Background and Purpose: The study evaluated the performance between norm-derived age and education adjusted vs single cutoff scores of the Montreal Cognitive Assessment, Hong Kong version (HK-MoCA) in classifying cognitive impairment in Chinese older adults. Methods: Total scores of HK-MoCA were collected from 315 subjects (128 with dementia, 122 with mild cognitive impairment (MCI) and 65 normal) attending a public district hospital-based cognition clinic from 2012 to 2017. The HK-MoCA total scores were evaluated using different cutoffs. Norm-derived age and education adjusted cutoff scores were at 16th, 7th, and 2nd percentiles. Comparison was made with the single cutoff scores validated in a local study with 21/22 for MCI and 18/19 for dementia. Results: Single cutoff score of HK-MoCA differentiated MCI from normal with sensitivity of 0.861 and specificity of 0.723. To detect dementia, its sensitivity was 0.922, and specificity was 0.923. In identifying cognitive impairment, the sensitivity and specificity were 0.932 and 0.723, respectively. However, age and education adjusted cutoff scores achieved high specificities at all levels of cognitive impairment with trade-off of sensitivities. The accuracy of correctly classifying tested subjects into appropriate groups was 85.3% if single cutoff was used though the consistency between norm-derived cutoffs and expert diagnoses were only 59.0%, 54.2%, and 53.9% at 16th, 7th, and 2nd percentiles, respectively. The consistency decreased with older age and lower education level, and majority of misclassifications were false negatives. Conclusion: HK-MoCA is a convenient screening tool to detect cognitive impairment. Administration time is relatively short, and it has incorporated essential cognitive domains. Single cutoff scores with inherent simple education adjustment achieved screening purpose of mild cognitive impairment and dementia in Chinese older adults.
Among different sterilization methods, heat-treatment of bone is recognized as one of the simple and practical methods to lower the human immunodeficiency virus (HIV) infection and overcome the risks of rejection and disease transfer from allograft and xenograft during bone transplantation. In order to best characterize the micro-structural mechanical property of bone after heat treatment, the nanoindentation technique was applied in this study to measure the localized elastic modulus and hardness for interstitial lamellae and osteons lamellae of bovine cortical bones at temperature 23°C (room temperature-pristine specimen), 37°C, 90°C, 120°C and 160°C, respectively. The elastic modulus (E) and hardness (H) of interstitial lamellae obtained higher values as compared with osteons lamellae which show that interstitial lamellae are more stiff and mineralized than osteons. Moreover, as a specimen pre-heat treated at 90°C, the E and H values of interstitial lamellae and osteons were closed to a pristine specimen. For a specimen pre-heat treated at 120°C, both interstitial lamellae and osteons obtained an increase in E and H values. As a specimen pre-heat treated at 160°C, the interstitial lamellae and osteons obtained a slight decrease in E and H values. These findings are correlated to results reported by other researchers [1, 2] that calcified collagen molecules starts to degenerate at about 120°C and complete at 160°C. Interestingly, when a specimen was pre-heat treated at 37°C, both interstitial lamellae and osteons obtained significant decreases in E values of 57% and 40%, respectively as compared to the pristine specimen; while in H values, there was a decrease of 27.4% and 15%, respectively. Thus, this paper will investigate the mechanical properties of bovine cortical bones under various temperature ranges by nanoindentation technique.
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