Folstein Mini-Mental State Examination Research Articles

Low-Vision Rehabilitation in Patients with Visual and Cognitive Impairment

Purpose: To evaluate the prevalence of cognitive impairment among patients at a low-vision clinic and to determine whether low-vision rehabilitation (LVR) strategies improve visual function in these patients. Methods: We studied 50 consecutive patients presenting to a low-vision clinic. Folstein's Mini-Mental State Examination (MMSE) was administered to screen for cognitive impairment. During the low-vision examination, visual acuity was measured with and without the use of optical low-vision aids. The percentage visual acuity improvement with the use of low-vision aids was calculated for each patient. Results: Of the 50 patients examined, 16 (32%) had an MMSE score less than 24. Of these 16 patients, 14 (87.5%) experienced an improvement in visual acuity using low-vision devices. The visual acuity improvement with low-vision aids was statistically significant (p < 0.0001). Five of the 50 (10%) patients had MMSE scores less than 21. All five of these patients had improved visual acuity and function with l...

Detrimental Effects of Tumor Progression on Cognitive Function of Patients With High-Grade Glioma

There is growing recognition that the primary cause of cognitive deficits in adult patients with primary brain tumors is the tumor itself and more significantly, tumor progression. To assess the cognitive performance of high-grade glioma patients, prospectively collected cognitive performance data were analyzed. We studied 1,244 high-grade brain tumor patients entered onto eight consecutive North Central Cancer Treatment Group treatment trials that used radiation and nitrosourea-based chemotherapy. Imaging studies and Folstein Mini-Mental State Examination (MMSE) scores recorded at baseline, 6, 12, 18, and 24 months were analyzed to assess tumor status and cognitive function over time. The proportion of patients without tumor progression who experienced clinically significant cognitive deterioration compared with baseline was stable at 6, 12, 18, and 24 months (18%, 16%, 14%, and 13%, respectively). In patients without radiographic evidence of progression, clinically significant deterioration in MMSE scores was a strong predictor of a more rapid time to tumor progression and death. At evaluations preceding interval radiographic evidence of progression, there was significant deterioration in MMSE scores for patients who were to experience progression, whereas the scores remained stable for the patients who did not have tumor progression. The proportion of high-grade glioma patients with cognitive deterioration over time is stable, most consistent with the constant pressure of tumor progression over time. Although other factors may contribute to cognitive decline, the predominant cause of cognitive decline seems to be subclinical tumor progression that precedes radiographic changes.

PR_259: A Pilot Study of the Interaction Between Spirituality and Rehabilitation Outcome in Patients With Spinal Cord Injury or Disease

Objective: To determine if spirituality (spiritual well-being, spiritual and religious practices, positive religious coping) impacts rehabilitation outcomes for persons with spinal cord injury or severe neurologic illness. Design: Prospective observational survey using 3 patient self-reported spirituality instruments: the Duke Religious Index, the Spirituality Well-Being Scale, and the Brief Religious Coping Scale were used to measure spirituality. Setting: Academic medical center rehabilitation unit. Participants: 103 subjects admitted to an acute inpatient rehabilitation unit between January 2003 and June 2005. The exclusion criteria were: age less than 18, Folstein Mini-Mental Status Examination score less than 22, diagnosis of an acquired brain disorder that could impair cognition or perception, or status as a federal medical center prisoner. Interventions: Not applicable. Main Outcome Measures: FIM instrument, rehabilitation length of stay (LOS), and discharge location. Results: Diagnoses were paraplegia in 50 subjects; tetraplegia in 31 subjects; and neurologic disease in 15 subjects. 10 patients failed to complete data collection after enrollment. Admission FIM score was 66.4±15.9 and discharge FIM score was 95.0±18.0. Rehabilitation LOS was 19.8±14 days. 87% of participants went home. Except for a relationship between negative religious coping and reduced LOS, linear regression was unable to identify any relationship between the measures of spirituality and any rehabilitation outcome. Conclusions: There does not appear to be a relationship between these measures of spirituality and rehabilitation outcomes (rehabilitation LOS, FIM score change, discharge location). The relationship between negative religious coping and LOS is of questionable significance.

Intracranial Pressure Parameters in Idiopathic Normal Pressure Hydrocephalus Patients with or without Improvement of Cognitive Function after Shunt Treatment

Background/Aims: Previous research has shown improvements in the clinical triad (gait, incontinence and cognitive dysfunction) after shunt surgery in idiopathic normal pressure hydrocephalus (iNPH) patients with intracranial pulse pressure amplitudes >4–5 mm Hg, the pulse amplitudes being <4 mm Hg in the nonresponders. However, it is unknown whether similar differences exist regarding change in cognitive functioning after shunt surgery. The aim of this study was to compare preoperative intracranial pressure (ICP) parameters between iNPH that either improved or not improved in cognitive function after shunt treatment. Methods: Neuropsychological testing was performed before and after surgery in 27 consecutive iNPH patients treated with ventriculoperitoneal shunts. The ICP recordings were performed as part of routine preoperative assessment, stored as raw data files, and analyzed retrospectively. The mean ICP as well as single ICP wave amplitudes were computed and analyzed in consecutive 6-second time windows. Results: Significant improvement in neuropsychological tests, defined as a 4-point improvement in Folstein Mini-Mental State Examination or improvement by one standard deviation in 50% of subtests of Dementia Rating Scale, was found in 12 patients (44%; shunt responders). In these patients, mean ICP was similar though the mean ICP wave amplitude was significantly higher than in the shunt nonresponders. Conclusions: While preoperative mean ICP was similar, the mean ICP wave amplitudes were considerably higher in iNPH patients with significant change in cognitive function following shunt surgery.

Is Subclinical Thyroid Dysfunction in the Elderly Associated with Depression or Cognitive Dysfunction?

Widespread use of automated sensitive assays for thyroid hormones and thyroid-stimulating hormone (TSH) has increased identification of mild thyroid dysfunction, especially in elderly patients. The clinical significance of this dysfunction, however, remains uncertain, and associations with cognitive impairment, depression, and anxiety are unconfirmed. To determine the association between mild thyroid dysfunction and cognition, depression, and anxiety in elderly persons. Cross-sectional study. Associations were explored through mixed-model analyses. Primary care practices in central England. 5865 patients 65 years of age or older with no known thyroid disease who were recruited from primary care registers. Serum TSH and free thyroxine (T4) were measured. Depression and anxiety were assessed by using the Hospital Anxiety and Depression Scale (HADS), and cognitive functioning was established by using the Middlesex Elderly Assessment of Mental State and the Folstein Mini-Mental State Examination. Comorbid conditions, medication use, and sociodemographic profiles were recorded. 295 patients met the criteria for subclinical thyroid dysfunction (127 were hyperthyroid, and 168 were hypothyroid). After confounding variables were controlled for, statistically significant associations were seen between anxiety (HADS score) and TSH level (P = 0.013) and between cognition and both TSH and free T4 levels. The magnitude of these associations lacked clinical relevance: A 50-mIU/L increase in the TSH level was associated with a 1-point reduction in the HADS anxiety score, and a 1-point increase in the Mini-Mental State Examination score was associated with an increase of 50 mIU/L in the TSH level or 25 pmol/L in the free T4 level. Because of the low participation rate, low prevalence of subclinical thyroid dysfunction, and other unidentified recruitment biases, participants may not be representative of the elderly population. After the confounding effects of comorbid conditions and use of medication were controlled for, subclinical thyroid dysfunction was not associated with depression, anxiety, or cognition.

Health Status Measurements at Diagnosis As Predictors of Survival Among Adults With Brain Tumors

The intent of this study was to determine whether baseline measures of functional capacity and performance could be used to predict survival in adults following the diagnosis of brain tumors. Comprehensive health status and health-related quality of life (HRQL) were measured using the Health Utilities Index (HUI; McMaster University, Hamilton, Canada) system by a self-assessment questionnaire in a survey of 100 consecutive patients. The Karnofsky Performance Score (KPS) and Folstein's Mini-Mental State Examination (MMSE) scores were measured by a physician blinded to the HUI results. The patients were observed for up to 5 years to recorded dates of death. An HUI questionnaire was completed for 93% of the patients and 69% died within 5 years of assessment. The HUI revealed a burden of morbidity and complexity of disability that far exceeded that reported for the general population. KPS and MMSE correlated strongly with each other (r = 0.52; P < .001). A decrease of 0.1 units in HUI Mark 2 (HUI2) self-care single-attribute utility score was associated with an increased hazard of death of 30% (P = .023) for patients with low-grade tumors (n=25). For patients with high-grade tumors (n=56), a 10 unit decrease in the KPS, a 5 unit decrease in MMSE, and a 0.1 decrease in HUI Mark 3 (HUI3) speech and dexterity single-attribute scores were associated with an increased hazard of death of 20% (P = .022), 26% (P = .015), 36% (P = .021), and 18% (P = .035), respectively. Scores derived from the measurement of HRQL following diagnosis can predict survival in adults with brain tumors.

Multidisciplinary Congestive Heart Failure Clinic for Older Women: A Randomized Controlled Trial

Objectives: To determine whether a multidisciplinary clinical pathway, a blueprint of the patient care processes for female patients over age 65, will improve patients' quality of life and functional capacities in comparison to usual care for CHF. Design: A randomized controlled trial. The intervention consisted of a series of 12 visits over 6 weeks to optimize medical care, and to engage in an exercise program with strong educational, counseling and dietary management, involving physician, nursing, dietary, physiotherapy, pharmacy, occupational therapy and social work. Setting: Patients were referred from the Ottawa Hospital and the community with a diagnosis of CHF and were screened to ensure they met the eligibility criteria. Participants: Ninety-one community dwelling women aged 63 to 89 with the diagnosis of CHF were enrolled in this study. Measurements: The primary outcome measure was the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The secondary outcome measures included the MOS 36-Item Short-Form Health Survey (SF-36), the Folstein Mini-mental State Examination (MMSE), the 15 item Geriatric Depression Scale (GDS), the Physical Self-Maintenance Scale (PSMS), and survival and health service utilization over 6 months. Results: There was no difference between the two groups in MMSE or GDS scores by the end of six weeks cycle. Comparison of change from baseline MLHFQ score, including physical and emotional components, did not show a difference (P < 0.470). There was also no difference between the two groups in functional outcome as measured by change from baseline PSMS score (P < 0.321). The treatment group had a tendency to more ER visits (for all reasons and for CHF) and hospitalizations. The treatment group had significantly more cardiologist visits during the study period (P < 0.0001). Conclusion: It is feasible to conduct a randomized study in a frail community-based older female population and to test a complex multidisciplinary pathway. Future studies should provide further insight into the optimal intensity and duration of heart failure management programs, and which patients derive the greatest benefit.

P4-403: Results of next day crossover of donepezil to extended release galantamine in Alzheimer’s disease patients: A six-month follow up study

To investigate the safety, tolerability and caregiver impression of switching Alzheimer's disease (AD) treatment from donepezil to extended release galantamine. Patients switched from donepezil to extended release galantamine were followed for a period of six months. All patients were treated with donepezil for more than two years. Study participants met the DSM–IV and NINCDS–ADRA criteria for possible AD. Since no switch protocol was available, the investigators recommended that patients stop donepezil treatment and start treatment with extended release galantamine 8 mg once a day at lunch. Data regarding adverse events and caregiver impressions were obtained during routine monthly subsequent office visits. As part of office protocol, Folstein Mini Mental Status Examination (MMSE) was performed every three months for each patient. A total of 43 patients were evaluated & monitored for six months. Average donepezil treatment time prior to switch was 3.4 years. No noticeable cognitive deterioration was reported during the study period. Sixteen caregivers reported noticeable cognitive improvement. No patients stopped extended release galantamine due to adverse events. A total of 7 patients did experience adverse events: 3 had gastrointestinal symptoms, 2 experienced headache, one with bradycardia, and 5 with weight loss. Average MMSE was 16.4 (range 11–24) at baseline. There was an average of a + 2.4 point change in MMSE during the 6 month follow up exam. Next day crossover from donepezil to extended release galantamine is safe and well tolerated in most patients. No cognitive deterioration was reported during the follow up period. A + 2.4 point difference was noted in MMSE at the end of the study period.

P4-404: Safety, tolerability & clinical impression of high dose rivastigmine treatment for patients with Alzheimer’s disease

To investigate the safety, tolerability and clinical impression of high dose rivastigmine treatment for Alzheimer's disease (AD) patients. Patients receiving 12 mg/day of rivastigmine were included in the study. All met the DSM–IV and NINCDS–ADRDA criteria for possible AD. Enrolled patients were treated with 12 mg/day of rivastigmine for at least three months prior to study participation. Enrolled patients had no documented adverse events during previous treatment. Prior to study participation, all patients showed a subjective cognitive decline as described by caregivers. Folstein Mini Mental Status Examination (MMSE) scores further supported cognitive decline. Those with renal or hepatic disease were excluded from the study. At baseline, each patient was treated with rivastigmine 6 mg, 30 minutes after breakfast & dinner. An additional 1.5 mg was added after lunch. If no reported adverse events, dose was increased by 1.5 mg monthly, to a maximum of 6 mg after lunch. Patients were expected to reach 6 mg of rivastigmine 3 times daily, 30 minutes post meals, after a 4–month titration period. If a patient was unable to tolerate titration pattern, the dose was reduced to the previous tolerated level. Another titration was attempted after 4 weeks. Caregiver impressions and MMSE scores were obtained as part of the facility's routine for subsequent office visits. Thirty–nine patients were evaluated. Average length of previous treatment with rivastigmine 12 mg/day was 4.2 months. Average age was 83.8 & average baseline MMSE was 19.4 (range 13–24). Nine patients reached maximum doses of 15 & 16.5 mg/day due to poor compliance in office visits & availability of medication. Thirty patients reached the target dose of 18 mg/day. No adverse events were reported. Average MMSE for those who reached maximum dose and completed four months of treatment was 22.2 (range 14–27). Caregivers reported no cognitive deterioration. High dose rivastigmine at 18 mg/day, in 3 divided doses, was well tolerated in AD patients previously taking 12 mg/day, with no adverse events for at least 3 months. Cognitive benefits were documented by MMSE scores and subjective caregiver feedback.

Relación entre los factores que determinan los síntomas depresivos y los hábitos alimentarios en adultos mayores de México

To determine the factors that are commonly associated with both the dietary habits of older adults living in the community and depressive symptoms in this group. Secondary analysis of data on Mexico City obtained by means of the multicenter study on Health, Well-being, and Aging (Salud, Bienestar y Envejecimiento, SABE) that was carried out in 1999 and 2000. The following variables were examined: presence or absence of depressive symptoms, according to Yesavage's Geriatric Depression Scale (GDS); mental status, as reflected by the score obtained on a modified, shortened version of Folstein's Mini-mental State Examination (MMSE); and functional capacity, as measured by Katz' Index of Independence in Activities of Daily Living. Those whose score on the shortened MMSE was 12 points or less were asked to respond to the Pfeffer Functional Activities Questionnaire, which was used to assess their ability to perform the basic activities of daily living. Information was obtained through self-report on the material, physical, psychological, and social aspects of purchasing, preparing, and consuming food products and of oral health status during the most recent 12-month period. Variables that were significantly associated with the results obtained on the GDS were included in a multivariate regression analysis; several statistical models were created, and variables that were shown to be statistically significant in the stepwise multivariate linear regression were used to determine the best-fitting explanatory model for the results obtained on the GDS. The average age of study participants was 64.4 +/- 8.6 years, and the prevalence of depressive symptoms was 66%. The score obtained on the GDS showed a significant association with the presence of arterial hypertension (P < 0.01), but not with the self-reported presence of diabetes, neoplasia, stroke, lung disease or heart disease. However, the use of dental prostheses (P < 0.01), urinary incontinence (P < 0.01), and falls (P < 0.01) were significantly associated with the results on the GDS. The intake of milk products, meat, fish, fowl, fruit, and vegetables was significantly lower in the group that had depressive symptoms. An inverse correlation was detected between the score obtained on the GDS on the one hand, and the number of complete meals consumed during the day (P < 0.01) and total fluid intake (P < 0.01) on the other. The determining factors that were most closely associated with these results were, in addition to the presence of arterial hypertension, the presence of cognitive impairment (P < 0.01), difficulty performing the basic activities of daily living (P = 0.03) and the instrumental activities of daily living (P < 0.01), poor mobility (P < 0.01), difficulty using the telephone (P < 0.01), and the self-perception of having poor memory (P < 0.01), of having insufficient resources with which to live (P < 0.01), and of having poor oral health (P < 0.01). These variables explained 31% of the variance seen in the R2 values linked to the SDG variables that were incorporated into the final explanatory model. A number of determining factors for depressive symptoms and the results obtained on the GDS resemble the factors that determine poor dietary habits among older adults. The potential existence of common causative mechanisms calls attention to the need for designing interventions aimed at preventing both types of problems and their negative consequences. These results confirm the need to take dietary habits and other parameters into account when studying depression in older adults.

The Rowland Universal Dementia Assessment Scale (RUDAS) and the Folstein MMSE in a multicultural cohort of elderly persons

To compare the accuracy of the Rowland Universal Dementia Assessment Scale (RUDAS) and the Folstein Mini-mental State Examination (MMSE) for diagnosis of dementia in a multicultural cohort of elderly persons. A total of 129 community-dwelling persons were selected at random from a database of referrals to an aged-care team. Subjects were stratified according to language background and cognitive diagnosis, and matched for age and gender. The RUDAS and the MMSE were administered to each subject in random order. Within several days, a geriatrician assessed each subject for dementia (DSM-IV criteria) and disease severity (Clinical Dementia Rating Scale). All assessments were carried out independent and blind. The geriatrician also administered the Modified Barthel Index and the Lawton Instrumental Activities of Daily Living Scale, and screened all participants for non-cognitive disorders that might affect instrument scores. The area under the receiver operating characteristic curve (AUC) for the RUDAS [0.92, 95% confidence interval (95%CI) 0.85-0.96] was similar to the AUC for the MMSE (0.91, 95%CI 0.84-0.95). At the published cut-points (RUDAS < 23/30, MMSE < 25/30), the positive and negative likelihood ratios for the RUDAS were 19.4 and 0.2, and for the MMSE 2.1 and 0.14, respectively. The MMSE, but not the RUDAS, scores were influenced by preferred language (p = 0.015), total years of education (p = 0.016) and gender (p = 0.044). The RUDAS is at least as accurate as the MMSE, and does not appear to be influenced by language, education or gender. The high positive likelihood ratio for the RUDAS makes it particularly useful for ruling-in disease.

IPA survey of brief cognitive screening instruments

Cognitive screening is a "first step" in detecting dementia and other neuropsychiatric syndromes and hence represents an important public health and clinical initiative. A plethora of cognitive screening instruments has been advocated in recent years, but the extent to which these instruments are used or their effectiveness is not well known. An International Psychogeriatric Association (IPA) survey was designed to determine which cognitive screening instruments were used most frequently by clinicians with special expertise in the neuropsychiatric aspects of old age and also to determine the ones considered most useful by these specialists. Under the auspices of the IPA, the survey was mailed in the fall of 2004 to all IPA members as well as members of the American and Canadian Associations of Geriatric Psychiatry. The survey inquired about demographic information, the frequency of use of cognitive screening instruments, and the value attributed to the cognitive screening instruments. Participants also had an opportunity to provide written commentary. A total of 334 completed surveys were processed. The majority of respondents were geriatric psychiatrists (58%). Of the 20 different instruments that were listed on the survey, only six were selected as "routinely" or "often used" by the survey respondents. These instruments in declining order were: (1) the Folstein Mini-mental State Examination; (2) the Clock Drawing Test; (3) Delayed Word Recall; (4) the Verbal Fluency Test; (5) Similarities; and (6) the Trail Making Test. "Effectiveness" and "ease of administration" were the test characteristics most highly predictive of frequency of use. Open-ended comments highlighted patient factors that continue to provide challenges, including ethnicity/culture, language, education/literacy, and sensory impairment. Respondents concluded that "no single test is adequate." Psychogeriatricians worldwide routinely use a relatively small number of brief cognitive screening instruments. Further evaluation is necessary as the need increases for cognitive screening guidelines that inform public health initiatives related to dementia and neuropsychiatric syndromes.

Inpatient Rehabilitation Outcome After Hip Fracture Surgery in Elderly Patients: A Prospective Cohort Study of 946 Patients

Lieberman D, Friger M, Lieberman D. Inpatient rehabilitation outcome after hip fracture surgery in elderly patients: a prospective cohort study of 946 patients. Objective To identify the factors associated with inpatient rehabilitation outcome after surgical repair of hip fracture in elderly patients. Design A noninterventional prospective cohort study. Setting Geriatric inpatient rehabilitation center in a tertiary university medical center in southern Israel. Participants Patients (N=946) aged 65 years of age or older who were hospitalized for rehabilitation after surgery for hip fracture. Interventions Not applicable. Main Outcome Measures Functional studies by the FIM instrument and a broad spectrum of clinical, demographic, and social variables. Stepwise multiple regression was used to assess the relative contribution of the variables to the variance of the percentage change in the FIM score during the course of rehabilitation in relation to the severity of the functional impairment at its inception. Results Eight variables were significantly and independently associated with rehabilitation outcome. Prefracture FIM scale (standardized regression coefficient in multiple regression [β]=.261, P<.001), serum albumin at discharge (β=.222, P<.001), Folstein Mini-Mental State Examination (β=.174, P<.001), visual impairment (β=−.089, P=.002), dyspnea at mild exertion (New York Heart Association class III) (β=−.080, P=.005), age (β=−.080, P=.007), poststroke motor impairment (β=−.072, P=.011), and decreased serum folic acid (β=−.055, P=.047). The total percentage of the explained variance of the primary rehabilitation outcome measure accounted for by these 8 variables (adjusted R 2) was 31.9%. Conclusions The outcome of rehabilitation of elderly patients after surgical repair of hip fracture is associated with 4 clinical and nutritional correctable parameters. The other 4 variables that are associated with the process cannot be corrected but may help predict outcomes and adjust expectations.

Towards a Measure of Function for Home and Community Care Services in Australia: Part 1 - Development of a Standard National Approach

The aim of the project was to recommend, for national use, validated and reliable instruments for measuring the dependency of people eligible for Australian Home and Community Care (HACC) services. The project was split into two stages. Stage 1- reported here - reviewed the suitability of existing instruments and scales to measure levels of dependency within the target group and made recommendations on a set of measures for national field testing in Stage 2. The review covered four domains of function (domestic or instrumental, self-care, challenging behaviour, and cognitive) and recommended an instrument for each domain. A two-tier assessment system was developed. The first tier consists of a simple nine-item functional screen. It consists of seven items from the OARS instrument (Fillenbaum &amp; Smyer, 1981) and two additional items to cover cognitive and behavioural functioning. The second tier consists of five functional assessment instruments, used only with those triggered for an assessment from the first tier assessment. The five instruments are the Barthel Index (Collin, Wade, Davies, &amp; Horne, 1988) or the Functional Independence Measure (FIM, Granger et al., 1993) to assess self-care; the Lawton's Instrumental Activities of Daily Living (IADL) Scale, with modifications to make it suitable for the HACC program, to assess domestic functioning; the Australian Resident Classification Scale (RCS), with modifications to make it suitable for the HACC program, to assess behaviour; and the Folstein Mini-Mental State Examination (MMSE [30-point]) to assess cognition. The selected instruments were, on the weight of the available evidence, those that best met our criteria in terms of validity, reliability and acceptability. The performance of the instruments with a representative sample of HACC clients and services forms Stage 2 of the research; this empirical evidence is reported elsewhere in this Journal.

Evaluación de la versión española del Memory Impairment Screen

Screening tests for detecting dementias are usually long, sometimes difficult to apply, and require a certain amount of instruction prior to using them. The Memory Impairment Screen (MIS) is a fast (3-4 minutes), easy-to-apply screening test that evaluates short-term verbal memory.To evaluate the value of the MIS for screening for dementia in our population.We evaluated 101 subjects who were divided into two groups, one consisting of 49 individuals with dementia according to DMS-IV criteria and the other made up of 52 subjects with no cognitive impairment. Demographic variables (sex, age, schooling) were studied together with the results from the Global Deterioration Scale, the Folstein Mini-Mental State Examination (MMSE), the MIS, the Semantic Verbal Fluency (SVF) and the Command-Condition Clock Test (CCCT).demographic variables and the results from the tests for the two groups (with and without dementia) were compared, and the parameters for diagnostic usefulness and the areas under the ROC (aROC) were determined.No significant differences were found between the sociodemographic variables except for a higher mean age in the group with dementia. The MIS showed a sensitivity of 83.7% (95% CI: 71-97.9), which was higher than the SVF and the CCCT, and a specificity of 94.2% (95% CI: 84.4-98), which was higher than the MMSE and the SVF. The aROC of the MIS was 0.935 (95% CI: 0.954-1.006).These findings show that the MIS is a good test for screening for dementia, and its simplicity and quick application could make it suitable for use in our population.

Caregiver distress in parkinsonism

This study examined the frequency and degree of caregiver burden in persons with parkinsonism, a group of disorders with four primary symptoms that include tremor, rigidity, postural instability, and bradykinesia. We assessed associations between perceived caregiver burden and physical, cognitive, and functional impairments using well-established tools for persons with parkinsonism. The 49 individuals with parkinsonism ranged in age from 61 to 87 (mean = 75), while their caregivers (N = 49) ranged in age from 48 to 83 (mean = 70). The caregivers were predominantly either wives (82%) or daughters (6%), with other family members, friends, and/or neighbors (12%) making up the rest. The caregivers reported a relatively high ability for coping (mean scores = 4.6/6). Caregiver burden was significantly negatively associated with activities of daily living and motoric difficulties as measured on the Unified Parkinson's Disease Rating Scale (UPDRS). Likewise, caregiver burden was negatively associated with caregiver self-reported sleep and coping ability. Results did not demonstrate an association on the UPDRS among mentation, behavior, and mood. We found a significant negative correlation for mentation between the Folstein Mini-Mental Status Examination and caregiver burden measures; however, we did not find this association with the Dementia Rating Scale-2. Patient's self-reported pain and caregiver burden were not associated.

Exploring Time of Day Effects on Mini-Mental State Examination Performance in Alzheimer's Disease and Age-Associated Cognitive Decline

AbstractNeuropsychological assessment plays a prominent role in the diagnosis of Alzheimer's disease (AD) and other cognitive impairments. Increasingly, neuropsychological test results are also used to guide clinicians in the prescription of anti-dementia medication. There is evidence to suggest that the cognitive ability of an individual with AD may vary over the course of a day. If time of day can influence an individual's performance on cognitive tests, then it could potentially affect his or her diagnosis and eligibility for treatment. This study set out to explore the effect of time of day on Mini-Mental State Examination (MMSE) performance in individuals with AD and Age-Associated Cognitive Decline (AACD). No significant effect of time of day (TOD) on Folstein MMSE performance was found. However, some interesting results were highlighted and future research suggested. Overall, the study does not provide evidence that time of day needs to be considered when interpreting the result of a short cognitive screening test.

The effect of hormone replacement on physical performance in community-dwelling elderly women

PurposeOur aim was to determine the effect of hormone replacement on physical performance measures, functional ability, physical activity, falls, and cognitive function in elderly women. Subjects and methodsFollowing a 3-month, open-label, run-in phase, we randomized 373 community-dwelling women aged 65 years and older to receive conjugated equine estrogen 0.625 mg/day plus or minus medroxyprogesterone 2.5 mg/day vs placebo for 3 years in a double-blind fashion. We assessed time to rise from a chair, timed walking, balance, Instrumental Activities of Daily Living, Physical Activity Scale of the Elderly, Folstein Mini-Mental State Examination, and falls. ResultsOver 3 years, except for balance scores, performance measures declined significantly (all P<.05). There were no significant mean differences between women on hormone replacement versus placebo for rising time (0.1, −0.5 to 0.7 seconds [mean, 95% confidence interval]), walking normal (0.0, −0.4 to 0.4 seconds), and walking fast (0.2, −0.1 to 0.6 seconds). There were no significant mean differences between the two groups for the Instrumental Activities of Daily Living (0.1, −0.1 to 0.3 points), Physical Activity Scale of the Elderly (−3, −15 to 8 points), Folstein Mini-Mental State Examination (−0.1, −0.3 to 0.3 points), or the proportion of participants reporting falls (−1, −11 to 9%). ConclusionIn elderly women, hormone replacement had no statistically significant effect on cognition or balance, nor did it prevent the age-related decline in physical measures of mobility, ability to rise from a chair, self-reported activities of daily living, physical activity scores, or falls.

Delusions and hallucinations are associated with worse outcome in Alzheimer disease.

Delusions and hallucinations are common in Alzheimer disease (AD) and there are conflicting reports regarding their ability to predict cognitive decline, functional decline, and institutionalization. According to all previous literature, they are not associated with mortality. To examine whether the presence of delusions or hallucinations has predictive value for important outcomes in AD. A total of 456 patients with AD at early stages (mean Folstein Mini-Mental State Examination [MMSE] score of 21 of 30 at entry) were recruited and followed up semiannually for up to 14 years (mean, 4.5 years) in 5 university-based AD centers in the United States and Europe. Using the Columbia University Scale for Psychopathology in AD (administered every 6 months, for a total of 3266 visit-assessments, average of 7.2 per patient), the presence of delusions and hallucinations was extracted and examined as time-dependent predictors in Cox models. The models controlled for cohort effect, recruitment center, informant status, sex, age, education, a comorbidity index, baseline cognitive and baseline functional performance, behavioral symptoms, and use of neuroleptics and cholinesterase inhibitors. Cognitive (Columbia MMSE score of < or =20/57 [approximate Folstein MMSE score of < or =10/30]), functional (Blessed Dementia Rating Scale [parts I and II] score of > or =10), institutionalization equivalent index, and death. During the full course of follow-up, 38% of patients reached the cognitive, 41% the functional, 54% the institutionalization, and 49% the mortality end point. Delusions were noted for 34% of patients at baseline and 70% at any evaluation. Their presence was associated with increased risk for cognitive (risk ratio [RR], 1.50; 95% confidence interval [CI], 1.07-2.08) and functional decline (RR, 1.41; 95% CI, 1.02-1.94). Hallucinations were present in 7% of patients at initial visit and in 33% at any visit. Their presence was associated with increased risk for cognitive decline (RR, 1.62; 95% CI, 1.06-2.47), functional decline (RR, 2.25; 95% CI, 1.54-2.27), institutionalization (RR, 1.60; 95% CI, 1.13-2.28), and death (RR, 1.49; 95% CI, 1.03-2.14). Delusions and hallucinations are very common in AD and predict cognitive and functional decline. Presence of hallucinations is also associated with institutionalization and mortality.

Prospective Study of Quality of Life in Adults with Newly Diagnosed High-grade Gliomas

To assess baseline quality of life (QOL) and its prognostic importance for adults with newly diagnosed high-grade gliomas, we analyzed QOL and outcome data prospectively collected in three phase II high-grade glioma protocols. At study entry, patients completed five self-administered forms to assess overall QOL (linear analogue scale assessment [LASA] and Functional Assessment of Cancer Therapy-Brain [FACT-Br]); fatigue (Symptom Distress Scale [SDS]); excessive daytime somnolence (Epworth Sleepiness Scale [ESS]); and depression (POMS-SF). Folstein Mini-Mental State Examination (MMSE) and Eastern Cooperative Oncology Group (ECOG) performance scores (PS) were obtained by the health care provider. Baseline QOL data were available for 194 of 220 patients (88%) enrolled in the three protocols. Differences in baseline QOL among the three studies were not statistically significant. One-third of patients had clinically significant fatigue at baseline. Increased fatigue (P = 0.003), excessive daytime somnolence (P = 0.01), and lower overall QOL scores (LASA, P = 0.001; FACT-Br, P = 0.0001) correlated with worse ECOG PS. No relation was found between QOL and corticosteroid or anticonvulsant therapy, extent of resection, tumor grade, or sex. Multivariate analyses found worse ECOG PS (PS 2, P = 0.007) associated with increased fatigue. Worse ECOG PS (PS 2, P = 0.002) was also associated with worse overall QOL (LASA). On multivariate analyses of survival, increased fatigue (P = 0.003) predicted poorer overall survival. Performance status is related to QOL in patients with newly diagnosed high-grade brain tumors. Increased fatigue is an independent predictor of overall survival. Interventional studies directed at improving QOL, especially fatigue, may have important benefits for these patients.