The Bell’s test: a quantitative test evaluation of inattention and visuospatial neglect in the elderly

To determine the frequency of multiple pathology [Alzheimer Disease (AD) plus Vascular Dementia and/or Dementia with Lewy Bodies] in patients enrolled in clinical trials of AD therapy, and to compare the cognitive and functional assessments between patients with pure AD and AD with multiple pathology. We conducted a retrospective analysis of patients with a clinical diagnosis of AD who were enrolled in AD therapy clinical trials and subsequently received an autopsy for confirmation of their diagnosis from 2000 to 2009. Performance on cognitive screening tests, namely Modified Mini Mental state (3MS) exam, Mini Mental state Exam (MMSE) and Functional Rating Scale (FRS) were compared between patients with pure AD and multiple pathology. Autopsy reports were available for 16/47 (34%) of deceased patients. Of these 16 patients, 5 (31%) had pure AD pathology, 10 (63%) had AD with other pathology, and 1 (6%) had non-AD pathology. Compared to patients with pure AD, patients with AD mixed with other pathology had poorer baseline FRS in problem-solving (p<0.01) and community affairs (p<0.02). While the strict enrollment criteria for clinical trials identified the presence of AD pathology in the majority of cases (15/16), multiple pathology was more common than pure AD in our series of autopsied patients. Premortem biomarkers that can distinguish between pure AD and AD with multiple pathology will be beneficial in future clinical trials and dementia patient management.

To explore the attentional bias in unilateral spatial neglect (USN) patients. The grey discriminant test was conducted on 12 right-brain-damaged patients with USN (USN+), 12 right-brain-damaged patients with no evidence of USN (USN-) and 20 health controls (HC). They were matched for age, years of education, mini-mental state examination (MMSE) scores and handedness. And all patients were recruited from First Affiliated Hospital of Anhui Medical University. The attentional deviation scores were compared between three groups. The differences in scores of neglect tests for the USN+, USN- and HC groups were significant (Albert test: USN+ group -0.56 ± 0.39, USN- group 0.00 ± 0.00, HC group 0.00 ± 0.00, F((2, 41)) = 33.708, P < 0.001; line bisection test: USN+ group 0.28 ± 0.29, USN- group 0.03 ± 0.04, HC group -0.02 ± 0.04, F((2, 41)) = 14.527, P < 0.001; clock drawing by memory: USN+ group 3.58 ± 4.03, USN- group 0.08 ± 0.29, HC group 0.00 ± 0.00, F((2, 41)) = 12.558, P < 0.001; daisy copying: USN+ group 0.83 ± 0.65, USN- group 0.13 ± 0.23, HC group 0.00 ± 0.00, F((2, 41)) = 21.621, P < 0.001). The comparative results of lesion locations showed that USN+ patients were predominantly related to lesions in temporal-parietal junction. The attentional deviation scores for the USN+, USN- and HC groups were 0.92 ± 0.11, 0.41 ± 0.12 and -0.28 ± 0.15 respectively. The difference was significant (F((2, 41)) = 334.324, P < 0.001). There was with a small leftward bias in the HC group and a rightward bias in the USN+ and USN- groups. LSD test revealed that the USN+ group displayed a rightward bias much strongly than the USN- group (P < 0.001). And the results of grey discriminant test were consistent with the neglect symptoms. The USN patients show a marked attentional bias toward the right side of space. And it may be attributed to the dysfunction of temporal-parietal junction.

Performance on the Mini-Mental State Examination and Mattis Dementia Rating Scale Among Older American Indians

e13000 Background: Brief cognitive screening measures are often selected by clinicians and researchers for brain tumor patients, primarily because of their ease of use. Currently, the Mini Mental State Examination (MMSE) is the most commonly chosen, despite a reported low sensitivity. The primary objective of this study was to compare the sensitivity of the MMSE with the Montreal Cognitive Assessment (MoCA). Methods: 44 patients with brain tumors were prospectively accrued and administered the MMSE and MoCA by blinded investigators, 75% of who completed a 4-hour “gold standard” neuropsychological assessment (NPA). Quality of life and community integration were measured with the Functional Assessment of Cancer Therapy-Brain (FACT-Br) and Community Integration Questionnaire (CIQ), respectively. McNemar's test was used to compare sensitivity and specificity at pre-defined cutoff scores and receiver operating characteristic curve analyses were used to examine outcomes across all cutoffs. Correlations were assessed with Spearman's rank correlation coefficient. Results: 55% of patients met criteria for the DSM-IV diagnosis of Cognitive Disorder NOS on the NPA. Using pre-defined cutoffs, the MoCA was significantly more sensitive than the MMSE (55.5% versus 16.6%; p = 0.016), although specificity of the MoCA was poor (60.0%). MMSE scores below 27 were 100% specific; however, this applied to only three subjects. Furthermore, 39% of cognitively impaired subjects scored perfectly on MMSE. A MoCA cutoff of 22 had 28% sensitivity and 93% specificity, and a cutoff of 28 had 94% sensitivity and 20% specificity. The MoCA was correlated with both the FACT-Br (r = 0.319, p = 0.04) and CIQ (r = 0.427, p = 0.005), while MMSE scores did not correlate with either (p &gt; 0.2). Conclusions: The MoCA is more sensitive than the MMSE, though at no cutoff is it both sensitive and specific. Despite its limitations, the MoCA may offer cost saving in the oncology clinic as a cognitive screen: individuals with MoCA scores a) below 22 are likely cognitively impaired, b) above 27 are likely cognitively normal, and c) 22–27 would likely benefit most from NPA. Furthermore, the MoCA is better able to detect cognitive impairment that is related to functional limitations and quality of life. [Table: see text]

Background: The Modified Mini Mental State (3MS) is the extended version of the original Mini Mental State test with additional items improving the coverage of the remaining cognitive functions of the original version. Aim: The aim of this pilot study is to translate the Modified Mini Mental State test and assess its psychometric properties, in order to enable the use of 3MS test for Greek speakers. Method and Material: Independent sample t-test analysis was performed to test for differences between the study groups (N=105) and dependent sample (N=37), while pair sample t-test for pre-post differences in the treatment group for the 3MS. Results: Cronbach’s a was 0.867 showing very good internal consistency. Children in the cases group presented significantly lower scores after the tonsil operation as compared to controls revealing good discriminant validity of the measurement. Finally, test-retest scores were shown to be significantly correlated, revealing excellent test-retest reliability of the measurement. Conclusions: The reliability and validity of the 3MS test is established for the healthy children undergoing routine surgery population.

The purpose of this study was to examine the relationship between visual inattention and daily life performance in people with Alzheimer's disease. Twenty persons with Alzheimer's disease (Mini Mental Status Exam [MMSE] > 20) and 21 community dwelling persons (MMSE > 26) voluntarily participated in this study. One line bisection test and two cancellation tests were used for testing attention abilities. The Functional Spatial Abilities Questionnaire (FSAQ), the Disability Assessment for Dementia (DAD), and the behavioral subtests of the Behavioral Inattention Test (BIT) were used to assess daily functioning. The presence of visuospatial neglect in people with Alzheimer's disease was determined by comparing performance on the three attention tests with the control group. People with Alzheimer's disease who omitted more targets on the symbol cancellation test showed more deficits on the behavioral subtests of the BIT (p = .02). They also used less systematic searching strategies (p = .001), spent more time looking for targets (p = .001), and made more commission errors (p = .007) than controls on the cancellation test. However, those with Alzheimer's disease who had visuospatial neglect did not differ from those without neglect on the FSAQ, DAD, and most of the BIT behavioral subtests. People with Alzheimer's disease have visual inattention problems; however, visuospatial neglect did not interfere with their performance in daily activities as measured in this study. Further research focusing on the relationship between visual attention and daily life function as the disease progresses is suggested.

The aim of this study was to describe the performance in Clock Drawing Test (CDT) of the elderly individuals assessed in a geriatric clinic, with at least 1 year of schooling, comparing with other groups with higher education and with Clinical Dementia Rating (CDR) levels. The study also aims to correlate the results of CDT and other used diagnostic tests for dementia by CDR levels, providing additional validity evidence to the CDT. Cross-sectional study with 426 elderly individuals, >60 years old and at least 1 year of education. All participants searched for medical assistance at Geriatric and Gerontology Ambulatory of Jundiaí city, in Brazil. The community-dwelling outpatients previously undergone a detailed clinical examination and neuropsychological evaluation: Cambrigde Cognitive Examination (CAMCOG), Mini-Mental State Examination (MMSE), andCDT. To differentiate data from diagnostic groups based on CDR, it Kruskal-Wallis test was used. Pearson statistics were calculated to compare data from CDT and CDR. The statistical analyses were 2-tailed and were considered significant when P < .05. Regarding CDT, groups with more years of schooling showed similar means in CDR = 0 and CDR = 0.5 and in CDR = 1 and CDR = 2. Shulman and Sunderland scale were high score in groups with more years of education and above of cutoff points in all CDT score. On the contrary, in Mendez scale we did not observed similar means. Otherwise, in the group with less years of schooling greater means differences in the CDT were observed. The CDT did not show a strong correlation with MMSE and CAMCOG, both important instruments in Brazilian population to investigate dementia. For elderly individuals with high education levels, the CDT did not seem to be a good test to detect cognitive impairment.

To determine if unilateral spatial neglect can be found in very young children with acquired brain lesions. A retrospective study was carried out over a 10-year period in a pediatric rehabilitation department specializing in acquired brain lesions. Twelve cases were selected involving children aged 7 months to 14 years. Neglect was assessed by behavior observation for all children and, depending on age, by drawing, copying, reading, writing, and arithmetic tasks. Seven patients underwent the experimental "Teddy Bear" cancellation task, specially adapted to children. All children exhibited spatial and motor neglect in daily activities. In addition, children who were over 2 years of age made lateralized omissions in paper and pencil tasks as well as in the "Teddy Bear" cancellation task. Nine of the 12 children exhibited left spatial and motor neglect, whereas the other three, all of whom were very young (under 4 years), exhibited right spatial neglect. In three cases, cortical lesions were restricted to one lobe, either the parietal, frontal, or temporal. In eight children, lesions extended over more than one lobe, and one child sustained only subcortical lesions. Unilateral spatial and motor neglect occurs even in very young children. Right spatial neglect described in very young children may be related to the development of hemispheric specialization.

Background: The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are the most commonly used tools for cognitive impairment screening. The present study aimed to investigate the ability of the MOCA and MMSE to differentiate between cognitively normal elderly individuals, MCI patients and dementia patients at different ages and education levels and to establish the optimal cutoff scores of the MoCA and MMSE for MCI and dementia in the Chinese elderly.Methods: A total of 2,954 Chinese elderly individuals, including 1,746 normal controls, 599 MCI patients and 249 dementia patients, were consecutively recruited in the study. The optimal cutoffs for MoCA and MMSE were determined using receiver operating characteristic (ROC) analysis among the different age and education levels in the three groups. Furthermore, comparison of ROC curves were made to evaluate the performances of the two tests.Results: The area under the curve(AUC) of the MoCA (0.82) for detecting MCI was significantly higher than that of the MMSE (0.75) (P < 0.001). When the sample was divided according to age and education level, the AUC of the MoCA (0.84) was higher than those of the MMSE (0.71) for MCI (P < 0.001) in the younger and more highly-educated groups. The optimal cutoff scores of the MoCA for the groups aged ≤ 75 years old and education ≤ 6 years, aged > 75 years old and education ≤ 6 years, aged ≤ 75 years old and education > 6 years, aged > 75 years old and education > 6 years in screening for MCI were identified as 19.5, 15.5, 24.5 and 24.5, respectively, and the optimal cutoff scores for dementia were 18.5, 10.5, 18.5 and 20.5, respectively. For MMSE in the above four groups, the cutoff scores to detect MCI were 26.5, 22.5, 28.5 and 26.5, respectively, and the optimal cutoff scores for dementia were 23.5, 19.5, 23.5 and 23.5, respectively.Conclusion: Compared to MMSE, the MoCA is more suitable for discriminating MCI in younger and more highly educated elderly Chinese individuals. However, the MMSE has advantage over MoCA in screening MCI in individuals with lower education levels and the older groups of Chinese elderly.

The “Test Your Memory” test performs better than the MMSE in a population without known cognitive dysfunction

Background: Mini Mental State Examination (MMSE) has been used widely for screening of cognitive disorders. It has been validated and adapted in various languages. Corrections have been proposed to rule out the bias in the scoring of MMSE based on education and age. However association of MMSE scores with socioeconomic status (SES)has not been studied. Aim: This study was aimed at evaluating the association of SES and MMSE. Materials and Methods: SES and the MMSE scores of participants more than 55 years of age were determined by trained social workers and clinical psychologists. The SES was determined by SES scale. Education and age bias was corrected using specific cut-off criteria for education and age bias while applying MMSE. The data thus obtained was analyzed using Epi-Info software to find the differences in MMSE positive (cognitive impairment present for the educational status and age) and MMSE negative (cognitive impairment absent for the educational status and age) individuals across different SES. Results: The study included 2,283 participants of whom 652 (28.6%), 1326 (58.1%) and 305 (13.4%) belonged to lower socio economic status (LSES), middle socio economic status (MSES) and upper socio economic status (USES) respectively. The MMSE scores were also compared across the SES. Persons from MSES had higher cognitive impairment when compared with LSES and USES, respectively. Significant difference was found among the two genders on the MMSE scores (more females had cognitive impairment) in only the LSES and not in USES and MSES. Conclusion: The findings suggest putative relationship between cognitive functioning and SESsocioeconomic status amongst the elderly.

<sec><title>Objective</title> To explore the effect of mirror image therapy combined with whole body vibration training on the rehabilitation of patients with unilateral spatial neglect after stroke. </sec><sec><title>Methods</title> According to the inclusion criteria, patients with unilateral spatial neglect after stroke who attended the rehabilitation center of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from October 2019 to December 2020 were selected. After the hospital ethics committee approvaled, 90 eligible patients were included. According to the random grouping method, participants were divided into mirror image therapy group, whole body vibration training group and combination group, with 30 cases in each group. There was no statistically significant difference in the general data of the three groups. The mirror image therapy group used a mirror box dedicated to mirror therapy for upper limb and hand mirror training. According to the differences in the patients functional status, different movement tasks were selected, such as grooming, eating, buttoning, turning books, and holding objects. The whole body vibration training group adopted whole body vibration training, using the Wellengang vibration therapy instrument developed by SVG company in Germany, the vibration frequency with 30 Hz, the vibration amplitude with 3 mm, the total treatment time was 30 minutes, 1 time/d, 6 days a week for 8 weeks. The combined group used both mirror image therapy (20 min) + whole body vibration training (10 min) for 6 days once a week for 8 weeks. All three groups were treated with the Catherine Bogor scale (CBS) before treatment and at the time of treatment for 8 weeks, respectively, to assess the severity of the spatial neglect of the patients. The mini-mental status examination (MMSE) was used to evaluate the cognitive dysfunction of patients. The simplified Fugl-Meyer Assessment scale (FMA) was used to evaluate the patients upper limb motor function. The Barthel index (BI) was used to measure the self-care ability of patients. </sec><sec><title>Results</title> Before treatment, there was no significant difference in CBS, MMSE, FMA and BI scores among the three groups (<italic>P</italic>>0.05). After 8 weeks of treatment, the CBS scores of the three groups were significantly lower than those before treatment, however MMSE, FMA and BI scores were significantly higher than those before the treatment, but the combined group was better than the mirror image group and the whole body vibration training group, and the difference was statistically significant respectively (<italic>P</italic><0.05). </sec><sec><title>Conclusion</title> Mirror image therapy combined with whole body vibration training can effectively improve the degree of spatial neglect and cognitive dysfunction in patients with unilateral spatial neglect after stroke, and enhance upper limb motor function and self-care ability. </sec>

We assessed whether subitem scores on the Mini-Mental State Examination (MMSE) associated independently with cerebral white matter hyperintensity (WMH) and lacunar infarction (LI). Magnetic resonance imaging (MRI) and neuropsychological evaluation (MMSE) were performed in 1008 elderly individuals from the Ohasama Study (348 men, 660 women [65.5%]; age 68.0 ± 6.0 [mean ± SD] years; MMSE score, 26.5 ± 2.9). The relationships between MRI findings and MMSE subitem scores were analyzed by logistic regression. Significant associations were observed between the MMSE subitems “Orientation to place” and WMH, and “Copy a figure” and LI. Pathological changes were detected by brain MRI associated with a decrease in cognitive function in healthy elderly individuals.

COMT polymorphisms and Mini-Mental State Examination performance in schizophrenia

VALIDATION AND CULTURAL ADAPTATION OF THE ARABIC VERSIONS OF THE MINI–MENTAL STATUS EXAMINATION – 2 AND MINI-COG TEST