Mean MMSE Research Articles

Efficacy and Cognitive Side Effects of Electroconvulsive Therapy (ECT) in Depressed Elderly Inpatients With Coexisting Mild Cognitive Impairment or Dementia

To study cognitive performance in depressed geriatric inpatients with or without preexisting cognitive impairment who received a first course of electroconvulsive therapy (ECT). Forty-four elderly inpatients with major depressive disorder (ICD-10 criteria) were included in a prospective consecutive case series of a university hospital. The patients were divided into 3 groups (no cognitive impairment [NCI], mild cognitive impairment [MCI], dementia) and rated for cognitive performance with the MMSE before first ECT, after sixth ECT, and 6 weeks and 6 months after ECT termination. Affective symptoms were rated by 21-item Hamilton Depression Rating Scale (HDRS-21) before and 6 weeks after ECT. Analysis of variance or Kruskal-Wallis tests on ECT-induced MMSE and HDRS-21 score changes were compared to baseline. Binary logistic regression was used for predictor analysis. The study was conducted from April 2004 to April 2008. After initial nonsignificant cognitive deterioration in all 3 groups, the NCI group improved cognitively 6 weeks (P = .018) and 6 months (P = .027) after ECT. The MCI group improved in cognition 6 months (P = .036) after ECT. In the dementia group, mean MMSE scores also improved numerically over the course of ECT without significance. Dementia patients with antidementia treatment improved in cognition to a clinically relevant extent after the sixth ECT. Dementia subjects without antidementia treatment deteriorated. After the sixth ECT, 70.0% of dementia patients (P = .004) presented a cognitive decline, and 68.8% of MCI patients (P < .001) presented a decline 6 weeks after ECT. Six months after ECT, one-third of the dementia patients (P < .036) still had a cognitive decline. Affective symptoms remitted after ECT in all 3 groups (P < .001). Pre-ECT cognitive deficits were the best predictor of MMSE decline (6 weeks after ECT, P = .007; 6 months after ECT, P = .055). ECT is effective and well tolerated in geriatric depressed inpatients regardless of preexisting cognitive impairment. Cognitive deficits were transient.

Microsurgical clipping in forty patients with unruptured anterior cerebral circulation aneurysms: an investigation into cognitive outcome

It is a consensus that most unruptured intracranial aneurysms (UIA) can be treated with acceptably low morbidity. However, some studies recently reported postoperative cognitive impairment, suggesting that it could be attributable to surgical damage. Our goal is to evaluate cognitive function before and after microsurgical clipping in patients with UIA. A consecutive series of 40 patients who underwent microsurgical clipping for UIA were studied. The cognitive assessment (Mini Mental State Examination, MMSE) was performed immediately before and at least one month after surgery. Paired Student's "t" test and analysis of variance (ANOVA) were used for statistical purposes. The mean MMSE score in the preoperative analysis was 28.12 (SD, 1.34). In the postoperative period the mean MMSE score was 28.40 (SD, 1.46). Paired Student's "t" test was applied to the scores and no significant difference was found (p = 0.315). ANOVA did not find independent associations between MMSE scores and age, hypertension, smoking, dyslipidemia, education, aneurysm location, number, laterality or size. The present study suggests that microsurgical clipping for UIA does not result in major cognitive dysfunction as determined by the MMSE.

Pet therapy in elderly patients with mental illness

To evaluate the effects of pet therapy on cognitive function, mood and perceived quality of life on elderly inpatients (mean age 84.7 years; 95.2% women) affected by dementia, depression and psychosis. Mini-Mental State Examination (MMSE) and 15-items Geriatric Depression Scale (GDS) were administered to 10 patients (pet group) and 11 controls (control group) together with a self-perceived quality-of-life questionnaire, before and after a pet therapy intervention that lasted 6 weeks. MMSE and GDS mean scores were compared between and within groups by Student's t-test. Both the pet group and control group improved on GDS and MMSE. Within the pet group, GDS symptoms decreased by 50% (from 5.9 to 2.7, P= 0.013), whereas mean MMSE score increased by 4.5 (P= 0.060). The between group comparison showed a positive effect of pet therapy intervention on GDS (P= 0.070). Most of the participants reported an improvement of their perceived quality of life. Pet therapy is efficient in improving depressive symptoms and cognitive function in residents of long-term care facilities with mental illness.

Five-year Survival After Helicobacter pylori Eradication in Alzheimer Disease Patients

Alzheimer disease (AD) is a progressive, fatal neurodegenerative condition. We tested the hypothesis that eradication of Helicobacter pylori infection (Hp-I) could improve survival in a Greek cohort of AD patients, in a 5-year follow-up. Forty-six patients diagnosed with probable AD were enrolled in the analysis. Study population was classified into 3 groups: patients for whom Hp eradication treatment was successful; those for whom eradication of Hp had failed, they refused, and/or were noncompliant with eradication therapy; and those who were Hp negative at baseline. Cox proportional hazards model was built with all-cause mortality as the dichotomous outcome. During the 5-year follow-up [47.19±15.11 mo (range 12 to 60)], overall 21 patients died and 25 patients remained alive. Patients who died were older and exhibited lower mean MMSE score compared with the patients still alive. Successful eradication of Hp-I was associated with a significantly lower mortality risk [HR (95% CI)=0.287 (0.114-0.725), P=0.008]. The results were similar in adjusted and unadjusted models, for age and MMSE at baseline. Hp eradication regimen in AD patients is associated with a higher 5-year survival rate.

Correlation of white matter changes with behavioral and psychological symptoms in Alzheimer's disease

Background: Because deficits in inhibition and cognitive-shifting have been noted in early Alzheimer’s disease (AD), the first goal of this study is to determine whether impairments in these domains are also present in the preclinical stages of AD. Neuroimaging studies suggest that the precuneus is active during cognitive-shifting processes and that decreased cerebral blood flow in this region may be a risk factor for AD. Therefore, the second goal of this study is to examine whether precuneus volume and thickness is associated with inhibition and cognitive shifting performance in subjects in the preclinical stages of AD. Methods: Thirty-nine cognitively normal (CN, mean MMSE: 29.5) older adults and 68 patients with single or multiple-domain mild cognitive impairment (MCI, mean MMSE: 27.7) were studied with the D-KEFS Color-Word Interference Test; CWIT; Delis et al., 2001). The Inhibition/Switching condition in the CWIT depends upon both inhibitory and cognitive-shifting abilities. Subjects also received structural magnetic resonance imaging on a 1.5 or 4 tesla scanner (scanner strength was included as a covariate in the analyses). Freesurfer was used to determine precuneus volume and thickness. Results: MCI patients performed comparably to CN in the less cognitively demanding conditions, but were slower on the Inhibition (p 1⁄4 0.01) and Inhibition/Switching (p 1⁄4 0.04) conditions and committed more uncorrected errors in the Inhibition/Switching condition (p 1⁄4 0.001). There was no significant group difference in precuneus volume or thickness (p > 0.2). However, both predicted time to complete the Inhibition/Switching condition (all subjects; thickness: b 1⁄4 0.36, p < 0.01; volume: b 1⁄4 0.33, p 1⁄4 0.02; MCI alone; thickness: b 1⁄4 0.34, p 1⁄4 0.04; volume: b 1⁄4 0.39, p 1⁄4 0.04). Finally, performance on the Inhibition/Switching condition was significantly correlated with global cognitive status (i.e., MMSE) among APOE-e4 positive (CN: r 1⁄4 060, p 1⁄4 0.04; MCI: r 1⁄4 0.59, p < 0.0001) but not among non-e4 subjects (CN: r 1⁄4 -0.04, p 1⁄4 0.9; MCI: r 1⁄4 0.02, p 1⁄4 0.9). Conclusions: These findings suggest that deficits in inhibition and cognitive-shifting are present during the preclinical stages of AD and can be predicted by the volume and thickness of the precuneus. Moreover, the association between these executive-function deficits and overall cognitive status in CN older adults positive for the APOE-e4 allele provides further support for the utility response inhibition and cognitive flexibility deficits as a possible preclinical marker of AD.

Relationship between Microstructural Degeneration of the Corpus Callosum, White Matter Hyperintensities, and Motor Function in Cognitively Intact Elderly

Age-related changes in cerebral white matter, such as decreased corpus callosum (CC) volume and the presence of periventricular white matter hyperintensities (PVWMH) on fluid attenuated inversion recovery (FLAIR) MRI sequences have been demonstrated in nondemented elderly and are associated with motor impairment. Diffusion tensor imaging (DTI) can potentially detect microstructural white matter changes prior to macrostructural volume change. Examination of the relationship of microstructual CC degeneration detected by DTI, PVWMH's and motor function in cognitively intact elderly may suggest a structural-functional connection to this pathology. 14 cognitive intact (CDR = 0, mean MMSE 29.5) elderly men and women (mean age 80.2, range 70 - 92) underwent 3T MRI and detailed neurological evaluation, including fine motor and balance testing. WMH volumes were obtained with FLAIR sequences and were adjusted for intracranial volume. CC microstructural integrity was assessed using fractional anisotrophy (FA) from DTI (TR = 9500 ms; TE = 95 ms; slice thickness 2.0 mm; 20 non-collinear directions). For each subject, a 24 mm2 region of interest was placed in the CC genu (figure) . Relationships between WMHs, CC integrity, and motor function were examined using multivariate analyses adjusted for age. Greater age was associated with decreased CC genu FA (R2 = 0.41, p = 0.01) and total CC volume (R2 = 0.37, p = 0.02). Neither total nor anterior CC volume was associated with motor test performance. %PVWMH volume was associated with slower finger tapping (R2 = 0.23, p = 0.08), but was not associated with one leg standing (OLS). After adjusting for age and %PVWMH, decreased CC genu FA was associated with slower finger tapping (p = 0.02). After adjusting for age, decreased CC genu FA was associated with OLS with eyes open (p = 0.03 left; p = 0.02 right), and OLS with eyes closed (p = 0.07). Advanced age is associated with microstructural degeneration of the anterior corpus callous that disrupts fine motor skills and balance function in cognitively intact elderly, independent of WMH's or CC atrophy. Identification of risk factors to prevent such white matter change is needed to preserve motor abilities in our elderly population

‘The Chitchatters’: A leisure activity for people with dementia to stimulate social interaction

Purpose Worldwide, there are 30 million people with dementia (PWD) in 2009 and 100 million in 2050, respectively.These numbers show the need for a change in care for PWD. Leisure is one of these care aspects. Leisure activities can support PWD in several ways: meeting basic needs, providing comfort and social interaction, and reducing boredom, agitation, and isolation1. An exemplary activity targeted at meeting these needs is ‘De Klessebessers (KB)’ (The Chitchatters), which aims to stimulate social interaction among PWD and provide comfort with supporting technology2. This is innovative since technology for PWD generally concentrates on safety and monitoring activities3 . The activity comprises a radio, television, telephone, and treasure box. Method This study’s focus follows from the original aim of the KB-designers; to stimulate social interaction. In a nursing home and day care centre, the KB game was played with different groups of PWD (n=21: 12 females, 9 males, mean MMSE=17, range 3-28). In the morning KB (with technology), and in the afternoon an activity called ‘Questiongame’ (without technology) were played for 45 minutes. These activities were played twice in a two-month period, and outcomes were compared in terms of impact on social interaction. Group sizes ranged from 3 to 8 PWD assisted by 1 or 2 activity therapists. Two researchers observed the players during the activity with the Oshkosh Social Behavior Coding (OSBC) scale, which encompasses both verbal and nonverbal social and nonsocial behaviour. These behaviours can have a person-initiated and otherinitiated character (quantitative study)4. A total of 6 activity therapists were interviewed on the KB afterwards (qualitative study). Results & Discussion The quantitative results showed significantly higher scores for KB for the total of social interaction compared to Questiongame. Most of the behaviour is other-initiated (activity therapist). PWD with a lower MMSE score showed more non-verbal behaviour. For PWD with a MMSE score below 7, there was no difference in social interaction between the two activities. According to the qualitative research, KB triggered more social interaction, since the movies and music were stimulating the players to initiate a conversation, to which other players responded. The results of this research correspond with earlier research, which concludes that leisure activities with technology can show positive results on well-being5.

Clinical efficacy and cognitive and neuropsychological effects of levetiracetam in epilepsy: An open-label multicenter study

The aim of this prospective, multicenter, open-label study was to investigate the efficacy of levetiracetam (LEV) and determine its effects on cognitive and neuropsychological function. Sixty-nine patients were evaluated for effects of LEV on seizure control, cognitive (Mini-Mental State Examination [MMSE]) and neuropsychological (Symptom Checklist-90 Revised [SCL-90-R]) functions, and quality of life (Quality of Life in Epilepsy—10 [QOLIE-10]) assessments at 3 and 12 months of follow-up. Thirty-nine percent of patients achieved seizure freedom, and 68% had a ⩾50% seizure frequency reduction after 1 year of LEV (1235.5 ± 392.7 mg/day). There were also significant improvements in mean MMSE score and in the recall and language items of MMSE. There were modest improvements in interpersonal sensitivity and paranoid ideation scales of the SCL-90-R, and improvements in cognition and medication effect items of the QOLIE-10. The results demonstrate that LEV not only effectively reduces seizure frequency, but also possibly contributes to improvements in neuropsychological functions such as recall, language, interpersonal sensitivity, and paranoid ideation.

Apolipoprotein ϵ4 status is associated with behavioral symptoms in nursing home residents with dementia

While the relationship of apolipoprotein E (APOE) to behavioral symptoms of dementia (BSD) has been studied in community-dwelling persons with AD, it has received limited attention within the nursing home (NH) population. The aim of this study was to examine the association between APOE genotype and BSD in NH residents using direct observation. Thirty-six participants, aged 71-102 years, were compared using a non-randomized two-group design with continuous measures. APOE genotype was obtained by buccal swab. BSD, including restlessness, escape restraint, tapping and banging, searching and wandering, pacing and walking, and vocalization, were measured using the Modified Agitated Behavior Rating Scale. Participants were observed every 20 minutes for 12 hours per day for five days. Each participant's mean behavior scores were compared according to the presence or absence of the APOE epsilon4 allele. Resident characteristics included a mean MMSE of 10.44 indicating moderate to severe dementia and a mean of 3.44 medical co-morbidities. Fifty-six percent of the participants had one epsilon4 allele. A significant difference was found between APOE epsilon4+/4- and mean behavioral scores (F(1,31)) = 4.40, p = 0.04). Restlessness was significantly inversely correlated with MMSE (r = -0.367, p = 0.03), but not APOE genotype. There was no significant correlation between proxy reporting and direct observation (r = 0.257, p = 0.13). Findings indicate that the presence of the APOE epsilon4+ genotype increases the risk for BSD in NH residents with dementia. Direct observation proved a more accurate estimate of BSD than proxy report.

Apathy Is Not Depression in Huntington's Disease

Apathy Is Not Depression in Huntington's Disease

HOW TO MANAGE OVERACTIVE BLADDER IN ELDERLY INDIVIDUALS WITH DEMENTIA? A COMBINED USE OF DONEPEZIL, A CENTRAL ACETYLCHOLINESTERASE INHIBITOR, AND PROPIVERINE, A PERIPHERAL MUSCARINE RECEPTOR ANTAGONIST

HOW TO MANAGE OVERACTIVE BLADDER IN ELDERLY INDIVIDUALS WITH DEMENTIA? A COMBINED USE OF DONEPEZIL, A CENTRAL ACETYLCHOLINESTERASE INHIBITOR, AND PROPIVERINE, A PERIPHERAL MUSCARINE RECEPTOR ANTAGONIST

Effects of Antihypertensive Therapy on Cognitive Decline in Alzheimer's Disease

Therapeutic trials concerning the effect of antihypertensive therapy on cognition have produced controversial findings. Our objective was to evaluate the impact of antihypertensive therapy on the cognitive function in subjects already diagnosed with Alzheimer's disease (AD). We conducted an observational study in a memory clinic assessing outpatients suffering from AD. A total of 321 patients were included. Cognitive function was assessed yearly by the Mini-Mental State Examination (MMSE; score/30). The mean age of patients was 78.1 +/- 6 years, 54% of them received antihypertensive therapy and the mean MMSE scores were similar in both groups (patients taking antihypertensive therapy and patient without antihypertensive therapy). The mean follow-up was 34.1 +/- 6 months. MMSE means were significantly higher among patients using antihypertensive therapy compared to those without antihypertensive therapy (MMSE scores = 21.9 +/- 4.9 vs. 21.2 +/- 5.1 at 1 year (P = 0.001); 20.8 +/- 5.5 vs. 19.4 +/- 5.7 at 2 years (P < 0.001); 19.0 +/- 6.7 vs. 17.5 +/- 6.4 at 3 years (P < 0.001)), after adjustment for age, gender, education level, systolic blood pressure (SBP), and diastolic blood pressure (DBP) at baseline, MMSE at baseline, coronary heart disease, statins, and antiplatelet agents' consumption. Furthermore, the use of antihypertensive therapy was associated with a lower estimated risk of cognitive decline (as defined by a decrease of at least one point in MMSE score over time) (hazard ratio = 0.61; 95% confidence interval = 0.45-0.81) after adjustment for the same factors. These results suggest an association between antihypertensive therapy, a lower decrease in mean MMSE and a lower cognitive decline over time in AD.

Safety and efficacy of tarenflurbil in subjects with mild Alzheimer's disease: Results from an 18-month international multi-center phase 3 trial

Tarenflurbil is a selective Aβ42-lowering agent that modulates γ-secretase activity to preferentially reduce production of Aβ42in vivo and in vitro. Preliminary evidence for potential benefit of tarenflurbil 800 mg bid in subjects with mild AD was observed in a randomized, double-blind Phase 2 trial, however, a large Phase 3 trial in 1649 subjects with mild AD conducted in the US failed to show efficacy. In this additional randomized, double-blind, placebo-controlled international phase 3 trial, individuals with mild AD (MMSE score 20-26, inclusive) were randomized (1:1) to receive tarenflurbil 800 mg bid or placebo for 18 months. Randomization was stratified according to use/non-use of acetylcholinesterase inhibitors and/or memantine. The co-primary outcome measures of efficacy were the ADAS-cog and the ADCS-ADL, with assessments conducted every 3 months. The key secondary outcome was the CDR-sb and other secondary outcomes included the Neuropsychological Test Battery (NTB), MMSE, the QOL-AD and the Caregiver Burden Inventory (CBI). Adverse events were monitored throughout the study. Analysis was conducted by first comparing changes from baseline to Month 18 between the two treatment groups for each co-primary endpoint using a z-score LOCF imputation method. A second method compared treatment differences in slopes without imputation. To control for multiple comparisons, a gatekeeper approach was used for the analyses of the co-primary and key secondary endpoints. 841 participants were randomized at 99 sites throughout the US, Canada and Europe between May 2006 and March 2007. At baseline, participants were 50.3% female, had a mean age (± standard deviation, range) of 74.6 (± 7.9, 53-100) and mean MMSE score of 23.2 (± 2.0, 20-26). The length of double-blind treatment was to be 18 months, but the trial was terminated on July 11th, 2008 for some 300 patients before their 18 month visit based on the recommendation of the Data Monitoring Committee after the outcome of the United States Phase 3 trial. Database lock, unblinding and data analysis were scheduled to take place in February 2009. Results for the primary and secondary efficacy outcomes and safety will be presented.

Cut-off scores in MMSE: A moving target?

Cognitive tests are known to be influenced by language, culture and education. In addition there may be an impact of “epoch” in cognition that is not so well understood. In children, there is a secular improvement of general cognitive ability, measured by IQ tests. If we assume this is a long lasting process, then its effect should be persist into late adult life. To test this hypothesis we compared the performance of two independent samples of healthy adults (>50 years of age), autonomous in daily living activities, evaluated 20 years apart using the MMSE. Study population included 135 participants in 1988 and 411 in 2008. In both epochs MMSE scored variance was related primary to literacy but also to age (linear regression analysis). Mean MMSE values were higher in 2008 than 1988. This difference remained significant, when populations were matched by literacy groups (0-2 yrs, 3-6 yrs and >6 yrs of education), on multiple t tests (p<0.00 for 0-2 yrs; p=0.007 for 3-6 yrs and p=0.02 for >6 yrs). Operational cut off scores, between normal and pathological values, calculated as -1.5sd below mean, were also higher in 2008, for all literacy groups (0-2 yrs: 15 versus 22; 3-6 yrs: 23 vs 25; >6 yrs: 26 vs 27 in 1988 compared to 2008, respectively). The present study suggests that there is a secular improvement in cognitive function in adult and elderly individuals, in an interval of 20 years. The operational cut-off values may also changes with time, which may have clinical impact in the diagnosis of disorder like mild cognitive impairment or dementia.

Health and nutritional promotion program for patients with dementia (NutriAlz Study): design and baseline data.

There is a lack of data on global weight loss prevention programs for patients with dementia or clear evidence about their impact on a functional level, caregiver burden or the use of healthcare and social resources. NutriAlz is a socio-educative and nutritional intervention program to prevent weight loss and loss of function in dementia patients. A cluster randomized multi-centre study, which will allow the comparison of a group benefiting from the intervention with a control group after a year of monitoring. Patients were recruited from 11 hospitals in the ambulatory diagnostic units and day care centres. The baseline interview include: sociodemographic and socioeconomic variables (age, gender, educational level, marital status); diagnostic, treatments, MMS, a list of comorbid conditions; activities of daily living (ADL, IADL), Zarit Scale, brief-NPI, Cornell scale and nutritional status as measured by the Mini Nutritional Assessment. All participants or their family signed the inform consent form. Total of 946 patients were included, with a mean (+/- SD) of 79 +/- 7.3 year of age; 68,1 % were women; 44,9% lives with their partner, only 3% lives alone; 79.8% had Alzheimer's dementia, 5.25 +/- 3.0 years since symptoms of dementia and 2.8 +/- 2.11 years since diagnosis. Mean MMSE score was 15.4 +/- 6.2; mean weight was 64.4 +/- 12.5 kg; mean BMI was 27.0 +/- 4.5 (with 3% below 19, 5% between 19-21, 10% between 21-23, and 82% above 23). Mean ADL without difficulties was 3.2 +/- 2.1; mean IADL without difficulties was 0.7 +/- 1.6; mean number of symptoms in the NPI was 4.4 +/- 2.59, with severity score of 7.9 +/- 5.9 and distress score of 11.3 +/- 9.0; mean Zarit scale was 27.4 +/- 15.5; mean MNA was 23.2 +/- 3.5 with 5 % as malnourished, 32 % at risk of malnutrition, and 63 % with adequate nutritional status.

Un estudio empírico de los correlatos psicosociales y clínicos del trastorno delirante: el estudio DELIREMP

We aim to describe psychosocial and clinical correlates of delusional disorder (DD) and its types. This approach is important because most knowledge on DD does not come from empirical data collected using a validated systematic research method.A cross-sectional study was conducted in a sample of 86 patients fulfilling DSM-IV criteria for DD as established using the SCID-I. Variables were evaluated using a systematic methodology and standardized instruments, and included possible psychosocial risk factors (low socioeconomic status or social isolation, immigration, sensory deficits, older age at onset), family history of psychiatric disorders and premorbid personality (SAP), psychotic psychopathology (PANSS), depressive syndrome (MADRS), global cognitive functioning (MMSE), axis I comorbidity (MINI) and other clinical aspects such as global functionality (GAF), and disability (SDI). A sociodemographic and clinical questionnaire was also completed.The mean age at onset was 39.6 years and 61.6% of the cases were female. The most frequent DD types were persecutory (59.3%) and jealous (22.1%). Nearly 21% had a family history of schizophrenia and 17.4% had DD (significantly higher among those with the jealous subtype). Sixty-four percent had a premorbid personality disorder (38.4% paranoid, 12.8% schizoid). The grandiose type was significantly associated with higher scores on the PANSS positive subscale and the mixed type with lower scores on the PANSS negative subscale. Depression affected 45.3% of subjects (mainly mild depression) and 45.3% had hallucinations (20.9% tactile, 16.3% olfactory), which were more common among somatic cases. The mean MMSE was 27.6±2.5 suggesting a preserved cognitive function. Mean GAF was 63.9±11.3 indicating a moderate degree of disability, which was significantly worse amongst grandiose cases.This study provides unique empirical and reliable evidence on the real psychosocial, clinical, and psychopathological correlates of DD and its types.

The effect of modified jazz dance on balance, cognition, and mood in older adults

The purpose of this pilot study was to evaluate the impact of jazz dance class instruction on balance, cognition, and mood (specifically depression) in 13 healthy, community-dwelling, English-speaking older women with a mean age of 68. Data were collected using self-report questionnaires (Folstein Mini Mental Status Examination [MMSE] and Geriatric Depression Scale [GDS]), and the sensory organization test (SOT) for balance measurements (using the NeuroCom Smart Balance Master) was performed at three time periods in the study: time 1: between week 1 and week 2 of jazz class (baseline), time 2: between week 8 and week 9 of jazz class (midpoint), and time 3: after week 15 of jazz class (final measurement). Differences in mean MMSE and GDS scores over time were not significant; however, SOT scores showed an increasing trend (p < .001). Data analysis using analysis of variance with repeated measures showed that balance measures improved throughout the duration of the study (F(2,10)= 19.68, p < .001). Post hoc analyses using paired t tests with a Bonferroni correction indicated that significant increases in balance occurred from time 1 to time 2 and from time 2 to time 3. These preliminary pilot study findings suggest that jazz dance does not impact cognition or mood but may improve balance in older women. This finding may have significant implications for fall prevention in the postmenopausal population. Because falls are a leading cause of morbidity and mortality in older adults of both genders, research is needed to evaluate both the impact of jazz dance on balance in older men and jazz dance as a fall prevention strategy in aging adults. Additionally, longitudinal research with a larger sample size is needed to test the effectiveness of jazz dance as a strategy for improving balance, cognition, and mood.

An empirical study of psychosocial and clinical correlates of delusional disorder: the DELIREMP study

ObjectiveWe aim to describe psychosocial and clinical correlates of DD and its types. This approach is important because most knowledge on DD does not come from empirical data collected using a validated systematic research method. MethodsA cross-sectional study was conducted in a sample of 86 patients fulfilling DSM-IV criteria for DD as established using the SCID-I. Variables were evaluated using a systematic methodology and standardized instruments, and included possible psychosocial risk factors (low socioeconomic status or social isolation, immigration, sensory deficits, older age at onset), family history of psychiatric disorders and premorbid personality (SAP), psychotic psychopathology (PANSS), depressive syndrome (MADRS), global cognitive functioning (MMSE), axis I comorbidity (MINI) and other clinical aspects such as global functionality (GAF), and disability (SDI). A sociodemographic and clinical questionnaire was also completed. ResultsThe mean age at onset was 39.6 years and 61.6% of the cases were female. The most frequent DD types were persecutory (59.3%) and jealous (22.1%). Nearly 21% had a family history of schizophrenia and 17.4% had DD (significantly higher among those with the jealous subtype). Sixty-four percent had a premorbid personality disorder (38.4% paranoid, 12.8% schizoid). The grandiose type was significantly associated with higher scores on the PANSS positive subscale and the mixed type with lower scores on the PANSS negative subscale. Depression affected 45.3% of subjects (mainly mild depression) and 45.3% had hallucinations (20.9% tactile, 16.3% olfactory), which were more common among somatic cases. The mean MMSE was 27.6 (SD=2.5) suggesting a preserved cognitive function. Mean GAF was 63.9 (SD=11.3) indicating a moderate degree of disability, which was significantly worse amongst grandiose cases. ConclusionThis study provides unique empirical and reliable evidence on the real psychosocial, clinical, and psychopathological correlates of DD and its types.

Quality Improvement in Long Term Care: The Psychotropic Assessment Tool (PAT)

There are already a substantial number of individuals with dementia in long-term care. Many nursing home patients have difficult behaviors and are currently managed with psychotropic medications. Medications for behavior need to be titrated and monitored over time for efficacy and safety, and subsequently tapered if ineffective. Some of these medications are not without risk, and that risk-benefit ratio should be discussed and documented with the family. Currently, we are not aware of any quality improvement process that has been developed in long-term care to address these issues. To describe the process of a novel quality improvement intervention that was designed to improve documentation in the medical record and interdisciplinary communication of the usefulness and possible side effects of psychotropic agents used in the management of difficult behaviors for dementia. Retrospective review of the chart and quality improvement records in a long-term care facility. An academic long-term care facility that specializes in dementia care in St. Louis, MO. The quality improvement team created a process and a form named the Psychotropic Assessment Tool (PAT) to document current behavioral symptoms of the residents; determine whether the resident was on psychotropic agents; identify whether agents had been initiated, titrated, and/or tapered if appropriate; and whether there were any side effects related to the behavioral medications. A letter was created and provided to the surrogate decision maker that described the risk-benefit ratio of the use of antipsychotic agents when these drugs were prescribed. Recommendations from the quality improvement team were provided to the primary care physician. After 1 year of this process, we reviewed the medical charts and quality improvement PAT forms of all residents. We documented the use of psychotropic agents before and after initiating the PAT process, the presence of current behavioral symptoms, the presence of possible side effects, and the recommendations of the interdisciplinary team that met after the monthly quality improvement meetings. A total of 110 patients were included in this study, which reviewed psychotropic drug use between July 2005 and July 2006. The mean age of the residents was 83.8 +/- 7.5 years. All residents had a diagnosis of dementia. Mean MMSE score was 13.5 +/- 7.3. The prevalence of potential problems that could have been associated with psychotropic drug use was not insignificant and included falls (45%), weight loss (16%), weight gain (7%), dizziness (9%), and sedation (5%). However, behaviors that might warrant psychotropic drug use were not uncommon and included active depression (12%), anxiety (24%), hallucinations (11%), disruptive behavior (21%) and delusions (21%). The percentage of residents on antipsychotics changed from 26.5% pre-PAT process to 25.2% post-PAT process; those on anxiolytics changed from 6.0% to 4.0%. There was a change in hypnotics from 2.6% to 3.4%. Antidepressant usage remained the same at 55%. The PAT CHAT discussion resulted in recommendation of medication changes in 25% of residents. The initiation of this quality improvement process using the PAT led to improved chart documentation and interdisciplinary communication between the team, primary care physicians, and families. Further studies are needed to determine whether this process can impact use of psychotropic agents, improve quality of life, decrease adverse drug events, and/or reduce medical-legal risk.

GuidAge Study: A 5-Year Double Blind, Randomised Trial of EGb 761 for the Prevention of Alzheimers Disease in Elderly Subjects with Memory Complaints. I. Rationale, Design and Baseline Data

Primary and secondary prevention strategies for Alzheimer's disease (AD) are urgently needed. We have initiated a five-year prospective prevention study involving patients spontaneously reporting memory complaints. The primary objective is to determine the effect of treatment with EGb 76 on the rate of conversion from memory complaints to AD using survival analysis. Ambulatory patients aged at least 70 years who spontaneously reported a memory complaint during a GP or memory centre consultation were eligible for inclusion. Patients with major objective memory impairment or clinically relevant symptoms of anxiety and depression were excluded. Subjects were randomised to receive either EGb 761 120mg bid or matching placebo. Participants undergo an annual visit at a memory centre, where a series of neuropsychological tests are administered to assess cognitive function (Grober and Buschke, Trail-Making and controlled oral word association tests) and cognitive status (MMS and CDR). Functional status is evaluated with the Instrumental Activities of Daily Living questionnaire. The primary outcome is the transition to a diagnosis of AD (DSM-IV and NINCDS-ADRDA criteria), determined at the annual memory centre visit. A total of 4066 patients were screened for participation, of whom 2854 fulfilled the eligibility criteria and were entered into the study. Their mean age was 76.8+/-4.4 years and 66.7% were female. The mean MMSE score was 27.8+/-1.7 and 55.5% presented a CDR score of 0.5. This study will enable us to evaluate the efficacy of EGb761 in the prevention of AD, and to assess the usefulness of various baseline characteristics as predictors of conversion to AD in this population.