Mini-Mental State Examination Screening Research Articles

The Clock Drawing Task reveals executive dysfunction in the dialysis population – an underrecognized and underestimated problem

Aim of the study The study aimed to assess the prevalence of executive function impairment among patients with chronic kidney disease (CKD) undergoing dialysis, with no subjective cognitive problems and with normal global cognition on the Mini-Mental State Examination (MMSE). We also investigated the relationship between cardiovascular risk factors and cognitive test results. Rationale for the study Patients with CKD, including those undergoing renal replacement therapy, are at a higher risk of developing cognitive impairment (CI) than the general population. Recent research has shown CI to be a growing problem among CKD patients worldwide. Yet, it remains underdiagnosed, even though it may significantly influence the lives of patients. Materials and methods In this cross-sectional, prospective study, 58 dialysis patients with no cognitive decline on the MMSE screening were assessed for executive function impairment using the Executive Clock-Drawing Task (CLOX). Moreover, past medical history, demographic data, and laboratory test results were collected. Results The mean patient age was 59.47 ± 14.98 years, and the mean duration of dialysis was 45.93 ± 48.49 months. The prevalence of executive function impairment amounted to 8.6%. Moreover, remarkably similar pattern of clock drawing was observed, with numbers written outside the clock face in the CLOX1 test. Conclusions Executive dysfunctions in dialysis patients may manifest itself before the onset of global cognitive impairment. There appear to be a deficit in the spatial domain as well. Better education may play a protective role.

Analisis Klasifikasi Hipertensi dan Gangguan Fungsi Kognitif pada Lanjut Usia

<span class="tlid-translation"><em><span>Hypertension is an increase in blood pressure which can interfere with the circulation of blood flow in the brain region so that it is at risk of cognitive dysfunction. Elderly people are prone to cognitive impairment. The five cognitive impairments include concentration, language, orientation, memory, and attention. The research objective was to analyze the correlation between hypertension classification and cognitive dysfunction in the elderly. This type of research is observational analytic using cross sectional design. The sample consisted of 65 hypertension patients consisting from 42 men and 23 women from 3 health centers in Medan City. Samples were taken by purposive sampling technique, namely hypertensive patients from secondary data of more than 5 years and received regular treatment of antihypertensive drugs from medical records of health centers. Measurement of the cognitive function of the interview using the Mini Mental State Examination screening examination. Univariate and bivariate data analysis used the chi-square test. There were 37 patients with grade I hypertension, 23 people with mild cognitive dysfunction and 14 severe cognitive dysfunction. Meanwhile, there were 28 patients with grade II hypertension who had mild cognitive function disorders 11 people and 17 people with severe cognitive dysfunction. The results of the bivariate analysis showed that there was a relationship between the classification of hypertension and impaired cognitive function in the elderly where the p-value was 0.04 (p <0.05). There is a correlation between the classification of hypertension and impaired cognitive function in the elderly</span></em></span><br /><pre><em> </em></pre><pre><strong><em>Keywords:</em></strong><em> </em><em>Hypertension classification, Cognitive function disorders, Elderly</em></pre>

Hearing Loss and Risk of Mild Cognitive Impairment and Dementia: Findings from the Singapore Longitudinal Ageing Study

Aim: To investigate the associations between hearing loss and prevalent and incident mild cognitive impairment (MCI), dementia and MCI or dementia (all cases). Methods: Cross-sectional and longitudinal analyses of baseline and follow-up data were performed in a population-based cohort. The baseline sample of 2,599 adults aged ≥55 included 1,515 cognitively normal subjects who were followed up to 8 years. Hearing loss at baseline was determined by the whispered voice test, and MCI and dementia by Mini-Mental State Examination screening, Clinical Dementia Rating scale, neurocognitive tests, MRI, and panel consensus diagnosis. Results: Hearing impairment was associated with increased prevalence of dementia (odds ratio = 3.63, 95% confidence interval [CI] 1.16-11.4, p = 0.027) but not MCI alone or all cases of MCI or dementia, adjusted for sex, age, ethnicity, education, central obesity, hypertension, diabetes, dyslipidemia, smoking, alcohol, leisure time activity, cardiac diseases, and depressive symptoms. Among participants who were cognitively normal at baseline, those with hearing impairment were more likely to develop MCI or dementia (hazard ratio [HR] = 2.30, 95% CI 1.08-4.92, p = 0.032). Hearing loss was associated with elevated but statistically nonsignificant estimates of adjusted HR (1.85, 95% CI 0.78-4.40) for incident MCI alone. Conclusions: Hearing loss is independently associated with prevalent dementia and incident MCI or dementia.

Test Your Memory (TYM) as a screening instrument in clinical practice – the Polish validation study

Objectives: The Test Your Memory (TYM) test is a short, self-administered screening cognitive instrument designed for the detection of Alzheimer's disease (AD). The study was aimed to examine the Polish version of TYM as a screening instrument in Polish clinical practice. Method: In this study 199 patients were assessed whereas 131 patients with AD and mild cognitive impairments (MCI) and 94 healthy control subjects took part in the final analysis. The sensitivity and specificity of the TYM test were evaluated among the AD group and healthy control group. The TYM test was compared to other neuropsychological tests, such as Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), DemTect and Verbal Fluency Test (FAS). Results: The average TYM score in healthy control group: 45.4, 40.9 in the MCI patients and 23.4 in AD patients. The Polish version of the TYM test showed good correlation with other neuropsychological instruments among AD patients. Participants aged ≥75 and those with primary education performed significantly worse in TYM. The TYM achieved the best differentiation between AD and the healthy control group for ≤39 cut-off with a sensitivity and specificity of 91% and 90%, respectively. Conclusion: The Polish version of the TYM test is a useful instrument and may be seen as an alternative to the MMSE screening test in clinical practice in patients with dementia. However, the normative data suggested that the age and the level of education of the respondents should be considered as important factors affecting the interpretation of the final score.

Under-recognition of dementia in long-term care homes in Hong Kong

Objective: To examine the extent to which dementia in nursing homes is recognized by staff. Methods: About 189 residents with very mild to moderate dementia (Clinical Dementia Rating, CDR ≥ 0.5) and Mini-Mental State Examination (MMSE) = 10–24 were recruited from 12 nursing homes in Hong Kong. A senior staff in each home provided information on whether the participant was known to have dementia, and if so, the exact diagnosis. Logistic regression was conducted to predict identification by age, gender, whether for-profit or non-profit home, length of stay, MMSE, CDR, activities of daily living, and use of cholinesterase inhibitors and antipsychotic medications. Results: It was observed that 42.3% of the sample had mild dementia and 14.8% had moderate dementia. Although identification rates increased with increasing severity of cognitive impairment, only 30.0% of those with mild dementia and 64.3% of those with moderate dementia were known to have dementia by the homes. Identification rates did not differ between for-profit homes and non-profit homes which had regular MMSE screening. Logistic regression analysis showed that only MMSE (OR = 0.85, 95% CI = 0.76–0.95, p = 0.005) and CDR = 2 (as compared with CDR = 0.5; OR = 4.78, 95% CI = 1.23–18.65, p = 0.024) were significantly associated with dementia recognition. No other factors were related to dementia recognition. Conclusions: Despite a high prevalence of dementia in long-term care facilities, recognition of dementia as a medical condition in residents by staff was suboptimal, and MMSE screening in some homes did not seem to increase awareness significantly.

New Diagnostic Test May Improve Dementia Care

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessNew Diagnostic Test May Improve Dementia CareJim RosackJim RosackSearch for more papers by this authorPublished Online:1 Dec 2006https://doi.org/10.1176/pn.41.23.0024A new screening tool for dementia developed by geriatric experts at St. Louis University School of Medicine appears to be better at identifying mild cognitive problems in elderly patients, compared with the most commonly used screening tool.Identifying mild cognitive changes at an earlier point in the progression of a patient's cognitive decline could allow clinicians to initiate effective treatments earlier, potentially altering the progression of the disease.Since its development in 1975, the Mini-Mental State Examination (MMSE) has been routinely administered by physicians to patients who they suspect may have Alzheimer's disease or another dementia. While the MMSE is quick and easy to administer and has been validated in many research studies as a sensitive test for moderate to severe cognitive decline, the MMSE does not effectively spot early, mild cognitive changes, according to the geriatric experts at St. Louis Univeristy.The new screening tool, the St. Louis University Mental Status Examination (SLUMS), was developed to give clinicians a better gauge of early changes that could signal the onset of dementia and indicate to physicians when they should pursue further testing to support or rule out a dementia diagnosis.A comparison of the SLUMS and the MMSE for detecting dementia and mild cognitive disorders appeared in the November American Journal of Geriatric Psychiatry. The research was funded by St. Louis University School of Medicine and the Department of Veterans Affairs.“[The] early detection of mild neurocognitive disorder by the SLUMS offers the opportunity for clinicians to begin early treatment, as it becomes available,” syed Tariq, M.D., an associate professor of geriatric medicine at St. Louis University and the lead author of the report, said in a press release.John Morley, M.D., director of the Division of Geriatric Medicine at St. Louis University and the principal investigator on the research, created the SLUMS specifically to detect early cognitive problems in patients with higher levels of education.“The Mini-Mental Status Examination has limitations, especially with regard to its use in more educated patients and as a screen for mild neurocognitive disorder,” Tariq said.It takes a clinician about seven minutes to administer the SLUMS, which supplements the Mini-Mental Status Examination by asking patients to perform tasks such as doing simple math computations, naming animals, recalling facts, and drawing the hands on a clock.To determine validity and reliability of the SLUMS, the St. Louis University team prospectively recruited 705 male patients aged 60 or older from January 2003 through September 2003 at the Geriatric Research Education and Clinical Center of the Veterans' Affairs Medical Center in St. Louis. Recruiting was done during routine clinic visits in which study participants were evaluated for signs of cognitive impairment or dementia. With some of the patients, a full history was also obtained from corroborating sources (family members or caregivers), if available.In addition, for all patients a complete physical and mental status examination was performed and laboratory findings reviewed. The investigators used DSM-IV criteria to make a diagnosis of mild neurocognitive disorder or dementia. The investigators then completed the MMSE and SLUMS. Those who did not qualify by any of the DSM-IV criteria were considered to have normal cognition or no cognitive problems, without considering the scores of MMSE or SLUMS.The researchers found that while both tools reliably detected dementia, only the SLUMS recognized a subset of patients having mild cognitive problems.“SLUMS has the advantage in that it can help the clinician identify patients with mild neurocognitive disorder on the initial visit compared with the MMSE, which requires follow-up screening,” Tariq explained.The researchers cautioned that neither the SLUMS nor the MMSE screening tools substitute for clinical assessment and fuller neuropsychological testing to diagnose cognitive problems and dementia.The SLUMS is currently used at many VA hospitals, Tariq said, and is available online.The SLUMS is posted at<http://medschool.slu.edu/agingsuccessfully/pdfsurveys/slumsexam_05.pdf>.“ Comparison of the St. Louis University Mental Status Examination and the Mini-Mental State Examination for Detecting Dementia and Mild Neurocognitive Disorder—A Pilot Study” is posted at<www.ajgponline.org/cgi/content/abstract/14/11/900>.▪ ISSUES NewArchived