Mini-Mental Examination Score Research Articles

76 Baseline Frontoparietal Gray Matter Volume Predicts Executive Function Performance at 24-Months in Early and Late Mild Cognitive Impairment

Objective:To examine the relationships between baseline gray matter volumes, diagnostic status, and executive function performance at 24-month follow-up, and the relative importance of predictors of executive function in a cohort of non-demented older adults.Participants and Methods:The study sample included 147 participants from the Alzheimer’s Disease Neuroimaging Initiative (mean age = 70.6, SD = 6.4; mean education = 17 years, SD = 2.4). At baseline, 49 participants were diagnosed as cognitively normal (CN), 60 as early mild cognitive impairment (EMCI), and 38 as late mild cognitive impairment (LMCI). Magnetic resonance imaging (MRI) data were collected at baseline. A composite score of executive function and FreeSurfer-derived gray matter regions-of-interest (ROI; whole brain, superior frontal gyrus, middle frontal gyrus, inferior frontal gyrus, orbitofrontal cortex, anterior cingulate cortex, superior parietal lobule, inferior parietal lobule, hippocampus) were examined. Hierarchical linear regression models were employed to assess whether brain volume predicted executive function at 24-month follow-up and interaction effects between baseline ROI volume and diagnostic status. Age, gender, education, Mini-Mental State Examination scores, and APOE-e4 allele status were included as control variables in each model. Relative importance metrics, which quantifies an individual regressor’s contribution to a multiple regression model, were computed using the Lindemen, Merenda, and Gold (lmg) method to assess the relative contribution of each variable in predicting executive function performance.Results:Across all participants, baseline gray matter ROI volume accounted for a significant amount of variance in executive function at 24-months after accounting for control variables. Specifically, anterior cingulate cortex and superior parietal lobule accounted for an additional 7% and 6% of variance in executive function at 24-months. Significant brain region X diagnostic status interaction effects were observed in executive function performance at 24-months. Relative importance metrics within each group indicated that age is the most important predictor of executive function at 24-months for CN, anterior cingulate cortex is most important for EMCI, and Mini-Mental Examination score is most important for LMCI.Conclusions:Our findings implicate frontoparietal gray matter regions as significant predictors of executive function performance at 24-months, and that this relationship is moderated by diagnostic status. Our results indicate that the value of specific variables to predict executive function performance varies based on diagnostic status. Specifically, anterior cingulate cortex was a significant predictor of executive function performance across all participants and was the most important variable in predicting performance in the earliest stage of mild cognitive impairment. These results support previous studies examining gray matter correlates of executive function and extend the literature by exploring predictors of executive function in early and late stages of mild cognitive impairment.

Role of Magnetic Resonance Imaging in Dementia

Abstract Background: Dementia is a condition of elderly individuals, marked with emotional and cognitive disabilities which are severe enough to impair their routine daily life and its quality. It is mainly a disease affecting elderly population with an approximate prevalence rate of 1% at the age of 60 years and quadruples every 10 years, up to 30%–50% by the age of 85 years. There are about 5.5 crore people suffering with dementia with more than 60% in developing countries.To overcome this, a multipronged strategy with timely diagnosis is the need of the hour. Materials and Methods: The present study was conducted at the Department of Radiodiagnosis and Department of Psychiatry of J. N. Medical College and Hospital, Aligarh, over a period of 2 years. Forty-five patients in the age group of more than 55 years who presented with the complaints of cognitive impairment and were referred for magnetic resonance imaging (MRI) head after clinical examination and Mini–Mental State Examination (MMSE) score assessment were included in the study. On MRI images are assessed using the Global Cortical Atrophy (GCA) scale, medial temporal lobe (MTL) atrophy scale, and Fazekas Scale, then findings are correlated with clinical MMSE scores. Results: There were 45 patients with the age group of more than 50 years, among 66.67% of patients were males and 33.33% of patients were females. In 60.00% of patients, socioeconomic status was lower middle class, 46.67% of patients were illiterate followed by studied till primary school (22.22%). In 66.67% of patients, mini–mental score examination score was mild. Among the imaging scales, 82.22% of patients showed moderate GCA scale; in 55.56% of patients, interpretation of MTL atrophy scale was widening of choroid fissure and temporal horn of lateral ventricle. 33.33% of patients showed Fazekas 3 Scale with large confluent lesions. All these imaging scales showed a significant negative correlation with MMSE scores. Conclusion: MRI plays an important role in the assessment of structural changes in patients presenting with cognitive impairment as well as it points toward the diagnosis of certain type of dementia depending on the involvement of specific areas or lesions and their distribution in the cerebral hemispheres. Visual assessment using various scales has helped in assessing the severity as well as possible type. There has been establishment of significant correlation between the MRI scales of atrophy and clinical MMSE scoring system.

IPSC‐derived neurons with amyloid‐β treatment reflect features of Alzheimer’s disease patients

AbstractBackgroundThere is increasing evidence showing that induced pluripotent stem cells (iPSC)‐derived brain cells recapitulate disease‐relevant processes in patients with Alzheimer’s disease (AD). However, it remains unclear to what extent iPSC‐derived neurons treated with amyloid‐β (Aβ) reflect patient Aβ burden and other endophenotypes as determined by changes in protein expression.MethodTo investigate this, we firstly generated iPSC lines from 14 individuals with AD from the Deep and Frequent Phenotyping (DFP) pilot cohort. All of these individuals had undergone clinical measures (i.e. Mini Mental Score Examination) and neuropathological measures (i.e. Aβ, p‐tau and tau). We then differentiated these lines into cortical neurons and treated them with Aβ oligomers. We collected both cell media and cell lysates and measured over 5000 proteins in these samples using SOMAscan assay. In addition, proteins in the cerebrospinal fluid (CSF) and plasma of the same individuals were also measured using the same assay.ResultUsing Wilcox test, we identified 627 proteins that were differentially expressed in neuronal cultures under Aβ oligomers treatment after multiple correction. These proteins were significantly enriched in 14 pathways such as TGF‐β signaling pathway, Ras signaling pathway and MAPK signaling pathway etc. From protein co‐expression network analysis, we identified 12 modules (ranging from 45 to 2029 proteins) in neuronal cultures. Of them, eight were significantly associated with at least one endophenotype of the amyloid/Tau/Neurodegeneration/Cognition AT(N)C framework. We further checked the replication of these modules in human. We found that eight and nine modules were significantly preserved in CSF and plasma, respectively. Furthermore, some preserved modules were also significantly associated with some AD endophenotypes including Aβ.ConclusionThese results suggests that iPSC‐derived neurons with Aβ treatment reflect the patients’ endophenotypes, indicating that their use in capturing disease‐relevant processes in AD.

Relationship between Middle Cerebral Artery Pulsatility Index and Delayed Neurocognitive Recovery in Patients undergoing Robot-Assisted Laparoscopic Prostatectomy.

A steep Trendelenburg (ST) position combined with pneumoperitoneum may cause alterations in cerebral blood flow with the possible occurrence of postoperative cognitive disorders. No studies have yet investigated if these alterations may be associated with the occurrence of postoperative cognitive disorders. The aim of the study was to evaluate the association between an increased middle cerebral artery pulsatility index (Pi), measured by transcranial doppler (TCD) 1 h after ST combined with pneumoperitoneum, and delayed neurocognitive recovery (dNCR) in 60 elderly patients undergoing robotic-assisted laparoscopic prostatectomy (RALP). Inclusion criteria were: ≥65 years; ASA class II-III; Mini-Mental Examination score > 23. Exclusion criteria were: neurological or psychiatric pathologies; any conditions that could interfere with test performance; severe hypertension or vascular diseases; alcohol or substance abuse; chronic pain; and an inability to understand Italian. dNCR was evaluated via neuropsychological test battery before and after surgery. Anesthesia protocol and monitoring were standardized. The middle cerebral artery Pi was measured by TCD, through the trans-temporal window and using a 2.5 MHz ultrasound probe at specific time points before and during surgery. In total, 20 patients experiencing dNCR showed a significantly higher Pi after 1 h from ST compared with patients without dNCR (1.10 (1.0-1.19 95% CI) vs. 0.87 (0.80-0.93 95% CI); p = 0.003). These results support a great vulnerability of the cerebral circulation to combined ST and pneumoperitoneum in patients who developed dNCR. TCD could be used as an intraoperative tool to prevent the occurrence of dNCR in patients undergoing RALP.

Psychometric Properties of the Urdu Translation of Berg Balance Scale in People with Parkinson's Disease.

Background: The most common assessment tool used in clinical settings to detect changes in balance performance is the Berg Balance Scale (BBS). Thus, the purpose of this study was to translate the BBS into Urdu and investigate the psychometric properties (acceptability, internal consistency reliability, interrater reliability, construct validity) for individuals with Parkinson’s disease (PD). Methods: Eighty patients of either gender with idiopathic Parkinson’s disease, stages I–III on the modified Hoehn–Yahr (H&Y) scale, with intact cognition according to the Mini Mental Score Examination (MMSE) score (greater than or equal to 24) and independent of transfers, were included in this study. The BBS was translated according to international guidelines based on forward and backward translation processes. The test-retest reliability as well as intra- and inter-observer reliability was assessed by calculating the intra-class correlation coefficient (ICC). The internal consistency of the entire BBS score was assessed by calculating Cronbach’s α. The convergent validity was assessed by correlating the scale with the Unified Parkinson Disease Rating Scale (UPDRS) parts II and III and the Activity-specific Balance Confidence Scale (ABCS). The construct validity was assessed using a factor analysis. Results: The mean age of the subjects was 62.35 ± 5.74 in years (range: 60–87 years). The ICC for intra- and inter-observer reliability was 0.95 (p < 0.0001) and 0.99 (p < 0.001), respectively. Cronbach’s α was calculated as 0.81, which showed acceptable internal consistency of the Urdu version of the BBS. The test-retest reliability (ICC) of the Urdu version of the BBS was determined as 0.97 for the total score, and ranged from 0.66–0.95 for individual items. In terms of validity, the Urdu version of the BBS was correlated with the ABCS (in the positive direction) and UPDRS-II and III (in the negative direction) (r = 0.53, p < 0.001; r = −0.68, p < 0.001, r = −0.78, p < 0.0001), respectively. Conclusion: The Urdu version of the BBS is a reliable and valid scale to be used in balance assessment of population diagnosed with PD with excellent psychometric properties.

Evaluation of cognitive functions in traumatic brain injury patients using mini mental state examination and clock drawing test

Background:Traumatic brain injuries (TBIs) are the leading cause of morbidity, mortality, disability, and socioeconomic losses globally, but of more concern, in India and other developing countries. The Mini mental state examination (MMSE) and clock drawing test (CDT) are the two mostly adapted methods for cognitive impairment screening. Therefore, it is necessary to establish a robust evaluation system exclusively for post-TBI cognitive impairment.Materials and Methods:One hundred and thirty-four cases treated previously at the health facility for TBIs were evaluated for cognitive functions during the follow-up period ranging from 3 weeks to 6 months in the out-patient department. All cases underwent mini-mental score examination (MMSE) and CDT to assess their cognitive performances. The data were analyzed statistically using Chi-square and ANOVA tests of significance.Results:Statistically significant association (P < 0.001) between the cognitive status of patients on the basis of overall MMSE score and the site of brain injury was observed. It was noted that 76 (56.7%) of the cases had cognitive impairment (MMSE score <24) with majority 44 (32.8%) patients having frontal lobe injuries, followed by 14 (10.1%) having brain injuries in the temporal lobe. On the other hand, using CDT score, it was observed that 102 (76.1%) of the cases had cognitive impairment (CDT score <5) with the majority 49 (36.6%) cases having frontal lobe injury followed by 19 (14.2%) having brain injury in the parietal lobe.Conclusion:The CDT was able to access cognitive function disruption in those patients, in whom the mini-mental score examination was not able to assess the same, and this difference in detection capabilities of both the tests was statistically found significant.

Vitamin D Serum Level in Elderly Patients with Alzheimer’s Disease: Preliminary Analysis from Cilento Region

Introduction: It is estimated that 46 million people in the world live with dementia and it is estimated that this number will increase 3-fold by 2050, being a leading cause of disability worldwide and major welfare and economic problem. The aging of the general population increase these problems, especially in regions, such as Cilento (Southern Italy), where we can register higher longevity. Preserving cognitive health is one of the most important aims of the current research, also through the identification of possible preventative life-style strategies. Recent meta-analyses suggest that low serum vitamin D concentrations could be associated with Alzheimer's disease (AD) and cognitive impairment. The specific role of Vitamin D, however, is still controversial. There is a growing evidence of high rates of vitamin D deficiency in the elderly and there is still much uncertainty about the cause of AD and other forms of dementia. On the other hand, there is no definitive evidence is not conclusive and vitamin D could be involved in many other physiological and pathological mechanisms. Objective: Our aim is to investigate vitamin D serum levels in a small preliminary sample of AD patients from the Cilento area. Materials and Methods: Patients were recruited from the AD centre of the San Luca Hospital, in Vallo della Lucania (SA). We enrolled 25 consecutive patients, 13 women, and 12 men. The mean age was 78.5±8.3 years, the mean duration of the disease was 3.5±1.8 years. The average school-age of the patients was 6.1 +/- 3.5 years, the average disease age was 6.3 +/- 1.7 years, the average basal Mini-Mental Score Examination (MMSE) score was 17.6 +/- 3.6. We determined serum 25-hydroxyvitamin D (25[OH]D) in 25 consecutive AD patients. Results: The mean vitamin D serum level was 17.9+7.9 UI/ml, denoting a state of insufficiency. Among our 25 patients, only 3 had serum level above 30 UI/ml; most patients (17 out of 25) showed serum level among 10 and 30 UI, while in 5 patients, serum level was less than 10 UI. Conclusion: Our preliminary data showed that Vitamin D deficiency was, in our patients, independently associated with AD, even in a special population, high rate of centenarians, like Cilento people. However, our preliminary study has different limitations. The vitamin D deficiency has been evaluated through a single time-point of measurement (or in different periods of the year), that may be susceptible to bias. Even the differences in age and level of education should be taken into consideration. Nevertheless, these data in the Cilento region are original (there are no similar reports to our knowledge). However, our results confirm the necessity of other study, and this result is an important opportunity to introduce a modifiable risk fact and, consequently, a new treatment for AD.

Combined Use of MRI, fMRIand Cognitive Data for Alzheimer’s Disease: Preliminary Results

MRI can favor clinical diagnosis providing morphological and functional information of several neurological disorders. This paper deals with the problem of exploiting both data, in a combined way, to develop a tool able to support clinicians in the study and diagnosis of Alzheimer’s Disease (AD). In this work, 69 subjects from the ADNI open database, 33 AD patients and 36 healthy controls, were analyzed. The possible existence of a relationship between brain structure modifications and altered functions between patients and healthy controls was investigated performing a correlation analysis on brain volume, calculated from the MRI image, the clustering coefficient, derived from fRMI acquisitions, and the Mini Mental Score Examination (MMSE). A statistically-significant correlation was found only in four ROIs after Bonferroni’s correction. The correlation analysis alone was still not sufficient to provide a reliable and powerful clinical tool in AD diagnosis however. Therefore, a machine learning strategy was studied by training a set of support vector machine classifiers comparing different features. The use of a unimodal approach led to unsatisfactory results, whereas the multimodal approach, i.e., the synergistic combination of MRI, fMRI, and MMSE features, resulted in an accuracy of 95.65%, a specificity of 97.22%, and a sensibility of 93.93%.

Comparison of Mini Mental Score Examination, Quantitative Electroencephalography and Cerebrospinal Fluid Biomarkers in Clinical Practice Examining Dementia

Background: A new method to measure the cholinergic status with quantitative electroencephalography (qEEG) to distinguish healthy from early dementia patients and identify responders of Acetylcholinesterase inhibitor treatment. The objective is to evaluate cognition via Mini Mental Score Examination (MMSE) at baseline and follow-up examination after approximately 2 years for patients with suspected dementia and comparison with the predictive baseline values for (qEEG) and Cerebro-spinal fluid (Csf) biomarkers. If qEEG predicts the cognitive decline best, a noninvasive and inexpensive method is offering the possibility to start Acetylcholinesterase inhibitor treatment early in the dementia disease course. Methods: The average power of four qEEG epochs with eyes closed (E.Cl.) and open eyes (E.O.), and the ratio of E.O. / E.Cl. (Vigilance-index), and average peak frequency of E.Cl. epochs, calculated. The Csf parameters; total-Tau, phospho-Tau, and Amyloid β-42 analyzed. The correlation between the number of pathological MMSE-scores and pathological values of baseline biomarkers evaluated. Results: The Spearman rank correlation between MMSE revealed no linear relation for the examined biomarkers. When comparison of pathological values for MMSE at follow up after approximately 2 years the sensitivity to identify from the baseline values for qEEG and Csf biomarkers, found Vigilanceindex to have the highest sensitivity (1.0) then total-Tau (0.5) and the rest parameters lower, lowest for the combination of Csf parameters (0,09) to predict cognitive decline. The specificity for the baseline Vigilance-index was (0.87) and for total-Tau (0.39) and lower for the other parameters at the follow-up examination. Conclusion: Vigilance-index best reflects the cognitive decline after two years in early dementia disease, by measuring cholinergic deficit, compared to Csf biomarkers to measure total-Tau, phospho-Tau, and Amyloid β-42.

Cases of amyloidosis with diabetic encephalopathy

Basic clinical manifestations of diabetic encephalopathy in pre-stroke and stroke stages in the elderly are considered. Psychometrical tests (Shulte tables of and Mini Mental Score Examination scale) were used to reveal cognitive impairments, which are markers of diabetic encephalopathy progression. The case of intravital visualization of diabetic cerebral angiopathy using magnetic resonance imaging in susceptibility weighted imaging mode was described in detail. And the case of amyloidosis confirmed by kidney biopsy material coloring with Congo Red. The results of immunological examination are given, proving a high rate of Interleukin-1 production - initiator of serum amyloid A synthesis in liver (serum amyloid A). Histories of lethal cases and pathohystological analysis results of ultrathin sections, obtained by the means of cerebrum autopsy with Congo Red coloring, were investigated. Autopsy materials with positive qualitative reaction on amyloid were taken for further analyzing in polarizing light and amyloid typing. AA-amyloid was discovered in all cases. Morphologic characteristic of diabetic encephalopathy was revealed using coloring by hematoxylin, eosin and Van Gieson’s stain: angioedema, microhemorrhagia, leukoaraiosis, gliomatosis and atrophy of neurons. Case of genetic polyorganic AA- amyloidosis, not diagnosed intravital, was described in detail. It was established that impaired protein metabolism with its final conformation in toxic amyloid components of tissues is an early and fairly frequent manifestation of diabetic encephalopathy metabolic disorders. The substantiated opinion, implying the necessity of deep protein metabolism investigation in cases of diabetes complicated with encephalopathy and amyloidosis, is given. The term «diabetic amyloid encephalopathy» is offered to include in diabetic encephalopathy classification.

Increased Serum Level of IGF-1 Correlates With Better Cognitive Status in End-Stage Renal Disease Patients Undergoing Hemodialysis.

Prevalence of cognitive function decline in end stage renal disease (ESRD) patients undergoing hemodialysis is higher than in the general population. We analyzed risk factors for cognitive function decline in those patients. This study included 93 ESRD patients undergoing hemodialysis two or three times a week in three centers for hemodialysis in Montenegro. The cognitive status of patients was assessed using the mini mental score examination (MMSE) test. All 93 patients have been divided into three groups according to the results of MMSE. Patients in the first group had severe cognitive impairment and MMSE score below 17 (26.88%), patients in the second group with MMSE score 18-23 had moderate cognitive impairment (40.86%) and third group of patients have MMSE >24 and no cognitive impairment (32.26%). There were no significant differences between groups for gender, smoking habits and level of parathyroid hormone. Level of schooling was significantly different between groups of patients (P<0.001). Laboratory markers observed in this study with significant differences between groups were: IGF 1, IGFBP 3, erythrocytes and hemoglobin (P<0.001, P=0.004, P<0.001, P=0.002, respectively). IGF 1 proved to be of great importance for evaluating cognitive status in our study. This marker was statistically different between groups (P<0.001) and Tukey post hoc analysis showed significant differences between all three groups (first and second group P=0.045, second and third group P=0.015, first and third group P<0.001). Our data suggest that IGF 1 can be considered as novel biomarker for assessment of cognitive functioning in CKD patients, which can be of huge clinical importance.

Outreach Rehabilitation Program Improves the “Chaotic Journey” After Hip Fracture

A 4-week outreach rehabilitation program for nursing home residents after hip fracture repair appears to have provided hope and self-confidence as well as early mobilization and improved activity levels when compared with the usual care after hospital discharge. These findings come from a small qualitative analysis conducted in parallel to a randomized, controlled trial evaluating the efficacy and cost-effectiveness of the hospital team-led outreach rehabilitation program. Almost all the 28 residents included in the qualitative analysis had severe cognitive impairment. The larger trial recruited 240 older people in three hospitals in South Australia who had been admitted from nursing homes and were recovering from hip fracture surgery. The residents were randomized to receive either the usual care, which included physiotherapy provided by the nursing home staff and medical care provided by the residents’ usual general practitioner, or outreach rehabilitation in addition to the usual care. Outreach rehabilitation involved an average of 14 visits over 4 weeks from the local hospital team, including a geriatrician, physiotherapist, dietician, and, when required, a rehabilitation nurse. The physiotherapist focused on restoration of transfers and mobility, used positive motivational scripts to encourage engagement, and worked with nursing home staff to “encourage a rehabilitation approach between formal therapy sessions.” The qualitative subanalysis — as detailed in the report “The Chaotic Journey: Recovering from Hip Fracture in a Nursing Home” (Arch Gerontol Geriatr 2016;67:106–12) — aimed to understand the experiences and perceptions of 14 residents who returned to “usual care” and 14 residents who received outreach rehabilitation, through interviews and focus groups with family members and nursing home staff. Information on the 28 residents (out of the first 30 recruited for the randomized, controlled trial) was collected on average 5 weeks after each resident had returned from the hospital. The residents had a mean age of 87.5 years (range of 70 to 97 years), and each had been mobile before the fracture. Discharge occurred 2 to 19 days after surgery (a median of 4.5 days). Most of the residents (23 of the 28) had severe cognitive impairment after surgery and three had mild to moderate cognitive impairment, according to the scores on the Mini Mental Score Examination taken at entry to the trial. The challenges “started in the hospital with hospital staff ill-equipped to treat people with dementia and, following discharge home, nursing staff frequently reported poor handovers.” A dearth of information or guidelines from the acute hospital setting about how to handle and manage people after a hip fracture was reported by Maggie Killington of Flanders University and Repatriation General Hospital in Adelaide, Australia, and her associates in the same study. In the usual care group, “the nursing home staff lacked the knowledge and confidence to support [the residents’] recovery following hip fracture repair,” and the physiotherapists were unable to provide timely advice to the nursing home staff and were “unable to provide the intensity of therapy required to promote return of patients’ mobility.” Moreover, ongoing pain, malnourishment, and delirium — and a loss of hope and motivation to engage in activity — were more common among those who received the usual care. Eight of the 14 people who returned to usual care endured either ongoing pain or unacceptable medication side effects. By contrast, the caregivers and families of the residents who received outreach therapy “were positive about the experience and often surprised at the progress,” the investigators wrote. “In addition to good pain management strategies and improved activity levels, [they] were less likely to report anxiety and more often focused on improved quality of life.” Outreach physiotherapy was the most valued aspect of the outreach program, the investigators reported. Residents received psychological support in conjunction with mobility training and strengthening exercises, and the physiotherapists often “worked in conjunction with family members and nursing home staff to provide a safe environment with graduated challenges as the resident attempted to move in bed, get to stand, use stand lifting devices when necessary and undertake stand transfers.” The value of geriatrician input and improved nutritional status were also among the themes that emerged across interviews. “Ways need to be found for the appropriate expertise to follow the patient through post-operative recovery after hip fracture,” the authors said, calling for “integrated care pathways for people with dementia and hip fracture.” Christine Kilgore is a freelance writer in Falls Church, VA.

Thromboprophylaxis in atrial fibrillation and association with cognitive decline: systematic review.

atrial fibrillation (AF) is associated with dementia. If AF-related cognitive decline is driven by cerebral embolic events, thromboprophylaxis may impact on this. This systematic review assessed the association between cognitive impairment and AF thromboprophylaxis. two independent reviewers searched CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science Core Collection and Cochrane Library from inception until 12 November 2014. Eligible studies compared AF thromboprophylaxis to control with an outcome measure of cognition or dementia. Where data allowed, meta-analyses describing between-group differences in cognitive test scores or rates of incident dementia were performed. nineteen studies were eligible. For two prospective studies (one randomised controlled trial, RCT) comparing anticoagulation against antiplatelet therapy, change in Mini-Mental Score Examination (MMSE) score from baseline to last follow-up (maximal duration: 5.9 years) suggested a difference favouring anticoagulation (mean difference: 0.90, 95% CI: 0.29-1.51), in keeping with a trend seen in the single RCT (mean difference MMSE: 0.80, 95% CI: -0.07 to 1.67). Pooled odds ratio (OR) suggested no association with incident dementia, comparing anticoagulant to antiplatelet therapy (two studies, OR: 1.23, 95% CI: 0.80-1.91) or no treatment (three studies, OR: 0.89, 95% CI: 0.47-1.69). our analyses show no definitive evidence of cognitive benefit or harm from anticoagulation. We demonstrated a potential benefit of anticoagulation in comparison to antiplatelet over time. Larger scale studies with longer follow-up are needed to determine the true cognitive impact of AF thromboprophylaxis.

Predictive factors for disease progression in patients with early-onset Alzheimer's disease.

Only a few studies have investigated disease progression in patients with early-onset Alzheimer's disease (EOAD). Therefore, the aim of this study was to investigate disease progression in patients with EOAD and the influence of various factors, such as gender, education, and apolipoprotein E (APOE) genotype on disease progression. A total of 288 EOAD patients were enrolled in the study. Linear mixed models were used to investigate the rate of cognitive and functional decline in terms of age at onset, gender, education, follow-up period, and APOE genotype. EOAD patients showed an annual decline of -1.54 points/years in the Korean version mini-mental examination score, an annual increase of 3.46 points/year in the Seoul instrumental activities of daily living (SIADL) score, and an annual increase of 1.15 points/year in the clinical dementia rating scale-sum of boxes score. After stratification, higher educated patients showed faster disease progression in all three parameters, and female patients demonstrated faster disease progression as assessed by the SIADL score. Age at onset and APOE genotype had no influence on disease progression. We confirmed the rate of disease progression in Korean patients with EOAD in real-life hospital-based clinical practice. The results of this study suggest that education and female gender, not APOE genotype, may be important as independent strong predictive factors for disease progression in patients with EOAD.

Serum vitamin D and functional impairment in octogenarian women

PurposeSerum vitamin D deficiency has been associated with frailty in people aged 65 and over, however its relationship with functional impairment has not been investigated in octogenerian (aged 80–90 years) institutionalized women. MethodsWe assessed functional impairment in this latter group by measuring frailty syndrome and other geriatric and psychological assessment scales: the Tinetti gait and balance index to determine the risk for falls, the Barthel index to measure the basic activities of daily living, the Lawton index for instrumental activities, the mini-mental score examination test for cognitive impairment, the Yesavage scale for geriatric depression, and the Norton scale for the risk of ulceration. ResultsFrail individuals had significantly reduced serum vitamin D concentrations (measured as total 25-hydroxyvitamin D; 25(OH)D) compared to robust individuals, but reduced 25(OH)D concentration did not significantly correlate with frailty syndrome severity, and mean 25(OH)D concentrations were within the recommended levels in all groups. The 25(OH)D concentration did not correlate with any of the blood analytical parameters measured and with the geriatric assessment scales used, suggesting a selective relationship with frailty. ConclusionThese results highlight the need to individualize treatment such as vitamin D supplementation in order to treat frailty syndrome.

Gait speed and related factors in Parkinson's disease.

[Purpose] The aim of this study was to investigate the relationship between gait speed and various factors in ambulatory patients with idiopathic Parkinson’s disease. [Subjects] Fifty ambulatory patients with idiopathic Parkinson’s disease who were admitted to an outpatient clinic were included in this cross-sectional study. [Methods] The Hoehn and Yahr Scale was used for measurement of the disease severity. Gait speed was measured by the 10-Meter Walk Test. Mobility status was assessed by Timed Up and Go Test. The Hospital Anxiety and Depression Scale was used for evaluation of emotional state. Cognitive status was examined with the Mini-Mental State Examination. The Downton Index was used for fall risk assessment. Balance was evaluated with the Berg Balance Scale. Comorbidity was measured with the Cumulative Illness Rating Scale. The 36-Item Short Form Health Survey was completed for measurement of quality of life. [Results] The mean age was 66.7 (47–83) years. Twenty-eight (56%) patients were men. Gait speed was correlated positively with height, male gender, Mini-Mental Examination score, Berg Balance Scale score and physical summary scores of the 36-Item Short Form Health Survey. On the other hand, there was a negative correlation between gait speed and age, disease severity, TUG time, Downton Index, fear of falling, previous falls and the anxiety and depression scores of the Hospital Anxiety and Depression Scale. There was no correlation between gait speed and comorbidity. [Conclusion] The factors related with the slower gait speed are, elder age, clinically advanced disease, poor mobility, fear of falling, falling history, higher falling risk, and mood disorder.

THE PREVALENCE OF MILD COGNITIVE IMPAIRMENT IN A NORTH INDIAN ELDERLY POPULATION: CORRELATION WITH DIABETES MELLITUS AND SOCIO-ECONOMIC STATUS

Improvements in health care have extended the average life expectancy which has lead to the increase in the number of individuals over 60yrs of age. Mild Cognitive Impairment (MCI) is hence emerging as a major health problem as the people with MCI are three to four times more likely to develop Alzheimer's disease (6% to 25% annually). Various studies have shown that the prevalence of MCI lies between 0.5% and 36% depending upon the diagnostic criteria used and nature of the study population. The study was conducted in the municipal area of Bikaner, Rajasthan. Individuals to be interviewed were selected by systematic random sampling method. Mini Mental Score Examination (MMSE) score was applied to screen for dementia and persons with score 20 or less were excluded. Clinical Dementia Rating (CDR) score was used to confirm and stage the cognitive status. Kolkata cognitive test battery was also applied to detect the. Overall prevalence of MCI was accountable i.e.19.26%. Prevalence of amnestic MCI (aMCI) was 7.78% and that of multiple domain MCI was 11.48%. Prevalence of both forms of MCI was more among diabetics as compared in non diabetics with statistically significant difference (p<0.01). Prevalence of both types of MCI was high in people of lower socio-economic class in comparison with higher class people (p<0.01). There was no difference in their prevalence in middle and upper class people. Diabetes and lower socio-economic status were associated with higher prevalence of MCI in elderly. These observations are particularly important in developing countries like India which is also considered as the diabetic capital of the world and hence prevalence of MCI is expected to rise in near future.

Is mini-mental score examination scoring a new predictor of uncontrolled hypertension?

Essential hypertension is an important risk factor for target organ damage. The brain is among the target organs infrequently visited. The authors evaluated whether an abnormal Mini-Mental Score Examination (MMSE) score predicts uncontrolled hypertension even if office blood pressure is normal. Seventy-seven hypertensive patients were included. The cognitive function of each patient was assessed using MMSE and a customized brain magnetic resonance imaging study. Patients were classified into normal cognitive function group and mild, moderate, and severe cognitive impairment groups. A significance level of P=.05 was used. There was a higher percentage of uncontrolled BP in every cognitive impairment class. In patients older than 65 years, MMSE score had a sensitivity and specificity of 94% and 83%, respectively, in the prediction of uncontrolled hypertension. MMSE is a simple test to run in the clinic to predict whether patients have well-controlled blood pressure.

Is mini-mental score examination (MMSE scoring) a new predictor of uncontrolled hypertension?

Essential hypertension is still an important cardio-vascular morbidity and risk factor for many target organ damage. There still remain a large number of patients, especially in the under-developed countries who have an apparently controlled blood pressure (based on a single clinic visit) when it is actually poorly controlled. The brain is among the target organs infrequently visited by researchers. This is probably due to the common occurrence of systemic hypertension and non-hypertensive atherosclerosis in the elderly. Similarly, vascular and non-vascular dementia may also be seen. The separation of these different pathological entities for studying the sole effect of hypertension on the CNS is difficult. We aimed to evaluate whether the abnormal MMSE score predicts an un-controlled hypertension, confirmed by the 24-h Ambulatory Blood Pressure Monitoring (24-h ABPM), even if the office blood pressure measurement is normal. Seventy seven patients were included. All patients were aged 65 years old or above, with history of hypertension and are on treatment (even if their office blood pressure was within the normal range). All patients had clinic and 24-hour ABPM. The cognitive function of each patient was assessed by using mini-mental state examination (MMSE) and a customized simple brain MRI study. Patients with other causes of dementia and diabetes were excluded from the study. Patients were classified into a normal cognitive function group ( n = 19), a mild ( n = 9), moderate ( n = 38) and severe cognitive impairment ( n = 11) groups. The deep white matter hyperintensities were scored according to the modified Scheltens score. Significance level for the used tests is p = 0.05. The mean age was 68.8 ± 3.4 years old. The distribution of gender, smoking and dyslipidemia among the 4 groups was not significant. The hypertension duration, office and 24-h ABPM BP measurements and MRI score varied significantly between the 4 groups ( p < 0.0005). The hypertension duration and the average awake systolic blood pressure had the stronger impact on the MMSE class of the patient ( R 2 = 0.87, p < 0.0005). Classifying the patients into controlled and uncontrolled hypertensives, we had a higher percentage of uncontrolled BP in every cognitive impairment class. Only 1 patient with normal cognitive function had an uncontrolled hypertension. MMSE score has a sensitivity and specificity of 94% and 83% respectively in the prediction of uncontrolled hypertension. We conclude that MMSE is a simple test to run in clinic and can give an idea about the degree of structural damage caused to the brain; and hence predict whether or not the patient’s BP is well controlled. This would not replace the 24-hour ABPM but may help guide the clinicians to request this 24-hour monitoring.

Drug utilization pattern in patients with different types of dementia in Western India.

Background. Dementia is one of the most frequent disorders among elderly patients, reaching to epidemic proportions with an estimated 4.6 million new cases globally annually. Partially effective treatments are available for dementia. Aims & Objectives. We aim to study drugs used in dementia and find out frequency of types of Dementia. Method. This was an observational study conducted at rurally based tertiary care hospital. Prospective data was collected from outpatient department, while retrospective data was collected from medical records. Descriptive statistics were used to analyze data. Result. Total 125 prescriptions of patients diagnosed with dementia were analyzed. Alzheimer's dementia was most common (65.6%), followed by vascular dementia (21.6%), and frontotemporal dementia (10.4%), with the rarest being Lewy body dementia in (2.4%) cases. 60.57% of patients were males. Mini Mental Score Examination mean score was 15.93 ± 1.37. Frontal Battery Assessment mean score was 4.75 ± 1.01. Prescribed drugs were Donepezil (68.49%), Rivastigmine (13.63%), Donepezil + Memantine (6.43%) and Galantamine (12.83%), Quetiapine (38.46%), Lorazepam (23.07%), Clozapine (11.53%), Escitalopram (10.25%), Haloperidol (3.84%), Zolpidem, Sertraline, Olanzepine (2.56%), Nitrazepine, Lamotrigine, Fluoxetine, Tianeptine (1.28%), Folic acid, and Vitamin B12, respectively. Conclusion. Alzheimer's is the most common type of dementia while Donepezil was the most frequent drug.