Impairment Mini-Mental State Examination Research Articles

Cerebral blood flow-single-photon emission computed tomography and Brodmann mapping may facilitate the evaluation of clinical features of early-onset Alzheimer’s disease

A relatively large numbers of studies have reported on the clinical features, classifications, and impairment of cerebral blood flow (CBF) in cases with Alzheimer’s disease. However, only few reports have investigated the relationships between clinical tests and lesion areas in the brain with significantly reduced CBF, assessed using single-photon emission computed tomography (SPECT). This study aimed to assess the correlations between impaired Mini-Mental State Examination (MMSE) scores and reduced CBF using Brodmann area mapping and classify early-onset Alzheimer’s disease (EOAD). Thirty-one patients aged <65 years, with memory impairment, were examined using CBF-SPECT, and MMSE during the same period. Twenty patients were diagnosed with EOAD. We divided the patients into two groups: one with bilateral reduction of CBF in temporo-parietal region and the other with unilateral reduction. The bilateral group had significantly lower MMSE scores than the unilateral reduction group, but it had significantly less family history, significantly poor prognoses, and ten significantly reduced CBF in the Brodmann area (BA) with SPECT. In the bilateral group, there were large correlations between impaired MMSE and reduced CBF regions in the BA. These findings confirm that the classification of EOAD may pave the way to understand patients with EOAD.

Is carotid artery atherosclerosis associated with poor cognitive function assessed using the Mini-Mental State Examination? A systematic review and meta-analysis

ObjectivesTo determine associations between carotid atherosclerosis assessed by ultrasound and the Mini-Mental State Examination (MMSE), a measure of global cognitive function.DesignSystematic review and meta-analysis.MethodsMEDLINE and EMBASE databases were searched up...

Kidney Function and Risk of Physical and Cognitive Impairment in Older Persons with Type 2 Diabetes at an Outpatient Clinic with Geriatric Assessment Implementation.

PurposeDiabetes is associated with an increased risk of cognitive and physical functional decline that may impede disease self-management. By incorporating cognitive and physical function assessment, this study aimed to evaluate prevalence and factors associated with cognitive and physical dysfunction in older diabetic people.MethodsThe cross-sectional study was performed from August 1, 2017 to November 30, 2018. The patients aged 65 years or older with type 2 diabetes mellitus were enrolled and the disease was routinely evaluated by blood hemoglobin A1c (A1C), blood pressure, lipids, and kidney function measured by estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine rate (UACR). Besides, cognitive dysfunction through Mini-mental State Examination (MMSE), and functional disabilities by Activities of Daily Living (ADL) questionnaire were assessed simultaneously.ResultsAmong 863 patients (48.3% men) with a median age of 72.0 years (interquartile range or IQR: 67.0–78.0 years), 159 (18.5%) had cognitive impairment assessed by MMSE, while 40 (4.6%) experienced at least one problem in ADL. With different A1C stratifications, it was shown that both MMSE and ADL scores were associated with glycemic control. Patients with impaired MMSE and ADL scores were older, had lower eGFR, lower blood pressure, and higher UACR levels. After adjustment of possible confounders, it was shown that age and eGFR predicted MMSE and ADL score impairment.ConclusionBy incorporating physical and cognitive function screening program into routine care at a diabetes outpatient clinic, our study found that both cognitive and physical function impairment were common in older diabetic patients, and their relevant factors, including older age, and lower eGFR. It was recommended that in older individuals with diabetes, particularly those with risk factors, an additional assessment of cognitive and physical functions can be integrated into routine clinical process to provide more comprehensive management plans.

Cognitive Impairment in Older Cancer Patients Treated with First-Line Chemotherapy.

Simple SummaryChemotherapy-related cognitive impairment is frequently reported by patients and can have a negative impact on their quality of life. Elderly patients appear to be particularly at risk for cognitive decline but they are rarely included in studies. Our study investigated cognitive impairment during chemotherapy and its predictive factors among a large elderly population (≥70 years) treated with first-line chemotherapy. The aim was to identify risk factors before starting chemotherapy in order to manage and help elderly patients with decision making.Older cancer patients are vulnerable to chemotherapy-related cognitive impairment. We prospectively evaluated cognitive impairment and its predictive factors during first-line chemotherapy in elderly cancer patients (≥70 years). Cognitive function was evaluated by the Mini-Mental State Examination (MMSE) with adjusted scores for age and sociocultural level. Multidimensional geriatric assessment was performed at baseline and during chemotherapy including the MMSE, Instrumental Activities in Daily Living (IADL), Mini-Nutritional Assessment (MNA), and the Geriatric Depression Scale (GDS15). Quality of life (QoL) was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire (QLQ-C30). Of 364 patients included, 310 had two MMSE evaluations including one at baseline and were assessed. Among these patients, 86 (27.7%) had abnormal MMSE, 195 (62.9%) abnormal MNA, 223 (71.9%) abnormal IADL, and 137 (43.1%) had depressive symptoms at baseline. MMSE impairment during chemotherapy was observed in 58 (18.7%) patients. Abnormal baseline MNA (odds ratio (OR) = 1.87, p = 0.021) and MMSE (OR = 2.58, p = 0.022) were independent predictive factors of MMSE impairment. These results suggest that pre-existing cognitive impairment and malnutrition are predictive factors for cognitive decline during chemotherapy in elderly cancer patients. Detection and management of these risk factors should be systematically considered in this population before starting chemotherapy.

Cognitive function assessed by Mini-mental state examination and risk of all-cause mortality: a community-based prospective cohort study

BackgroundThe Mini-Mental State Examination (MMSE) is the most widely used instrument to test cognitive functioning. The present study prospectively investigated the association between MMSE scores, MMSE domains, and all-cause mortality.MethodsA total of 2134 participants aged 60 years or over, selected from one urban community-dwelling population in China, were enrolled in the study. The cognitive test was performed by use of the MMSE at baseline, and covariates were recorded simultaneously. Cox regression models were used for examining the cognitive function, expressed by different MMSE transformations, and all-cause mortality. After followed up for a median of 10.8 years (ranging from 1.0 to 11.3 years), loss to follow-up was 13.1% and 1854 individuals were finally included in the analyses.ResultsThe subjects had the mean (SD) age of 71.01 (7.00) years, and 754 (40.67%) of them were women. Per point increase on MMSE scores was associated a 4% decreased risk of all-cause mortality [hazard ratio (HR): 0.96; 95%confidence interval (CI): 0.93–0.98]; compared to MMSE scores of ≥24, MMSE scores of < 24 was associated with a 43% increased risk of all-cause mortality (HR: 1.43; 95% CI: 1.05–1.95); compared to MMSE scores of 30, MMSE scores of 27–29 (HR: 1.27; 95% CI: 0.89–1.82), 24–26 (HR: 1.30; 95% CI: 0.86–1.99), and < 24 (HR: 1.79; 95% CI: 1.15–2.77) had a graded increase in risk of all-cause mortality (p for trend =0.003). Of MMSE domains, orientation to time (HR: 2.00; 95% CI: 1.29–3.11), attention and calculation (HR: 1.49; 95% CI: 1.16–1.92), recall (HR: 2.59; 95% CI: 1.22–5.47), and language (HR: 1.68; 95% CI: 1.25–2.26) were significantly associated with all-cause mortality in the unadjusted model; for one increase in the number of impaired MMSE domains, the unadjusted HR (95% CI) of mortality is 1.51 (1.38, 1.65), and the HR (95% CI) of mortality is 1.12 (1.01, 1.25) with full adjustment; compared to 0 and 1 impaired MMSE domains, the HRs of all-cause mortality associated with 2, 3, 4, and ≥ 5 impaired MMSE domains were 1.14 (95% CI: 0.84–1.54), 1.50 (95% CI: 0.98–2.28), 2.14 (95% CI: 1.12–4.09) and 2.29 (95% CI: 1.24–5.04), respectively, and a dose-dependent relationship was significant (p for trend =0.003).ConclusionCognitive impairment is associated with the increased risk of all-cause mortality in the Chinese elderly. Similarly, reduced MMSE scores, as well as impaired MMSE domains, are also associated with the increasing risk of all-cause mortality.

Post-Stroke Depression in Patients with Large Spontaneous Intracerebral Hemorrhage

ObjectivesTo determine factors associated with post-stroke depression (PSD) and relationship between PSD and functional outcomes in spontaneous intracerebral hemorrhage (ICH) using prospective data from a large clinical trial. Materials and MethodsMISTIE III, a randomized, multicenter, placebo-controlled trial, was conducted to determine if minimally invasive surgery with thrombolysis improves outcome compared to standard medical care. Our primary outcome was post-stroke depression at 180 days. Secondary outcomes were change in blinded assessment of modified Rankin Scale (mRS) from 30 to 180 days, and from 180 to 365 days. Logistic regression models were used to assess the relationship between PSD and outcomes. ResultsAmong 379 survivors at day 180, 308 completed Center for Epidemiologic Studies Depression Scale, of which 111 (36%) were depressed. In the multivariable analysis, female sex (Adjusted Odds Ratio [AOR], 95% Confidence Interval [CI]: 1.93 [1.07-3.48]), Hispanic ethnicity (3.05 [1.19-7.85]), intraventricular hemorrhage (1.88 [1.02-3.45]), right-sided lesions (3.00 [1.43-6.29]), impaired mini mental state examination at day 30 (2.50 [1.13-5.54]), and not being at home at day 30 (3.17 [1.05-9.57]) were significantly associated with higher odds of PSD. Patients with PSD were significantly more likely to have unchanged or worsening mRS from day 30 to 180 (42.3% vs. 25.9%; p=0.004), but not from day 180 to 365. ConclusionsWe report high burden of PSD in patients with large volume ICH. Impaired cognition and not living at home may be more important than physical limitations in predicting PSD. Increased screening of high-risk post-stroke patients for depression, especially females and Hispanics may be warranted.

The relationship between blood pressure and cognitive function

BackgroundAlthough an elevated systolic blood pressure (SBP) is associated with cognitive dysfunction, BP may decrease with advanced cognitive dysfunction; therefore, we attempted to identify the turning point in the relationship between cognitive function and SBP in elderly subjects. MethodsIn pooled datasets of general populations and outpatient clinics (age>65 years), in which the risk of frailty or cognitive dysfunction was assessed (N = 4076), the relationship between SBP and the Mini Mental State Examination (MMSE) score was examined. ResultsMean age was 72.5 ± 6.2 years (male 45.1%), and SBP was 133.0 ± 19.5 mmHg. In an analysis of locally weighted scatter plot smoothing, the relationship between SBP and MMSE scores changed at an MMSE score of 24 points. In subjects with preserved cognitive function (MMSE ≥24 points), MMSE scores decreased with increases in SBP (B = −0.047 per 10 mmHg increase, P = 0.002) after adjustments for age, sex, body mass index, alcohol habit, smoking status, diabetes, a history of stroke, and the geriatric nutritional index; however, in subjects with reduced cognitive function (MMSE<24 points), decreases in the MMSE score were associated with reductions in SBP (B = 1.178 per 1 point decrease in the MMSE score, P = 0.002). ConclusionThe relationship between SBP and cognitive function changed at a MMSE score of approximately 24 points (mild to moderate cognitive dysfunction). In patients with preserved MMSE, higher BP values were associated with a reduction of cognitive function, but this was not a case for those with impaired MMSE.

Association between self‐reported night sleep duration and cognitive function among older adults with intact global cognition

The purpose of this study was to clarify the association between self-reported night sleep duration and cognitive functions such as word memory, story memory, attention, executive function, and processing speed of older adults with normal global cognitive function. A total of 241 functionally independent older adults (mean age, 75.5 ± 6.4 years) participated in this study. No participants had a history of dementia diagnosis, and each had a Mini-Mental State Examination (MMSE) score ≥ 24. Participants were evaluated for self-reported sleep duration and cognitive function using the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT). The longest sleep duration group (≥9 h) had lower MMSE scores (p = 0.010), Z-score of word list memory II (delayed recall; p = 0.001), and Z-score of story memory II (delayed recognition; p = 0.002) than the medium sleep duration group (7-8 h). Longest and long sleep duration (8-9 h) was significantly associated with impairment of story memory II (longest sleep duration: adjusted odds ratio [OR] = 3.58, 95% confidence interval [CI] = 1.13-11.37, long sleep duration: adjusted OR = 4.30, 95% CI = 1.34-13.82) with reference to medium sleep duration, but no impairment of MMSE according to multiple logistic regression analysis. Furthermore, short sleep duration (<7 h) was not associated with cognitive impairment. This study suggests that long sleep duration is associated with cognitive impairment, especially of story memory (delayed recognition) in older adults with normal global cognitive function.

Adverse Effects of Anticholinergic Drugs on Cognition and Mobility: Cutoff for Impairment in a Cross-Sectional Study in Young–Old and Old–Old Adults

Drugs with anticholinergic properties are commonly prescribed in older adults despite growing evidence of their adverse outcomes. Several issues regarding these detrimental effects remain unresolved, such as the putative existence of a threshold above which anticholinergic drug consumption impairs cognitive or mobility performance. We aimed to investigate the number of anticholinergic drugs and the anticholinergic burden that leads to mobility or cognitive impairment and compare the effects in community-dwelling older adults in two age groups ("young-old" 55-74 vs. "old-old" ≥ 75years). In a cross-sectional study, we identified drugs with anticholinergic (antimuscarinic) properties using the Anticholinergic Drug Scale. Cognition was assessed using the Mini Mental State Examination (MMSE) and the Trail Making Test (TMT-A and TMT-B), and mobility was assessed using the Timed Up and Go (TUG) test. The study population consisted of 177 volunteers, 114 of whom were classed as young-old and63 were classed as old-old adults. Despite the lack of cutoff values for impaired outcomes in young-old adults, impaired MMSE were significantly more numerous in users than in nonusers of anticholinergic drugs. In old-old adults, receiver operating characteristic (ROC) curve analysis indicated that taking a single anticholinergic drug per day was associated with impaired TMT-B completion time, TMT difference score (B-A), and TUG scores. The cutoff for anticholinergic burden was also one for these same outcomes. Based on these cutoff values, multivariate logistic regressions in old-old adults showed that the increased risk of impaired cognition and mobility was independent of confounding factors, including comorbidities. They also suggested that anticholinergic drugs would affect mobility through executive functions. Drugs with anticholinergic (antimuscarinic) properties are associated with cognitive impairment in individuals as young as 55years, and only one such drug per day, regardless of its anticholinergic burden, is associated with both impaired cognition and impaired mobility in old-old adults. Therefore, wherever possible, clinicians should avoid prescribing drugs with anticholinergic properties.

Fibromiyalji Sendromunda Serum Ürik Asit ve Ortalama Trombosit Hacmi Düzeylerinin Bilişsel Fonksiyonla İlişkisi

Objective: Patients with fibromyalgia syndrome (FMS) have mild cognitive dysfunction. Higher serum uric acid (UA) levels in some diseases are reported to be associated with cognitive impairment. Mean platelet volume (MPV) is an indicator of platelet activation. Activated platelets may play a role in neuroinflammation and cognitive dysfunction. The purpose of this study was to compare cognitive functions of FMS patients and controls and investigate the relation of serum UA and MPV levels with cognitive functions. Method: Fifty-four patients with FMS and 33 healthy controls were enrolled,retrospectively. Evaluations were performed with Visual Analog Scale (VAS), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory(BDI) and to asses phychological status and cognitive impairment Mini Mental State Examination(MMSE) was used in both groups. Results: Mean VAS and sleep quality of FMS group were significantly higher than the control group (p&lt;0.05). Mean MMSE score was statistically significantly lower in the FMS group (p=0.0001). There was not statistically significant correlation between serum UA levels and VAS pain/sleep quality, FIQ, BDI and MMSE scores (p&gt;0.05). No significant correlation was found between serum MPV levels and VAS pain/ sleep quality, FIQ, BDI and MMSE scores (p&gt;0.05) but declined cognitive functions were determined in the FMS group when compared with the control group. Conclusion: Declined cognitive functions were determined in the FMS the FMS group when compared with the control group. Although we did not determine an association of serum uric acid and MPV levels with cognitive functions, larger prospective studies with longer follow up periods are warranted to elucidate the role of these biomarkers in FMS and to determine the factors affecting cognitive functions.

ANTICHOLINERGIC DRUGS: CUT-OFF FOR IMPAIRED COGNITION AND MOBILITY IN SENIORS

Background and Objectives: Anticholinergic drugs are commonly prescribed in older adults despite growing evidence of their adverse outcomes. We aimed to improve knowledge about deleterious effects of anticholinergic drugs on both cognition and mobility, in particular whether there is a threshold value for the number of anticholinergic drugs or for the anticholinergic burden leading to mobility or cognitive impairment. Methods: 177 community-dwelling individuals aged 55 years or over, with a fall history in the previous year, took part in the study. Anticholinergic drugs were identified using the Anticholinergic Drug Scale (ADS), and global cognition and mobility were assessed using the Mini Mental State Examination (MMSE) and the Time-Up-and-Go (TUG) test, respectively. Results: ROC (Receiver Operating Characteristics) curve analysis indicated that consumption of a single anticholinergic drug per day was a risk factor for impaired MMSE (p < .05) and TUG scores (p < .05). There was also a cut-off of anticholinergic burden of one for impaired MMSE scores (p < .05). Logistic regressions showed that impaired cognition induced by anticholinergic drugs were independent of confounding factors including comorbidities, while impaired mobility would be influenced by age and cardiac comorbidities. Conclusion: Daily consumption of a single anticholinergic drug, regardless of its anticholinergic burden, impairs both cognition and mobility community-dwelling seniors. Alternative solutions to anticholinergic drug prescription should thus be considered whenever possible.

Transitions across cognitive states and death among older adults in relation to education: A multistate survival model using data from six longitudinal studies

IntroductionThis study examines the role of educational attainment, an indicator of cognitive reserve, on transitions in later life between cognitive states (normal Mini-Mental State Examination (MMSE), mild MMSE impairment, and severe MMSE impairment) and death. MethodsAnalysis of six international longitudinal studies was performed using a coordinated approach. Multistate survival models were used to estimate the transition patterns via different cognitive states. Life expectancies were estimated. ResultsAcross most studies, a higher level of education was associated with a lower risk of transitioning from normal MMSE to mild MMSE impairment but was not associated with other transitions. Those with higher levels of education and socioeconomic status had longer nonimpaired life expectancies. DiscussionThis study highlights the importance of education in later life and that early life experiences can delay later compromised cognitive health. This study also demonstrates the feasibility and benefit in conducting coordinated analysis across multiple studies to validate findings.

Cognitive dysfunction in chronic obstructive pulmonary disease

Background Chronic obstructive pulmonary disease (COPD) is an increasingly common disease among older adults that has been linked to other comorbid conditions with serious morbidity and mortality, including cognition impairment. However, it remains poorly understood in COPD. The aim of the study The aim of this study is to evaluate cognitive dysfunction in COPD and to relate it to the severity obtained from spirometric and gasometric evaluation of COPD patients. Patients and methods In this case–control study design, 25 COPD patients and 25 age-matched and sex-matched healthy control patients were compared. Wechsler Adult Intelligence Scale-III (WAIS-III) and Mini-Mental State Examination (MMSE) were used to evaluate cognition in COPD patients. Results There was significant impairment of MMSE with a cognitive dysfunction reported in 72% of the COPD group. There was significant impairment in all components of WAIS-III, namely the verbal IQ, performance IQ, total scale IQ, and deterioration index in the COPD group than in the control group.WAIS-III scale was positively correlated to both oxygen tension and saturation, denoting the utmost role of hypoxemia in the pathogenesis of cognitive dysfunction in COPD patients. Receiver operator characteristics curves were plotted for the use of both oxygen tension and saturation, denoting good use of oxygen tension and saturation as a predictive value for impairment of MMSE and WAIS-III scale and hence cognitive dysfunction. Results Cognitive dysfunction is a fixed finding that occurs in the course of COPD. Hypoxemia seems to play the principal role in cognitive disorders. Spirometric parameters seem to be closely related to the progression and prediction of the course of those disorders.

Basal Ganglia Cerebral Microbleeds and Global Cognitive Function: The Kashima Scan Study

We previously showed that global cognitive function was associated with deep or infratentorial (D/I) cerebral microbleeds (CMBs) in a Japanese healthy cohort. We continually recruited participates and performed further investigation to focus on the impact of different distributions of D/I CMBs on gradient-echo magnetic resonance imaging on global cognitive function. A total of 1392 subjects including subjects without CMBs (n = 1335), with D/I CMBs limited to the basal ganglia (BG; BG group, n = 33), thalamus (thalamus group, n = 14), and infratentorial area (infratentorial group, n = 10) were included in analyses. Subjects with strictly lobar CMBs (n = 43) were excluded, but subjects in the BG, thalamus, and infratentorial groups could also have lobar CMBs. The mini-mental state examination (MMSE) was administered to determine global cognitive function; scores less than 27 or more than 1.5 standard deviations (SDs) below the age-education-related mean were regarded as impaired. In the multivariable logistic regression analyses, hypertension and severe white matter hyperintensities were associated with the BG group and the thalamus group. In multivariable logistic regression analysis of the association between D/I CMBs classification and impaired MMSE score, only the BG group consistently displayed associations with both MMSE score less than 27 (odds ratio [OR], 5.96; 95% confidence interval [CI], 2.08-17.09) and MMSE score more than 1.5 SDs below the age-education-related mean (OR, 3.34; 95% CI, 1.24-8.99). In the BG group, adjusted mean scores of total MMSE and "attention and calculation" were lower compared with subjects without CMBs. In our study of D/I CMBs, only BG CMBs have strong association with global cognitive function. This association was independent of CMBs in other location.

Cardiovascular Events and Geriatric Scale Scores in Elderly (70 Years Old and Above) Type 2 Diabetic Patients at Inclusion in the GERODIAB Cohort

OBJECTIVE To analyze the relationships between cardiovascular complications and geriatric scale scores in French elderly (≥70 years of age) type 2 diabetic patients at inclusion in the GERODIAB cohort. RESEARCH DESIGN AND METHODS GERODIAB is the first French multicenter, prospective, observational survey designed to analyze the influence of glycemic control on morbidity/mortality in type 2 diabetic patients aged ≥70 years during a 5-year follow-up period. This study analyzed the relationships between classical macroangiopathic complications and geriatric scale scores in 987 patients at baseline, using bivariate and multivariate analyses. RESULTS Cardiac ischemia (31.2%) was significantly associated with impaired activities of daily living (ADL) scores (P < 0.001). Stepwise logistic regression included hypercholesterolemia, ADL, sex, and hypertension successively (70.3% concordance; P < 0.001). Heart failure (10.1%) was associated with impaired Mini Mental State Examination (MMSE), instrumental ADL (IADL) (P < 0.05), and ADL scores (P < 0.001). With the logistic model, waist circumference, age, and HDL cholesterol were significant factors (70.7% concordance; P < 0.001). Arterial disease of the lower limbs (25.6%) was associated with impaired IADL and ADL scores (P < 0.001). Significant factors using the logistic model were duration of diabetes, IADL score, hypertension, and sex (62.8% concordance; P < 0.001). Cerebral ischemia (15.8%) was associated with impaired MMSE, Mini Nutritional Assessment, ADL, and IADL scores (P < 0.01). IADL, sex, hypertension, and ADL were included in the logistic model successively (65.6% concordance; P < 0.001). CONCLUSIONS In this specific population, impaired geriatric scale scores were found to be associated with classical macrovascular complications, notably using multivariate analyses. This suggests the benefits of thorough screening and management of cognitive and functional decline in elderly type 2 diabetic patients.

Does self-reported sleep quality predict poor cognitive performance among elderly living in elderly homes?

Objectives: Sleep complaints are common among elderly, especially institutionalized elderly, as they experience poorer sleep quality and higher use of sedative hypnotics, when compared to community-dwelling elderly. Recent findings suggest that there may be a relationship between poor quality of sleep and cognitive deficits. This study aimed at studying the relation between sleep quality and cognitive performance in older adults living in elderly homes. Method: 100 elderly living in an elderly home in El Mansoura, Egypt, were recruited in this study, 50 cases with subjective poor quality of sleep and 50 controls with subjective good quality of sleep as assessed by Pittsburgh sleep quality index (PSQI). Each participant went through comprehensive geriatric assessment (CGA), including geriatric depression scale (GDS), assessment of cognitive function by mini mental state examination (MMSE). Results: 52% of poor sleepers showed impaired MMSE, while only 24% of good sleepers had impaired MMSE. Both orientation and (attention and calculation) were more affected (P = 0.027 and 0.035, respectively). Linear correlation coefficient between PSQI and different variables revealed significant negative correlation with total MMSE score, attention and calculation. Conclusion: Poor quality of sleep is related to cognitive impairment among elderly living in elderly homes and this problem should be taken in consideration among this group of elders.

Left ventricular function and cognitive impairment at age 85

The association between dementia and cardiac function is yet to be fully described. We examined the relationship between left ventricular function and structure with cognitive impairment, among a representative sample of home dwelling 85 year olds. Subjects were drawn from the Jerusalem Longitudinal Cohort Study Third Phase (2005/6). A total of 412 subjects, all aged 85, underwent portable home echocardiographic assessment of cardiac structure and function, including ejection fraction (EF), diastolic function (assessed by E/e' measurements obtained by tissue Doppler) and LV mass index (LVMI g/m2) (normal for men and women defined as 0-125 and 0-110 g/m2 respectively). Mini Mental State Examination (MMSE) was performed, as part of a comprehensive assessment. Among the total sample, the prevalence of impaired EF of < 55% was 44.9% (185/412), and of impaired MMSE (≤ 24) was 18.9% (78/412). The prevalence of LV EF < 55% among subjects with MMSE ≤ 24 vs. MMSE > 24 was similar: 48.72% vs.44.0% (p = 0.45). Furthermore, no differences were observed when LV EF was subdivided as > 55%, 45-55%, 35-45%, 25-35%, or 15-25%. The prevalence of abnormal diastolic function (E/e' > 13) among subjects with MMSE ≤ 24 vs. MMSE > 24 was not significantly different: 41.3% vs. 30%, p = 0.0846. No differences were observed when E/e' was examined as < 8, 8-15, > 15. The prevalence of raised LVMI was higher among subjects with MMSE ≤ 24 vs. MMSE > 24: 65% vs. 49.1% (p = 0.025). In logistic regression analyses examining MMSE ≤ 24 as the dependent variable, after adjusting for gender, diabetes mellitus, ischemic heart disease, and hypertension, the odds ratio associated with EF < 55% was 1.16 (95%CI 0.69-1.93); the OR for E/e' > 13 was 1.5 (95%CI 0.85-2.72), and the OR for LVMI was 1.82 (95%CI 0.996-3.32). Among a community of home dwelling 85 year olds, neither impaired systolic or diastolic ventricular function was associated with cognitive impairment. The significant association observed with high left ventricular mass index, was weakened after adjusting for the presence of hypertension, diabetes and ischemic heart disease.

The assessment of frailty in older people in acute care

Develop a measure of frailty for older acute inpatients to be performed by non-geriatricians. The Reported Edmonton Frail Scale (REFS) was adapted from the Edmonton Frail Scale for use with Australian acute inpatients. With acute patients aged over 70 years admitted to an Australian teaching hospital, we validated REFS against the Geriatrician's Clinical Impression of Frailty (GCIF), measures of cognition, comorbidity and function, and assessed inter-rater reliability. REFS was moderately correlated with GCIF (n = 105, R = 0.61, P < 0.01), Mini-Mental State Examination impairment (n = 61, R = 0.49, P < 0.001), Charlson Comorbidity Index (n = 59, R = 0.51, P < 0.001) and Katz Daily Living Scale (n = 59, R = 0.51, P < 0.001). Inter-rater reliability of REFS administered by two researchers without medical training was excellent (kappa = 0.84, n = 31). In this cohort of older acute inpatients, REFS is a valid, reliable test of frailty, and may be a valuable research tool to assess the impact of frailty on prognosis and response to therapy.

Correlation between Cognitive Impairment and Prognostic Parameters in Patients with Congestive Heart Failure

Cognitive impairment has been observed in patients with congestive heart failure (CHF). We analyzed in-hospital CHF patients with neuropsychological tests attempting to correlate the results with prognostic parameters. All subjects underwent a mini-mental state examination (MMSE), memory and learning tests (Corsi Block-tapping test, Verbal Span test, Prose Memory test, Visual Search), anxiety and depression scale test. New York Hospital Association (NYHA) class, brain natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) were evaluated. Sixty patients (mean age 65.5 years) were analyzed. NYHA class was 2.9 +/- 0.9, LVEF was 32.9 +/- 13.7%, BNP plasma level 683.3 +/- 864.3 pg/mL. In 23.3% of cases a pathological MMSE score emerged; memory and learning test results were abnormal in 3.4-37%. A positive correlation between MMSE and age (r = 0.18, p = 0.01), BNP (r = 0.25, p = 0.02) was observed but not between MMSE and years of education, NYHA class and LVEF. The Corsi Block-tapping test was related to educational duration (r = 0.12, p = 0.02) with a positive trend for BNP (r = 0.2, p = 0.07). The Prose Memory test and Visual Search were influenced by the patients' educational level (r = 0.36, p = 0.0001; r = 0.27, p = 0.0001). CHF patients manifest an impairment of MMSE and memory and learning test performance. In our population MMSE correlates to plasma BNP and advanced age.

Recoverable cognitive dysfunction at hospital admission in older persons during acute illness

While acute illness and hospitalization represent pivotal events for older persons, their contribution to recoverable cognitive dysfunction (RCD) has not been well examined. Our goals were to estimate the frequency and degree of RCD in an older hospitalized cohort; to examine the relationship of RCD with delirium and dementia; and to determine 1-year cognitive outcomes. Prospective cohort study. Four hundred and sixty patients aged > or =70 years drawn from consecutive admissions to an academic hospital. Patients underwent interviews daily during hospitalization and at 1 year. The primary outcome was RCD, defined as an admission Mini-Mental State Examination (MMSE) score that improved by 3 or more points by discharge. Recoverable cognitive dysfunction occurred in 179 of 460 (39%) patients, with MMSE impairment at baseline ranging from 3 to 13 points (median=5.0 points). The majority of cases were not characteristic of either delirium or dementia, as 144 of 179 (80%) cases did not meet criteria for delirium, and 133 of 164 (81%) cases did not meet criteria for dementia at baseline. In multivariable analysis controlling for baseline MMSE level, 3 factors were predictive of RCD: higher educational level, preadmission functional impairment, and higher illness severity. At 1 year, further improvement in MMSE score occurred in 38 of 92 (41%) patients with RCD. Recoverable cognitive dysfunction was independently predictive of 1-year mortality with an adjusted odds ratio of 1.82 (95% confidence interval [95% CI] 1.03 to 3.20). Acute illness is accompanied by a high rate of RCD that is neither characteristic of delirium or dementia. Our observations underscore the reversible nature of this cognitive dysfunction with continued improvement over the ensuing year, and highlight the potential clinical implications of this under-recognized phenomenon.