Screening Test For Cognitive Impairment Research Articles

French consensus procedure for assessing cognitive function in Parkinson's disease

IntroductionOne of the objectives of the French expert centers for Parkinson's disease (NS-Park) network was to determine a consensus procedure for assessing cognitive function in patients with Parkinson's. This article presents this procedure and briefly describes the selected tests. MethodsA group of 13 experts used the Delphi method for consensus building to define the overall structure and components of the assessment procedure. For inclusion in the battery, tests had to be validated in the French language, require little motor participation, have normative data and be recognized by the international community. Experimental tasks and tests requiring specific devices were excluded. ResultsTwo possibilities were identified, depending on whether an abbreviated or comprehensive assessment of cognitive function was necessary. For an abbreviated assessment, the experts recommended the Montreal Cognitive Assessment (MoCA) as a screening test for cognitive impairment or dementia. For a comprehensive neuropsychological assessment, the experts recommended assessing global efficiency plus the five main cognitive domains (attention and working memory, executive function, episodic memory, visuospatial function and language) that may be impaired in Parkinson's disease, using two tests for each domain. Discussion and conclusionA common procedure for assessing cognitive function is now available across the French network dedicated to Parkinson's disease, and is recommended for both research and clinical practice. It will also help to promote standardization of the neuropsychological assessment of Parkinson's disease.

Abnormal Mini-Cog Is Associated with Higher Risk of Complications and Delirium in Geriatric Patients with Fracture.

The Mini-Cog test is a validated and simple tool to screen for dementia. The purpose of this study was to investigate the relationship of cognitive impairment as measured by Mini-Cog testing as a predictor for in-hospital complications and mortality in geriatric patients with fracture. From 2011 to 2014, patients who were seventy years of age or older, had a fracture, and were admitted to co-managed orthopaedic trauma and geriatrics services embedded at two Level-I trauma centers were enrolled in our study. As part of the patients' routine admission evaluation, the Mini-Cog examination was performed. An observational cohort study was completed documenting pre-injury functional status, in-hospital complications, length of stay, thirty-day readmission, and mortality. All patients in the study were followed for at least one year. Seven hundred and thirty-nine patients (median age, eighty-three years) attempted Mini-Cog testing. Of those, 513 were able to complete the test, demonstrating a 35.1% prevalence of cognitive impairment. The cohort's rate of in-hospital medical complications was 28.6%. Patients with an abnormal Mini-Cog test or those unable to complete the test had significantly higher odds of in-hospital complications (2.16 and 2.27, respectively) compared with patients with a normal Mini-Cog test (p < 0.001). Delirium was significantly increased in patients with an abnormal Mini-Cog test (odds ratio, 3.22; p = 0.001). The all-cause, one-year mortality rate after fracture in our population was 18.1%. Adjusted for age, sex, comorbidity, and fracture type, only the patients unable to complete the Mini-Cog test showed a higher risk of mortality at one year (hazard ratio, 2.26; p < 0.001). The Mini-Cog examination is a quick, easily administered screening test for cognitive impairment that is useful in identifying high-risk geriatric patients with fracture. With this tool, we found more than one-third of our elderly patients with fracture were cognitively impaired at the time of admission. These patients had higher rates of in-hospital complications and a trend toward early mortality. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cognitive deficits in chronic pain patients, in a brief screening test, are independent of comorbidities and medication use.

Objective To describe and analyze cognitive aspects in patients with chronic pain and a control group without pain. Method A case-control study was conducted on 45 patients with chronic pain and on 45 control subjects. Data including pain diagnosis, comorbidities and medication used, were evaluated. Cognitive tests, such as the Montreal Cognitive Assessment (MoCA), Verbal Fluency Test, Clock Drawing Test and Stroop Test, were applied. Results Patients with chronic pain showed a poorer performance, as shown by the scores of the MoCA test (p < 0.002), Verbal Fluency Test (p < 0.001), Clock Drawing Test (p = 0.022) and Stroop Test (p < 0.000). Chronic pain variable (p = 0.015, linear regression model) was an independent factor for results obtained with the MoCA. Conclusion Patients with chronic pain showed a poorer performance in a brief screening test for cognitive impairment not related to confounding variables, as comorbidities and pain-medication use.

Neuropathologic comorbidity and cognitive impairment in the Nun and Honolulu-Asia Aging Studies.

To examine frequencies and relationships of 5 common neuropathologic abnormalities identified at autopsy with late-life cognitive impairment and dementia in 2 different autopsy panels. The Nun Study (NS) and the Honolulu-Asia Aging Study (HAAS) are population-based investigations of brain aging that included repeated cognitive assessments and comprehensive brain autopsies. The neuropathologic abnormalities assessed were Alzheimer disease (AD) neuropathologic changes, neocortical Lewy bodies (LBs), hippocampal sclerosis, microinfarcts, and low brain weight. Associations with screening tests for cognitive impairment were examined. Neuropathologic abnormalities occurred at levels ranging from 9.7% to 43%, and were independently associated with cognitive impairment in both studies. Neocortical LBs and AD changes were more frequent among the predominantly Caucasian NS women, while microinfarcts were more common in the Japanese American HAAS men. Comorbidity was usual and very strongly associated with cognitive impairment. Apparent cognitive resilience (no cognitive impairment despite Braak stage V) was strongly associated with minimal or no comorbid abnormalities, with fewer neocortical AD lesions, and weakly with longer interval between final testing and autopsy. Total burden of comorbid neuropathologic abnormalities, rather than any single lesion type, was the most relevant determinant of cognitive impairment in both cohorts, often despite clinical diagnosis of only AD. These findings emphasize challenges to dementia pathogenesis and intervention research and to accurate diagnoses during life.

Lower cognitive function in patients with age-related macular degeneration: a meta-analysis.

ObjectiveTo investigate the cognitive impairment in patients with age-related macular degeneration (AMD).MethodsRelevant articles were identified through a search of the following electronic databases through October 2015, without language restriction: 1) PubMed; 2) the Cochrane Library; 3) EMBASE; 4) ScienceDirect. Meta-analysis was conducted using STATA 12.0 software. Standardized mean differences with corresponding 95% confidence intervals were calculated. All of the included studies met the following four criteria: 1) the study design was a case–control or randomized controlled trial (RCT) study; 2) the study investigated cognitive function in the patient with AMD; 3) the diagnoses of AMD must be provided; 4) there were sufficient scores data to extract for evaluating cognitive function between cases and controls. The Newcastle–Ottawa Scale criteria were used to assess the methodological quality of the studies.ResultsOf the initial 278 literatures, only six case–control and one RCT studies met all of the inclusion criteria. A total of 794 AMD patients and 1,227 controls were included in this study. Five studies were performed with mini-mental state examination (MMSE), two studies with animal fluency, two studies with trail making test (TMT)-A and -B, one study with Mini-Cog. Results of the meta-analysis revealed lower cognitive function test scores in patients with AMD, especially with MMSE and Mini-Cog test (P≤0.001 for all). The results also showed that differences in the TMT-A (except AMD [total] vs controls) and TMT-B test had no statistical significance (P>0.01). The Newcastle–Ottawa Scale score was ≥5 for all of the included studies. Based on the sensitivity analysis, no single study influenced the overall pooled estimates.ConclusionThis meta-analysis suggests lower cognitive function test scores in patients with AMD, especially with MMSE and Mini-Cog test. The other cognitive impairment screening tests, such as animal fluency test and TMT, need more studies to assess.

FACTORS ASSOCIATED WITH DURATION OF NAPS AMONG COMMUNITY-DWELLING ELDERLY: DATA FROM THE MULTICENTER STUDY FIBRA

This study aimed to analyze the association between the duration of the nap and the variables gender, age, education, family income, frailty levels and frailty criteria of community-dwelling elderly. This was a descriptive and cross-sectional study, an excerpt from the multicenter project Frailty in Elderly Brazilians. A total of 3,075 older adults were evaluated, aged 65 and over, using a sociodemographic questionnaire, question about nap (Minnesota Leisure Activity Questionnaire), phenotype of frailty proposed by Fried and screening test for cognitive impairment (Mini Mental State Examination). Descriptive analysis, Mann-Whitney and Kruskal-Wallis tests (p&lt;0.05) and multiple linear regression were applied. Ethical principles were respected. Most of the elderly participants napped (61.7%), with an average of 53.4±42.7 min/day. There was an association between duration of naps and variables gender (p=0.002), frailty (p=0.022) and frailty criterion "hand grip strength" (p=0.008). It was observed that the length of the naps is greater for male and frail elderly.

The montreal cognitive assessment-basic (MoCA-B): A new mild cognitive impairment screening test for illiterate and low educated elderly

The montreal cognitive assessment-basic (MoCA-B): A new mild cognitive impairment screening test for illiterate and low educated elderly

Verbal Fluency as a Rapid Screening Test for Cognitive Impairment in Early Parkinson's Disease.

The phonological verbal fluency test can act as a fast screening test to detect cognitive deficits in neurological conditions. In the present study, its utility in the detection of executive deficits in patients with early Parkinson's disease is demonstrated.

The Montreal Cognitive Assessment-Basic (MoCA-B): A New Mild Cognitive Impairment Screening Test for Illiterate and Low Educated Elderly (P6.200)

The Montreal Cognitive Assessment-Basic (MoCA-B): A New Mild Cognitive Impairment Screening Test for Illiterate and Low Educated Elderly (P6.200)

방문간호사의 재가노인 인지기능장애 관리에 대한 실태조사: 광역시보건소와 중소도시보건소를 중심으로

【Purpose: The purpose of this study was to investigate the status and characteristics of visiting nurses' management for elders with cognitive impairment living in a community focused on health centers in a metropolitan city and five medium-sized cities. Methods: Data were collected from 47 visiting nurses working in a metropolitan city and 47 visiting nurses working in five medium-sized cities from November to December 2012. Results: There were no statistically significant differences in knowledge, attitudes, and nursing behaviors of cognitive impairment between two groups (F=2.13, p=.148; F=3.64, p=.060; F=0.28, p=.595). Among the elders referred to a physician in a metropolitan city by visiting nurses, 42.4% were diagnosed as mild cognitive impairment and 15.2% were diagnosed as severe dementia. The major intervention programs which visiting nurses currently applied for elders were medication and exercise intervention programs, and the intervention programs which they would want to apply in the future were playing, music and recall intervention programs. Conclusion: The cognitive impairment screening test can be done effectively by visiting nurses. This study also suggests to develop various kinds of intervention programs to improve cognitive function for elders living in a community.】

Brief Memory and Executive Test: evaluation of a new screening test for cognitive impairment due to small vessel disease

cerebral small vessel disease (SVD) is the most common cause of vascular cognitive impairment (VCI). Despite this, there is a paucity of rapid simple screening tools to identify cognitive impairment in SVD and differentiate it from other common dementia types. to validate a new screening test for cognitive impairment in SVD, the Brief Memory and Executive Test (BMET) battery, and examine its ability to detect SVD and differentiate it from Alzheimer's disease (AD). 45 patients with SVD, 27 patients with AD and 80 normal controls. the BMET includes brief tests of executive functioning and processing speed, with comparative tests of memory and orientation. Group discrimination was calculated using discriminant function analysis. the BMET took an average of 10min to administer. It showed high sensitivity (91%) and specificity (85%) in differentiating SVD patients with cognitive impairment from AD patients. As a comparison the mini-mental state examination had lower sensitivity (63%) and specificity (62%). the BMET is a simple and quick to administer clinical tool for the detection of VCI in SVD and its differentiation from AD impairment. Further multicentre studies are required to evaluate and compare it with other existing screening tests.

Formal education, health literacy and Mini-Mental State Examination.

The Mini-Mental State Examination (MMSE) is a widely used screening test for cognitive impairment, but is heavily biased by education. Educational level has frequently been ranked using years of schooling, which may not be a good indirect measure of educational level because there is great heterogeneity in standards of schooling among populations and across regions of the same country. S-TOFHLA is a measure of health literacy with some results indicating that it is a good measure for literacy level.ObjectiveTo evaluate the correlations between years of schooling and scores on the S-TOFHLA and the MMSE.MethodsHealthy subjects without cognitive impairment were submitted to the S-TOFHLA and the MMSE. Correlations and regression analysis were performed to determine possible associations among variables.ResultsBoth years of schooling and S-TOFHLA scores were strongly correlated with MMSE scores, but the strongest association was reached by the S-TOFHLA (r=0.702, p<0.01), where the S-TOFHLA was the best predictor of MMSE scores (R2=0.494, p<0.001).ConclusionsA stronger association between S-TOFHLA scores and MMSE performance was found than between years of education and MMSE scores. This finding justifies further studies incorporating years of schooling together with S-TOFHLA score, to evaluate cognitive performance.

Cognitive impairment and depression in older patients labelled as “vague”, “poor historians” or “poorly motivated”

Purpose Geriatricians often teach that older people labelled “poor historians”, “poorly motivated” or “vague” may have underlying conditions such as cognitive impairment and depression. The aim of this study was to examine the accuracy of this contention. Patients and methods The use of the phrases “poor historians”, “poorly motivated” or “vague” by qualified health-care staff regarding older patients was noted prospectively for 1113 patients aged 65 or more seen by a single consultant geriatrician over a 6-month period. All patients were screened for depression using the question “are you depressed?” and for cognitive impairment using the Folstein Mini-Mental State Examination or the Abbreviated Mental Test followed by more detailed evaluation. Results Description of a patient as “vague” or as a “poor historian” was associated with a positive screening test for cognitive impairment (positive likelihood ratio [LR] 3.4 [2.3–4.9]) and with a final diagnosis of dementia, delirium or both (positive LR 3.1 [2.1–4.4]). Description of a patient as “poorly motivated” predicted a positive screening test for depression (positive LR 11.8 [4.9–19.9]) and a final diagnosis of depression (positive LR 14.0 [5.8–35.0]). Conclusions Older patients described as “poor historians”, “poorly motivated” or “vague” often have underlying cognitive impairment or depression. Education is required to ensure that that this is recognised by health care professionals.

The Introduction of a New Screening Tool for the Identification of Cognitively Impaired Medically At-Risk Drivers

The number of drivers with a cognitive impairment due to dementia or other age-associated pathologies will increase significantly over the next 3 decades. Physicians are well placed to identify medically at-risk drivers, but are hampered by the lack of a valid, easy to administer screening tool. This research develops and validates a brief screening tool for use in the primary care setting to identify drivers with cognitive impairment with or without dementia. Initial Study Participants: A cohort of 146 consecutive referrals from community-based family physicians, diagnosed with an undifferentiated cognitive impairment or dementia, as well as 35 community dwelling healthy controls. Validation Study: A cohort of 192 consecutive referrals carrying the same diagnosis as above and 52 community dwelling healthy controls. Criterion Measure: Pass/fail on an On-Road evaluation. Predictor Measures: Subtests of the DemTect, a screening test for cognitive impairment or dementia developed by Kalbe and colleagues.(1) Initial Study: Three of the DemTect measures predicted On-Road outcomes (R(2) = .262). Regression results were used to develop a simple scoring algorithm, with cut-points then derived by identifying those most at risk for failing and passing the On-Road assessment, and those needing a driving assessment for determination of driving competency. 89 individuals scored in the indeterminate range, with 49 and 43 predicted to fail and pass, respectively-86% and 84% of those predicted to fail and pass did subsequently fail and pass. Validation Study: 123 individuals scored in the indeterminate range, with 66 and 55 predicted to fail and pass, respectively-80% and 87% of those predicted to fail and pass did subsequently fail and pass. The SIMARD A Modification of the DemTect ( S creen for the I dentification of cognitively impaired M edically A t- R isk D rivers) is a brief paper and pencil screening tool with a high degree of accuracy that can be used for immediate decisions in the clinical setting.

Evaluación cognitiva de los pacientes ancianos en el servicio de urgencias: Comparación entre instrumentos estándar, historia clínica y la percepción de los médicos

We evaluated the accuracy of physician recognition of cognitive impairment in elderly patients in emergency departments (ED). In particular, we evaluated the accuracy of the subjective impression of the physician on patients' cognition (a comparison of the information obtained from the responsible physician with the S-IQCODE, a cognitive impairment screening test), and the accuracy of the medical records (a comparison of the information in the medical record with the S-IQCODE). Cross-sectional study on 101 elderly patients selected at random from those attending ED, their ED physicians, and family member-carer. The study was conducted in the ED of four tertiary university teaching hospitals in a city, from July through November 2003. Cognitive data shown in the patient's medical records were compared against the S-IQCODE obtained from the family member-carer, using the kappa (kappa) concordance index. The physicians' impressions on the patients' cognitive status were also compared against the S-IQCODE results, using the kappa (kappa) concordance index. Each patient and their family member-carer were paired with a single physician. A logistic regression model was constructed to identify factors associated with the physicians' impressions of the patients' cognitive capacity. The concordance between information on cognitive decline from medical records and the results of the S-IQCODE, was 0.47 (IC95%: 0.05-0.88). Concordance between the physicians' impression on the presence of cognitive impairment, and the S-IQCODE obtained from family member-carer was 0.26 (IC95% 0.06-0.45). The multivariate analysis demonstrated that the functional status of patients, as perceived by the physicians, were the variable that better explained the physicians' impressions of patient cognitive function. The cognitive status of elderly patients is not properly assessed by emergency department physicians.

Cognitive functions changes among Egyptian sewage network workers

The current work aimed at investigating the cognitive functions impairment among workers of sewer networks due to exposure to hydrogen sulfide (H(2)S) and the relation of this impairment, if any, to the level of H(2)S exposure biomarker 'urinary thiosulfate.' Besides, the validity of using Mini Mental State Examination (MMSE) as screening test for cognitive impairment among the exposed workers was tested. The work was conducted among 33 sewage network maintenance male workers and a matched unexposed control group (n = 30). The participants were subjected to clinical neurological history, estimation of urinary thiosulfate, and assessment of cognitive dysfunction by using neurophysiological (simple reaction time, P300 test) and neuropsychological tests (Wechsler Memory Scale) and frontal executive functions tests. Clinical neurological history revealed significantly higher neurological symptoms (headache, memory defects, lack of concentration) among exposed workers compared to their controls (p < 0.05). Exposed workers had significantly prolonged simple reaction time and delayed P300 latency and showed poor performance of most of neuropsychological tests. Marked elevation of urinary thiosulfate was observed among the exposed workers (p < 0.001) but this elevation was not correlated with the duration of exposure or any of the other measured parameters. Exposed workers had significantly lower mean value of MMSE scoring than that of the controls (p < 0.001). In conclusion, exposure to H( 2)S among sewer network workers is associated with cognitive impairment, which can be screened by applying MMSE as a simple rapid test for H( 2)S occupationally exposed workers.

Rendimiento diagnóstico de los test cognitivos aplicados desde atención primaria. Concordancia y validez de los test de cribado

Objective To estimate the prevalence of cognitive impairment in elderly people living in the community. To assess the diagnostic yield of the main cognitive screening tests in Primary Care: the Mini Mental State Examination (MMSE), the Clock Drawing Test (CDT), the Verbal Fluency Test (VFT) and the Informant Questionnaire test (IQ). We also calculated their correlation and validity. Design Descriptive study based on a personal interview by professionals using a standardised method to assess cognitive impairment. Participants A total of 293 men and women, who were older than 64 years old and residing in the province of Huesca. The sample was recruited by systematic random sampling from the database of personal health care card. Main measurementsWe analysed social and demographic variables (age, educational level, marital status) and the assessment of cognitive impairment by means of MMSE, CDT, VF, IQ tests. Results The prevalence of cognitive impairment with MMSE was 18.1% (95% CI: 15.3–24.4%). The correlation between MMSE and the other cognitive screening tests was moderate: CDT kappa=0.40; VF kappa=0.33; IQ kappa=0.36. Using the MMSE as a gold standard and the prior diagnosis of CI, the sensitivity of CDT was 78.3% and the specificity was 76.9%, 80%; there was 70% sensitivity and 76.7% specificity for the VF; and 71.4% for IQ respectively. The area under the VF ROC curve was significantly higher than the other tests. Conclusions The agreement between cognitive impairment screening tests was moderate. The VF yielded better diagnostic accuracy.

COGNITIVE FUNCTIONS CHANGES AMONG EGYPTIAN SEWAGE NETWORK WORKERS

Objectives: The current work aimed at investigating the cognitive functions impairment among workers of sewer networks due to exposure to H2S and the relation of this impairment ,if any, to the level of H2S exposure biomarker “urinary thiosulfate”. Besides, the validity of using Mini Mental State Examination (MMSE) as screening test for cognitive impairment among the exposed workers was tested.Subjects: The work was conducted among 33 sewage network maintenance male workers and a matched unexposed control group (n= 30).Methods: The participants were subjected to clinical neurological history, estimation of urinary thiosulfate, and assessment of cognitive dysfunction by using neurophysiological (simple reaction time, P300 test) and neuropsychological tests (Wechsler MemoryScale) and frontal executive functions tests. Results: Clinical neurological history revealed significantly higher neurological symptoms(headache, memory defects, lack of concentration) among exposed workers compared to their controls (P< 0.05). Exposed workers had significantly prolonged simple reaction time and delayed P300 latency and showed poor performance of most of neuropsychological tests. Marked elevation of urinary thiosulfate was observed among theexposed workers (P< 0.001) but this elevation was not correlated with the duration of exposure or any of the other measured parameters. Exposed workers had significantly lower mean value of MMSE scoring than that of the controls (P<0.001). Conclusion: Exposure to H2S among sewer network workers is associated with cognitive impairment which can be screened by applying MMSE as a simple rapid test for hydrogen sulfide occupationally exposed workers.

Cognitive impairment in Parkinson's disease: Tools for diagnosis and assessment

Cognitive impairment (CI) and dementia are frequent and debilitating features associated with Parkinson's disease (PD). Formal neuropsychological examination is required to ascertain the degree and pattern of CI over the course of the disease. The use of different tools may explain heterogeneous data obtained from studies to date. Normative data for extensively used scales [Mattis Dementia Rating Scale (MDRS), Mini-Mental State Examination (MMSE)] is incomplete in PD populations. According to sample characteristics, statistical analyses, and methodological quality, 33 studies using scales not specific to PD (MDRS, MMSE, Cambridge Cognitive Assessment, FAB) or PD-specific scales (Mini-Mental Parkinson, Scales for Outcomes of Parkinson's disease-Cognition, Parkinson's Disease-Cognitive Rating Scale, and Parkinson Neuropsychometric Dementia Assessment) were eligible for the critical analysis of their appropriateness to assess cognition in PD. Of the four scales specifically designed for PD, the SCOPA-COG and the PD-CRS have undergone extensive and rigorous validation processes. While the SCOPA-COG mainly assesses "frontal-subcortical" cognitive defects, the PD-CRS also assesses "instrumental-cortical" functions, allowing better characterization of the different patterns of CI that may be present in PD from the earliest stages. The MMP and PANDA scales were designed as brief screening tests for CI and have not yet been subjected to extensive clinimetric evaluations. Further research on PD-specific tools seems mandatory to help establish accurate cut-off scores for the diagnosis of mild PDD, detect cognitive profiles more prone to the future development of dementia, and allow comparisons between different descriptive or interventional studies.

Short Cognitive Performance Test: Diagnostic Accuracy and Education Bias in Older Brazilian Adults

The "Short Cognitive Performance Test" (Syndrom Kurztest, SKT) is a cognitive screening battery designed to detect memory and attention deficits. The aim of this study was to evaluate the diagnostic accuracy of the SKT as a screening tool for mild cognitive impairment (MCI) and dementia. A total of 46 patients with Alzheimer's disease (AD), 82 with MCI, and 56 healthy controls were included in the study. Patients and controls were allocated into two groups according to educational level (< or =8 years or >8 years). ROC analyses suggested that the SKT adequately discriminates AD from non-demented subjects (MCI and controls), irrespective of the education group. The test had good sensitivity to discriminate MCI from unimpaired controls in the sub-sample of individuals with more than 8 years of schooling. Our findings suggest that the SKT is a good screening test for cognitive impairment and dementia. However, test results must be interpreted with caution when administered to less-educated individuals.