Lower Mini-Mental State Examination Scores 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.

Clinical features and reclassification of essential tremor with NOTCH2NLC GGC repeat expansions based on a long‐term follow‐up

NOTCH2NLC GGC repeat expansions have been identified to be associated with essential tremor (ET). Our aim was to characterize ET patients with NOTCH2NLC repeat expansions versus non-expansions and describe distinctive clinical features of repeat expanded patients with long-term follow-up according to the new tremor classification. Participants included 597 ET pedigrees, 412 sporadic cases and 1085 healthy controls. Repeat expansions of GGC in NOTCH2NLC were screened, and comprehensive clinical features were investigated. A longitudinal clinical assessment and reclassification were performed in NOTCH2NLC expanded patients. In total, 27 ET pedigrees (27/597) and three sporadic patients (3/412) were identified with pathogenic NOTCH2NLC GGC repeat expansions (≥60 repeats). Intermediate-length GGC repeats (41-59 repeats) were found in four sporadic ET cases and one control subject, and the frequency was higher than that in control participants (4/412 vs. 1/1085, p=0.022). About 46 ET patients (43 familial cases from 27 pedigrees and three sporadic cases) with NOTCH2NLC GGC repeat expansions had higher Essential Tremor Rating Assessment Scale I, Essential Tremor Rating Assessment Scale II and Non-Motor Symptoms Scale scores and lower Mini-Mental State Examination scores than the patients without expansions. Patients with pathogenic GGC repeats were reclassified as pure ET (25/46), ET-plus (11/46) and ET-neuronal intranuclear inclusion disease (10/46) subgroups at 2-8 years of follow-up. Our results further supported that NOTCH2NLC GGC repeat expansions were associated with ET. Patients with pathogenic GGC repeats presented with more severe motor and non-motor symptoms. Further long-term follow-up and subtype studies will help to define the role of NOTCH2NLC in ET.

Association of marital status with cognitive function in Chinese hypertensive patients: a cross-sectional study

PurposeThe aim of this study was to evaluate the association of marital status with cognitive function and to examine the potential effect modifiers in Chinese hypertensive populations.MethodsA total of 9,525 adult Chinese hypertensive patients were enrolled in this cross-sectional study. Cognitive function, as the dependent variable in our study, was assessed by the Chinese version of the Mini‐Mental State Examination (MMSE). We adjusted for potential confounding factors in multiple linear regression models to examine the relationship of marital status with cognitive function. In addition, we divided the population according to sex to explore whether there were sex-specific differences.ResultsAmong the 9,525 study participants, the mean (SD) age for men was 63.5 (10.3) years, and the mean MMSE score was 24.9 ± 5.0, whereas for women, the mean (SD) age was 63.8 (9.3) years, and the mean MMSE score was 19.4 ± 6.4. Unmarried persons had lower scores on the MMSE and lower subscores in each of the cognitive domains. A stronger correlation between marital status and a lower MMSE score was statistically significant in men (unmarried men: β = -1.55; 95% CI: -1.89, -1.21) but not women (unmarried women: β = -0.22; 95% CI: -0.56, 0.12; p interaction = 0.006). Compared to men who were widowed or divorced, never married men were more likely to have lower MMSE scores (β = -2.30, 95% CI -3.10,—1.50; p < 0.001).ConclusionsOur study demonstrated that being unmarried is an extremely important but neglected social risk factor for cognitive function. Sex was a strong effect modifier: being unmarried was correlated with a higher risk of cognitive decline than being married in Chinese hypertensive men, especially among older men, but this correlation was not observed among women. Moreover, never married men showed poorer cognitive function than those who were divorced or widowed.

Cognitive impairment in the population-based ural very old study.

BackgroundDespite its marked importance in public health, the prevalence of cognitive impairment (CI) and its associated factors have only rarely been examined in old populations in general or in Russia at all.ObjectiveTo assess CI prevalence and its determinants in a very elderly population in Russia.Materials and methodsThe population-based Ural Very Old Study, conducted in rural and urban region in Bashkortostan/Russia, included 1,526 (81.1%) out of 1,882 eligible individuals aged 85+ years. A series of medical examinations including the Mini-Mental State Examination (MMSE) for the assessment of CI was performed.ResultsMini-Mental State Examination data were available for 1,442 (94.5%) individuals (mean age: 88.3 ± 2.9 years; range: 85–103 years). The median MMSE score was 24 (interquartile range: 19, 27). Prevalence of any CI (MMSE score < 24 points) was 701/1,442 [48.6%; 95% confidence interval (CI): 46.0, 51.2]. Prevalence of mild, moderate and severe CI (MMSE score 19–23 points, 10–18 points, and ≤9 points, respectively) was 357/1,442 (24.8%; 95% CI: 22.5, 27.0), 246/1,442 (17.1%; 95% CI: 15.1, 19.0), and 98/1,442 (6.8%; 95% CI: 5.5, 8.1), resp. A lower MMSE score correlated (regression coefficient r2: 0.31) with older age (beta: −0.13; P < 0.001), rural region of habitation (beta: 0.15; P < 0.001), lower level of education (beta: 0.19; P < 0.001), higher depression score (beta: −0.33; P < 0.001) (or alternatively, higher prevalence of hearing loss (beta: −0.10; P = 0.001), worse visual acuity (beta: −0.10; P = 0.001), and lower physical activity (beta: 0.06; P = 0.04).ConclusionIn this elderly study population from rural and urban Russia, prevalence of any, mild, moderate and severe CI was 48.6, 24.8, 17.1, and 6.8%, resp. Besides medical and lifestyle factors, vision and hearing impairment were major factors associated with CI.

Correlation between 5-HTTLPR gene polymorphism and cognitive function of traumatic stress in Chinese Han children.

BackgroundPost-traumatic stress disorder (PTSD) is a trauma-related psychological disorder with serious social and familial impacts. The involvement of 5-hydroxytryptamine transporter gene-linked polymorphic region (5-HTTLPR) in numerous mental disorders has been documented. This study explored the correlation between 5-HTTLPR gene polymorphism and cognitive function in Chinese Han children with PTSD.MethodsA total of 60 PTSD children treated from December 2019 to December 2021 were selected as study participants, with another 60 healthy children selected as controls. We assessed the cognitive function of participants using the Mini-Mental State Examination (MMSE). Additionally, the PTSD level was estimated by the Children’s Revised Impact of Event Scale (CRIES). The 5-HTTLPR gene polymorphism was detected by reverse transcription quantitative polymerase chain reaction (RT-qPCR). The genotype and allele frequency were evaluated via case-control association analysis.ResultsChildren in the PTSD group showed low MMSE scores and high CRIES scores. In terms of genotype, cases of LL, LS, and SS in PTSD children were 4 (6.67%), 20 (33.3%), and 36 (60.00%), and 18 (30.00%), 28 (46.67%), and 14 (23.33%) cases in healthy controls. In terms of allele gene frequency, incidences of L and S were 23.33% and 76.67% in PTSD children, respectively, and were 53.33% and 46.67% in healthy controls, respectively. Moreover, the CRIES and MMSE scores of LS and SS genotypes were evidently different from those of LL genotype in PTSD children.ConclusionsPolymorphism of the 5-HTTLPR gene is correlated with cognitive dysfunction in Chinese Han children with PTSD.

Do Mini-Mental State Examination and Montreal Cognitive Assessment predict high-cost health care users? A competing risks analysis in The Irish Longitudinal Study on Ageing.

ObjectivesPolicymakers want to better identify in advance the 10% of people who account for approximately 75% of health care costs. We evaluated how well Mini–Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) predicted high costs in Ireland.Methods/DesignWe used five waves from The Irish Longitudinal Study on Ageing, a biennial population‐representative survey of people aged 50+ (2010–2018). We used competing risks analysis where our outcome of interest was “high costs” (top 10% at any wave) and the competing outcome was dying or loss to follow‐up without first having the high‐cost outcome. Our binary predictors of interest were a ‘low score’ (bottom 10% in the sample) in MMSE (≤25 pts) and MoCA (≤19 pts) at baseline, and we calculated sub‐hazard ratios after controlling for sociodemographic, clinical and functional factors.ResultsOf 5856 participants, 1427 (24%) had the ‘high cost’ outcome; 1463 (25%) had a competing outcome; and 2966 (51%) completed eight years of follow‐up without either outcome. In multivariable regressions a low MoCA score was associated with high costs (SHR: 1.38 (95% CI: 1.2–1.6) but a low MMSE score was not. Low MoCA score at baseline had a higher true positive rate (40%) than did low MMSE score (35%). The scores had similar association with exit from the study.ConclusionsMoCA had superior predictive accuracy for high costs than MMSE but the two scores identify somewhat different types of high‐cost user. Combining the approaches may improve efforts to identify in advance high‐cost users.

Longitudinal change of Th1, Th2, and Th17 cells and their relationship between cognitive impairment, stroke recurrence, and mortality among acute ischemic stroke patients.

BackgroundT‐helper (Th) cells regulate immunity and inflammation, and modulate cognitive impairment in both cardio‐cerebrovascular and neurological diseases. This study aimed to explore the correlation of longitudinal change of Th1/2/17 cells with cognitive impairment and prognosis in acute ischemic stroke (AIS).MethodsTh1/2/17 cells were detected by flow cytometry in peripheral blood samples from 150 AIS patients at admission (baseline), Day (D)1, D3, and D7 after admission, and from 30 controls. Mini‐Mental State Examination (MMSE) score among AIS patients at discharge was assessed. Stroke recurrence and mortality were evaluated.ResultsTh1 (p = 0.013) and Th17 cells (p < 0.001) but not Th2 cells (p = 0.105) were elevated in AIS patients versus controls. Th1 cells (p = 0.027) and Th17 cells (p < 0.001) but not Th2 cells (p = 0.227) were positively correlated with NIHSS score in AIS patients. Furthermore, Th1 and Th17 cells elevated from baseline to D3 and then decreased on D7 after AIS onset, while Th2 cells illustrated an opposite trend (all p < 0.001). Th17 cells on D1 (p = 0.011), D3 (p = 0.014), and D7 (p < 0.001) were correlated with lower MMSE score, and their levels on D3 (p = 0.033) and D7 (p = 0.004) were related to elevated cognitive impairment. Th1 and Th2 cells were not related to cognitive function (all p > 0.05). Additionally, Th17 cells at baseline, D1, D3, and D7 (all p < 0.05) were increased in recurrent patients versus non‐recurrent patients, and in survived patients versus dead patients, but Th1 or Th2 cells did not vary (all p > 0.05).ConclusionTh17 cells correlate with increased cognitive impairment, stroke recurrence, and mortality among AIS patients.

MO503: Cognitive Performance in Patients With Chronic Kidney Disease: Results From the CKD-Rein Cohort Study

Abstract BACKGROUND AND AIMS Chronic kidney disease (CKD) is a risk factor for cognitive impairment. In the general population, many risk factors have been reported in association with incident major neurocognitive disorders. The link between CKD and cognitive dysfunction is not completely understood; it may involve different mechanisms such as vascular dysfunction or uremic toxin toxicity. We aimed to assess the influence of cardiovascular risk factors, cardiovascular disease and depression on the association between kidney function and cognitive function in patients with CKD. METHOD We analyzed baseline data from 3033 patients with CKD stage 3–5 included in the Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort between 2013 and 2016. Cognitive function was assessed with the Mini Mental State Examination (MMSE), and the glomerular filtration rate was estimated with the CKD EPI formula. We applied unadjusted and adjusted linear and logistic regression models, with the MMSE score as a continuous or categorical variable (at a cut-off point at 24/30). RESULTS The mean patient age was 66.8, the mean estimated glomerular filtration rate (eGFR) was 33 mL/min/1.73 m2 and 393 patients (13.0%) had a MMSE score &amp;lt;24. We observed that, relative to patients with an MMSE score of 24 or more, patients with a score &amp;lt;24 were older and more likely to be female and dependent on activities of daily living (ADL) and/or instrumental ADL. They were taking more medications and they were more affected by depressive symptoms as measured by the CES-D-10 (10 item Centre for Epidemiological Studies-Depression scale). Patients with a score &amp;lt;24 were also more likely to present cardiovascular (CV) risk factors and CV comorbidities. They had a significantly higher parathyroid hormone level, lower haemoglobin, lower albumin and lower eGFR. The eGFR was positively associated with the MMSE score before and after adjustment for age, sex, education level, cardiovascular risk factors, cardiovascular disease and depression, giving point increases in the MMSE score of 0.24 (0.15–0.33; P &amp;lt; .001) and 0.14 (0.04–0.23; P = .006) for a 10 mL/min/1.73 m2 increment in the eGFR, respectively. Other risk factors significantly associated with a lower MMSE score in multivariate analysis were age, female sex, lower educational level, diabetes, obesity, cerebrovascular disease, atrial fibrillation and CES-D-10 score. The eGFR was associated with a low MMSE score (defined as MMSE score &amp;lt;24/30) with a crude odds ratio (OR) of 0.82 (0.75–0.90), which remained significant at 0.88 (0.78–0.98) after adjustment for age, sex, educational level, cardiovascular risk factors (hypertension, diabetes mellitus, dyslipidaemia, obesity and smoking), cardiovascular comorbidities (cerebrovascular disease, atrial fibrillation and heart failure), history of depression, laboratory parameters (haemoglobin and phosphate) and CES-D score (after imputation of missing values). CONCLUSION In a cohort of well-phenotyped patients with CKD, lower eGFR is associated with worse cognitive function, independent of age, sex, educational level, cardiovascular injury and depression.

Association between Baseline Cognitive Function and Longitudinal Functional Outcome Change after Ischemic Stroke

Introduction: Ischemic stroke can cause impairment of daily function and cognitive function. Higher cognitive function is reported in many studies to be associated with better functional outcomes; however, evidence from longitudinal study is lacking. Therefore, in the present study, the association between cognitive function and longitudinal changes of functional outcome was investigated based on stroke severity. Furthermore, whether the effect of cognitive function remained consistent after controlling for depression was investigated. Methods: The data of 423 stroke patients (292 minor strokes, 93 moderate strokes, and 38 severe strokes) were collected. Baseline Mini-Mental State Examination (MMSE) score was considered a predictor, and change of modified Rankin Scale (mRS) score during 12 months of follow-up was the outcome. First, the association between the baseline MMSE score and longitudinal change in the mRS score was analyzed using linear mixed-effects models. Fixed effects were MMSE score group, time, and MMSE score group × time interaction. Additional adjustment was made for the Geriatric Depression Scale (GDS) score. Results: Among the 423 subjects, the mean age was 73.5 years, and 43.4% were female. In the minor stroke group, the high MMSE score group had a decreased mRS score, and the low MMSE score group had an increased mRS score (p < 0.001). This association remained after additional adjustment of the GDS score. Association was not observed between cognitive function and functional recovery in the moderate or severe stroke group. Conclusion: After ischemic stroke, higher baseline global cognitive function was a predictive factor for better functional recovery regardless of depression symptoms in the minor stroke group.

Living in a rural area: a potential risk factor for falls in people with Parkinson disease.

Falls are prevalent in patients with Parkinson disease (PD). Previous work focused on the impact of motor and non-motor symptoms on falls and ignored the impact of environmental factors, such as residence, economic level, and nursing status. The aim of this study was to investigate the prevalence and risk factors of falls in patients with PD and explore the impact of residence on falls. A cross-sectional study of 100 patients with PD was carried out. Patients were recruited from Anhui Provincial Hospital (Hefei, Anhui province, China) between July 2017 and December 2020. Participants were grouped based on whether they had fallen in the previous 3 months, and demographic information was collected through detailed interviews. In addition, severity of motor symptoms, cognitive function, and self-care abilities were assessed with the Unified Parkinson's Disease Rating Scale part III (UPDRS-III), the Hoehn-Yahr (H&Y) scale, the Mini-Mental State Examination (MMSE), and the Barthel Index. The results were analyzed using student t-test, Mann-Whitney U-test, χ2 test and multivariate binary logistic regression analyses. A total of 42% of the patients had fallen in the previous 3 months. The patients who had fallen were older and with a longer disease period, a higher UPDRS-III score, a higher H&Y stage, a lower MMSE score, and a lower Barthel Index score (all p<0.05). According to the logistic regression analysis, living in a rural area (odds ratio (OR)=3.34, 95% confidence interval (CI) 1.15-9.65), MMSE<24 (OR=4.79, 95%CI 1.17-19.65), having sleep disorders (OR=4.97, 95%CI 1.74-14.2), and having a high UPDRS-III score (OR=1.07, 95%CI 1.02-1.11) were independent risk factors for falls. The incidence of falls was higher in rural areas. Urban and rural patients showed different levels of disease severity; rural patients had higher H&Y stages, higher UPDRS-III scores and lower Barthel Index scores. Falls are caused by a variety of factors in people with PD. Multidimensional factors should be considered comprehensively to develop a personalized plan to prevent falls in PD patients.

Association of chronic obstructive pulmonary disease with mild cognitive impairment and dementia risk: A systematic review and meta-analysis.

BACKGROUNDChronic obstructive pulmonary disease (COPD) is a common public health issue that has been linked to cognitive dysfunction.AIMTo investigate the relationship between COPD and a risk of mild cognitive impairment (MCI) and dementia.METHODSA comprehensive literature search of the PubMed, Embase, Google Scholar, and Cochrane Library electronic databases was conducted. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CIs) were calculated using a random or fixed effects model. Studies that met the inclusion criteria were assessed for quality using the Newcastle Ottawa Scale.RESULTSTwenty-seven studies met all the inclusion criteria. Meta-analysis yielded a strong association between COPD and increased risk of MCI incidence (OR = 2.11, 95%CI: 1.32-3.38). It also revealed a borderline trend for an increased dementia risk in COPD patients (OR = 1.16, 95%CI: 0.98-1.37). Pooled hazard ratios (HR) using adjusted confounders also showed a higher incidence of MCI (HR = 1.22, 95%CI: -1.18 to -1.27) and dementia (HR = 1.32, 95%CI: -1.22 to -1.43) in COPD patients. A significant lower mini-mental state examination score in COPD patients was noted (MD = -1.68, 95%CI: -2.66 to -0.71).CONCLUSIONOur findings revealed an elevated risk for the occurrence of MCI and dementia in COPD patients. Proper clinical management and attention are required to prevent and control MCI and dementia incidence in COPD patients.

A comparison of two approaches for modeling dementia progression in a changing patient context.

ObjectivesTo explain the heterogeneity in dementia disease trajectory, we studied the influence of changing patient characteristics on disease course by comparing the association of dementia progression with baseline comorbidity and frailty, and with time‐varying comorbidity and frailty.MethodsWe used individual growth models to study baseline and time‐varying associations in newly diagnosed dementia patients (n = 331) followed for 3 years. We measured cognition using the Mini‐Mental State Examination (MMSE), daily functioning using the Disability Assessment for Dementia (DAD), frailty using the Fried criteria and comorbidity using the Cumulative Illness Rating Scale for Geriatrics (CIRS‐G).ResultsAlthough baseline comorbidity and frailty were associated with decreased daily functioning at diagnosis, their effects clearly diminished over time. In contrast, when incorporating comorbidity and frailty as time‐varying covariates, comorbidity was associated with lower daily functioning, and frailty with both lower cognition and daily functioning. Being frail was associated with a 0.9‐point lower MMSE score (p = 0.03) and a 14.9‐point lower DAD score (p < 0.01). A 1‐point increase in CIRS‐G score was associated with a 1.1‐point lower DAD score (p < 0.01).ConclusionsTime‐varying comorbidity and frailty were more consistently associated with dementia disease course than baseline comorbidity and frailty. Therefore, modeling only baseline predictors is insufficient for understanding the course of dementia in a changing patient context.

Metabolic Syndrome and High-Obesity-Related Indices Are Associated with Poor Cognitive Function in a Large Taiwanese Population Study Older than 60 Years.

Metabolic syndrome (MetS) is prevalent in Taiwan; however, the association between MetS and cognitive function is unclear. The aim of this study was to explore the associations between MetS, its components, and obesity-related indices with cognitive function in a large Taiwanese cohort. We enrolled a total of 28,486 participants who completed the Mini-Mental State Examination (MMSE) questionnaire, which was used to evaluate cognitive function. MetS was defined according to the NCEP-ATP III guidelines and modified criteria for Asians. Ten obesity-related indices were also evaluated: body mass index (BMI), abdominal volume index (AVI), body adiposity index (BAI), waist–hip ratio (WHR), a body shape index (ABSI), lipid accumulation product, waist-to-height ratio (WHtR), conicity index (CI), body roundness index (BRI), and triglyceride glucose index. The prevalence of MetS and its components (except for hypertriglyceridemia) and the number of MetS components increased while the cognitive impairment worsened (from MMSE ≥ 24, 18–23 to 0–17). In addition, increases in all obesity-related index values were associated with a decline in cognitive function (from MMSE ≥ 24, 18–23 to 0–17, ANOVA p < 0.001). Multivariable analysis showed that MetS (p = 0.002), abdominal obesity (p < 0.001), low high-density lipoprotein cholesterol (p = 0.004), and hyperglycemia (p = 0.012) were significantly associated with a low MMSE score. Further, participants with high BMI (p = 0.001), WHR (p < 0.001), WHtR (p < 0.001), BRI (p < 0.001), CI (p < 0.001), BAI (p < 0.001), AVI (p < 0.001), and ABSI (p < 0.001) values were significantly associated with a low MMSE score. Our results show that MetS and its components (except for hypertriglyceridemia and high blood pressure) may lead to cognitive impairment, and that high values of obesity-related indices were associated with poor cognitive function.

Prediction of Postoperative Delirium After Cardiac Surgery with A Quick Test of Cognitive Speed, Mini-Mental State Examination and Hospital Anxiety and Depression Scale.

PurposeTo evaluate if preoperative assessment with A Quick Test of Cognitive Speed (AQT) could increase the accuracy of predicting delirium after cardiac surgery compared to Mini-Mental State Examination (MMSE), and examine if a composite of variables, including cognitive function and depressive symptoms, could be useful to predict delirium.Patients and MethodsCardiac surgery was performed in 218 patients (mean age 72 years). Preoperative evaluation involved AQT, MMSE and Hospital Anxiety And Depression Scale (HADS). Postoperative delirium was assessed using Nursing Delirium Screening Scale (Nu-DESC) and Confusion Assessment Method-ICU (CAM-ICU). Logistic regression was performed to detect predictors of postoperative delirium and receiver operator characteristic curves (ROC) with area under the curve (AUC) to determine the accuracy.ResultsPostoperative delirium occurred in 47 patients (22%) who had lower MMSE scores (median (range), 27 (19–30) vs 28 (20–30), p=0.009) and slower AQT (median (range), 76 (48–181) vs 70 (40–182) seconds, p=0.030) than patients without delirium. Predictive power measured as AUC (95% CI) was 0.605 (0.51–0.70) for AQT and 0.623 (0.53–0.72) for MMSE. Logistic regression (OR, 95% CI) showed MMSE <27 points (2.72, 1.27–5.86), AQT >70 sec (2.26, 1.03–4.95), HADS-D >4 points (2.60, 1.21–5.58) and longer cardiopulmonary bypass-time (1.007, 1.002–1.013) to be associated with postoperative delirium. Combining these parameters yielded an AUC of 0.736 (0.65–0.82).ConclusionThe ability of predicting delirium using AQT was similar to MMSE, and only slightly higher by combining AQT and MMSE. Adding HADS-D and cardiopulmonary bypass-time to MMSE and AQT increased the predictive power to a borderline acceptable discriminatory value. Preoperative cognitive tests and screening for depressive symptoms may help identify patients at risk of postoperative delirium. Yet, there is still a need to establish useful preoperative tests.

Association Between Copper and Global Cognition and the Moderating Effect of Iron.

BackgroundDespite the known association between abnormal serum copper levels and Alzheimer’s disease (AD) or cognitive decline, the association between copper, iron, and cognition remains poorly investigated. We examined the association between serum copper levels and global cognition measured using the Mini-Mental State Examination (MMSE) in older adults with normal copper levels. We also explored the moderating effect of iron on this association.MethodsThe study enrolled 99 non-demented adults between 65 and 90 years of age. All the participants underwent comprehensive clinical assessments and serum copper measurements. Global cognitive performance was measured by the MMSE. All copper levels were within the normal range and were stratified into three categories: < 87 (low), 87–98 (medium), and > 98 (high: used as a reference category) μg/dL.ResultsSerum copper level (as a continuous variable) was significantly associated with MMSE score (B = 0.065, 95% confidence interval = 0.023–0.108, p = 0.003). Low serum copper group showed significantly decreased MMSE score compared to high copper one (B = −2.643, 95% confidence interval = −4.169 to -1.117, p < 0.001), while middle copper category had no difference (B = −1.211, 95% confidence interval = −2.689 to 0.268, p = 0.107). There was a significant low serum copper ×iron interaction effect on the MMSE score (B = 0.065, 95% confidence interval = 0.016–0.114, p = 0.010). Subgroup analyses showed that low serum copper was significantly associated with a low MMSE score in the low-iron (B = −4.174, 95% confidence interval = −6.607 to −1.741, p = 0.001) but not high-iron subgroup (B = −0.721, 95% confidence interval = −2.852 to 1.409, p = 0.495).ConclusionOur findings from non-demented older adults suggest that a low serum copper level within the normal range was associated with AD or cognitive decline and this is moderated by iron. To prevent AD or cognitive decline, clinicians need to pay attention to avoiding low serum copper and iron levels, even within the clinical normal range.

Progression to Dementia or Reversion to Normal Cognition in Mild Cognitive Impairment as a Function of Late-Onset Neuropsychiatric Symptoms.

Background and ObjectivesMild cognitive impairment (MCI) is an at-risk state for dementia; however, not all individuals with MCI transition to dementia, and some revert to normal cognition (NC). Here, we investigate whether mild behavioral impairment (MBI), the late-life onset of persistent neuropsychiatric symptoms (NPS), improves the prognostic specificity of MCI.MethodsParticipants with MCI from the National Alzheimer's Coordinating Center Uniform Data Set were included. NPS were operationalized with the Neuropsychiatric Inventory Questionnaire to identify participants without NPS and those with MBI (persistent, late-onset NPS). Individuals with late-onset NPS not meeting the MBI persistence criterion (NPS_NOT_MBI) were retained for secondary analyses. Progression to dementia, stable MCI, and reversion to NC after 3 years of follow-up were defined per National Institute on Aging–Alzheimer’s Association and Petersen criteria.ResultsThe primary sample consisted of 739 participants (NPS− n = 409 and MBI+ n = 330; 75.16 ± 8.6 years old, 40.5% female). After 3 years, 238 participants (33.6%) progressed to dementia, and 90 (12.2%) reverted to NC. Compared to participants without NPS, participants with MBI were significantly more likely to progress to dementia (adjusted odds ratio [AOR] 2.13, 95% CI 1.52–2.99), with an annual progression rate of 14.7% (vs 8.3% for participants with MCI without NPS). Compared to participants without NPS, participants with MBI were less likely to revert to NC (AOR 0.48, 95% CI 0.28–0.83, 2.5% vs 5.3% annual reversion rate). The NPS_NOT_MBI group (n = 331, 76.5 ± 8.6 years old, 45.9% female) were more likely to progress to dementia (AOR 2.18, 95% CI 1.56–3.03, 14.3% annual progression rate) but not less likely to revert to NC than those without NPS. Accordingly, both NPS_NOT_MBI and MBI+ participants had lower Mini-Mental State Examination scores than NPS− participants after 3 years.DiscussionLate-onset NPS improve the specificity of MCI as an at-risk state for progression to dementia. However, only persistent late-onset NPS are associated with a lower likelihood of reversion to NC, with transient NPS (i.e., NPS_NOT_MBI) not differing from the NPS− group. Clinical prognostication can be improved by incorporating late-onset NPS, especially those that persist (i.e., MBI), into risk assessments. Clinical trials may benefit from enrichment with these higher-risk participants with MCI.

Abnormal Brain MRI Findings in Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Correlation With Outcomes.

PurposeThe reported prevalence of abnormal findings by brain MRI varies from 11 to 83% among patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Here, we investigated the prevalence of abnormal MRI findings in Chinese patients and explored whether such findings are correlated with clinical outcomes.MethodsThis retrospective study analyzed a consecutive series of 52 patients with anti-NMDAR encephalitis admitted to our hospital. The patients were assigned to the “MRI-normal” or the “MRI-abnormal” group based on brain MRI after admission. The groups were compared in terms of clinicodemographic characteristics and scores on the Mini-Mental State Examination (MMSE) and modified Rankin Scale (mRS) 3 and 12 months after admission.ResultsThirty-seven (71.15%) of the patients showed abnormalities on brain MRI; these patients were more likely to be men and showed abnormalities on electroencephalography. Patients who showed normal or abnormal MRI findings did not differ significantly in terms of clinical symptoms, rates of mortality or relapse, or mRS scores after 3 and 12 months. However, patients with abnormal MRI showed significantly lower MMSE scores than those with normal MRI after 3 and 12 months.ConclusionsWe found high prevalence of abnormal MRI findings in our sample of Chinese patients with anti-NMDAR encephalitis. We also found that the abnormal findings were associated with cognitive decline but not necessarily with mortality or functional outcomes in the short or long term.

Relationship Between Vitamin D Status and Brain Perfusion in Neuropsychiatric Lupus.

Neuropsychiatric manifestation of lupus (NPSLE) is related with vitamin D (vit-D) deficiency which is possibly amenable to supplementation. This study was done to explore link of serum vit-D level and clinical mini-mental state examination (MMSE) with brain perfusion SPECT (BS) in patients with NPSLE. Patients who underwent BS with the diagnosis of NPSLE and had serum levels of vit-D and MMSE within a span of 1 month were retrospectively included. The BS DICOM data were used to generate 3D surface images of brain for visual identification of regional hypoperfusion, and the z-scores from eZIS software and then to perform voxel-based regression analysis in order to explore association between serum vit-D level and cerebral perfusion deficit using SPM8. Distribution of serum vit-D level was checked across MMSE and BS z-score using R. A total 19 patients with means ± SD age of 28.4 ± 9.2 years, having mean levels of serum vit-D of 18.7 ± 9.8 ng/ml and mean MMSE scores 24.2 ± 1.6, had undergone BS. The eZIS-derived z-score fall in the category of normal in six (31.6%), mild perfusion deficit (PD) in 10 (52.6%) and moderate PD in three (15.8%) with the means ± SD of z-score being 0.52 ± 0.2, 1.72 ± 0.2, and 2.33 ± 0.2. Voxel-based analysis revealed significant positive correlation between vit-D level and hypoperfusion in brain regions related to cognitive function (p<0.05). Serum vit-D levels were significantly lower in NPSLE patients with lower MMSE scores as well as in higher eZIS z-score (p < 0.01). Our results may support the utility of vit-D supplementation in NPSLE and applicability of BS as a clinical adjunct for monitoring response to vit-D supplementation.

Mini-Mental State Examination predicts mortality in patients on chronic hemodialysis.

No available and easy to administer cognitive test has been evaluated for the prediction of mortality in prevalent patients on chronic hemodialysis. The aim of the present study was to determine if the Mini-Mental State Examination (MMSE) was predictor of mortality in patients on chronic hemodialysis. One hundred twenty-seven prevalent patients on chronic hemodialysis were studied. All patients underwent assessment of cognitive function through the MMSE. The MMSE was administered during a midweek hemodialysis session, avoiding the beginning and the end of each treatment to minimize the effects of fluctuations in uremic syndrome or blood pressure in accordance with a previous study. An MMSE score ≤23 was used as indicative of cognitive impairment. Demographic, clinical, and laboratory parameters were recorded for each patient. Mean (SD) MMSE was 23.2 ± 4.1. Median MMSE was 24 (min-max: 2-30). MMSE was ≤23 in 72 patients and >23 in 55. With data updated in March 2021, after a mean follow-up of 58.8 ± 41 months (range: 2-156 months), 75 patients died, and 17 were transplanted. None was lost to follow-up or was transferred to another unit. Dead participants, as compared with alive ones, were significantly older, had a higher Charlson Index score, had lower Activities daily living and Instrumental activities daily living, and had a lower MMSE score and lower serum albumin levels. Kaplan-Meier analysis showed that survival was significantly lower in patients with MMSE ≤23 than in those with MMSE >23 (log-rank χ2 : 8.825, p = 0.003). According to Cox regression analysis, mortality was associated with age and inversely associated with MMSE. We show that the MMSE predicts mortality in prevalent patients on chronic hemodialysis.

Prevalence and features of non-motor symptoms in Wilson’s disease

IntroductionWilson's Disease (WD) is an autosomal recessive disorder caused by excessive copper deposition in liver, brain and other organs. The clinical picture is characterized by hepatic, psychiatric and neurological dysfunction. Movement disorders are the core neurological features, although non-motor symptoms (NMS), as cognitive/affective, autonomic and sleep disorders, may occur over time. We aimed to assess the frequency of NMS in WD patients compared with healthy subjects. MethodsTwenty-seven patients affected with genetically proven WD (12 F, 15 M) and 35 healthy controls (Ctrl; 17 F, 18 M), comparable for age and education, were enrolled. Eighteen patients presented with the neurological form of the disease (NV) and nine with the non-neurological variant (NNV). NMS were assessed in all subjects by the following clinical scales: Mini-Mental State Examination (MMSE), Non-Motor Symptoms Scale (NMSS), SCOPA-AUT Questionnaire, Apathy Evaluation Scale (AES), Beck Depression Inventory (BDI), Epworth Sleepiness Scale (ESS), Restless Legs Syndrome Rating Scale (RLSRS), REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ), Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease (QUIP-RS). ResultsWe found that the patients showed more severe and frequent NMS and daytime sleepiness, and lower MMSE than Ctrl. In comparison to healthy subjects, NV subjects showed statistically significant higher ESS, NMSS, and RLSRS scores, and a lower MMSE score. Subtle and subclinical extrapyramidal/pyramidal signs and brain MRI signal abnormalities were detected in patients considered as asymptomatic for neurological disturbances. ConclusionsNMS are common among WD patient, in particular those with NV, likely due to the widespread pathological changes throughout the central nervous system.