Screening for cognitive impairment in systemic lupus erythematosus: Application of the Montreal Cognitive Assessment (MoCA) in a Greek patient sample.

BACKGROUND: Cognitive impairment (CI) is one of the most frequent neuropsychiatric manifestations of systemic lupus erythematosus (SLE). Given that extensive neuropsychological testing is not always feasible in routine clinical practice, brief cognitive screening tools are desirable. The aim of this study was to evaluate the Montreal Cognitive Assessment (MoCA) as a screening tool for CI in SLE. METHODS: Consecutive SLE patients followed at a single centre were evaluated using MoCA and an extensive neuropsychological test battery (NPT), including the Digits Forward and Digits Backwards, Rey Auditory Verbal Learning Memory Test, Trail Making Test, Stroop Colour-Word Test, Semantic and Phonetic Verbal Fluency tests and a 25-problem version of the General Adult Mental Ability test. The criterion validity of MoCA was assessed through receiver operating characteristic (ROC) analyses using three different case definitions: i) against normative population data, ii) and iii) against average performance of a comparison group of rheumatoid arthritis (RA) patients, to adjust for possible confounding effects of chronic illness and inflammatory processes on cognitive performance. The effect of patient-related (age, years of education, anxiety, depression, fatigue and pain) and disease-related (activity, damage, age at diagnosis, disease duration, use of glucocorticoid, psychotropic and pain medication) parameters on the MoCA was examined. RESULTS: A total of 71 SLE patients were evaluated. MoCA significantly correlated with all NPT scores and was affected by education level (p < 0.001), but not by other demographic or clinical variables. The optimal cutoff for detecting CI, as defined on the basis of normative population data, was 23/30 points, demonstrating 73% sensitivity and 75% specificity. A cutoff of 22/30 points, using neuropsychological profiles of the RA group as inflammatory disease controls, exhibited higher sensitivity (100%, based on both definitions) and specificity (87% and 90%, depending on the definition). The standard cutoff of 26/30 points displayed excellent sensitivity (91-100%) with significant expenses in specificity (43-45%). CONCLUSION: The MoCA is an easily applied tool, which appears to be reliable for identifying CI in SLE patients. The standard cutoff score (26/30) ensures excellent sensitivity while lower cutoff scores (22-23/30) may, also, provide higher specificity.

The association between obesity and fluid intelligence impairment is mediated by chronic low-grade inflammation.

Published evidence suggests that obesity impairs cognition. Development of chronic low-grade inflammation (CLGI) represents the earliest consequence of obesity. The present study investigated the association between obesity and fluid intelligence impairment and assessed the potential mediating role of CLGI and psychological (depression/anxiety symptoms), lifestyle (exercise) and physiological (metabolic dysfunction indices) factors in this association. Clinically healthy participants (n 188), grouped as per BMI, underwent cognitive (General Ability Measure for Adults), psychological (Beck Depression Inventory-II and State-Trait Anxiety Inventory) and activity (Godin leisure-time physical activity) measurements. Biochemical parameters included the following: (a) indices of CLGI (high-sensitivity C-reactive protein, erythrocyte sedimentation rate and fibrinogen); (b) insulin resistance (Homeostasis Model Assessment of Insulin Resistance index); (c) adiposity (plasma adiponectin). An inverse association between elevated BMI and fluid intelligence was observed, with obese participants displaying significantly poorer performance compared with age-matched normal-weight peers. Structural equation modelling results were consistent with a negative impact of obesity on cognition that was mediated by CLGI. The results of the present study support the hypothesis that reduced general cognitive ability is associated with obesity, an adverse effect mainly mediated by obesity-associated activation of innate immunity.

Greek adolescents' intimate relations before their transition to adulthood.

The study examined whether the characteristics of the other partner in a dyad could reveal some unique intimate relationships regardless of the commonalties in the intimate relationships adolescents and emerging adults endorse with four important partners (mother, father, female and male peers). Six hundred and thirteen (56.8% female) Greek adolescents and emerging adults participated in the study. Participants endorsed their agreement to nine items addressing issues of intimacy and companionship. The intimate relationships with the four important partners share some common characteristics reflecting the person who endorses the intimate relationships and are also reciprocal, depending on who is the other partner in the dyad. The intimacy participants endorsed with their parents contributed to the intimate relationship with their peers of the same sex with the parent. The way Greek youth is gendered could explain the characteristics of the intimate relationships they endorse with the other partners in the dyads.

Concurrent validity of the general ability measure for adults (gama) with sudden-onset neurological impairment.

The General Ability Measure for Adults (GAMA; Naglieri & Bardos, 1997) is a nonverbal brief measure of cognitive ability. Brief measures of cognitive ability are important in the assessment of individuals with impaired or limited test-taking skills. A sample of 50 adults with sudden-onset neurological impairment was compared to a demographically matched control group. The neurologically impaired adults scored significantly lower (t (98) = 6.2, p < .001) on the GAMA than did the control group. The Kaufman Brief Intelligence Test (K-BIT; Kaufman & Kaufman, 1990) was also administered to the neurologically impaired group. The K-BIT scores correlated significantly with the GAMA Total IQ score (K-BIT IQ, r = .59, p < .001; Matrices, r = .64, p < .001; Vocabulary, r = .30, p < .05). The study's findings suggested that the GAMA can be used successfully as a screening measure of cognitive ability with individuals with neurological impairment using a nonverbal means that is not dependent on prior academic knowledge or linguistic ability.