Cognitive Capacity Screening Examination Research Articles

Curve Fitting Algorithm-Based Contrast-Enhanced Ultrasound Image for Evaluating the Effect of Dexmedetomidine on Neurological Function in Patients Undergoing Brain Tumor Surgery

Objective. The study aimed to explore the influence of dexmedetomidine (Dex) guided by ultrasonic contrast on postoperative cognitive function, serum nerve injury factors, inflammatory response, and blood glucose in patients undergoing intracerebral tumor resection through curve fitting algorithm. Methods. 80 patients who underwent tumor resection were selected and randomly rolled into control (Ctrl) group and Dex group, with 40 in each. Then, patients in the Dex group received 0.4 μg/kg⋅h Dex, and patients in Ctrl received the same amount of normal saline. Both groups were diagnosed with benign or malignant tumors by contrast-enhanced ultrasound (CEUS) based on time-intensity curve (TIC) before surgery. Cognitive Capacity Screening Examination (CCSE) and Montreal Cognitive Assessment (MoCA) were used to assess the cognitive function 1 day before and 3 days after the operation, and the ELISA method was used to detect levels of nerve damage-related factors and inflammation factor. Finally, the fasting blood glucose (FBG) levels were detected at the same time. Results. In contrast with benign lesions, the AUC, MTT, and PI of malignant lesions were obviously reduced ( P < 0.05 ), while TP was obviously increased ( P < 0.05 ). The postoperative CCSE and MoCA scores of the Dex group were obviously higher than Ctrl ( P < 0.05 ). In contrast with the Ctrl, the CCSE and MoCA scores in the Dex group increased obviously after 3 days ( P < 0.05 ). In addition, the incidence of postoperative cognitive dysfunction (POCD) in the Dex group was obviously reduced ( P < 0.05 ). Besides, levels of S100β, NSE, and GFAP were obviously reduced in the Dex group 1 day after surgery ( P < 0.05 ), while levels of IL-6 and TNF-α were obviously reduced ( P < 0.05 ), and returned to the level of Ctrl 3 days after surgery. There was no obvious difference in FBG at each time point between the two. Conclusion. CEUS based on curve fitting algorithm is effective on nursing treatment of intracranial tumors. Dex can obviously improve POCD and reduce levels of serum nerve injury factors and inflammatory factors.

Risk factors for nonadherence to warfarin: results from the IN‐RANGE study

Warfarin is widely used to prevent stroke and venous thromboembolism despite its narrow therapeutic window. Warfarin nonadherence is a substantial problem, but risk factors have not been well elucidated. A prospective cohort study of adults initiating warfarin at two anticoagulation clinics (University and VA-affiliated) was performed to determine factors affecting nonadherence to warfarin. Nonadherence, defined by failure to record a correct pill bottle opening each day, was measured daily via electronic medication event monitoring systems (MEMS) caps. A multivariable explanatory model using logistic regression for longitudinal data was used to identify risk factors for nonadherence. One hundred eleven subjects were followed for a median of 137 days. Warfarin nonadherence was common (4787 of 22,425 or 21% of patient-days observed). Factors independently associated with higher odds of nonadherence included education beyond high school (odds ratio (OR) 1.8 (95%CI 1.2-2.7)), lower Short Form (SF)-36 mental component score (OR 1.4 (1.1-1.6) for each 10 point decrease); and impaired cognition (< or =19 points) on the Cognitive Capacity Screening Examination (CCSE) (OR 2.9 (1.7-4.8)). Compared to currently employed subjects, unemployed (OR 0.6 (0.3-1.2)) and retired (OR 0.5 (0.3-0.8)) subjects had somewhat improved adherence; disabled subjects over age 55 had worse adherence (OR 1.8 (1.1-3.1)) than younger disabled subjects (OR 0.8 (0.4-1.5)). Poor adherence to warfarin is common and risk factors are related to education level, employment status, mental health functioning, and cognitive impairment. Within the carefully controlled anticoagulation clinic setting, such patient-specific factors may be the basis of future interventions to improve nonadherence.

MRI confirms mild cognitive impairments prodromal for Alzheimer's, vascular and Parkinson-Lewy body dementias

Objectives MRI assessments were correlated with serial Combined Mini-Mental Cognitive Capacity Screening Examinations (CMC). Vascular-MCI (VMCI), Neurodegenerative MCI (NMCI) and Parkinson-Lewy body MCI (PLB-MCI) were compared during conversions to dementia. Mild cognitive impairments (MCI) are identifiable prodromes for all dementia subtypes. MRI abnormalities are characterized among MCI subjects prodromal for dementia of Alzheimer's disease (DAT), vascular dementia (VaD) and Parkinson-Lewy body dementia (PLBD). Methods Aging volunteers ( n = 166) were recruited from ongoing longitudinal studies of aging, stroke, cerebrovascular disease and dementia. Cognitively normal (CN, n = 52), MCIs of neurodegenerative (N-MCI, n = 30), vascular (V-MCI, n = 35) and Parkinson-Lewy Body (PLB-MCI, n = 8) subtypes, plus converted DAT ( n = 19), VaD ( n = 17) and PLBD ( n = 5) were all diagnosed according to established protocol recommendations. Cerebral MRI abnormalities were likewise intercorrelated utilizing quantitative volumetric measurements. Results V-MCI and converted VaD showed extensive leukoaraiosis with more lacunar infarcts than subjects with N-MCI or PLB-MCI. N-MCI, prodromal for DAT, showed medial temporal atrophy, greater enlargement of temporal horns, and fewer vascular lesions. PLB-MCI, prodromal for PLBD, displayed third ventricular enlargement greater than N-MCI and V-MCI, with similar but less severe atrophy of medial temporal lobe than N-MCI and fewer vascular lesions than V-MCI. Cognitive Impairments due to PLB with vascular features (V-PLB-CI) showed more lacunar and microvascular lesions involving both white matter and basal ganglia with greater frontal horn enlargement. Conclusions This study confirms different MCI subtypes prior to conversion to different dementias listed, recognizable by specific MRI abnormalities.

MRI identifies MCI subtypes: vascular versus neurodegenerative

As life expectancy increases worldwide, pandemics of cognitive impairment and dementia are emerging as major public health problems. Mild cognitive impairment (MCI), prodromal for dementia, is a descriptive term used for those clinical states showing early and subtle cognitive decline among the elderly, preceding the dementias. Psychometric screening combining Mini-Mental Status (MMSE) and Cognitive Capacity Screening (CCSE) Examinations, when combined now called CMC with C standing for Combined, M for MMSE, and C for CCSE, confirms diagnosis of MCI. Individuals identified with MCI are at increased risk for dementia of Alzheimer's type (DAT), vascular dementia (VAD) and other rare neurodegenerative dementias, including Lewy body dementia (LBD), fronto-temporal dementia (FTD) and Parkinson's disease dementia (PDD). Depending on different clinical compositions of cohorts studied, and MCI criteria used, between 19% and 50% of MCI progress to dementia within 3–5 years, two thirds to Alzheimer's (DAT) and one third to vascular types (VAD) in the United States. Not all Parkinsonians become demented, but PDD develops in 20–30%, however, PDD subjects were excluded from the present study, as were LBD and FTD. The incidence of MCI in those over age 70, with confirmed cognitive declines when tested 2 years later, is around 23%, but some spontaneously improve.

Correlation between Cognitive Capacity Screening Examination and Cognitive Evoked Potential in Alcohol-Dependent Patients

The aim of this study was to verify the significance of cognitive evoked potentials and the correlation between the auditory event-related potential and the Cognitive Capacity Screening Examination (CCSE) in alcohol dependent patients. The P300 studies using an auditory paradigm were performed on 25 alcohol dependent patients, and then the results were compared with score of the CCSE. 1) The latencies of the P300 were significantly prolonged in the patient group compared with the control group, and the scores of CCSE were significantly reduced in the patient group compared with the control group (p < 0.05). 2) There were significant negative correlation between P300 latency and scores of the CCSE (p < 0.05, r= -0.774). 3) There were no significant correlation between P300 latency and the total amount of ethanol ingestion (p > 0.05). 4) There was significant reliability in P300 latency study (alpha=0.9771). These findings suggest that the latency of P300 may be useful as a clinical electrodiagnostic measurement that can objectively reflect cognitive dysfunction in alcohol dependent patients, and it can be used as a quantitative analysis of cognitive dysfunction even for early asymptomatic alcohol dependent patients.

Donepezil treatment of vascular dementia.

Cholinergic deficits are clinicopathological hallmarks of Alzheimer's disease (DAT) and during the past decade have been the sole target for clinically effective treatments. By contrast, vascular dementia subtypes (VaD) are heterogeneous clinical syndromes, and therapeutic approaches have been directed toward control of vascular risk factors. Little attention has been paid to cholinergic deficits as a mechanism contributing to cognitive impairments in VaD as a potential target for treatment. The purpose of the study was to determine whether there are therapeutic benefits from long-term treatment with cholinesterase inhibitors among VaD patients. Ten VaD patients were diagnosed according to DSM-III-R and NINDS-AIREN criteria and classified into subtypes by neuroimaging. All were treated with titrated doses of donepezil for a mean interval of 15 months. At baseline and follow-up clinic visits, patients underwent medical and neurological examinations, as well as neuropsychological testing including Mini-Mental Status Examinations (MMSE) and Cognitive Capacity Screening Examinations (CCSE). Cognitive statuses of 10 treated patients were then compared before and after treatment. Net changes were expressed as annual MMSE score changes (DeltaMMSE/year) and annual CCSE score changes (DeltaCCSE/year). Of the 10 treated VaD patients, cognitive improvements were found when comparisons were made before and after treatment. Ten treated patients also showed greater cognitive improvements, while untreated patients showed continued cognitive decline. This study suggests that cholinergic deficits in VaD are due to neuronal ischemic damage with loss of acetylcholine and that treatment of VaD with cholinesterase inhibitors is a rational therapy.

Neuropsychiatric Significance of Subcortical Hyperintensity

Neuropsychiatric Significance of Subcortical Hyperintensity

Validating mini-mental status, cognitive capacity screening and Hamilton depression scales utilizing subjects with vascular headaches.

The Mini-Mental State Examination (MMSE) and Cognitive Capacity Screening Examination (CCSE) are easily and rapidly administered tests for quantifying the general cognitive status of young as well as geriatric subjects. Likewise, the Hamilton Depression Rating Scale (HDRS) is a brief instrument for quantifying depression that may confound cognitive test performances. Testing by means of all three scales concurrently provides useful information for longitudinal research among the elderly. To validate the combined longitudinal use of MMSE, CCSE and HDRS among a specific cohort of normal subjects with vascular headaches characterized by known well-established temporary cognitive decline occurring only during temporary intervals with headache. The MMSE, CCSE and HDRS were serially tested at 3-12 monthly intervals among 196 healthy subjects attending our out-patient headache clinic who suffered from migraine or cluster headaches. Stability and specificity of MMSE, CCSE and HDRS were evaluated by comparing consecutive normative scores during headache-free intervals. Sensitivity of MMSE and CCSE for detecting temporary cognitive decline were evaluated by comparing scores during headache and headache-free intervals. CCSE, MMSE and HDRS gave stable headache-free normative values over intervals of 3-10 years among 182 subjects. Among 77 subjects during headache intervals, temporary cognitive decline were confirmed by both CCSE and MMSE (p < 0.0001). When cutoff points for both CCSE and MMSE normal scores were placed at >/= 27, specificity for detecting cognitively normal values for CCSE and MMSE when headache-free were 92.2 and 89.6%, respectively (p > 0.05), while sensitivity for detecting cognitively decline during headache intervals were 83.7 and 49%, respectively (p < 0.001). Compared with scoring by a single rater, reliability estimates for all three rating scales were slightly lower when tested by different raters, but these differences were not significant. CCSE is reliable and more sensitive than MMSE for detecting cognitive decline.

A Confirmatory Factor Analysis of the Cognitive Capacity Screening Examination in a Clinical Sample

Structured mental status examinations offer several advantages over unstructured mental status examinations; however, few have been subjected to advanced psychometric analysis. Confirmatory factor analysis empirically tests the predictive validity of individual test indices within an a priori methodological framework. With such analysis, one can test hypotheses about the structure of latent variability within a given data set. The purpose of this study was to perform a confirmatory factor analysis of the Cognitive Capacity Screening Examination, the most comprehensive of the brief structured mental status examinations.A confirmatory factor analysis of the Cognitive Capacity Screening Examination (CCSE) was performed by applying EISREL 7 to a sample of 924 male veterans, 409 patients from a chemical dependence treatment program, and 515 individuals from a psychology consultation service. Constructs were derived from previous exploratory analysis of the scale. The results of the confirmatory factor analysis and three indices of model fit support an 11 factor model more complex than that originally formulated for the CCSE. However, three of these factors (digit span with interference, complex mental mathematics, and verbal memory) were more sensitive to impairment than other factors, accounting for over 909c of the CCSE total score variance. Although the CCSE is a more complex test than originally envisioned by its designers, it may not be necessary to give all items on the test. Either a subset of the CCSE items (the CCSE-A) or a relatively brief, informal mental status exam may be adequate for many patients.

Reversible Cognitive Decline Accompanies Migraine and Cluster Headaches

Vascular headaches, including migraine, cluster, and migrainous transformation to chronic daily headaches, are disabling. During and shortly after headache intervals, difficulties are reported in concentration, comprehension, and communication, not accounted for by nausea, photophobia, or sonophobia. These interfere with interpersonal relations and performance at work with economic loss. The hypothesis tested and reported here is that cognitive impairments comprise an important part of vascular headache diatheses. One hundred ninety-six otherwise normative subjects suffering from migraine or cluster, but not tension-type, headaches (136 women, 63 men; mean age, 46 years) participated in an outpatient prospective trial. One hundred thirty-three patients had migraine without aura, 39 migraine with aura, 11 periodic cluster (by IHS criteria), and 13 had migrainous transformation into chronic daily headaches. Neuropsychological testing was compared with and without headaches, by combined Mini-Mental Status Examination (MMSE), Cognitive Capacity Screening Examination (CCSE), and Hamilton Depression Rating Scale (HDRS). During headache intervals, significant decline was measured in both CCSE and MMSE scores (P <. 001) without HDRS change in all types of vascular headache and independent of headache severity, which often improved, or associated physical symptoms. Cognitive decline was promptly relieved by serotonin agonists and sleep. Disorders of cerebral serotoninergic projection systems appear to cause these reversible cognitive impairments.

Correlation of the Medication Management Evaluation Instrument with Compliance in Geriatric Patients

Objective: To assess the Medication Management Evaluation Instrument (MMEI), which has been shown to detect patient difficulties in compliance but has never been correlated with actual compliance. The goal was to determine the value of this instrument as a predictor of compliance difficulties. Methods: Volunteer patients in the Kansas City Veterans Affairs Medical Center currently enrolled in the Geriatric Evaluation and Management Clinic participated in this study. The MMEI, the Jacob's Cognitive Capacity Screening Examination (CCSE), and a pill count (at enrollment and at 6 wk) were conducted on all patients with medications meeting the inclusion criteria. Results: Twenty-two patients participated in the study, with eight compliance data dropouts. Follow-up averaged 44.7 days (range 32–62). The mean age was 71.3 years (range 66–81). The CCSE score was significantly lower in those who had problems defining how to take a medication four times daily than in those who did not (p = 0.002). Compliance ranged from 27.1% to 189% (&gt;100% indicates overcompliance). The CCSE average score was 25.1/30 (range 17–30). Other measures in the MMEI were not statistically significant. Conclusions: Higher cognitive function was found to correlate with better management of complex regimens. On the basis of these data, the MMEI score does not appear to correlate with compliance. Changes in study design and increased power may provide better assessment of correlation.

Cognitive declines correlate with decreased cortical volume and perfusion in dementia of Alzheimer type

Cerebral CT changes are correlated with cognitive declines among 18 patients with probable dementia of Alzheimer type (DAT) (7 men, 11 women, mean age 75.4 years) and are compared for control purposes with similar measures among 18 age-matched normal volunteers (8 men, 10 women, mean age 73.7 years). Mean follow-up intervals are 28.6 months for DAT and 27.0 months for controls. For DAT, annual rates for ventricular volume enlargement are + 9.2% and for cortical atrophy are −2.1%. Annual reductions in regional cerebral perfusions per 100 g brain/min, are: total cortex −1.1 ml, frontal −1.2 ml, temporal and parietal −0.9 ml, basal ganglia −1.6 ml, thalamus −2.5 ml, total white matter −0.6 ml, frontal white matter −0.7 ml. At entry evaluation, compared to normals, DAT patients had reduced CT densities in white matter, but not in cortex. Nevertheless, cortical CT densities declined progressively at annual rates of −0.72 Hounsfield units (HU), but remained constant in white matter. Annual point score declines for Cognitive Capacity Screening Examinations were −2.0 and for Mini Mental State: −2.8. Controls showed no cognitive change. Multiple regression analyses correlate cognitive declines with: (1) reductions in perfusion within parietal cortex ( p = 0.015), (2) decreases in cortical volume ( p = 0.019), and (3) decreases in HU within subcortical gray matter ( p = 0.007).

Lacune-associated cerebral hypoperfusion correlates with cognitive testing

The hypothesis was tested among 83 patients with multiple lacunar infarctions that cerebral hypoperfusion will correlate with cognitive impairments. Patients were subdivided according to Cognitive Capacity Screening Examination (CCSE) scores into a cognitively impaired group (Group D, n = 40; mean age, 68.2 years) with CCSE scores between 6 and 25 (mean, 19.9) and a cognitively intact group (Group I, n = 43; mean age, 66.0) with normal scores (mean, 29.4). Gray and white matter tissue densities were measured by plain computed tomography (CT), and their compartmental perfusions were estimated during stable xenon inhalation. Eighty infarcts in basal ganglia and white matter were detected in Group D and 62 in Group I. Cognitive impairments correlated with (a) multiplicity and bilaterality of lacunes; (b) hypertension, diabetes mellitus, and multiplicity of risk factors for stroke; (c) hypoperfusion of white and gray matter, but particularly of frontal white matter; (d) leuko-araiosis; (e) aging; and (f) lower education. The conclusion was that hypertension and diabetes mellitus are potent risk factors for cerebral small vessel disease or arteriolosclerosis ultimately resulting in lacunar infarcts, leuko-araiosis, white matter hypoperfusion, and impaired cognitive test performance.

Alzheimer's disease: correlational analysis of three screening tests and three behavioral scales

We administered three cognitive tests (the Mini Mental State Examination, the Cognitive Capacity Screening Examination, and the Blessed Information-Memory-Concentration test) and three behavioral scales (the Blessed Dementia Scale, the Gottfries-Bråne-Steen scale, and the Sandoz Clinical Assessment Geriatric) to 41 patients with a clinical diagnosis of "probable" Alzheimer's disease (NINCDS-ADRDA criteria). The six measures demonstrated good reliability and high intercorrelation values. These findings provide further evidence for the strength of relationship between cognitive and behavioral measures in Alzheimer's disease.

Cognitive recovery correlates with long-term increases of cerebral perfusion after head injury

Prospective measurements of cerebral blood flow (CBF) and Cognitive Capacity Screening Examinations (CCSE) were obtained following head injury among 42 patients for a mean total follow-up interval of 10 years. Clinical data obtained at the time of injury and detailed neurological examinations at each follow-up visit were correlated with serial CBF and CCSE scores. Comparisons of the group of patients who cognitively improved (n = 32) were made with the group that did not (n = 10). Of the total group, 76% showed cognitive improvements for as long as 10 years after injury, with CBF increases toward normal. Predictors for long-term cognitive improvements include: higher initial Glasgow Coma Scales, earlier recovery from coma, absence of signs of brain stem injury, and improvements of cerebral perfusion and autoregulation. Failure to improve correlated with low initial Glasgow Coma Scales, signs of brain stem injury, and persistent impairments of cerebral perfusion.

A Review of Screening Instruments for Assessing Cognition and Mental Status in Older Adults

Older adults in non-psychiatric acute and long-term care settings need to be screened routinely for cognitive function and mental status by clinicians and health care providers. Screening instruments increasingly are being used in order to evaluate programs, implement clinical decisions and conduct research. The purpose, scope and depth of needed assessment guides the selection of the screening instrument. This article critically reviews 11 screening instruments used to assess cognitive function and mental status in older adults: Dementia of the Alzheimer Type Inventory, Brief Cognitive Rating Scale, Blessed Dementia Scale, Cognitive Capacity Screening Examination, Cognitive Levels Scale, FROMAJE, Global Deterioration Scale, Mini-Mental State Exam, Clinical Dementia Rating, Mental Status Questionnaire and the Short Portable Mental Status Questionnaire. Since cognitive impairment is a broad construct, the descriptors used to search the literature were the following: age-associated memory impairment, acute confusional states, Alzheimer's disease, cognition, confusion, delirium, dementia, mental status, multi-infarct dementia, Pick's disease, primary degenerative dementia, pseudodementia and senile dementia of the Alzheimer's type. The Brief Cognitive Rating Scale and the Dementia of the Alzheimer Type Inventory are the only two instruments capable of distinguishing Alzheimer's from other dementias, and the CDR is the only instrument that assesses hobbies.

The safety and lack of efficacy of vinpocetine in Alzheimer's disease.

Fifteen Alzheimer patients were treated with increasing doses of vinpocetine (30, 45, and 60 mg per day) in an open-label pilot trial during a one-year period. Patients were assessed seven times both on and off drug with: the Buschke Selective Reminding Task, a letter fluency test, a category fluency test, the Boston Naming Test, a cognitive capacity screening examination, and a clinical global impression. Vinpocetine failed to improve cognition on psychometric testing or overall functioning, as measured by the clinical global impression, at any dose tested. Patients showed significant decline in most measures during the course of the study, at the same rate as a matched control group, consistent with progressive dementia. There were no significant side effects from drug therapy. We conclude that vinpocetine is ineffective in improving cognitive deficits and does not slow the rate of decline in individuals with Alzheimer's disease.

Reducing Hypertriglyceridemia in Elderly Patients with Cerebrovascular Disease Stabilizes or Improves Cognition and Cerebral Perfusion

Effects of lowering serum triglyceride levels were investigated among 44 elderly hypertriglyceridemic patients with risk factors for stroke, reduced cerebral perfusion, and a history compatible with symptomatic occlusive cerebrovascular disease. Patients were randomly assigned to either treatment with gemfibrozil, a lipid-lowering agent, or control conditions. Subjects in both groups were instructed to follow a diet recommended for lowering serum lipid levels, while the treatment group was additionally administered 600 mg daily of gemfibrozil. Subjects assigned to the treatment group (n = 22) showed significant reductions in serum triglyceride levels (p less than .0005). Control subjects (n = 22) did not show any significant changes in serum triglyceride levels. There were also no significant changes in total cholesterol levels in either group. Analyses of values for mean bihemispheric gray matter cerebral blood flow measured by the xenon 133 inhalation method and cognitive scores tested by the Cognitive Capacity Screening Examination indicated that gemfibrozil-treated patients maintained significantly higher levels of cerebral perfusion and cognitive performance than untreated controls did. Regression analyses for different treatment intervals indicated that both cerebral blood flow and cognition showed linear improvements that correlated directly with the duration of treatment. Lowering triglyceride levels in hyperlipidemic subjects appears to benefit cerebral perfusion and cognitive performance after four to six months.

Assessment of geriatric patients' functional ability to take medication.

The abilities of 93 geriatric patients (inpatients and outpatients) to perform medication-taking skills were assessed. These skills included the ability to read and interpret prescription labels, open and close vials, remove tablets, and identify tablet colors. The educational level and cognitive capacity using Jacobs' Cognitive Capacity Screening Examination (CCSE) was determined. The average age was 74.3 +/- 10.1 years. Eighty-nine of our participants were male. Age and educational level did not affect functional abilities. Fewer outpatients had problems interpreting prescription label directions than did inpatients. Patients who managed their own medications were more likely to be able to read and interpret labels, remove tablets, and identify colors (p less than 0.05). Patients with CCSE scores less than 20, indicating cognitive impairment, were less likely to correctly read and interpret labels and differentiate colors than patients without impairment. Motor skills (opening/closing vials, removing tablets) were not related to cognitive status. This functional tool was easily administered and was useful in the assessment of medication-taking skills in geriatric patients.

The mental status evaluation: Application in the emergency department

The mental status evaluation is a useful test in the emergency department. The major purposes of the examination are to determine the presence of neuropsychiatric illness and to determine whether this illness is functional or organic. The most accepted evaluation of mental status is the formal mental status evaluation. This extensive test is rarely necessary in the emergency department; rather a short test of cognitive function, such as the Cognitive Capacity Screening Examination or Mini-Mental Status Examination, may be more appropriate. With frequent repetition in use and the concomitant development of clear standards for interpretation of the examination used, the emergency physician will become more comfortable with bedside mental status testing.