Mini-Mental State Examination Total Score Research Articles

Cognitive dysfunction and the 25-item National Eye Institute Visual Function Questionnaire.

Visual function and cognitive impairment are interrelated; however, little is known about the impact of modifying treatable vision impairment on the development of cognitive dysfunction. This study examines the relationship between cognition and self-reported visual function using the National Eye Institute's Visual Function Questionnaire (NEI VFQ). Participants completed the NEI VFQ 25-Item questionnaire as well as the Mini-Mental State Examination (MMSE). Additionally, all participants were assigned a consensus clinical diagnosis based on established criteria. We used a general linear model and analysis of variance approach to compare means between multiple groups. A significant association between overall composite score on the NEI VFQ and total MMSE score was revealed (P = 0.04). On average, for every 1-point increase in MMSE score, the overall composite score increased by 0.40 units (95% confidence interval: 0.03-0.77). Reduced visual function should raise concerns about cognitive decline and prompt additional assessment.

Effects of novel Cognitive Stimulating Activities (CSAs) on cognition and depression: A 5‐year pragmatic and naturalistic study

AbstractBackgroundAccumulating epidemiological evidence suggest that cognitive stimulating activities (CSAs) improve cognition in older adults. However, there is a lack of longitudinal naturalistic follow‐up studies supporting the effectiveness of CSAs, particularly in a real‐world setting. Whether baseline cognitive status affects cognitive outcomes, and whether a higher involvement in CSAs elicits greater improvements are unknown. We aimed to investigate a novel multimodal CSA intervention to prevent cognitive decline amongst community‐dwelling older adults.MethodFrom the Singapore Longitudinal Diet and Healthy Aging (DaHA) study (n=991, aged ≥60), 264 subjects were assigned to the novel multimodal CSAs controlled trials (mindfulness intervention, horticultural therapy, arts and music reminiscence therapy, and choral singing). The other participants not involved in the CSAs (n=727) served as the control group. At the DaHA cohort’s 5‐year follow‐up, we examined the effects of CSAs on cognitive function. The primary outcomes were changes in global cognition measured by the mini‐mental state examination (MMSE) and its domain scores. Intention‐to‐treat analysis was performed utilizing a linear mixed model. We also conducted sub‐group analyses stratified by baseline cognitive status and the number of CSAs involved.ResultCompared to the control group, although non‐significant, there was an improvement in the CSA group after five years based on the total MMSE score (β =0.108, 95% CI= ‐0.022 to 0.239, P =0.104). Notably, there was a significant improvement in MMSE‐immediate recall score domain (β = 0.199, 95% CI = 0.048 to 0.351, P = 0.010). Sub‐group analyses showed that older adults with MCI and those involved in more CSAs had greater improvements in total MMSE and selective domain scores after 5 years, with effect sizes of Cohen’s D=0.42.ConclusionAlthough global cognition was not significantly improved, the multimodal CSA intervention showed significant improvements in the scores of working memory domain, possibly, highlighting the high malleability of this cognitive domain. Furthermore, moderate effect sizes of improvements observed in the MCI sub‐group and those involved in more CSAs suggesting that these individuals could gain greater long‐term benefits participating in CSAs. From a public health perspective, these sustained improvements in cognitive functions over five years’ time could potentially delay or prevent dementia.

Episodic long-term memory in post-infectious SARS-CoV-2 patients.

BackgroundEpisodic long-term memory (LTM) difficulties/deficits are frequent in COVID-19-recovered patients and negatively impact on prognosis and outcome. However, little is known about their semiology and prevalence, also being still debated whether they arise from primary amnesic features or are secondary to dysexecutive/inattentive processes and disease-related/premorbid status. Hence, this study aimed at (1) assessing LTM functioning in post-infectious SARS-CoV-2 patients by accounting for premorbid and disease-related confounders and (2) exploring its cognitive etiology.MethodsMeasures of global cognition (Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA)) and LTM (Babcock Memory Test (BMT)) of fifty-four COVID-19-recovered patients were retrospectively collected. Patients were subdivided into those being already at risk or not for cognitive decline (RCD + ; RCD −). Cognitive measures were converted into equivalent scores (ESs).ResultsLTM sub-clinical/clinical deficits (ESs = 0/1) were mildly-to-moderately prevalent in both RCD + (MoCA-Memory, 31.8%; BMT, 31.8%) and RCD − (MoCA-Memory, 28.6%; BMT, 39.3%) patients. MMSE and MoCA total scores, but not the MoCA-Attention subtest, were associated with the BMT. RCD + asymptomatic patients performed better on the BMT (p = .033) than those requiring O2 therapy (but not ventilation).DiscussionCOVID-19-recovered individuals might show LTM deficits of both primary and secondary etiology and should be thus screened for them, especially those having suffered mid-to-moderate COVID-19 and those already being at risk for cognitive decline. Both I- and II-level measures of verbal LTM can be adopted, although the former might be more sensitive.

Characteristics of behavioral symptoms in right-sided predominant semantic dementia and their impact on caregiver burden: a cross-sectional study

BackgroundThis study aimed to clarify the neuropsychiatric symptoms of right-sided predominant semantic dementia (SD-R) by comparing them with those of behavioral variant frontotemporal dementia (bvFTD), left-sided predominant SD (SD-L), and Alzheimer’s disease (AD). This study also aimed to identify clinical factors related to caregiver burden for bvFTD, SD-R, and SD-L.MethodsThe neuropsychiatric symptoms of 28 patients with bvFTD, 14 patients with SD-R, 24 patients with SD-L, and 43 patients with AD were evaluated using the Neuropsychiatric Inventory (NPI) and the Stereotypy Rating Inventory (SRI). Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Dementia severity was assessed using the Clinical Dementia Rating. Activities of daily living were assessed using the Lawton Instrument Activities of Daily Living (IADL) scale and the Physical Self-Maintenance Scale. We compared the NPI and SRI scores among the four groups using the Kruskal-Wallis test. In addition, clinical factors related to caregiver burden, represented by the Japanese version of the Zarit Burden Interview (J-ZBI), were analyzed using multiple regression analysis in the bvFTD, SD-R, and SD-L groups.ResultsThe NPI total score and the NPI subscale scores of apathy and disinhibition were significantly higher in the bvFTD group than in the SD-L and AD groups. The SD-R group scores were closer to those of the bvFTD group than the SD-L group. The SRI total score and SRI subscale scores for eating and cooking and speaking were significantly higher in the bvFTD, SD-R, and SD-L groups than in the AD group. The NPI total score was significantly associated with the J-ZBI score in the bvFTD group. The NPI total score and Lawton IADL scale score were independently associated with the J-ZBI score in the SD-R group. Furthermore, the NPI total score and MMSE score were independently associated with the J-ZBI score in the SD-L group.ConclusionsSD-R seemed to be a similar condition to bvFTD rather than SD-L regarding behavioral symptoms. Our results suggest that each frontotemporal dementia subgroup requires different approaches to reduce the caregiver burden.

Effect of early acupuncture on cognitive function in patients with vascular dementia after cerebral infarction

To observe the clinical efficacy of early acupuncture for vascular dementia (VD) after cerebral infarction, and explore its possible mechanism. A total of 120 patients with VD after cerebral infarction were randomized into an acupuncture combined with medication group (60 cases, 1 case dropped off) and a western medication group (60 cases, 1 case dropped off). In the western medication group, oxiracetam capsules were given orally, 2 capsules each time, 3 times a day. On the basis of the treatment as the western medication group, Bupi Peiyuan Yizhi acupuncture was applied at Baihui (GV 20), Sishencong (EX-HN 1), Zhongwan (CV 12), Wailing (ST 26), Xiawan (CV 10), Qihai (CV 6), Guanyuan (CV 4), etc. in the acupuncture combined with medication group, 30 min each time, once a day, 5 days a week. The treatment was given 8 weeks in both groups. Before and after treatment，the scores of mini-mental state examination (MMSE), Alzheimer's disease assessment scale cognitive part (ADAS-Cog), clock drawing test (CDT), Barthel index were observed, blood flow velocity of middle cerebral artery (MCA) was detected, and the clinical efficacy was evaluated in the two groups. The total effective rate was 89.8% (53/59) in the acupuncture combined with medication group, which was superior to 76.3% (45/59) in the western medication group (P<0.01). Compared before treatment, the subitem scores and total scores of MMSE, ADAS-Cog score, CDT score and Barthel index score after treatment were improved in the two groups (P<0.01, P<0.05), and the scores in the acupuncture combined with medication group were superior to those in the western medication group (P<0.05, P<0.01). After treatment, the blood flow velocity of bilateral MCA was increased in the acupuncture combined with medication group (P<0.05), which was faster than the western medication group (P<0.05). Early acupuncture could improve cognitive function and activities of daily living in patients with VD after cerebral infarction, its mechanism may be related to improving the blood flow velocity of MCA, promoting blood circulation, and improving cerebral perfusion.

The cognitive dysfunction related to Alzheimer disease or cerebral small vessel disease: What's the differences.

Alzheimer disease (AD) and sporadic cerebral small vessel disease (CSVD) are common cognitive disorders. Both AD and CSVD have mental symptoms including chronic progressive cognitive impairment, dysfunction, and behavioral abnormalities. However, the differences on the cognitive dysfunction of AD and CSVD remain unclear. It is necessary to elucidate the cognitive dysfunction differences of AD and CSVD, and to identify the potential risk factors.AD or sporadic CSVD patients treated in our hospital from December 1, 2018 to May 31, 2019 were included. And we selected healthy participants as controls. The mini-mental state examination and Montreal Cognitive Assessment Scale were used for neuropsychological assessment, and related medical information were collected and compared.A total of 190 patients were included. The total mini-mental state examination scores in AD, CSVD group were significantly less than that of control group, there were significant differences in the domains of directional ability, attention and computing ability, delayed recall, and visual perception (all P < .05); the total Montreal Cognitive Assessment Scale scores in AD, CSVD group were significantly less than that of control group. There were significant differences in the domains of visual space and execution, immediate remember, attention and computing ability, language, delayed recall, and directional ability (all P < .05); diabetes was a risk factor both for AD (hazard ratio = 1.63, 95% confidence interval: 1.35–1.97) and CSVD (hazard ratio = 1.15, 95% confidence interval: 1.08–1.27).The cognitive dysfunctions of AD are difference to that of CSVD patients, and diabetes is the risk factor both for AD and CSVD, future studies are needed to further identify the prevention and treatment of AD and CSVD.

Altered cerebral perfusion and microstructure in advanced Parkinson’s disease and their associations with clinical features

ABSTRACT Objective To explore the whole cerebral perfusion and microstructure alteration patterns in Parkinson’s disease (PD) and the associations of these patterns with clinical features. Methods Forty-one subjects [20 PD patients and 21 healthy controls (HCs)] underwent arterial spin labeling (ASL), diffusion tensor imaging (DTI) and 3D T1-weighted imaging (T1WI) MRI. The cerebral blood flow (CBF) of the whole brain and the fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD) of subcortical and cerebellar regions were measured and compared between groups. Pearson’s correlation was calculated between MRI measurements and clinical features [Unified Parkinson’s Disease Rating Scale (UPDRS), UPDRS III, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and olfactory test scores]. Results Compared to HCs, PD patients showed lower CBF in the frontal, parietal and temporal lobes but higher CBF in bilateral hippocampi, red nuclei, right substantia nigra, thalamus and most cerebellar regions. The MD in the right thalamus and several regions in the cerebellum increased in PD compared to HCs. In PD patients, the total UPDRS, UPDRS III, MoCA, MMSE and olfactory test scores were related to FA or CBF in cerebellum. (all p < 0.05) Conclusion Hypoperfusion in cortical regions, together with hyperperfusion in subcortical and cerebellar regions may be the characteristic perfusion pattern in advanced PD patients. The microstructures of the right thalamus and cerebellum were changed in PD patients. The cognitive, motor and olfactory performance of PD patients is closely related to the perfusion and microstructure of the brain, especially the cerebellum.

Precision Repetitive Transcranial Magnetic Stimulation Over the Left Parietal Cortex Improves Memory in Alzheimer's Disease: A Randomized, Double-Blind, Sham-Controlled Study.

ObjectiveWe aim to study the effect of precision repetitive transcranial magnetic stimulation (rTMS) over the left parietal cortex on the memory and cognitive function in Alzheimer’s disease (AD).MethodsBased on the resting-state functional magnetic resonance imaging, the left parietal cortex site with the highest functional connectivity to the hippocampus was selected as the target of rTMS treatment. Sixty-nine AD patients were randomized to either rTMS or sham treatment (five sessions/week for a total of 10 sessions). The Mini-Mental State Examination (MMSE), 12-Word Philadelphia Verbal Learning Test (PVLT), and Clinical Dementia Rating (CDR) were assessed at baseline and after the last session.ResultsAfter a 2-week treatment, compared to patients in the sham group, those in the rTMS group scored significantly higher on PVLT total score and its immediate recall subscale score. Moreover, in the rTMS group, there were significant improvements after the 2-week treatment, which were manifested in MMSE total score and its time orientation and recall subscale scores, as well as PVLT total score and its immediate recall and short delay recall subscale scores. In the sham group, the PVLT total score was significantly improved.ConclusionThe target site of the left parietal cortex can improve AD patients’ cognitive function, especially memory, providing a potential therapy.

Impact of chemotherapy on cognitive functioning in older patients with HER2-positive breast cancer: a sub-study in the RESPECT trial.

To investigate whether postoperative adjuvant trastuzumab plus chemotherapy negatively affected cognitive functioning during the post-chemotherapy period compared with trastuzumab monotherapy in older patients with HER2-positive breast cancer. In the randomized RESPECT trial, women aged between 70 and 80years with HER2-positive, stage I to IIIA invasive breast cancer who underwent curative operation were randomly assigned to receive either 1-year trastuzumab monotherapy or 1-year trastuzumab plus chemotherapy. Cognitive functioning was assessed using the Mini-Mental State Examination (MMSE) test at enrollment and 1 and 3years after initiation of the protocol treatment. The primary outcome was change in the MMSE total score from baseline. Secondary outcomes included prevalence of suspected mild cognitive impairment (MMSE total score < 28) and suspected dementia (MMSE total score < 24). The analytical population consisted of 29 and 26 patients in the trastuzumab monotherapy and trastuzumab plus chemotherapy groups, respectively. The group differences in mean changes of the MMSE total score were 0.6 (95% confidence interval [CI] - 0.3 to 1.6) at 1year and 0.9 (95% CI - 1.0 to 2.8) at 3years (P = 0.136 for the group difference pooling the two visits). The prevalence of suspected mild cognitive impairment at 3years was 41.7% in the trastuzumab monotherapy group and 28.6% in the trastuzumab plus chemotherapy group (P = 0.548). This randomized sub-study did not show worse cognitive functioning during the post-chemotherapy period with trastuzumab plus chemotherapy than with trastuzumab monotherapy in older patients with HER2-positive breast cancer. NCT01104935 (first posted April 16, 2010).

Dietary patterns and cognitive function in older adults residing in rural China.

Research has produced inconsistent findings on the association between dietary patterns and cognitive function. In the present study, we examined the association between dietary patterns and cognitive function among rural China's older adults and aimed to identify major dietary patterns. This cross-sectional study included 1176 individuals aged 65-85 years. Dietary intake was assessed using a food frequency questionnaire. Factor analysis and the Chinese Dietary Balance Index were respectively employed to determine dietary patterns and assess dietary quality. Cognitive function was evaluated using the Mini-Mental State Examination, and logistic regression analysis was performed to examine the relationship between dietary patterns and cognitive decline. Three main dietary patterns were identified and named on the basis of foods with high content: a "healthy dietary pattern," a "multigrain dietary pattern," and a "snack dietary pattern." With the increase in the score of the healthy dietary pattern, the Mini-Mental State Examination total score exhibited a significant downward trend (p<0.001). Moreover, we observed a prominent negative association between the healthy dietary pattern and mild cognitive impairment (4th to 1st quartile, OR=0.36; 95%CI, 0.24-0.54; p<0.001). After we adjusted for potential covariates, the negative correlation remained (4th to 1st quartile, OR=0.48; 95%CI, 0.28-0.81; p=0.006). However, no relation was observed between mild cognitive impairment and either the multigrain or snack dietary patterns. The healthy dietary pattern, which is based on the consumption of rice and flour, red meat, chicken, vegetables, seafood, and fruits, protects against cognitive dysfunction.

Linking the Mini-Mental State Examination, the Alzheimer’s Disease Assessment Scale–Cognitive Subscale and the Severe Impairment Battery: evidence from individual participant data from five randomised clinical trials of donepezil

BackgroundThe Mini-Mental State Examination (MMSE), the Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog) and the Severe Impairment Battery (SIB) are widely used rating scales to assess cognition in Alzheimer’s disease.ObjectiveTo understand...

Correlation between sleep characteristics and cognitive decline in the elderly people: A cross-sectional study in China.

In this study, we conducted a cross-sectional analysis of the sleep characteristics in the elderly Chinese people to comprehensively investigate the association between sleep and cognitive function in the elderly people. We aimed to evaluate the most important demographic factors, conventional physiological indices and living habits that may influence sleep. We surveyed 2901 elderly people (age ≥60years old) face-to-face from 1 July to 31 December 2017, who were recruited from 17 communities of the Pudong New Area (Shanghai, China) by probability proportional to size. The Pittsburgh sleep quality index (PSQI) scale was used to describe the sleep features of each participant. Cognitive assessment was performed using the mini-mental state examination (MMSE) scale, Montreal cognitive assessment (MoCA) and the clinical dementia rating (CDR) scale. Those factors which potentially influence sleep and consequentially may impact cognition in the elderly people were evaluated, and the correlations of sleep characteristics and cognitive function were explored by the linear regression analysis. Altogether, there were 1287 (44.4%) people taking part in the investigation. Sleep quality was significantly correlated with MMSE and MoCA total scores. Healthy sleep (especially enough sleep) was correlated with better cognitive functions. Besides recognised relative factors (such as age, sex and living alone), the number of children was found to be a strong risk factor of poor sleep. Anxiety before sleep and light/noise interference significantly damaged sleep while an exercise routine was associated with better sleep. Moderate levels of reading, watching TV and household work were correlated with superior sleep quality. In conclusion, sleep characteristics correlate with cognitive decline in the elderly people, and they can be influenced by multiple demographic factors and living habits. To improve sleep quality, it may be important to change sleep environment, to be relax, to increase physical exercise and recreational activities moderately.

Incidence and Progression of Rapid Eye Movement Behavior Disorder in Early Parkinson's Disease.

BackgroundRapid eye movement (REM) sleep behavior disorder (RBD) is associated with neurodegenerative diseases; however, few longitudinal studies assess the individual evolution of RBD and REM sleep without atonia (RWA) in Parkinson's disease (PD).ObjectivesWe aimed to evaluate RBD and RWA changes over time as well as potentially influential factors.MethodsRBD and RWA were analyzed using video‐supported polysomnography (vPSG) in initially de novo PD patients at baseline and every 2 years for a total of 6 years. The influence of time, age, sex, levodopa equivalent daily dose (LEDD), unified Parkinson's disease rating scale (UPDRS) sum scores, benzodiazepine intake, Mini‐Mental State Examination (MMSE) total scores, and dyskinesia on RWA were investigated using mixed‐effect models to account for intra‐individual correlations.ResultsAfter 6 years, vPSG data were available from 98 of the initial 159 de novo PD patients. RBD prevalence increased from 25% at baseline to 52%. Of the 31 PD patients with RBD and valid vPSGs at all time‐points, RWA increased from an average of 19% at baseline to 41% at 6‐year follow‐up modeled to grow by 29.7% every 2 years (P < 0.001). Time was an independent factor (P < 0.001) for RWA increase. Age was an independent factor influencing RWA increase (P = 0.04). Sex, LEDD, UPDRS sum scores, benzodiazepines, MMSE total scores, and dyskinesia did not have any significant influence.ConclusionsRBD and RWA increased significantly over time in PD; time and age were independent factors in a prospective cohort. RBD and RWA can be considered PD progression markers.

Late Menarche, Not Reproductive Period, Is Associated with Poor Cognitive Function in Postmenopausal Women in Taiwan.

Female sex hormones such as estrogen and progesterone play an important role in the regulation of a woman’s body, including cognition and neurogenesis. However, the effects of age at menarche and reproductive period on cognitive function are still controversial. The aim of this study was to investigate the relationships between age at menarche and reproductive period with cognitive impairment. Data were obtained from the Taiwan Biobank. Cognitive function was assessed using the Mini Mental State Examination (MMSE) and its five subdomains. Multivariable linear regression analysis revealed that an old age at menarche (per one year; coefficient β, −0.189; p = 0.020) was significantly associated with a low total MMSE score, whereas reproductive period (p = 0.733) was not significantly associated with total MMSE score. Furthermore, an old age at menarche was significantly associated with low MMSE G2 (registration) (per one year; coefficient β, −0.022; p = 0.035) and G5 (language, construction and obey) scores (per one year; coefficient β, −0.054; p = 0.047). However, age at menarche was not significantly associated with MMSE G1 (orientation), G3 (attention and calculation) and G4 (recall) scores. In addition, reproductive period was not significantly associated with any MMSE subscores. Late menarche was associated with poor cognitive function, including low total MMSE score and low MMSE G2 and G5 scores. However, reproductive period was not associated with cognitive function in postmenopausal women.

Association between biomass fuel use and the risk of cognitive impairment among older populations in China: a population-based cohort study

BackgroundCohort studies on the impact of biomass fuel use for cooking on cognitive impairment among older population are still lacking in China and elsewhere. The aim of this study was to examine whether biomass fuel use for cooking is associated with cognitive impairment in Chinese adults aged 65 years or older.MethodsThe prospective population-based cohort study of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) included participants aged 65 years or older in 2014 who were followed-up until 2018 in 23 provinces in China. The Mini-Mental State Examination (MMSE) was used to assess cognitive function, and cognitive impairment was defined as total MMSE scores less than 18. The association between biomass fuel use and cognitive impairment was evaluated using the Cox proportional hazards model.ResultsOf the 4145 participants included at baseline, participants who reported that they used biomass fuel for cooking (40.43%; IR: 3.11 versus 2.77 per 100 person-years; aHR: 1.27, 95% CI: 1.02–1.58) had a higher risk of cognitive impairment compared with participants who used clean fuels (53.75%). A stratified analyses showed greater effect estimates of cognitive impairment in the older people that lived in the rural areas (aHR: 1.444, 95% CI: 1.08–3.90) and never smoked (aHR: 1.33, 95% CI: 1.04–1.71).ConclusionsThese findings demonstrated that biomass fuel used for cooking was associated with cognitive impairment, as defined by MMSE, in a population-based study of elderly in China. To prevent cognitive impairment, the structure of cooking fuels requires improvements.

The CITIMERIVA Study: CITIcoline plus MEmantina plus RIVAstigmine in Older Patients Affected with Alzheimer's Disease.

Combined therapy of memantine or acetylcholinesterase inhibitors, with cholinergic precursors such as citicoline, can be effective in Alzheimer's disease. Indeed, they are able to increase the intrasynaptic levels of acetylcholine more than the single drug. Our aim was to evaluate the efficacy and safety of oral citicoline plus memantine plus rivastigmine in patients with Alzheimer's disease. This was a multi-centric, retrospective case-control study conducted in Italian Centers for Cognitive Impairment and Dementia on consecutive patients aged 65 years or older affected with Alzheimer's disease. Overall, 104 patients were recruited (27% male, mean age 76.04 ± 4.92 years); 41 (39.42%) treated with citicolin 1000 mg/day given orally + memantine + rivastigmine (Cases) and 63 (60.58%) treated with memantine + rivastigmine (Controls). At baseline (T0), month 6 (T1) and month 12 (T2), cognitive functions were assessed by the Mini Mental State Examination (MMSE), functional dependence by basal Activities (ADL) and Instrumental Activities of Daily Living (IADL), comorbidity by the Cumulative Illness Rating Scale (CIRS), mood by the Geriatric Depression Scale (GDS), and behavioural disturbances by the Neuropsychiatric Inventory (NPI). Adverse events were reported during the study. The difference in MMSE score was not significant when comparing the two groups at T0, T1 or T2. However, in the case group, the MMSE total score showed a statistically significant difference at T0 versus T1 (13.63 ± 2.46 vs. 14.17 ± 2.24; p = 0.008), and at T0 versus T2 (13.63 ± 2.46 vs. 14.32 ± 2.53; p = 0.002). In the control group, no statistical differences were found at baseline (T0), T1 and T2. ADL, IADL, GDS and NPI total score did not improve during the study in either the case or the control group. In our study we observed absence of a statistically significant difference between case and control groups for the MMSE total scores. However, in the case group in the MMSE total scores, there was a statistically significant increase between the baseline and the end of the study.

Association between Regional Cerebral Blood Flow and Mini-Mental State Examination Score in Patients with Alzheimer's Disease.

In patients with Alzheimer's disease (AD), cerebral blood flow (CBF) is decreased from the early stages. CBF in AD is currently estimated from Z-scores using statistical analysis. However, the Z-score is not considered the impaired area ratio. In the present study, a novel indicator, ΣzS, associated with brain surface area and Zscores, is defined and the association with regional CBF has been estimated using Mini-Mental State Examination (MMSE) scores, which indicate the severity of cognitive impairment in patients with AD. A negative correlation was detected between ΣzS in the posterior cingulate gyrus and the subset numbers 1, 2, and 5 of the total MMSE scores. Furthermore, a negative correlation was detected between the total MMSE score and ΣzS in Brodmann area 30, which is a subdivided area of the brain. These results suggest that ΣzS may be a useful indicator of CBF metabolism, and thus may improve the current understanding of cognitive function in patients with AD.

Correlation Between Brain 18F-AV45 and 18F-FDG PET Distribution Characteristics and Cognitive Function in Patients with Mild and Moderate Alzheimer's Disease.

Florbetapir (AV45) and fluorodeoxyglucose (FDG) PET imaging are valuable techniques to detect the amyloid-β (Aβ) load and brain glucose metabolism in patients with Alzheimer's disease (AD). The purpose of this study is to access the characteristics of Aβ load and FDG metabolism in brain for further investigating their relationships with cognitive impairment in AD patients. Twenty-seven patients with AD (average 70.6 years old, N = 13 male, N = 14 female) were enrolled in this study. These AD patients underwent the standard clinical assessment and received detailed imaging examinations of the nervous system by using Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MOCA), 18F-AV45, and 18F-FDG PET scans. Of 27 AD patients, 22 patients (81.5%) showed significantly increases in Aβ load and 26 patients (96.3%) had significantly reductions in FDG metabolism. The moderate AD patients had more brain areas of reduced FDG metabolism and more severe reductions in some regions compared to mild AD patients, with no differences in Aβ load observed. Moreover, the range and degree of reduced FDG metabolism in several regions were positively correlated with the total score of MMSE or MOCA, whereas the range of Aβ load did not. No correlation was found between the range of Aβ load and the range of reduced FDG metabolism in this study. The reduction in FDG metabolisms captured by 18F-FDG imaging can be used as a potential biomarker for AD diagnosis in the future. 18F-AV45 imaging did not present valuable evidence for evaluating AD patient in this study.

Effect of occupational therapy on cognitive functions and occupational performances in hospitalized patients with mental-health disorder: A single-arm interventional study

Background: Cognitive dysfunction, a distressing outcome of mental-health disorders (MHDs), hinders an individual's occupational performance (OP). OP is the outcome of dynamic interaction between a person, their unique environment and occupation. With only pharmacological treatment, symptom reduction was not in pace with the recovery rate of cognitive and OP dysfunction resulting persistence of these dysfunctions even post-hospital discharge. Hence, occupational therapy (OT) intervention before discharge would be required, for patient's functioning at premorbid level postdischarge. However, till date, very few Indian studies on the effect of OT on cognition and OP in individuals with MHDs are done with under-representation of the client population. Objectives: To study the effect of OT on cognitive functions and OP in hospitalized patients with MHDs. Study Design: A single-arm interventional study was conducted. Methods: Based on the selection criteria, 88 patients who were (aged 18–55 years) diagnosed with MHDs and were admitted in the hospital were enrolled after screening during their first visit to OT department using the purposive sampling method. Participants recruited were categorized into diagnostic groups: schizophrenia, neurotic disorders, mood disorders, and alcohol-substance use disorders for data analysis. Patients were assessed on Mini-Mental State Examination (MMSE) and comprehensive OT evaluation (COTE) scale pre- and post-therapy after 3 weeks, i.e. after 6 sessions. Cognitive-OP focused-OT intervention was given twice a week. Results: The descriptive data analysis showed an increase in performance posttherapy for all subtests (except Language-praxis subtest in Group-Neurotic Disorders) and overall scores of both assessments in all the groups. Total MMSE performance both pre- and post-therapy was better than total COTE performance in all the groups. Posttherapy, maximum improvement was observed in Recall among MMSE subtests and in Task-behavior among COTE subtests across all groups. Inferential data analysis showed highly significant improvement posttherapy for total MMSE and total COTE scores (P < 0.01, 95% confidence interval: Groups: schizophrenia [(−3.218, −2.302) and (15.991, 18.329)], neurotic disorders [(−3.169, −1.631) and (13.230, 18.970)], mood disorders [(−3.100, −1.650) and (15.095, 19.155)] and Group: alcohol and substance-use disorders [(−4.210, −1.456) and (17.855, 22.47)] respectively). Conclusion: OT intervention is effective in improving cognitive and OP in hospitalized patients with MHDs.

The role of cognitive functioning in predicting restoration among criminal defendants committed for inpatient restoration of competence to stand trial

In the United States, the due process and equal protection clauses of the 14th Amendment require that criminal defendants found incompetent to stand trial be committed for competency restoration only for such a time considered to be reasonable to achieve this aim. Adherence to these protections requires that forensic clinicians have the capacity to accurately identify defendants unlikely to be restored and to provide evidence-based estimates regarding anticipated restoration timelines. The present study examines restoration rates in a large sample (N = 492) of incompetent male defendants consecutively admitted for inpatient competency restoration between 2013 and 2017. Expanding on prior research suggesting that shared cognitive deficits might underlie impaired competency-related abilities across diverse psychiatric illnesses, the predictive classification accuracy of the Mini Mental State Examination (MMSE) on restoration was examined. Results showed that 90.4% of all defendants were restored in an average of 90.5 days and that restoration rates differed across psychiatric classification, such that patients with mood and psychotic disorders were more likely to be restored whereas those with intellectual disabilities and neurocognitive disorders were less likely. The MMSE was associated with restoration outcomes, such that over 90% of patients with no or mild cognitive impairment were restored compared to 68% of patients with severe cognitive impairment. Multivariable logistic regression showed that each one-point decrease on the MMSE total score was associated with a 19.7% (p < .001) increased odds of restoration failure and the MMSE total score produced an area under the curve (AUC) of 0.767. The MMSE appears to provide a brief, reliable screening instrument to quantify the presence and severity of cognitive impairment underlying a range of serious psychiatric illness that is capable of discriminating defendants based upon their likelihood of being restored in a reasonable amount of time with a moderate degree of accuracy.