LAUSR

Dear Editor-in-Chief, Vascular cognitive impairment (VCI) constitutes the prodromal stage of vascular dementia (VaD) with high rate of prevalence in individuals aged 65 to 80 years [1]. Research has demonstrated that the most common cause of VCI is the cerebral small vessel disease (SVD) [2]. Clinical studies have found that attention disorder and executive dysfunction are the core cognitive impairments in patients with VCI due to SVD [3]. Because of high rates of conversion to VaD, in clinical routine, we need sensitive, cost-effective, and non-timeconsuming cognitive measures identifying high-risk VCI patients for prevention management. Months backward test (MBT) is a simple, brief, and quick measure of attention and executive functioning which can be administered in any clinical setting, without special training or specific test material. MBT requires the rapid recitation of the months of the year in reverse order fromDecember to January. Time to completion and number of errors are the measurement variables. In previous studies, MBT has been successfully applied in patients with delirium, mild Alzheimer’s disease, and Parkinson’s disease, and it has been shown to have high sensitivity to detection of cognitive impairment [4]. The aim of this study was the ageand education-matched comparison ofMBT performance between a group of 45 patients with VCI due to SVD and a group of 50 cognitively healthy individuals. Patients were recruited from the Neurological Clinic of Athens Naval Hospital in Greece. The VCI diagnosis was based on neuroimaging and neuropsychological findings according to the guidelines of the National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et I’Enseignement en Neurosciences [5]. All participants were asked to recite the months of the year backward, and also they completed the Montreal Cognitive Assessment (MoCA) for the evaluation of global cognitive status (Table 1). Statistical analysis revealed significant differences between two groups in terms of their MBT-time and MBT-accuracy performance. Furthermore, MBT scores were significantly correlated with performance on MoCA for the both groups; i.e., faster time and fewer errors were related with higher global cognitive status. Finally, ROC curve analyses were employed to determine whether MBT variables can differentiate cognitively healthy individuals from patients with VCI. For MBT-time variable, the highest AUC was 0.83, the optimal cutoff score was 21 s with sensitivity 0.81 and specificity 0.77. For MBT-accuracy variable, the highest AUC was 0.78, and the optimal cutoff score was 1.2 errors with sensitivity 0.71 and specificity 0.74. Our data support the clinical utility ofMBT in patients with VCI due to SVD. MBT could be a part of clinical evaluations in patients with vascular disease in primary healthcare system as a sensitive cognitive screening measure targeting high-risk patient for further neurological and neuropsychological investigation. * Constantinos Kormas [email protected]