Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

Montreal Cognitive Assessment

 

Evaluación de Estimulación Cognitiva en Pacientes con Deterioro Cognitivo Leve Mediante un Estudio Analítico, Aleatorizado y Doble Ciego Evaluation Of Cognitive Stimulation In Patients With Mild Cognitive Impairment In An Analytical, Randomized, And Double-Blind Study

Introduction: The aging of the population increases the scientific interest in identifying and treating the stages preceding dementia. The concept of mild cognitive impairment (MCI) includes patients with demonstrated cognitive deficits but who are able to maintain adequate functionality. There are no pharmacological measures capable of slowing the progression to dementia in a percentage of these patients, although cognitive stimulation (CS) may be a promising treatment.

Methodology: A double-blind randomized clinical trial was conducted including 38 MCI patients who were followed up using neuropsychological and functionality tests for one year. CS was provided to the intervention group.

Results: The statistical analysis showed significant differences in the quantitative results of the Montreal Cognitive Assessment (MoCA) test between intervention and control groups. Furthermore, we detected a non-significant positive trend in the neuropsychological evaluation but not in the functionality scores.

Conclusions: Dementia is expected to triple its prevalence by 2050, making the study of pre-dementia stages necessary. Despite not achieving significance, CS therapy may be a useful tool in this situation. The MoCA is a useful score for the diagnosis and monitorization of these patients.

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Palabras clave: Deterioro Cognitivo Leve, Entrenamiento cognitivo, Estimulación, neuropsicología, Test de Montreal, Tests neuropsicológicos,

Keywords: Cognitive training, Mild Cognitive Impairment, Montreal Cognitive Assessment, Neuropsychologic tests, neuropsychology, Stimulation,

Función cognitiva en adultos mayores con y sin dedos de Dawson relacionados con enfermedad de pequeño vaso cerebral. Cognitive performance in older adults with and without Dawson’s fingers-related cerebral small vessel disease

Background/objective: Dawson’s fingers have been traditionally associated with multiple sclerosis. However, this imaging biomarker has also been linked to white matter hyperintensities related to cerebral small vessel disease. In the latter, Dawson’s fingers could represent damage of small venules in subjects with severe small vessel disease and could theoretically be associated with cognitive decline. In this study, we aimed to assess the association between Dawson’s fingers and cognitive performance in a population of older adults. 

Methods: Population-based study conducted in individuals aged 60 years or older, residing in three rural villages of coastal Ecuador (Atahualpa, El Tambo and Prosperidad). Of 712 older adults identified by means of a door-to-door survey, 590 underwent a brain MRI. Of them, 575 also had the Montreal Cognitive Assessment (MoCA). We selected the 157 individuals with moderate-to-severe white matter hyperintensities to assess the presence of Dawson’s fingers. The independent association between Dawson’s fingers and cognitive performance (as the dependent variable) was assessed by means of a linear regression model, after adjusting for demographics, cardiovascular risk factors, and the other biomarkers of cerebral small vessel disease. 

Results: Of 157 individuals with moderate-to-severe White matter hyperintensities, 17 (11%) had Dawson’s fingers on MRI. The mean MoCA score in subjects with Dawson’s fingers was 14.5±6.4 points and that of those without this neuroimaging biomarker was 17.3±6.2 points. The association between Dawson’s fingers and the MoCA score was marginal in univariate models (p=0.082), but it completely vanished in a multivariate linear regression model adjusted for relevant covariates (β:-0.31; 95% C.I.: -3.23 – 2.60; p=0.833). A mediation model disclosed that 83.5% of the effect of Dawson’s finger on cognitive performance was mediated by age. 

Conclusion: Dawson’s fingers are not independently associated with cognitive performance in individuals with cerebral small vessel disease. Most of the effect of this association is mediated by age. 

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Palabras clave: Adultos Mayores, dedos de Dawson, enfermedad de pequeño vaso cerebral, hiperintensidades de sustancia blanca, prueba cognitiva de Montreal,

Keywords: cerebral small vessel disease, Dawson’s fingers, Montreal Cognitive Assessment, older adults, White matter hyperintensities,
 
 
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