern Aß+ subjects from Aß- 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.