Mini-Mental State Examination Test Research Articles

Which is the Prognostic Value of the Mini Mental State Examination Test in Surgical Oncology?

Cancer patients are usually subjected to numerous surgeries during their course of treatment. Recent studies suggest that anesthetic drugs such as propofol, benzodiazepines, and opioids are linked to cognitive impairment. The aim of the study was to show and compare the cognitive function of oncology patients who have undergone surgery and have been sedated with propofol, fentanyl and benzodiazepines. In order to determine whether the cognition of oncological patients is being impaired, a mini-mental state examination (MMSE) test was obtained 6 to 24 hours pre- and postoperatively for the duration of one month from 8 eligible oncological patients and 7 non-oncological ones. Afterwards, the data were statistically processed with SPSS version 25.0 (Chicago, Ill. the USA). The analysis shows that there is statistically significant difference in the preoperative MMSE scores between oncological and non-oncological patients. Oncological patients compound a sensitive group for cognitive dysfunction, and indeed, MMSE test could be useful for cognitive evaluation. The present sample, however, is small, and the results could not be generalized. Therefore a more extensive study is needed.

IntelligenceGym — is an effective tool to improve cognitive functions in the elderly

Aim. The aim of our study was to verify the effectiveness of the innovative IntelligenceGym training in improving cognitive abilities in the elderly.Material and methods. We developed an original training method that requires interaction between motor and cognitive functions. In our study 123 women and 89 men, aged 68–76 were examined. The inclusion criteria were Mini-Mental State Examination (MMSE) scores of 23 to 25 at inclusion, autonomy in walking, medical certification to participate in light physical activity. We have proposed to the participants to attend IntelligenceGym training one hour twice a week for 24 weeks. Cognitive performance was assessed before and after intervention included MMSE, Forward and Backward Digit Span Test, Rey’s Auditory Verbal Learning test (RAVLT), TMT-A, TMT-B. Moreover, motor performance was tested by using the Time Up and Go (TUG) test.Results.The cognitive assessment after IntelligenceGym training showed statistically significant improvement in all the scores tested (t-test performed). The results showed that participants of the IntelligenceGym training had particularly improved performance in Digit Span, MMSE and TMT-B tests and also improvements in motor TUG test.Conclusion. These findings indicate that the IntelligenceGym training is an efficient tool to improve cognitive performance in older adults with borderline or mild cognitive deficiency.

Elevated Monocyte Chemoattractant Protein-1 as the Independent Risk Factor of Delirium after Cardiac Surgery. A Prospective Cohort Study.

Background: The pathogenesis of postoperative delirium is largely unknown. The primary objective of this study is to assess whether increased levels of monocyte chemoattractant protein-1 (MCP-1) and high-sensitivity C-reactive protein (hsCRP) are associated with postoperative delirium in patients who have undergone cardiac surgery. The secondary objective is to investigate whether any association between raised inflammatory biomarkers levels and delirium is related to surgical and anesthetic procedures or mediated by pre-existing psychiatric conditions associated with raised pro-inflammatory markers levels. Methods: The patients were screened for cognitive impairment one day preoperatively with the use of the Mini-Mental State Examination Test and the Clock Drawing Test. A diagnosis of major depressive disorder (MDD) and anxiety disorders was established on the basis of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Blood samples were collected pre- and postoperatively for hsCRP and chemokine levels. Results: Postoperative delirium developed in 34% (61 of 177) of patients. Both pre- and postoperative hsCRP, and preoperative MCP-1 levels were associated with postoperative delirium in univariate comparisons; p = 0.001; p < 0.001; p < 0.001, respectively. However, according to a multivariable logistic regression analysis, only a raised MCP-1 concentration before surgery was independently associated with postoperative delirium, and related to advancing age, preoperative anxiety disorders and prolonged intubation. Conclusions: The present study suggests that an elevated preoperative MCP-1 concentration is associated with delirium after cardiac surgery. Monitoring of this inflammatory marker may reveal the cardiovascular disease (CVD) patients who are at risk of neuropsychiatric syndromes development.

Evaluation of the validity and reliability of the Persian version of the Eurocest Neurotoxic Symptoms Questionnaire

Introduction: Modified Euro Quest questionnaire to assess neurological and psychiatric effects caused by exposure to organic solvents is used. This study investigates the validity, reliability, and usability of the modified Euro Quest questionnaire in Iran. Materials and Methods: This cross-sectional descriptive study was conducted on 206 workers of color and textile industries. Modified Euro Quest questionnaire was translated into Persian by using the forward-backward translation standard method. To evaluate the content validity, convergent validity, internal consistency, and reliability of the questionnaire were used the index CVI, Pearson correlation coefficient, Cronbach's alpha, and test-retest. The convergent validity was compared, results of the questionnaire, with results of mini-mental state examination (MMSE) and Multidimensional Fatigue Inventory (MFI). Results: The relationship between the modified Euroquest questionnaire was compare with the MMSE test and the MFI's questionnaire, Pearson correlation coefficients, and the results showed in order - 0.86 and 0.65, which represents a significant inverse correlation between this questionnaire with MMSE test(p&gt;0.001) And a moderate correlation with the MFI's questionnaire(p&gt;0.001). Content validity index (CVI) and intraclass correlation coefficient (ICC) were obtained in order amounts of ≤0.79 and 0.92, which was acceptable. The final questionnaire, Cronbach's alpha coefficient, was calculated (α =0.84). Conclusion: The modified Euroquest Persian version is a valuable tool to assess the neurological and psychological effects caused by exposure to organic solvents in Iranian workers.

Indiana jones and ganser syndrome

IntroductionGanser syndrome is a rare medical disorder situated between hysterical etiopathogenesis and psychosis, factitious disorders and organic lesions which results in a difficult diagnosis. It is listed in DSM VI as a dissociative disorder whose main symptom is approximate answers, other accompanying symptoms appearing in Ganser: clouding of consciousness, somatic conversion symptoms and hallucinations. Psychopathologically explains a mental state of escape from a situation difficult to being tolerated. Organically appears in pathologies involving the frontal lobesObjectivesWe present a case of a XX year old man who suddenly develops a depressive disorder with no apparent cause. Initially he was a professionally developed man. Famous archaeologist. University professor. Guitarist in a musical group. He deteriorated through the years, appearing dementia data with auditive hallucinations and resistant headache. He begins to have difficulty speaking correctly, with paraphasias and short answers, continually repeating “I don´t know”, Short-term amnesia and bed-chair lifeMethodsIt was impossible to perform both the Mini-Mental State Examination test and the fototest because the patient refused claiming to be very nervous. The CT and MRI showed a slight temporary atrophy and vascular age changes. Subsequently, PET was performed without notable findings. Antidepressant and anxiolytic treatment was introduced without success as well as treatment for dementia and antipsychotic treatment.ResultsThe headache was improved. The rest of the symptoms did not disappearConclusionsGanser syndrome is a psychiatric condition that is difficult to diagnose and treat.DisclosureNo significant relationships.

Raised preoperative monocyte chemoattractant protein-1 as the independent predictor of delirium after cardiac surgery. A prospective cohort study

IntroductionDelirium is a frequent and serious complication of cardiac surgery. However, the knowledge regarding pathogenesis of postoperative delirium is limited.ObjectivesTo investigate whether increased levels of monocyte chemoattractant protein-1 (MCP-1) and hyper-sensitive C-Reactive Protein (hsCRP) are associated with postoperative delirium in cardiac surgery patients.MethodsPatients were examined and screened for major depressive disorder (MDD) and cognitive impairment one day preoperatively, using the Mini International Neuropsychiatric Interview and The Mini-Mental State Examination Test. Blood samples were collected pre- and postoperatively for hsCRP and chemokine levels. Following surgical interventions, the Confusion Assessment Method for the Intensive Care Unit and the Memorial Delirium Assessment Scale with the cut-off score 10 were used to diagnose delirium.ResultsPostoperative delirium screening was found positive in 34% (61 of 177) of patients. Both, pre- and postoperative hsCRP, and preoperative MCP-1 levels were associated with postoperative delirium in univariate comparisons; p=0.001; p=0.0004; p &lt; 0.001, respectively. However, according to a multivariate stepwise logistic regression analysis only MCP-1 concentration raised before surgery was independently associated with postoperative delirium, and related to advancing age of participants (Spearman’s Rank Correlation 0.192; p=0.0103). According to ROC analysis, the most optimal cut-off for MCP-1 concentration in predicting the development of delirium was 371.81 ng/ml with sensitivity of 77.0% and specificity of 58.6%.Conclusions The present study suggests that raised preoperative MCP-1 concentration is independently associated with delirium after cardiac surgery. Preoperative monitoring of pro-inflammatory markers combined with regular surveillance may be helpful in the prediction and early detection of postoperative delirium in this patient group.

WHICH AMBULATORY BLOOD PRESSURE PARAMETERS ARE RELATED TO COGNITIVE IMPAIRMENT AND DEMENTIA IN HYPERTENSIVE PATIENTS?

Objective: Ambulatory blood pressure monitoring (ABPM) parameters are more accurately linked to target organ damage than office or home blood pressure values. Few studies focus on the relationship between ABPM parameters and cognitive aging. We aimed to investigate the relationship between ABPM parameters and prevalence of cognitive impairment and dementia among hypertensive patients. Design and method: In the present paper, we included 294 consecutive hypertensive patients admitted to a Cardiovascular Rehabilitation Clinic aged between 50–91years (mean age: 68.6 ± 8.8 years; 50.3% female; 49.7% male). After routine clinical assessment all participants had an ABPM recording (on antihypertensive medical treatment), completed the Montreal Cognitive Assessment (MoCA) test used for the detection of cognitive impairment, and the Mini Mental State Examination (MMSE) test for detection of dementia. We divided patients in two groups acording to cognitive status based on these cutoff values: 26 points for MOCA score, respectively 24 points for MMSE score – and compared ABPM parameters of the two groups. Statistical analysis was performed with the IBM SPSS v.20 program. Results: In patients with cognitive impairment (MOCA &lt;26) we found significantly lower mean diastolic (69.9 vs. 72.4 mmHg, p = 0.023), daytime diastolic (72.0 vs. 75.1 mmHg, p = 0.012), nighttime diastolic (64.5 vs. 66.9 mmHg, p = 0.039), and higher pulse pressure values (average pulse pressure 61.5 vs. 55.5 mmHg, p = 0.002, daytime pulse pressure 61.7 vs. 56.6 mmHg, p = 0.003, nighttime pulse pressure (59.8 vs. 55.1 mmHg, p = 0.004). In patients with dementia (MMSE&lt;24) we found significant differences between nighttime systolic values (129.7 vs. 124.5 mmHg, p = 0.04), average pulse pressure (63.5 vs. 58.9 mmHg, p = 0.038), and nighttime pulse pressure (63.5 vs. 57.4 mmHg, p = 0.003), values compared to patients with normal cognitive function. Conclusions: The presence of cognitive impairment was related to lower diastolic values, and higher pulse pressure values, while dementia was associated with higher nighttime systolic values in the studied patient population. Lowering too much diastolic blood pressure leading to higher pulse pressure and insufficient control of systolic blood pressure over night could have deleterious effect on neurocognitive abilities of treated hypertensive patients.

Cognitive profile in early stage Parkinson disease

Purpose: Parkinson’s disease (PD) is a neurodegenerative disorder characterized by both motor and nonmotor symptoms mainly due to striatal dopamine deficiency. Cognitive dysfunction is one of nonmotor symptoms. The purpose of this study is to determine the cognitive dysfunction with practical screening tests and to investigate relationship between cognitive dysfunction and clinical severity in early stage of PD (EPD) Materials and Methods: EPD patients and healthy control group were included into the study. Mini mental state examination (MMSE), digit span (DS), clock drawing (CD), verbal and visual memory tests were applied to all cases. Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn & Yahr Staging (H&Y) tests were performed to EPD patients. Correlation of neurocognitive tests with UPDRS and H&Y scores were examined in EPD patients. Results: There were 30 EPD patients (11 female/19 male) and 20 healthy controls (10 female/10 male). There was a significant difference only in CD test between EPD and healthy controls. EPD with H&Y stage 1. group had higher score on backward DS, CD, and visual memory tests than EPD with H&Y stage 2. Verbal memory test scores had negatively correlated with UPDRS scores. Conclusion: The first impaired test was CD in EPD compared to control group. Other cognitive tests (backward DS, verbal and visual memory tests) were also impaired with increasing severity of disease. MMSE was not different from the control group and did not change with increasing severity of disease. MMSE alone is not enough for evaluating of EPD, other cognitive tests have to be used.

Impact of Comorbidity Burden on Cognitive Decline: A Prospective Cohort Study of Older Adults with Dementia

Introduction: The lack of longitudinal data of comorbidity burden makes the association between comorbidity and cognitive decline inconclusive. We aimed to measure comorbidity and assess its effects on cognitive decline in mild to moderate dementia. Methods: This was a prospective cohort study. The participants were enrolled from the Hualien Tzu Chi Hospital between January 2015 and December 2018. We enrolled 175 older adults with mild to moderate dementia and conducted in-person interviews to follow-up comorbidity and cognitive function annually. The comorbidity burden indices included Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Charlson Comorbidity Index (CCI), and Medication Regimen Complexity Index (MRCI), and cognitive function was measured by Mini-Mental State Examination (MMSE) and clock drawing test. We employed the generalized estimating equations to assess the longitudinal effect of time-varying comorbidity burden on cognitive decline after adjusting for age, sex, and education. Results: Most patients were diagnosed with Alzheimer’s disease (88.6%) and in the early stage of dementia (Clinical Dementia Rating [CDR] = 0.5, 57.1%; CDR = 1, 36.6%). Multimorbidity was common (median: 3), and the top 3 most common comorbidities were osteoarthritis (67.4%), hypertension (65.7%), and hyperlipidemia (36.6%). The severity index of CIRS-G was significantly associated with cognitive decline in MMSE after adjusting for age, sex, and education. CCI and MRCI scores were, however, not associated with cognitive function. Conclusion: The severity index of CIRS-G outperforms CCI and MRCI in reflecting the longitudinal effect of comorbidity burden on cognitive decline in mild to moderate dementia.

The Application of P300-Long-Latency Auditory-Evoked Potential in Parkinson Disease.

Introduction Parkinson disease (PD) is a degenerative and progressive neurological disorder characterized by resting tremor, stiffness, bradykinesia, and postural instability. Despite the motor symptoms, PD patients also consistently show cognitive impairment or executive dysfunction. The auditory event-related potential P300 has been described as the best indicator of mental function, being highly dependent on cognitive skills, including attention and discrimination. Objective To review the literature on the application and findings of P300 as an indicator of PD. Data Analysis The samples ranged from 7 to 166 individuals. Young adult and elderly male patients composed most study samples. The Mini-Mental State Examination test, the Unified Parkinson Disease Rating Scale, and the Hoehn and Yahr Scale were used to assess neurological and cognitive function. In terms of testing hearing function, few studies have focused on parameters other than the P300. The factors we focused on were how the P300 was modified by cognitive effects, its correlation with different PD scales, the effect of performing dual tasks, the effect of fatigue, and the influence of drug treatments. Conclusion The use of the P300 appears to be an effective assessment tool in patients with PD. This event-related potential seems to correlate well with other neurocognitive tests that measure key features of the disease.

Feasibility Study on the Role of Personality, Emotion, and Engagement in Socially Assistive Robotics: A Cognitive Assessment Scenario

This study aims to investigate the role of several aspects that may influence human–robot interaction in assistive scenarios. Among all, we focused on semi-permanent qualities (i.e., personality and cognitive state) and temporal traits (i.e., emotion and engagement) of the user profile. To this end, we organized an experimental session with 11 elderly users who performed a cognitive assessment with the non-humanoid ASTRO robot. ASTRO robot administered the Mini Mental State Examination test in Wizard of Oz setup. Temporal and long-term qualities of each user profile were assessed by self-report questionnaires and by behavioral features extrapolated by the recorded videos. Results highlighted that the quality of the interaction did not depend on the cognitive state of the participants. On the contrary, the cognitive assessment with the robot significantly reduced the anxiety of the users, by enhancing the trust in the robotic entity. It suggests that the personality and the affect traits of the interacting user have a fundamental influence on the quality of the interaction, also in the socially assistive context.

Increased Carotid Intima-Media Thickness was not Associated With Cognitive Dysfunction After Off-Pump Coronary Surgery in Older Adult Patients Without Carotid Stenosis

Increased carotid intima-media thickness (C-IMT), a marker of atherosclerosis, is known to be associated with cerebrovascular and cortical abnormalities and cognitive impairment. This prospective observational study investigated the association between increased C-IMT and postoperative cognitive dysfunction (POCD) in older adult patients undergoing off-pump coronary artery bypass surgery. A total of 201 patients (57 females, 144 males; >60 years) were classified into increased (n = 105) or normal (n = 96) C-IMT groups by a cut-off value of 0.9 mm (bilateral C-IMT mean). Cognitive function was serially assessed with the Korean Mini-Mental State Examination, and Korean Montreal Cognitive Assessment scores preoperatively and at 7 days and 3 months postoperatively. POCD was defined as the deterioration of 1 standard deviation in at least one of the postoperative tests compared with their corresponding baseline scores. Independent risk factors for POCD were evaluated using multivariable analysis. Overall, POCD occurred in 46 patients (23%) over the 3 months. The incidences of POCD at 7 days and 3 months after surgery were similar, and there was no difference in both Korean Mini-Mental State Examination and Korean Montreal Cognitive Assessment test scores before and after surgery between groups. Chronic obstructive lung disease and intraoperative hyperglycemia episodes (>180 mg/dL), but not increased C-IMT, were independent risk factors for POCD. Unlike in nonsurgical cohorts, increased C-IMT was not significantly associated with the occurrence of POCD in older adult patients undergoing off-pump coronary artery bypass surgery.

Functional correlates of self-reported energy levels in the Health, Aging and Body Composition Study

BackgroundEffects of fatigue on health in older age are well studied, yet little is known about the clinical relevance of energy perception.AimsTo explore cross-sectional associations of self-reported energy with physical and mental health metrics in the Health, Aging, and Body Composition Study.MethodsParticipants rated their energy from 0 to 10; the outcome was energy dichotomized at the median (≥ 7 = higher energy). Four domains were assessed: depressive symptoms (Center for Epidemiologic Studies Depression Scale); physical performance (function: usual and rapid gait speed; fitness: 400-m walk time); physical activity (casual walking, walking for exercise, and intense exercise); and cognitive function (Modified Mini-Mental State Examination and Digit Symbol Substitution Test). Covariates bivariately associated with energy entered a multivariable logistic regression model, adjusted for demographics, chronic conditions, and strength.ResultsDepressive symptoms, physical performance and activity, but not cognition, were bivariately associated with energy (p < 0.0005). Younger age, male sex, greater strength, and absence of chronic conditions predicted higher energy (p < 0.001). In a multivariable model, depressive symptoms [adjusted odds ratio (aOR) 95% CI 0.69 (0.62, 0.76)] and 400-m walk times [aOR = 0.81 (0.72, 0.91)] were inversely associated with energy; usual and rapid gait speed [aOR = 1.3 (1.2, 1.4); aOR = 1.2 (1.1–1.4)], and time spent in intense exercise [aOR = 1.4 (1.1–1.7)] were positively associated with energy.DiscussionIn this cohort with a range of chronic conditions and fatigue, perceiving higher energy levels may reflect better emotional and physical health.ConclusionEnergy should be considered in multidimensional clinical assessments of older age.

Balance and cognitive decline in older adults in the cardiovascular health study.

Previous studies have demonstrated an association between gait speed and cognitive function. However, the relationship between balance and cognition remains less well explored. This study examined the cross-sectional and longitudinal relationship of balance and cognitive decline in older adults. A cohort of 4,811 adults, aged ≥65years, participating in the Cardiovascular Health Study was followed for 6years. Modified Mini-Mental State Examination (3MSE) and Digit Symbol Substitution Test (DSST) were used to measure cognition. Tandem balance measures were used to evaluate balance. Regression models were adjusted for demographics, behavioural and disease factors. Worse balance was independently associated with worse cognition in cross-sectional analysis. Longitudinally, participants aged ≥76years with poorer balance had a faster rate of decline after adjustment for co-variates: -0.97 points faster decline in 3MSE per year (95% confidence interval (CI): -1.32, -0.63) compared to the participants with good balance. There was no association of balance and change in 3MSE among adults aged <76years (P value for balance and age interaction < 0.0001). DSST scores reflected -0.21 (95% CI: -0.37, -0.05) points greater decline when adjusted for co-variates. In Cox proportional hazard models, participants with worse balance had a higher risk of being cognitively impaired over the 6 years of follow-up visits (adjusted HR:1.72, 95% CI: 1.30, 2.29). Future studies should evaluate standing balance as a potential screening technique to identify individuals at risk of cognitive decline. Furthermore, a better understanding of the pathophysiological link between balance and cognition may inform strategies to prevent cognitive decline.

Virtual reality for limb motor function, balance, gait, cognition and daily function of stroke patients: A systematic review and meta‐analysis

To explore the beneficial effects of virtual reality (VR) interventions on upper- and lower-limb motor function, balance, gait, cognition and daily function outcomes in stroke patients. A systematic review and meta-analysis of randomized controlled trials. English databases (PubMed, EMBASE, the Cochrane Library, CINAHL, Web of Science, Physiotherapy Evidence Database, ProQuest Dissertations and Theses) and Chinese databases (Chinese BioMedical Literature Service System, WANFANG, CNKI) and the Clinical Trial Registry Platform were systematically searched from inception until December 2019. Additionally, reference lists of the included studies were manually searched. The methodological quality of studies was scored with the Cochrane 'risk-of-bias tool' and PEDro scale from the Physiotherapy Evidence Database by two independent evaluators. In total, 87 studies with 3540 participants were included. Stroke patients receiving VR interventions showed significant improvements in Fugl-Meyer assessment of Upper Extremity, Action Research Arm Test, Wolf Motor Function Test, Fugl-Meyer Assessment of Lower Extremity, Functional Ambulation Classification, Berg Balance Scale, Time Up and Go, Velocity, Cadence, Modified Barthel Index and Functional Independence Measure. However, differences between VR intervention and traditional rehabilitation groups were not significant for Box-Block Test, 10m Walk Test, Auditory Continuous Performance Test, Mini-Mental State Examination and Visual Continuous Performance Test. This review suggests that VR interventions effectively improve upper- and lower-limb motor function, balance, gait and daily function of stroke patients, but have no benefits on cognition. This review identified the positive effects of VR-assisted rehabilitation on upper- and lower-limb motor function, balance, gait and daily function of stroke patients. And, we verified the duration of VR intervention affects some health benefits. The benefit of VR on cognitive function requires further investigation through large-scale multicentre RCTs.

An elaborative NMR based plasma metabolomics study revealed metabolic derangements in patients with mild cognitive impairment: a study on north Indian population.

Mild cognitive impairment (MCI) is transition phase between cognitive decline and dementia. The current study aims to investigate altered metabolic pattern in plasma of MCI for potential biomarkers. MCI (N= 50) and healthy controls (HC, N = 50) age group 55-75years were screened based on Mini Mental State Examination Test (MMSE) and diffusion tensor imaging (DTI imaging). The MMSE score of MCI was significantly lower (25.74 ± 1.83) compared to healthy control subjects (29 ± 1). The MCI patients exhibit significant changes in white matter integrity in the right frontal lobe, right temporal lobe, left frontal lobe, forcep major, fornix, corpus callosum. Further, the plasma samples of twenty seven MCI patients (N= 27) and twenty HC subjects (N= 20; having no significant differences in any demographics) were analyzed using 1H NMR based metabolomics approach. Consistent with many previous reports, the levels of several plasma metabolites were found to be elevated in MCI patients compared to healthy controls. Further univariate and multivariate ROC curve analyses provided three plasma metabolites as a diagnostic panel of biomarker for MCI; which are lysine, glycine, and glutamine. Overall, the results of this study will help to improve the diagnostic and prognostic strategies of MCI in addition to improving our understanding about disease pathogenesis. We believe that the over-nutritional metabolic phenotype of MCI needs to be targeted for developing future dietary interventions so that the progression of MCI can be limited. Metabolic derangements associated with Mild Cognitive Impairment.

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 Status and Cognitive Performance of Post Stroke Patients

Background: The prevalence of post-stroke cognitive impairment (PSCI) ranges from 20-80%. Some studies found that vitamin D deficiency was common in stroke patients, yet the relationship with cognitive performance remains unclear. The study aimed to investigate the relationship between levels of vitamin D and cognitive performance in post-stroke patients.Materials and Methods: This was a cross-sectional study with 20 post-ischemic stroke patients. Vitamin D levels were measured using enzyme-linked fluorescent assay (ELFA). The cognitive performance was assessed by computerized mini-mental state examination (MMSE) and clock drawing test (CDT). The relationship between vitamin D levels and cognitive tests were performed using paired T-test.Results: Vitamin D insufficiency (&lt;30 ng/mL) was experienced by all of the study subjects (100%), with the mean±SD of vitamin D level was 13.75±4.06 ng/mL. More than 70% subjects had cognitive impairment. Based on MMSE, patients with cognitive impairment had lower vitamin D levels, compared with those patients with normal cognition (13±4.38 vs. 16±2.44 ng/mL, p&lt;0.001). In CDT examination, patients with cognitive impairment had slightly higher vitamin D levels, compared with those patients with normal cognition (13.93±4.25 vs. 13.33±3.93 ng/mL, p&lt;0.001).Conclusion: The insufficiency of vitamin D on post-ischemic stroke patients appears to generate a bigger chance of PSCI occurrence. Physicians should be aware of vitamin D status of post-stroke patients, especially in the older population.Keywords: vitamin D levels, post-stroke cognitive impairment, risk factors

External carotid artery stenting in patients with ipsilateral internal carotid artery occlusion: Peri-operative and 12-month follow-up.

This study aimed to evaluate the safety and clinical efficacy of external carotid artery (ECA) stenting in patients with ipsilateral internal carotid artery (ICA) occlusion. In patients with ICA occlusion, severe ipsilateral ECA stenosis may exacerbate pre-existing cerebral ischemia and cognitive impairment. It remains unclear whether ECA stenting to normalize ECA collaterals to the cerebralis alleviates cerebral ischemia and improves cognitive function. From January 2008 to June 2019, we retrospectively collected clinical data of 36 consecutive patients with ipsilateral ICA occlusion who had undergone ECA stenting (mean age, 66.7 ± 8.3 years; males, n = 26 [72.2%]). Neurocognitive test results, including Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA) tests, symptom assessment, and adverse events were recorded. ECA stenting was successful in all 36 patients. Intra-operatively, six (16.7%) patients experienced hemodynamic depression during balloon dilation and recovered completely within 2 days. Within a 12-month follow-up period, two patients experienced a transient ischemic attack, one patient had a contralateral minor stroke, and 33 patients remained asymptomatic. No other adverse events occurred in the peri-operative or follow-up periods. Compared with baseline, significant MMSE (25.3 ± 1.3 vs. 23.6 ± 1.7; p < .05) and MOCA (24.1 ± 1.3 vs. 22.8 ± 1.7; p < .05) test score improvements were observed 3 months post-operatively and were maintained throughout follow-up. ECA stenting may improve cerebral ischemia and cognitive function in patients with severe ECA stenosis and ipsilateral ICA occlusion; however, further research is required to support our findings.

Abstract PS9-71: The effect of using adjuvant aromatase inhibitors on cognitive functions in postmenopausal women with hormone receptor-positive breast cancer

Abstract Background:Aromatase inhibitors (AIs) are used for the adjuvant treatment of early breast cancer. Although generally well-tolerated, they have some adverse effects. Because of AIs are used long term in adjuvant treatment, side effects are also very important. Preclinical and a little clinic data indicate that estrogens exert neurotrophic and neuroprotective actions in the brain. So estrogen appears to play an important role in cognitive function and memory. We know that AIs reduce circulating estrogen to very low levels. For this reason, there has been concern that these agents may have a negative effect on cognitive functions. However, this situation is still unclear. The purpose of our study is to evaluate the relationship between duration of treatment and cognitive functions in patients with breast cancer who use AIs in adjuvant therapy. Methods:Patients diagnosed with breast cancer who use AIs as adjuvant treatment and followed up at the Akdeniz University Medical Oncology Clinic were included. The patients were surveyed for demographic characteristics. Montreal Cognitive Assessment (MoCA) and Standardized Mini-Mental State Examination (SMMT) tests were applied to patients by the same investigator to evaluate their cognitive functions. The total scores of the tests and the orientation, naming, short-time memory, visuospatial functions-executive functions, attention, abstract thinking, language which are the MoCA subscales were evaluated separately. In the Turkish population, the normal range of the MoCA and SMMT tests are 21-30 points and 24-30 points, respectively. Patients were grouped as 0-6, 6-12, 12-24, 24-36, 36 and more months according to the duration of AIs using time. 200 patient’s data were analyzed with SPSS package program. This study was approved by the Akdeniz University Faculty of Medicine Clinical Research Ethnics Committee and was conducted in accordance with declaration of Helsinki. Results:The median follow-up time was 55.5 months. The median duration of AIs treatment was 36.5 months. The mean age of patients was 61.3 years-old. There was no relationship between duration of treatment and MoCA and SMMT scores which indicates cognitive functions (p&amp;gt;0.05). In addition, no statistically relationship was found in the evaluation of MoCA subscales (p&amp;gt;0.05). As expected, the total MoCA and SMMT scores were affected by factors such as age, education level, and employment status. Interestingly, although it was not our main purpose, a causal relationship between the presence of hypertension and cognitive decline was shown in our study (p: 0.004). A statistically strong correlation was found between the MoCA and SMMT scores. So, our data are reliable. The duration of treatment with AIs and MoCA and SMMT scores of the patients were given in Table 1. Conclusions:As a result, despite conflicting results in the literature, we showed with 200 patients that adjuvant treatment with AIs does not affect cognitive functions in post-menopausal hormone receptor-positive breast cancer patients. Table 1: Relationship between the duration of treatment with AIs and MoCA and SMMT scoresDuration of AInMoCA*Mean±SDMoCAMed (min-max)SMMT**Mean±SDSMMTMed (min-max)0-6 m2319,7±5,221 (10-26)25±425 (15-30)6-12 m2420,7±5,421,5 (8-28)24,7±3,624 (16-30)12-24 m1418,2±4,118,5 (13-27)24,3±425 (13-29)24-36 m2920,3±4,920 (11-29)24,1±3,225 (17-30)36 m and more11020,3±4,521 (8-29)25±3,225 (14-30)Total20020.1±4,721 (8-29)24,8±3,425 (13-30)AI: Aromatase inhibitors, m: Mounths, n: Number, MoCA: Montreal Cognitive Assessment, SMMT: Standardized Mini-Mental State Examination, SD: Standart Deviation, Med: Median*p: 0.550 **p:0.533 Citation Format: Rukiye Guler Ilhan, Yusuf Ilhan, Sema Sezgin Goksu, Ali Murat Tatli, Hasan Senol Coskun. The effect of using adjuvant aromatase inhibitors on cognitive functions in postmenopausal women with hormone receptor-positive breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-71.