Background:The Montreal Cognitive Assessment (MoCA) has a high sensitivity for detecting cognitive dysfunction. Swedish normative data does not exist and international norms are often derived from populations where cognitive impairment has not been screened for and not been thoroughly assessed to exclude subjects with dementia or mild cognitive impairment.Objective:To establish norms for MoCA and develop a regression-based norm calculator based on a large, well-examined cohort.Methods:MoCA was administered on 860 randomly selected elderly people from a population-based cohort from the EPIC study. Cognitive dysfunction was screened for and further assessed at a memory clinic. After excluding cognitively impaired participants, normative data was derived from 758 people, aged 65–85.Results:MoCA cut-offs (–1 to –2 standard deviations) for cognitive impairment ranged from <25 to <21 for the lowest educated and <26 to <24 for the highest educated, depending on age group. Significant predictors for MoCA score were age, sex and level of education.Conclusion:We present detailed normative MoCA data and cut-offs according to the DSM-5 criteria for cognitive impairment based on a large population-based cohort of elderly individuals, screened and thoroughly investigated to rule out cognitive impairment. Level of education, sex, and age should be taken in account when evaluating MoCA score, which is facilitated by our online regression-based calculator that provide percentile and z-score for a subject’s MoCA score.

The concept of enuresis as a primary delay in development of bladder control is not new (Denny-Brown and Robertson, 1933), but much effort has been expended in order to find other physical or emotional causes for this symptom. Bakwin (1961) has pointed out the unsatisfactory nature of the evidence for such causes and has re-emphasized the fact that enuresis tends to disappear with increasing age and has a striking familial incidence. We have not found in the literature an investigation attempting to make a comprehensive assessment of a series of enuretic children which also includes a follow-up study. The study reported here provides evidence regarding the effects of maturation in a series of comprehensively investigated children. Material and MethodsIn a 12-months period during 1951-2 children with enuresis attending the Bristol Royal Hospital for Sick Children were, by arrangement with the consultants concerned, referred to one of us (M. M. B.) for investigation. Preliminary selection of the cases had been made by the family doctor or local authority medical officer; but once referred to the medical, psychological, or urological clinics they were put consecutively into the study. Cases were accepted only if bed-wetting was the major complaint and if the patients had attained the age of 5 years.A total of 111 cases entered the study, and the initial assessment was designed to be comprehensive. A full medical, psychological, and social history was obtained by M. M. B., who also performed the physical examination and cystometry. Psychological assessment included not only the history from the parents but also observations on the child's behaviour and personality in the ward, and a school report was obtained. Intelligence-testing and electroencephalography were done by the specialist departments. Urological examination included cystoscopy, radiological examination included intravenous pyelography, but cystourethrography was done only if indicated.Treatment was individualized according to the results of the assessment. All the patients were given an explanation of the condition, and the majority received medication in the form of ephedrine or belladonna. If a severe degree of obstruction of the bladder neck with troublesome frequency and urgency was present a transurethral resection was performed, and a few cases received intensive psychiatric treatment. Conditioning devices were not in use at this time. The duration of treatment under hospital out-patient supervision was in most cases quite short and many lost touch after a few months.Five years after the initial assessment it was decided (R. F. B. and T. E. 0.) to trace the children and ascertain whether they still had symptoms. The follow-up assessments were made by E. M. B. and T. E. 0. It was neither possible nor justifiable to repeat all the investigations, but information obtained included the degree of bladder control achieved, the age at which dryness had occurred, an assessment of puberty status, and the social and psychological climate at home, school, or...

Background and Objectives:Identifying a clinically meaningful change in cognitive test score is essential when using cognition as an outcome in clinical trials. This is especially relevant as clinical trials increasingly feature novel composites of cognitive tests. Our primary objective was to establish minimal clinically important differences (MCIDs) for commonly used cognitive tests, using anchor-based and distribution-based methods, and our secondary objective was to investigate a composite cognitive measure that best predicts a minimal change in the Clinical Dementia Rating – Sum of Boxes (CDR-SB).Methods:From the Swedish BioFINDER cohort study, we consecutively included cognitively unimpaired (CU) individuals with and without subjective or mild cognitive impairment (MCI). We calculated MCIDs associated with a change of ≥0.5 or ≥1.0 on CDR-SB for MMSE, ADAS-cog delayed recall 10-word list, Stroop, Letter S Fluency, Animal Fluency, Symbol Digit Modalities Test (SDMT) and Trailmaking Test (TMT) A and B and triangulated MCIDs for clinical use for CU, MCI and amyloid positive CU. For investigating cognitive measures that best predict a change in CDR-SB of ≥0.5 or ≥1.0 point we conducted ROC analyses.Results:Our study included 451 cognitively unimpaired individuals, 90 with subjective cognitive decline and 361 without symptoms of cognitive decline (pooled mean follow-up time 32.4 months, SD 26.8, range 12-96 months) and 292 people with MCI (pooled mean follow-up time 19.2 months, SD 19.0, range 12-72 months). We identified potential triangulated MCIDs (cognitively unimpaired; MCI) on a range of cognitive test outcomes: MMSE -1.5; -1.7, ADAS-delayed recall 1.4; 1.1, Stroop 5.5; 9.3, Animal Fluency: -2.8; -2.9, Letter S Fluency -2.9; -1.8, SDMT -3.5; -3.8, TMT A 11.7; 13.0, TMT B 24.4; 20.1. For amyloid positive CU we found the best predicting composite cognitive measure included gender, and changes in ADAS delayed recall, MMSE, SDMT and TMT B. This produced an AIC 130.5, AUC of 0.87 (95% CI 0.79-0.94, sensitivity 75%, specificity 88%).Discussion:Our MCIDs may be applied in clinical practice or clinical trials for identifying if a clinically relevant change has occurred. The composite measure can be useful as a clinically relevant cognitive test outcome in preclinical AD trials.

Background As research in treatments for neurocognitive diseases progresses, there is an increasing need to identify cognitive decline in the earliest stages of disease for initiation of treatment in addition to determining the efficacy of treatment. For early identification, accurate cognitive tests cutoff values for cognitive impairment are essential. Methods We conducted a study on 297 cognitively healthy elderly people from the BioFINDER study and created subgroups excluding people with signs of underlying neuropathology, i.e., abnormal cerebrospinal fluid [CSF] β-amyloid or phosphorylated tau, CSF neurofilament light (neurodegeneration), or cerebrovascular pathology. We compared cognitive test results between groups and examined the age effect on cognitive test results. Results In our subcohort without any measurable pathology (n = 120), participants achieved better test scores and significantly stricter cutoffs for cognitive impairment for almost all the examined tests. The age effect in this subcohort disappeared for all cognitive tests, apart from some attention/executive tests, predominantly explained by the exclusion of cerebrovascular pathology. Conclusion Our study illustrates a new approach to establish normative data that could be useful to identify earlier cognitive changes in preclinical dementias. Future studies need to investigate if there is a genuine effect of healthy aging on cognitive tests or if this age effect is a proxy for higher prevalence of preclinical neurodegenerative diseases.