The Montreal Cognitive Assessment (MoCA) is a brief cognitive screening instrument that is known for its good psychometric properties and sensitivity to detect mild cognitive impairment (MCI). After ten years, it became relevant to update the previous Portuguese normative study due to changes in the population and some limitations present in the study itself. The study sample was composed of 860 cognitively healthy adults, stratified according to verified distribution of the Portuguese population across several sociodemographic variables. All participants completed a neuropsychological assessment battery, in which the MoCA was included. The analysis of the relationships between the sociodemographic variables and the MoCA show that age and educational level had a significant effect on MoCA scores, with educational level being the better predictor. These results foster the consideration of age and educational level in the development of normative data. The present study contributes to a reliable update of the normative data of MoCA. The new age groups and more stratified norms comply with the natural changes on the Portuguese population, providing an increase of power and clinical accuracy. The presented norms consider the cognitive domains subscores, consequently improving the comprehension and utility of the results obtained from the MoCA test.

The aim of this study was to compare the Montreal Cognitive Assessment (MoCA) performances of people who report no, subclinical, and clinical symptoms of depression.

Data was collected for the randomized controlled trial BrainFit-Nutrition. A secondary data analysis of 1,111 participants (age ≥ 60 years; M = 68.4 years; 55.1% female) was performed. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), cognitive performance was assessed via the MoCA. Performance differences were tested with Kruskal-Wallis tests. Two sensitivity analyses were conducted, one with data from people with MCI and one with the original item structure of the MoCA.

No differences were found in the MoCA total score or in visuospatial, executive functioning, attention, memory, or orientation subscores between individuals with no, subclinical, or clinical symptoms of depression. A sensitivity analysis also showed no differences.

Cognitive screening with the MoCA seems to be robust against depression and could therefore be used to screen for MCI regardless of depression level.

The study was prospectively registered at the International Standard Randomized Controlled Trial Number Registry on 23/11/2021 (ISRCTN 10560738).

Approximately 1.8 million people with dementia live in Germany and the number is expected to increase in the coming years. Between 360,000 and 440,000 new cases are diagnosed each year. General practitioners (GPs) are often the first point of contact for people with concerns about their memory performance or already noticed symptoms of dementia. However, structural barriers can hinder timely diagnosis by GPs, resulting in diagnoses frequently being made later in the disease's progression. Tablet-based cognitive testing, carried out by medical assistants (MAs) in GP practices, is being tested in the iCreate feasibility study, and could facilitate detection of dementia, allowing those affected to receive timely treatment and support. However, the acceptance, user experience and perceived benefits and consequences of routine implementation of such a not established procedure remain unclear until now.

In this qualitative study, seven GPs, six MAs and eight patients were qualitatively interviewed regarding the acceptance, user experience of the tablet-based procedure and its implications for GP care. Semi-structured interviews were conducted using newly developed guidelines, recorded, transcribed and analysed according to Kuckartz and Rädiker using MAXQDA.

All respondent groups had a positive perception of the digital testing in GP practices. Interviewed MAs welcomed the new responsibilities, and patients gladly accepted the opportunity of cognitive assessment in response to their memory concerns. GPs supported delegating additional tasks to MAs. Patients found the digital testing tasks feasible to complete on the tablet and MAs also had positive experiences using the tablet as test administrators. All groups can generally envision a long-term implementation of the tests in practice, but also noted possible barriers, like the need for additional communication with specialists, limited time resources, and currently insufficient remuneration of cognitive testing.

The positive user experience and high acceptance of participants indicate that tablet-based cognitive testing in GP settings can be highly feasible and can thus lead to indicated specialist referrals. Consequently, the management of patients exhibiting dementia symptoms should increasingly commence in GP practices, receive adequate funding, and occur in close collaboration with other specialized disciplines.

The poor affordability of hearing aids (HAs) limits their adoption. To justify higher costs, HAs fitted by audiologists (AUD service model) and high-end HAs should deliver better outcomes than over-the-counter (OTC) service models and low-end HAs.

To determine the effect of HA service models (AUD, OTC, and a hybrid OTC+ model) and technology levels (high end and low end) on patient outcomes.

This randomized clinical trial was conducted at the University of Iowa and Vanderbilt University Medical Center in research laboratories from February 2019 to December 2023 and included adults older than 55 years with mild to moderate hearing loss and no previous HA experience who were randomly assigned to 1 of 6 parallel groups, representing factorial combinations of 3 service models and 2 technology levels. The data were analyzed between January 2024 and March 2024.

The trial included 3 service models: AUD, in which audiologists fitted prescription HAs following best practices; OTC+, in which audiologists provided limited services for OTC HAs; and OTC, in which participants independently used OTC HAs. OTC HAs were simulated using prescription HAs. Two models of prescription HAs were used throughout the trial: a high-end HA with advanced features and a low-end HA.

The primary outcome measure was the Glasgow Hearing Aid Benefit Profile (GHABP), which was administered using ecological momentary assessment (EMA). EMA-GHABP was conducted preintervention and throughout the seventh week postintervention.

A total of 245 participants completed the study (121 women [49.4%]; mean [SD] age, 67.7 [8.1] years). After controlling for preintervention scores, the postintervention EMA-GHABP global score (ranging from 1 to 5) for AUD was significantly higher (indicating better outcomes) than for OTC+ and OTC by 0.33 points (95% CI, 0.14-0.52) and 0.32 points (95% CI, 0.13-0.51), respectively. The difference between OTC+ and OTC was not significant (0.02 points, 95% CI, -0.21 to 0.18). Nevertheless, EMA-GHABP global scores for OTC+ and OTC were close to 4 points, indicating positive outcomes. The effect of technology level and interaction between service model and technology level were not significant.

The trial results suggest that while OTC+ and OTC were effective, they did not achieve the same outcomes as AUD. As high-end and low-end HAs yielded similar outcomes, support for the higher cost of high-end HAs was not identified for individuals with mild to moderate hearing loss.

ClinicalTrials.gov Identifier: NCT03579563.

Neurocognitive disorders (NCD) are neurodegenerative diseases characterized by decline or loss of cognitive functions. Aging and the APOE genotype have been identified as major risk factors. Telomere length (TL) has been proposed as a biomarker of aging, with shorter TL associated with cognitive decline. This study investigated the relationship between TL and the APOE genotype in individuals with cognitive impairments (CIs). A total of 170 participants aged >55 years were included. Cognitive function was assessed using the MMSE and MoCA tests. Relative telomere quantification and APOE genotype were determined by real-time PCR. A significant association was observed between shorter TL and an increased risk of CI (p < 0.001). Although APOE ε4 is a known genetic risk factor, its association with CI was less clear in this study population, as a considerable proportion of ε4 carriers did not present cognitive impairment (p < 0.05). However, ε4 carriers with CI tended to have shorter TL than those with non-cognitive impairment (NCI-SMC). Furthermore, fewer years of education were strongly correlated with higher CI risk (p < 0.0001). Overall, individuals with both shorter telomeres and lower educational levels exhibited the highest risk of CI. APOE ε4 may contribute to telomere shortening.

To investigate the pathophysiological characteristics of cerebral blood flow (CBF) in patients with narcolepsy type 1 (NT1) via the arterial spin labeling (ASL) technique.

Thirty patients with diagnostic NT1 (PTs) and 34 age- and sex-matched healthy controls (HCs) were recruited for this study. Basic information was collected, and clinical evaluation and neuroimaging, including ASL and T1-3DBRAVO, was performed. The z-normalized CBF (zCBF) and spatial coefficient of variation (sCoV) were calculated, and the changes in NT1 were compared via analysis of covariate (ANCOVA). Furthermore, spearman's correlation analysis between impaired regional perfusion and clinical features was performed. Age, sex, and normalized grey matter volume were included as covariates.

Compared with that of HCs, the zCBF of PTs significantly differed in regions of fronto-temporal-occipital cortex, right insula and posterior insula, and left rostral/dorsal anterior cingulate gyrus (ACG) (P < 0.006). Moreover, the sCoV was significantly altered in the frontotemporal cortex, rostral ACG, right hippocampus, and posterior insula (P < 0.003). In PTs, positive correlations were identified between the zCBF of the right superior/middle frontal gyrus (SFG/MFG) and mean sleep latency, and between the zCBF of the left SFG of the frontal pole and sleep hallucination severity. Moreover, the sCoV of the right MFG/hippocampus were positively associated with Rapid Eye Movement efficiency and negatively associated with Hamilton Anxiety Scale score, respectively.

PTs exhibited abnormal regional perfusion in the frontal-temporal-occipital cortex and limbic system regions, which may serve as patient-specific imaging markers. Alterations in perfusion may lead to the clinical manifestations of underlying psychological and sleep disorders in PTs.

Remimazolam, a novel ultra-short-acting benzodiazepine, is a potential sedative for non-general anesthesia surgery in the elderly. This study aimed to investigate the appropriate sedative dosage of remimazolam and its effects on perioperative cognitive function in elderly patients undergoing non-general anesthesia surgery.

This multicenter, placebo-controlled trial enrolled 330 elderly patients undergoing non-general anesthesia procedures at eight centers in China from July 2021 to February 2022, with 238 ultimately completing the study. The primary endpoints were the dose of successful sedation with remimazolam and the changes in perioperative cognitive function. Adverse events were recorded to assess drug safety.

The induction dose of remimazolam for sedation in spinal anesthesia in elderly patients was 5.38 mg (95% confidence interval [CI], 5.20-5.56), maintained at a rate of 0.223 mg·kg-1·h-1 (95% CI, 0.201-0.237) with no serious adverse effects. Compared with the standard saline group, there was no statistical difference in the MMSE scores on Day 2 morning (P = 0.886), Day 2 afternoon (P = 0.864), and Day 7 (P = 0.613), and no statistical difference in the MoCA scores on Day 2 morning (P = 0.687), Day 2 afternoon (P = 0.827), and Day 7 (P = 0.483) in remimazolam group.

Remimazolam besylate is an effective sedative for elderly patients undergoing neuraxial anesthesia. It was successfully induced at a dose of 5.38 mg and maintained at 0.223 mg·kg-1·h-1, demonstrating a good safety profile without affecting short-term postoperative cognitive function.

http://www.chictr.org.cn (ChiCTR2100048744).

Background/Objectives: Diabetes is a chronic metabolic disease affecting over 500 million adults worldwide, which is over 10% of the world's population. Diabetes is associated with a high risk of complications, including cognitive impairment of varying severity. Effective treatment of diabetes requires the patients not only to follow medical recommendations, but also to have appropriate health literacy (HL). The aim of the study was to determine the level of health literacy in diabetes patients, taking into account their cognitive functions. Methods: the study design consists of an anonymous survey involving 312 patients with type 1 and 2 diabetes, treated at the Diabetology Clinic of the Institute of Rural Health in Lublin, Poland. The survey was based on two standardized research tools, the 47-item European Health Literacy Questionnaire (EU-HLS-Q47) and the Mini-Mental State Examination (MMSE), and an original questionnaire focusing on the patients' health situation, metric questions, questions about self-assessment of knowledge, and educational needs. Results: The EU-HLS-Q47 and MMSE showed that diabetic patients mostly presented a sufficient level of health literacy. A limited level of health literacy was presented by 36.86% of the examined diabetic patients. A statistically significant relationship between the length of diabetes (in years) and the General Health Literacy, Health Care, and Health Promotion Indices was reported. The MMSE test showed that every third patient with diabetes had cognitive disorders of varying intensity. Conclusions: Patients with diabetes and their family members require coordinated care and targeted therapeutic education to prepare them for self-care and self-control so as to reduce the risk of complications.

The Brain Health Test-7 (BHT-7), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA) are valid dementia and mild cognitive impairment (MCI) screening tools. Relevant validation studies have usually used receiver operating characteristic (ROC) curve analysis or a fixed-threshold approach. In this study, we adopted stratum-specific likelihood ratio (SSLR) analysis to capture more information about their performance in detecting MCI.

Cross-sectional multi-site study.

Hospitals in northern and southern Taiwan.

1090 subjects aged 50 years or older were assigned to a cognitively normal group, an MCI group, or a dementia group.

BHT-7, MMSE, and MoCA to differentiate cognitively normal subjects from those with MCI or dementia.

The three cognitive assessment tools were valid for detecting subjects with MCI or dementia according to ROC analysis. The overall area under the ROC curve (AUC) of the BHT-7 was significantly higher than that of the MoCA and MMSE in differentiating MCI or dementia from controls. Five strata were generated by SSLR analysis for the BHT-7 and MoCA, while 4 for the MMSE. The five strata of the BHT-7 and MoCA well represented the different degrees of probabilities of having MCI. However, it was still difficult to rule out the presence of MCI even by a test score within the highest-score stratum of the MMSE.

The BHT-7 performed slightly better than MoCA and MMSE in detecting subjects with MCI. The strata generated from the SSLR analysis were more informative than single cutoff values.

GPs can detect cognitive impairment (CI) at a very early stage, allowing early support for people and their caregivers. The early onset of CI is between 50 years and 60 years. Currently, in France, the Mini-Mental State Examination (MMSE) remains the most used screening test, although it has a lower sensitivity and specificity than the Montreal Cognitive Assessment (MoCA) for detecting mild CI, taking an average of 15 minutes to complete.

To investigate the feasibility of the MoCA during routine consultations in general practice for the early detection of CI and to determine prevalence of CI in a primary care setting.

A quantitative, prospective feasibility study was carried out in real-life working conditions during routine GP consultations in France.

GPs performed MoCA on adults aged ≥50 years, without suspected or confirmed CI.

Sixty-one GPs performed 221 MoCA with a mean duration of 8 minutes and detected mild neurocognitive impairment in 62% of patients.

The MoCA is feasible and easy to perform during routine consultations in general practice by trained and experienced physicians.

Dementia progression is heterogeneous and predicting who will decline quickly remains an open problem. Most work in this area has focused on volunteer-based cohorts, which are subject to recruitment biases. Instead, we examine predictors of rate of cognitive decline in cognitive assessment scores using electronic health record (EHR) data from a US memory clinic.

Data include patients with their first memory clinic visit (baseline) between January 1, 2014 and May 31, 2024. We used a discrete-time model to identify significant predictors of baseline and 6 month change in Mini-Mental State Examination (MMSE) scores (Montreal Cognitive Assessment scores were converted to MMSE equivalents for analysis). Inverse probability weighting was used to account for selection and censoring biases and p values were adjusted for multiple comparisons.

The cohort included 9583 patients, of which 7113 had a baseline cognitive assessment. Average MMSE at baseline was 23.2. Variables associated with lower baseline MMSE included female sex, non-White race, Medicaid enrollment, baseline dementia diagnosis, and cholinesterase inhibitor prescription, while higher scores were associated with prior diagnoses of chronic pain or fatigue. Quicker post-baseline decline was associated with older age, dementia diagnoses, and cholinesterase inhibitor prescription, while slower decline was associated with a higher number of total prescriptions, distance from home to clinic, and Social Deprivation Index. Notably, rate of decline was not associated with mild cognitive impairment, other non-dementia cognitive impairment, or any of the comorbidities considered.

While several significant predictors were identified, the lack of associations with broad categories of comorbidities and social determinants of health suggest that finer grained predictors may be needed. Additionally, the finding that cholinesterase inhibitor prescriptions predicted quicker decline merits additional investigation in real-world samples. The model developed in this work may serve as a first step toward an EHR-based progression risk tool.

In a memory clinic setting, faster decline in Mini-Mental State Examination scores was associated with age, dementia diagnosis, and cholinesterase inhibitor or memantine prescription.Slower decline was associated with the patient's total number of prescriptions.Neither race nor ethnicity were associated with rate of decline, nor were baseline mild cognitive impairment, other non-dementia cognitive impairment, diabetes, hypertension, obesity, depression, anxiety, chronic pain/fatigue, or hearing loss.

The association between obesity and cognitive function in older adults remains inconsistent due to the use of various anthropometric indicators, such as body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). More conclusive evidence is warranted. The aim of this study was to systematically summarize and synthesize the association between specific obesity-related anthropometric indicators (BMI, WC, and WHR) and cognitive function in obese older adults. Higher BMI, WC, or WHR is linked to cognitive decline in this population.

Systematic review and meta-analysis.

A comprehensive literature search was carried out using PubMed, CINAHL, Scopus, Embase, and the Cochrane Library (from their inception to October 2023). Studies investigating the association between obesity indicators, including BMI, WC, WHR, and cognitive performance in older adults were included. The weighted mean difference (WMD), Odds Ratio, and 95 % confidence interval (CI) were used to estimate the pooled effect size. A random-effects model was employed as the main method. Subgroup analyses and the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach were assessed (registered number: CRD42023461770).

Thirty-three eligible studies, involving 83,251 participants, were included. Obese older adults, as assessed by WC, had lower Mini-Mental State Examination (MMSE) scores than non-obese counterparts (WMD -0.84, 95 % CI -1.64 to -0.05, very low certainty). Those measured by WHR had a 31 % higher risk of cognitive impairment (OR 1.31, 95 % CI 1.12 to 1.53, moderate certainty). Subgroup analysis revealed a lower Montreal Cognitive Assessment (MoCA) score in obese group classified by WHO criteria compared to controls (WMD -1.67, 95 % CI -2.94 to -0.39).

This review suggests an association between obesity, as measured by WHR and WC, and poorer cognitive performance in older adults. WHR is moderately recommended for identifying cognitive impairment-related obesity, while WC recommendations are limited by very low evidence certainty.

Investigating vertebral fractures and brain structure, we found significant gray matter volume reductions in the right hippocampus, amygdala, and parahippocampal gyrus, especially in males. These findings emphasize the importance of integrating skeletal and neural health in osteoporosis management.

Vertebral fractures (VF) due to osteoporosis impact morbidity and quality of life in the elderly. The relationship between VF and changes in brain structure remains underexplored. This study aimed to investigate the association between VF and gray matter volume (GMV) reductions in specific brain regions and to explore potential sex differences.

Data from 1,751 participants (571 males, 1,180 females; mean age 64.9, range 18-97) in the fourth survey of the population-based Research on Osteoarthritis/Osteoporosis Against Disability study (2015-2016) were used. Participants were classified into those with and without VF (VF + and VF - groups) based on Genant's semiquantitative method, assessed by spine radiographs. Voxel-based morphometry was applied to MRI images to measure GMV, and a general linear model analysis was performed to compare GMV between groups, adjusting for age, sex, total brain volume, and Mini-Mental State Examination scores as covariates. Additionally, a two-way analysis of variance was conducted on the significant GMV cluster, with sex and VF presence as independent variables, to explore interaction effects.

The VF+ group consisted of 113 participants, while the VF- group included 1,638 participants. The analysis identified a significant cluster with reduced GMV in the VF + group compared to the VF - group. This cluster included the right hippocampus, right amygdala, and right parahippocampal gyrus. Further analysis revealed that males in the VF + group exhibited more pronounced GMV reductions in the significant cluster compared to females.

These findings suggest that VF is associated with significant reductions in brain regions critical for memory, emotional processing, and visuospatial memory, with more severe effects observed in males.

The components of metabolic syndrome (MetS) have previously been demonstrated to be contributors to cognitive decline in older adults as individual factors, but not collectively as a syndrome. This study investigated whether adults ≥ 50 years old who meet the criteria for MetS were more likely to develop impaired cognition than those without MetS.

Adults aged 50 years or older without significant cognitive impairment who received outpatient care at Taipei Veterans General Hospital were recruited. Waist circumference, blood tests for Mets components, and high-sensitivity C-reactive protein (hsCRP) were measured. Demographics, health condition, cognitive function (by Montreal Cognitive Assessment Taiwanese version, MoCA-T, and AD-8), depression symptoms (by Geriatric Depression Scale-15) and functional status (by Barthel's Index, and Lawton & Brody instrumental activities of daily living, IADL) were evaluated. Associations between MetS and cognitive function were analyzed by multivariate logistic regression.

Data of 567 participants were analyzed. The prevalence of MetS of the study population was 34.2%. MetS status was not significantly correlated to cognitive decline as indicated by Montreal Cognitive Assessment Taiwan version (p = 0.13) and AD-8 (p = 0.42). Mild abdominal obesity decreased the risk of developing impaired cognition in women (adjusted OR = 0.62, 95% CI = 0.42, 0.93, p = 0.02) but not in men (adjusted OR = 0.84, 95% CI = 0.46, 1.53, p = 0.58).

MetS is not a significant contributory factor to cognitive decline in community-dwelling middle-aged and older adults. An optimal waist circumference in community-dwelling older women is protective against the development of mild dementia.

A common concern is that the stress induced by adult spinal deformity (ASD) surgery may cause a postoperative decrease in cognitive function, especially in the elderly patients with some component of cognitive impairment. On the other hand, it is possible that ASD surgery could stabilize cognitive function by increasing activity and decreasing pain.

Here, we evaluate the effect of ASD surgery on cognitive outcome in a prospective study.

This is a prospective study of patients undergoing ASD surgery at a single institution over a five-year period.

ASD patients treated with posterior spinal fusion of greater or equal to 7 vertebral segments for adult deformity were included. Only patients with 12 month follow up are included in this study.

The primary outcome variable was performance on the Montreal Cognitive Assessment (MoCA) test of dementia and cognitive impairment, collected prospectively preoperatively and at 12-month follow-up. We also collected outcome metrics including the Oswestry Disability Index (ODI), Scoliosis Research Society questionnaire (SRS-22) with mental health (MH), activity (ACT), pain (P), and self-image (SI) sub-components. Preoperative and postoperative morphine equivalent dose (MED) of narcotic medication was collected using patient surveys and verified using prescription data.

The primary outcome was assessed using a paired t-test. Further analyses included performing univariate and multivariable analyses comparing patients with improved versus nonimproved MoCA scores across demographic, radiographic, surgical, outcome data, and opioid usage.

We enrolled 55 patients who met inclusion criteria. There was a significant increase in MoCA scores at 12-month follow-up compared to preoperative MoCA scores (p<.001). Overall, 60% of patients exhibited an increase in MoCA scores, and 47.2% met minimally clinically important difference (MCID). More severely cognitively impaired patients tended to improve to a greater degree than less severely impaired patients (p=.003). While there was no clear association between reduction in postoperative opioid use and cognitive improvement, we observed a possible association between postoperative delirium and cognitive decline among patients with baseline cognitive impairment (p=.01).

Our prospective data suggests that ASD surgery is associated with an improvement in cognitive function at one year follow-up. Further work is required to understand the drivers associated with cognitive improvement and worsening after ASD surgery.

White matter hyperintensity (WMH) is associated with cognitive impairment, although the clinical significance of WMH remains unclear. We aimed to elucidate the clinical significance of WMH volume and whether a fully automated quantitative analysis of WMH would be an effective marker of cognitive function.

Patients with suspected cognitive impairment were retrospectively examined. Clinical data, including patient information, neuropsychological examinations, diagnoses of dementia disorders, and fluid-attenuated inversion recovery (FLAIR) images, were collected. Patient information included sex, age, and educational level. Neuropsychological examinations included the Mini-Mental State Examination (MMSE) and Japanese version of the Montreal Cognitive Assessment (MoCA-J). WMH volumes were analyzed from FLAIR images using a fully automatic analysis software. The relationship between WMH volume and clinical data was investigated.

WMH volume was analyzed using 889 FLAIR cases. The WMH volume did not differ significantly between the sexes. WMH volume showed a positive correlation with age. Multiple comparison tests showed no significant difference in WMH volume between junior high school and high school graduates, but all other differences were significant. Multiple comparison tests revealed significant differences in mean WMH volume among all groups in the classified MMSE. The Mann-Whitney U test revealed significant differences in WMH volume between the two groups. Multiple comparison tests revealed significant differences in WMH volume among all the groups of classified diagnostic results.

Quantitative analysis of WMH volume from FLAIR images may provide useful information for dementia treatment and may be effective as a new marker in cognitive function examinations.

With upcoming clinical trials targeting preclinical stages of genetic frontotemporal dementia (FTD), early detection through cognitive screening is crucial. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) have potential as screening instruments for early-stage genetic FTD. However, no comparative evaluation has been performed. We aimed to compare MMSE and MoCA performance among presymptomatic, prodromal, and symptomatic pathogenic variant carriers to analyze which screening test has superior discriminative abilities.

We used cross-sectional and longitudinal data from 2 longitudinal genetic FTD cohort studies in the Netherlands and the United Kingdom, collected between 2021 and 2024. Participants were either presymptomatic, prodromal, or symptomatic pathogenic variant carriers or healthy controls (first-degree family members without pathogenic variants for FTD). Grouping was based on the global CDR-plus-NACC-FTLD score. Participants were assessed with both MoCA and MMSE. Statistical analyses compared total and subscores between groups and evaluated predictive and classification accuracy of both tests.

A total of 243 participants (mean age 49.9 ± 13.1 years, mean education 14.5 ± 3.0 years, 56% female), 157 of whom were pathogenic variant carriers (MAPT, GRN, C9orf72, TARDBP, and TBK1) and 86 controls, were included. Carriers were classified as presymptomatic (n = 119), prodromal (n = 18), or symptomatic (n = 20). Both MoCA [F(3,239) = 16.565, p < 0.001] and MMSE [F(3,239) = 13.529, p < 0.001] total scores differed significantly between groups, with controls (median MoCA 28.5, 95% CI 28.0-29.0; median MMSE 30, 95% CI 30.0-30.0) outperforming prodromal (median MoCA 26, 95% CI 23.0-27.0; median MMSE 29, 95% CI 27.5-29.5) and symptomatic (median MoCA 20.5, 95% CI 17.0-24.0; median MMSE 26, 95% CI 23.5-29.0) carriers. MoCA distinguished between presymptomatic carriers and controls (median MoCA 28, 95% CI 27.0-29.0), but MMSE did not. MoCA demonstrated superior discriminative ability compared with MMSE (MoCA area under the curve [AUC] = 0.87, 95% CI 0.81-0.94; MMSE AUC = 0.80, 95% CI 0.72-0.89).

Its higher sensitivity and better discriminative power make MoCA a more valuable tool for cognitive screening in upcoming clinical trials targeting preclinical FTD. Future studies should aim for larger sample sizes from additional study centers.

Perturbed cholesterol metabolism may play an important role in the development of dementia and its preclinical stage, mild cognitive impairment (MCI). Oxysterols, the metabolites generated during cholesterol oxidation, also appear to be risk factors for MCI. Therefore, we aimed to investigate if the metabolic profile of blood oxysterols could be used to characterize MCI risk. This cross-sectional study incorporated 501 participants-253 patients with MCI and 248 cognitively normal controls. Serum levels of 22 free oxysterols were measured, and a set of 27 oxysterol-related gene polymorphisms was genotyped. Five [27-hydroxycholesterol (27-OHC), 27-OHC periphery-derived metabolite 3β-hydroxy-5-cholestenoic acid (27-CA) and brain-derived metabolite 7α-hydroxy-3-oxo-4-cholestenoic acid (7-HOCA), 4β-hydroxycholesterol (4β-OHC); 4α-hydroxycholesterol (4α-OHC)] of the twenty-two oxysterols detected in serum significantly differed between the patients with MCI and controls, greatly distinguishing patients with MCI from control individuals (AUC=0.834, 95 % CI: 0.804-0.866). Association analyses demonstrated significant correlations between these candidate oxysterol biomarkers with younger age, higher blood lipids, worse cognitive performance, and higher monounsaturated fatty acid intake. This panel of serum free oxysterols as candidate serum oxysterol biomarkers for MCI highlighted the essential role of 27-OHC in the pathogenesis of early dementia prevention. (The study registered in the Chinese Clinical Trial Registry as ChiCTR-OOC-17011882).

Postoperative delirium (POD) has a major impact on patient recovery after cardiac surgery. Although its pathophysiology remains unclear, there could be a correlation between cerebral blood flow (CBF) variations during cardio-pulmonary bypass (CPB) and POD. Our study aimed to evaluate whether variations in on-pump CBF, compared to pre-anesthesia and pre-CPB values, are associated with POD following coronary artery bypass grafting (CABG) surgery.

This prospective observational cohort study included 95 adult patients undergoing elective on-pump CABG surgery. Right middle cerebral artery blood flow velocity (MCAV) was assessed using Transcranial Doppler before anesthesia induction, before CPB and every fifteen minutes during CPB. Pre-anesthesia and pre-CPB values were chosen as baselines. Individual values, measured during CPB, were converted as percentage changes relative to these baselines and named as %MCAV0 and %MCAV1, respectively. POD was assessed using the Confusion Assessment Method for ICU (CAM-ICU) during the first 48 post-operative hours and with the 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) on the fifth post-surgical day.

Overall POD incidence was 17.9%. At 30 minutes of CPB, %MCAV0 was higher in POD group than in no-POD group (p = .05). %MCAV0 at 45 minutes of CPB was significantly higher in POD group (87 (±17) %) than in no-POD group (68 (±24) %), p = .04. %MCAV1 at 30 and 45 minutes of CPB were higher in POD group than in no-POD group, at the limit of statistical significance. We found %MCAV1 > 100% in POD group, but not in no-POD group.

Significant differences in %MCAV0 became evident after 30 minutes of CPB, whereas differences in %MCAV1 at 45 minutes of CPB were at limit of statistical significance. In POD group %MCAV1 was higher than 100% at 30 and 45 minutes of CPB, which is supposed to be a sign of cerebral hyperperfusion. Monitoring CBF during CPB could have prognostic value for POD.

The aim of this study was to investigate whether the level of decrease in cerebral oxygen saturation during the valve placement phase of the transcatheter aortic valve implantation (TAVI) procedure under sedation has an effect on postoperative delirium (POD).

The study initially assessed 50 patients between the ages of 50 and 90 years with an indication for TAVI by the cardiac team. Regional cerebral oxygen saturation (rScO2) was measured using Near-infrared spectroscopy (NIRS) before the procedure (T1), during surgical field sterilization (T2), catheter placement (T3), wire manipulation (T4), valve placement (T5) and access site artery repair (T6). Confusion Assessment Method for The Intensive Care Unit (ICU-CAM) test was performed on intensive care unit and the presence of POD was questioned. Patients were divided into two groups as those without POD (Group 1) and those with POD (Group 2).

The study was completed with 41 patients in total. While POD was present in 12 (29.3%) of the patients evaluated intensive care unit, POD was not observed in 29 (70.7%) patients. The rScO2 value measured at T5 was significantly lower in Group 2 compared to Group 1 (p < 0.001).

In our study, the rate of POD after TAVI was as high as 29.3%. Low rScO2 during valve placement was associated with delirium. Our findings indicate that NIRS devices could be a useful tool for assessing the risk of POD during the TAVI procedure; however, further research is needed to validate their routine clinical use.

Postural instability greatly reduces quality of life in people with Parkinson's disease (PD). Early and objective detection of postural impairments is crucial to facilitate interventions. Our aim was to use a convolutional neural network (CNN) to differentiate people with early to mid-stage PD from healthy age-matched individuals based on spectrogram images obtained from their body sway. We hypothesized the time-frequency content of body sway to be predictive of PD, even when impairments are not yet clinically apparent.

18 people with idiopathic PD and 15 healthy controls (HC) participated in the study. We tracked participants' center of pressure (COP) using a Wii Balance Board and their full-body motion using a Microsoft Kinect, out of which we calculated the trajectory of their center of mass (COM). We used 30 s-snippets of motion data from which we acquired wavelet-based time-frequency spectrograms that were fed into a custom-built CNN as labeled images. We used binary classification to have the network differentiate between individuals with PD and controls (n = 15, respectively).

Classification performance was best when the medio-lateral motion of the COM was considered. Here, our network reached a predictive accuracy, sensitivity, specificity, precision and F1-score of 100%, respectively, with a receiver operating characteristic area under the curve of 1.0. Moreover, an explainable AI approach revealed high frequencies in the postural sway data to be most distinct between both groups.

Heeding our small and heterogeneous sample, our findings suggest a CNN classifier based on cost-effective and conveniently obtainable posturographic data to be a promising approach to detect postural impairments in early to mid-stage PD and to gain novel insight into the subtle characteristics of impairments at this stage of the disease.

Diabetes is a chronic disease that affects many people, with both its incidence and prevalence rising globally. Diabetes can lead to various complications, among which cognitive impairment in diabetic patients significantly impacts their daily life and blood glucose management, complicating treatment and worsening prognosis. Therefore, the early diagnosis and treatment of cognitive impairment are essential to ensure the health of diabetic patients. However, there is currently no widely accepted and effective method for the early diagnosis of diabetes-related cognitive impairment. This review aims to summarize potential screening and diagnostic methods, as well as biomarkers, for cognitive impairment in diabetes, including retinal structure and function examination, brain imaging, and peripheral blood biomarkers, providing valuable information and support for clinical decision making and future research.

Methamphetamine stands as one of the most widely abused drugs globally. Methamphetamine Use Disorder not only impairs the physical and mental wellbeing of addicts but also elevates their risk of suicide. Despite the high suicide rate among individuals with methamphetamine use disorder, research on their clinical characteristics and suicide risk factors remains scarce. Therefore, it is imperative to investigate the risk factors associated with suicidal ideation in individuals with methamphetamine use disorder.

Employing Respondent Driven Sampling (RDS), a total of 11,825 individuals with methamphetamine use disorder were selected from April to May 2023 in Guangdong, China. The individuals with methamphetamine use disorder were assessed using the Beck Scale for Suicide Ideation (BSSI), and the detection rate of suicidal ideation among these patients was 23.92%. The Bayesian Mindsponge Framework (BMF) analysis was utilized to examine the risk factors for suicidal ideation among these individuals.

The result revealed that trait depression and cognitive impairment are positively correlated with suicidal ideation in people, whereas social support has a moderating effect on the relationship between trait depression and cognitive impairment with suicidal ideation.

Suicidal ideation in individuals with methamphetamine use disorder is influenced by a multitude of factors, including family, society, and stress. Consequently, comprehensive intervention measures are essential to address this issue.

Cognitive frailty, which is notably prevalent in nursing homes, correlates with a range of adverse health outcomes; however, interventions targeting this population are scarce, particularly those addressing activities of daily living (ADLs). The objective of this study was to evaluate the effects of virtual reality-based ADL rehabilitation training on older adults with cognitive frailty and ADL impairments.

A 2-arm randomized controlled trial.

Older adults with cognitive frailty and mild ADL impairments in a nursing home.

Sixty-six eligible participants were equally randomized into intervention and control groups. The intervention involved 45-minute sessions conducted twice weekly for 12 weeks. Outcomes evaluated included ADL performance, cognition, frailty, depression, and quality of life. Assessments were performed at baseline, 6 weeks (T1), and 12 weeks (T2).

There was no statistically significant difference between the 2 groups at baseline. The mean age of the participants was 80.20 ± 9.14 years, and most were women (54.55%). Compared with the control group, the intervention group showed significant improvements in ADLs (T1: β = 6.33, T2: β = 12.79), basic ADLs (T1: β = 4.09, T2: β = 6.97), instrumental ADLs (T1: β = 2.24, T2: β = 4.12), cognition (T1: β = 3.67, T2: β = 4.42), frailty (T1: β = -0.76, T2: β = -1.27), and mental component summary of quality of life (T1: β = 8.49, T2: β = 16.44) at T1 and T2. By T2, significant improvements were observed in depression (T2: β = -2.06) and physical component summary of quality of life (T2: β = 8.52).

For older adults with cognitive frailty and mild ADL impairments residing in a nursing home, the virtual reality-based ADL rehabilitation program was safe and effective. Following the 12-week intervention, significant improvements were observed in ADL performance, cognition, frailty, depression, and quality of life.

Patients' capacities to understand and act upon healthcare information is crucial to decision-making and high-quality care. Cognitive impairment (CI) has been associated with adverse outcomes across a range of diseases and surgeries. Despite the importance of CI, there is little to no information on its prevalence and severity in vascular surgery patients in the United States. We therefore conducted a prospective observational study to better characterize the prevalence and severity of CI in a contemporary vascular surgery practice.

We enrolled 111 outpatients attending a vascular surgery clinic using pragmatic consecutive sampling. Patients were excluded if they had a previous diagnosis of blindness, deafness, or dementia. Subjects completed a demographic survey and the Montreal Cognitive Assessment (MoCA), which was administered by a trained proctor. Chart review was used to assess comorbidities. The MoCA is a validated tool consisting of tasks such as clock drawing for assessing CI. It has a lower educational bias and higher sensitivity for detecting mild impairment compared to other examinations. The MoCA is scored from 0-30 based on an objective grading system. Scores between 0-9, 10-17, 18-25, and 26-30 indicate severe, moderate, mild, and no CI, respectively. Statistical analysis, including multivariable modeling, was performed using SAS (SAS Institute, Cary, NC).

Of 163 patients, our analysis included 111 consecutive vascular patients who completed the MoCA. The average age of the entire cohort was 64.1 years, and 58.6% were male. The majority of the patients in the study were White (80.1%). The mean MoCA score of the entire cohort was 22.6 (mild CI). Of all subjects, 77% had CI: 68% with mild and 9% with moderate CI. Hypertension (P = 0.024), congestive heart failure (CHF) (P = 0.028), fewer years of education (P = 0.032), and Medicaid enrollment (P = 0.046) all had significant univariate associations with CI. There was no statistically significant difference between age (P = 0.11) or the primary vascular diagnosis disease for which the patient sought treatment and CI (P = 0.49). Multivariable models demonstrated that only CHF (odds ratio 3.8, P = 0.046) was statistically significantly associated with risk of CI.

In this first-time prospective study of the entire spectrum of vascular patients in the United States, we found that nearly 4 of every 5 vascular surgery patients have undiagnosed CI. Furthermore, we found that having CHF was associated with a higher likelihood of CI. Given the implications on consent, decision-making, and postoperative care, future work should focus on enrollment of a larger cohort along with an examination of the impact of CI on mortality, length of stay, and other outcomes.

Early diagnosis of mild cognitive impairment (MCI) and Alzheimer's disease (AD) is very important in better management of these diseases, and serious games play an effective role in helping to diagnose these diseases more accurately owing to their innovative features. With respect to the diversity of available games, the purpose of this study was to investigate the effectiveness of using serious games to assess the cognitive status of the elderly at risk of MCI/AD. A systematic review was conducted and the correlation of serious game results with cognitive test scores were extracted from eligible studies for meta-analysis. We analyzed the correlation between the results of serious games with the scores of mini-mental state examination (MMSE), Addenbrooke's Cognitive Examination-revised edition (ACE-R), and Montreal Cognitive Assessment (MoCA) tests to evaluate cognitive status of the elderly at risk of MCI/AD, as well as the cognitive aspects examined by these tests. The random-effects model was used to obtain the overall correlation coefficient to assess the relationship between the results of serious games and the above mentioned paper-and-pencil tests. The correlation of game results with the MMSE, ACE-R, and MoCA was 0.604, 0.682, with 0.682, respectively. The correlation between the results of the games with the score of each cognitive aspect was also calculated. Overall, there is a positive correlation between serious game scores in terms of accurate patients' reactions with the scores of MMSE, ACE-R, and MoCA tests. Among the cognitive aspects, the highest correlation was obtained for fluency (0.591). For abstraction, however, the correlation was the lowest (0.036). In all three tests, the correlation was >0.6 and in cognitive aspects was <0.6. Thus, more studies should be conducted to develop serious games that are more in line with cognitive tests.

Postoperative delirium (POD) is a serious complication in elderly patients after major surgery, associated with high morbidity and mortality. Treatment and prevention methods are limited. Repetitive transcranial magnetic stimulation (rTMS) shows potential in enhancing cognitive function and improving consciousness.

To evaluate whether early postoperative rTMS has a protective effect against POD and to explore its potential mechanisms.

Patients aged 60 years or older, scheduled for major abdominal surgery, were randomly assigned to receive rTMS at 100 % RMT, 10 Hz, with 2000 pulses targeting the DLPFC after extubation in PACU, either as active rTMS(n = 61) or sham rTMS (n = 61). The primary outcome was the incidence of POD during the first 3 postoperative days.

In the modified intention-to-treat analysis of 122 patients (mean [SD] age, 70.2 [4.1] years; 53.3 % women), POD incidence was lower in the rTMS group (11.5 %) compared to the sham rTMS group (29.5 %) (relative risk, .39; 95 % CI, .18 to .86; P = .01). rTMS patients had higher BDNF (8.47 [2.68] vs. 5.76 [1.42] ng/mL; P < .001) and lower NfL (.05 [.04] vs. .06 [.04] ng/mL; P = .02) levels. Mediation analysis suggests that rTMS may reduce POD by increasing brain-derived neurotrophic factor (z = -3.72, P < .001) rather than decreasing neurofilament light (z = 1.92, P = .06).

Immediate postoperative rTMS can reduce the incidence of POD in elderly patients undergoing major abdominal surgery, probably by upregulating brain-derived neurotrophic factor levels.

Enhancing post-stroke cognitive impairment (PSCI) is a key aspect of prognosis for stroke patients. Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) is currently a widely utilised method for treating PSCI. With the increasing promotion of traditional Chinese medicine, Xingnao Kaiqiao (XNKQ) acupuncture has been progressively incorporated into clinical treatment. This paper observes the effect of LF-rTMS with XNKQ acupuncture on patients with PSCI.

Totally, 192 patients with PSCI were consecutively recruited and treated either with LF-rTMS and XNKQ acupuncture (observation group) or LF-rTMS only (control group) for 4 weeks. The pre- and post-treatment Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores, P300 latency and amplitude, inflammatory factor levels were compared and clinical efficacy was assessed.

Both groups exhibited increased MMSE/MoCA scores, and P300 amplitude, and shortened P300 latency, and the observation group had higher scores and P300 amplitude, and shorter P300 latency than the control group. Both groups displayed decreased inflammatory factor levels (Tumour necrosis factor-α, interleukin (IL)-6, IL-10, IL-1β) after treatment, which were lower in the observation group than the control group. Inflammatory factor levels in PSCI patients were negatively interrelated with MMSE, MoCA score and P300 amplitude, and positively with P300 latency. The observation group showed an increased number of patients showing cured and significantly effective results, a decreased number of patients showing effective and invalid results, and an observably elevated total effective rate.

LF-rTMS with XNKQ acupuncture can improve cognitive function and reduce inflammatory immune response, and has better clinical efficacy in PSCI patients.

Alzheimer's disease (AD) affects more women than men. Although women live longer than men, it is not longevity alone, but other factors, including metabolic changes, that contribute to the higher risk of AD in women. Metabolic pathways have been implicated in AD progression, but studies to date examined targeted pathways, leaving many metabolites unmeasured. Sex is often a neglected biological variable, and most metabolomic studies were not designed to investigate sex differences in metabolomic profiles. Here, we performed untargeted metabolomic profiling of sera from male and female patients with mild cognitive impairment (MCI), a common precursor to AD, and matched controls. We discovered significant metabolic changes in individuals with MCI, and found several pathways that were strongly associated with sex. Peptide energy metabolism demonstrated sexual dimorphism. Lipid pathways exhibited the strongest differences between female and male MCI patients, including specific phosphatidylcholine lipids, lysophospholipids, long-chain fatty acids, and monoacylglycerols. 1-palmitoleoyl glycerol and 1-arachidonoyl glycerol were higher in female MCI subjects than in male MCI subjects with no differences between control males and females. Conversely, specific dicarboxylic fatty acids were lower in female MCI subjects than male MCI subjects. In cultured astrocytes, 1-arachidonoyl glycerol promoted phosphorylation of the transcriptional regulator sphingosine kinase 2, which was inhibited by the transient receptor potential vanilloid 1 receptor antagonists, as well as chromatin remodelling. Overall, we identified novel sex-specific metabolites in MCI patients that could serve as biomarkers of MCI in both sexes, help further define AD etiology, and reveal new potential prevention strategies for AD.

Cognitive impairments have been reported among disadvantaged populations.

We aimed to ascertain how demographic factors are associated with cognitive performance in individuals enrolled in a local substance abuse recovery program.

In total, 106 participants were included in the study. Besides demographic information, vital signs and cognitive function, measured by Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA), were collected from each participant. Welch's t-test and regression analysis were used to analyze how different demographic factors are associated with cognitive assessment scores.

The mean age of African American (AA) participants (n = 43) were 48.35 ± 1.65 years, which are older than that for the White participants of 38.95 ± 1.36 (n = 63) years. Compared to the AA participants, the White participants had a larger variance in attained education levels. The average MMSE scores were 27.09 ± 0.40 for AA participants, which is lower than that for the White participants of 28.52 ± 0.33 (p < 0.05). The average MoCA scores were 23.71 ± 0.54 for AAs, which is lower that for the White participants of 26.65 ± 0.44 (p < 0.001). The AA and White participant groups had cognitive impairment rate of 18.6% and 6.35%, respectively. The regression analysis indicates age and education are two significant predictors for the cognitive performance difference between the two racial groups.

Significant disparities in cognitive performance exist between two racial groups of enrolled in a local substance abuse recovery program. The older age and lower levels of attained education in AA participants can explain the poorer cognitive function than the White participants.

Radiation therapy (RT) is a critical treatment modality for both primary and metastatic brain tumors, yet ∼30% of patients experience cognitive decline post-RT. This cognitive toxicity is linked to low radiation doses affecting the hippocampal dentate gyrus. Hippocampal avoidance-whole brain RT combined with memantine has shown promising outcomes in preserving cognitive function and quality of life in patients with brain metastases. Nowadays, it is the standard of care for those with good performance status and no hippocampal metastases.

We conducted a prospective trial approved by the institutional review board (SMC0307-23), including patients aged ≥18 years with primary brain tumors postresection or biopsy. Exclusion criteria included multifocal glioma crossing to the other hemisphere. RT was delivered to a total dose of 54 Gy in 30 fractions. Diffusion tensor imaging was performed to map hippocampal-associated white matter tracts. Using Eclipse treatment planning software, memory fiber tracts and hippocampi were contoured and integrated into RT planning. Dosimetric analyses compared 2 plans with memory fiber constraints and 1 without. The primary endpoints were safety and dosimetric feasibility.

Twelve patients with low-grade gliomas were included, and the contouring of memory fibers and hippocampi was successful. Volumetric modulated arc therapy (VMAT) treatment plans met-dose constraints for memory fibers, with an average mean dose of 10.1 Gy. The average Montreal Cognitive Assessment score before RT was 27.1 and 26.4 at 8 months post-treatment, with a P value of .07. Excluding 1 patient, the scores were 27.1 and 26.6, respectively (P = .13).

Magnetic resonance imaging planning using diffusion tensor imaging for memory fiber detection and incorporation into RT planning via VMAT techniques enables hippocampal and associated white fiber sparing, potentially preserving cognitive function. Preliminary cognitive data are promising, supporting the need for further validation in a larger cohort.

Mild cognitive impairment is increasingly recognized as a complication of type 2 diabetes (T2D). Although currently no disease-modifying treatments for cognitive disorders exist, interest surged in potential neuroprotective effects of newer anti-diabetic drugs. This study investigates the impact of newer anti-diabetic drug classes, dipeptidyl peptidase-4 (DPP-4i) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) - on cognitive decline in T2D patients on metformin therapy. A prospective observational cohort study was conducted, with a follow-up duration of 6 months. The study compared the cognitive performance of T2D patients on metformin monotherapy to those on a combination of metformin with DPP-4i or SGLT2i, using the Montreal Cognitive Assessment Battery. A group of healthy volunteers served as a reference. At baseline, patients receiving combination therapy had a cognitive performance comparable to that of healthy volunteers, while those on metformin monotherapy scored lower. These differences persisted for patients who completed the follow-up, though there was no change within group. Baseline differences were independent of glycemic control, blood lipids, renal function, and serum inflammatory markers. Comprehensive metabolomics and lipidomics revealed that T2D patients on metformin monotherapy exhibited enriched purine, glutathione and sphingolipid metabolism, with alterations in xanthine, L-pyroglutamic acid, and several sphingomyelins. These changes suggest increased oxidative stress in T2D, mitigated in the combination therapy group, as evidenced by total serum antioxidant capacity. As such, we conclude that the combination of DPP-4i or SGLT2i with metformin positively impacts cognitive function in T2D patients by modulating metabolic pathways rather than improving glycemic control, peripheral diabetic complications, or systemic inflammation.

Late-life depression (LLD) is a heterogenous disorder related to cognitive decline and neurodegenerative processes, raising a need for the development of novel biomarkers. We sought to provide preliminary evidence for acoustic speech signatures sensitive to LLD and their relationship to depressive dimensions.

Forty patients (24 female, aged 65-82 years) were assessed with the Geriatric Depression Scale (GDS). Vocal features were extracted from speech samples (reading a pre-written text) and tested as classifiers of LLD using random forest and XGBoost models. Post hoc analyses examined the relationship between these acoustic features and specific depressive dimensions.

The classification models demonstrated moderate discriminative ability for LLD with receiver operating characteristic = 0.78 for random forest and 0.84 for XGBoost in an out-of-sample testing set. The top classifying features were most strongly associated with the apathy dimension (R 2 = 0.43).

Acoustic vocal features that may support the diagnosis of LLD are preferentially associated with apathy.

The depressive dimensions in late-life depression (LLD) have different cognitive correlates, with apathy characterized by more pronounced cognitive impairment.Acoustic speech features can predict LLD. Using acoustic features, we were able to train a random forest model to predict LLD in a held-out sample.Acoustic speech features that predict LLD are preferentially associated with apathy. These results indicate a predominance of apathy in the vocal signatures of LLD, and suggest that the clinical heterogeneity of LLD should be considered in development of acoustic markers.