A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Objective: This study was performed to provide a detailed analysis of the MoCA versus the MMSE, including an item analysis and an examination of threshold scores appropriate for use in different clinical settings. Methods: 135 subjects enrolled in a longitudinal clinicopathologic study were administered the MoCA and MMSE. Subjects were classified as cognitively impaired or cognitively normal based on neuropsychological testing and consensus conference diagnosis. Results: 89 subjects were cognitively normal, 46 cognitively impaired (20 dementia, 26 MCI). ROC analysis showed that, for any threshold value selected for the MMSE to identify cognitive impairment, a MoCA value with better sensitivity and specificity could be identified. Recall performed best among individual items on the MMSE, and Orientation performed best on the MoCA. Overall, the best discrimination was obtained using a weighted combination of four items (2*MoCA-Orientation + MMSE-Recall + MoCA-Language + 0.5* MoCA-Visuospatial/Executive; AUC 0.94). A MoCA threshold score of 26 had a sensitivity of 98% and specificity of 52% for identifying cognitive 5 impairment. A MoCA threshold score of 21 had a sensitivity of 57% and specificity of 96%. Conclusions: The MoCA was superior to the MMSE in detecting cognitive impairment. Individual domains on the MoCA and MMSE made substantially different contributions to each instrument’s sensitivity, and a weighted subset of items from both instruments performed best in detecting cognitive impairment. A lower MoCA threshold score may be appropriate in a population with a higher prevalence of cognitive impairment such as a memory clinic.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Memory screening in the community promotes early detection of memory problems, as well as Alzheimer’s disease (AD) and related illnesses, and encourages appropriate intervention. The Montreal Cognitive Assessment (MoCA) is a rapid and sensitive screening tool for cognitive impairment that can be readily employed at the clinical level, but little is known about its utility as a community screening tool. Also, little is known regarding the demographics of the population that presents for a community screen. The research aims to evaluate the demographics of the participants that attended community memory screens in the greater Phoenix metropolitan area and to evaluate the prevalence of screen positives using the MoCA. It is hypothesized that cognitive impairment will be significantly prevalent in the screened population and that age and family history of dementia will correlate with the presence of cognitive impairment. The study methods involve descriptive analysis and application of statistical tests to evaluate for significant relationships between demographic variables and MoCA scores. The population (n=346) had a mean age of 72 (SD =10.7), was primarily female (70%), primarily Caucasian (68%) and 86% had greater than a high school education. A 58% prevalence of cognitive impairment was found in the population as defined by the MoCA. Increased age, male gender, and non‐Caucasian race correlated with lower MoCA scores. Lower education correlated with lower MoCA scores despite the inherent educational correction in the MoCA. Diabetes and a family history of AD were not significant factors. Although the number of true positives following methodical diagnosis is unknown, given the validity of the MoCA in discerning cognitive impairment, the screen was likely worthwhile and supports more routine use of community memory screens. Variables identified that were associated with increased cognitive impairment better describe the population at risk and can be utilized to focus future screening efforts.

This study explores cognitive impairment and its correlation to early- life adverse experiences in non-patient population between the ages of 50 to 65. This developmental approach and observational study design explores cognition in pre-clinical Alzheimer’s disease (AD). Using a standardized neuropsychological instrument, the Montreal Cognitive Assessment (MoCA) and clinically administered questionnaire, the ACE (Adverse Childhood Experiences), I hypothesized that participants with high ACE scores will inversely have low MoCA scores. My goal was to use a multiple linear regression model with 3 covariates and 1 predictor of interest (ACEs). At 80% power, a sample size of 40 was calculated as needed. This would mean that the results would have 80 % chance of declaring statistical significance. This corresponds to an R-squared value (percentage of variation in MoCA score explained by the predictor) of 17.2%. The desired sample size was not attained successfully due to several barriers in receiving sample data from the collaborating site and the 2017 Hurricane Irma causing a drop in participation rate. Overall 13 participants had successfully participated. The analysis of the results is demonstrated in a line graph indicating a relationship between ACE and MoCA scores. The accuracy of the descriptive statistics could be argued against due to the low sample size. The analysis of the ethnographic interviews brings out some trends in the participant responses. The focus here has been to discuss these responses as to how they advocate for the entanglement theory of aging. In other words, how the exposure to social and environmental factors at various stages of an individual’s lifecourse can interact with one’s physiology, resulting in exposure- specific health conditions at later life stages. Among the period of exposure, my focus through this study is specifically on the early exposures in the lifecourse. This is facilitated by the use of the ACE questionnaire regarding exposures to adverse experiences such as sexual/ physical abuse, familial mental health issues, alcohol/ drug abuse in the family and loss or separation from parents. The entanglement theory further allows for race or culture specific exposures to adversity that raises the question of varying health consequences among cultural or racial groups and the need for a more critical approach in providing access to healthcare and healthcare policy development. Trends in ethnographic results obtained have allowed for the critical discourse in the transgenerational effects of social adversity, effects of resilience- building from adversity and the need for care- giver mental health services. The study brought out critiques on how the ACE module could be made more inclusive of experiences specific to diverse cultures and regions, as well as the need to address the severity of individual experiences. We conclude by discussing how effects of social or environmental experiences can be used toward AD and aging research and what supporting literature and initiatives currently exist. The discussion is also inspired by the existing political discourse around the medicalization of AD and how that influences the reductionist methods in AD research. This new direction of applied and holistic approach derives its perspective from neuroanthropology and applied medical anthropology. The overall aim of this study is to ask questions challenging existing research methods with the ultimate hope to newly influence the allocation of AD research and risk reduction toward interdisciplinary focus and funding, involving early-life lived experiences and life course perspectives.

PDFには「高橋 由佳子」と記載 / 京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21955号 / 医博第4497号 / 新制||医||1037(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 古川 壽亮, 教授 富樫 かおり / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Many standardized measures of cognition include items that must be seen or heard. Nevertheless, it is not uncommon to overlook the possible effects of sensory impairment(s) on test scores. In the current study, we investigated whether sensory impairments could affect performance on a widely used screening tool, the Montreal Cognitive Assessment (MoCA). Three hundred and one older adults (mean age = 71 years) completed the MoCA and also hearing and vision tests. Half of the participants had normal hearing and vision, 38% impaired hearing, 5% impaired vision, and 7% had dual-sensory impairment. More participants with normal sensory acuity passed the MoCA compared to those with sensory loss, even after modifying scores to adjust for sensory factors. The results suggest that cognitive abilities may be underestimated if sensory problems are not considered and that people with sensory loss are at greater risk of cognitive decline.

This thesis deals with the neuropsychological diagnosis of Alzheimer's disease. The aim is to evaluate the psychometric characteristics ofthe new Czech translation of the Montreal Cognitive Assessment (MoCA) by comparison with the Mini-Mental State Examination (MMSE), a method widely used by doctors inscreening diagnostics of Alzheimer's disease. The theoretical part deals with the diagnostics of Alzheimer's disease and mild cognitive impairment. We describe international diagnostic criteria of cognitive disorders and provide an overview of the screening neuropsychological methods most commonly used by Czech specialists. We summarize the current psychometric and psychodiagnostic findings on these methods and focuse on description of MMSE and MoCA. In the empirical part we compare Czech version of MMSE and MoCA-CZ (the new Czech translation of the test). We examined 38 patients with Alzheimer's disease and 70 cognitively healthy seniors. The results show that MoCA-CZ is sufficiently valid and reliable screening method that accurately distinguishbetween healthy subjects and patiens with Alzheimer's disease. We believe that it can enrich screening tools that are available to Czech experts. Key words: Montreal Cognitive Assessment, Mini-Mental State Examination, Alzheimer's disease, psychodiagnostics,...

The thesis discusses screening psychodiagnostics with special attention given to amnestic mild cognitive impairment and Alzheimer's disease. The theoretical part describes the concepts of healthy aging and the disorders of cognitive functions. It provides an overview of the screening methods most frequently used in the Czech Republic and the description of MoCA test. It also briefly outlines the issues of retesting in psychodiagnostics. The objective of the empirical part of the work was to verify the psychometric characteristics of the Czech alternative version MoCA-CZ and to evaluate whether it is possible to use this test in practice. The evaluation also includes a comparison of the new version with the already established standard version of MoCA-CZ test. We assigned standard and alternative versions of MoCA-CZ in a 2-month interval to 59 healthy volunteers, 35 patients with mild cognitive impairment and 41 patients with dementia resulting from Alzheimer's disease. We found a strong correlation between alternative and standard version of MoCA-CZ test. We confirmed statistically significant differences in the average scores between individual research groups in both versions of the test. We proved that the alternative version MoCA-CZ 2 is reliable. And we demonstrated that the administration and...

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21669号 / 医博第4475号 / 新制||医||1035(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 村井 俊哉, 教授 古川 壽亮, 教授 宮本 享 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

OF MASTER THESIS Author: Bc. Kateřina Králová Supervisor: MUDr. Tereza Gueye Title of master thesis: Evaluation of Occupational Therapy Intervention in Acute Inpatient Rehabilitation of Cerebrovascular Units Abstract This diploma thesis deals with the evaluation of occupational interventions on the specific separation of beds of early rehabilitation of the cerebrovascular center of the General University Hospital in Prague. The subject of interest is primarily the results of the assessment obtained through the Functional Independence Measure (FIM) and the Montreal Cognitive Assessment. The thesis has two main objectives, namely mapping and analyzing the tools used to assess self-sufficiency and cognitive functions in the department. You can find the description of the evaluation tools in the theoretical part of the thesis. It is also an overview of the topic of the selected topic and a brief description of the system of cerebrovascular care in the Czech Republic. The second objective was to evaluate variables such as length of hospitalization and cognitive status in relation to patient self-sufficiency at the end of hospitalization. Three hypotheses have been identified to meet this goal. The practical part describes the results of the used tools for a particular department. The research group...

OF MASTER THESIS Author: Bc. Kateřina Králová Supervisor: MUDr. Tereza Gueye Title of master thesis: Evaluation of Occupational Therapy Intervention in Acute Inpatient Rehabilitation of Cerebrovascular Units Abstract This diploma thesis deals with the evaluation of occupational interventions on the specific separation of beds of early rehabilitation of the cerebrovascular center of the General University Hospital in Prague. The subject of interest is primarily the results of the assessment obtained through the Functional Independence Measure (FIM) and the Montreal Cognitive Assessment. The thesis has two main objectives, namely mapping and analyzing the tools used to assess self-sufficiency and cognitive functions in the department. You can find the description of the evaluation tools in the theoretical part of the thesis. It is also an overview of the topic of the selected topic and a brief description of the system of cerebrovascular care in the Czech Republic. The second objective was to evaluate variables such as length of hospitalization and cognitive status in relation to patient self-sufficiency at the end of hospitalization. Three hypotheses have been identified to meet this goal. The practical part describes the results of the used tools for a particular department. The research group...