MMSE Total Score Research Articles

Use of Potentially Harmful Medications and Health-Related Quality of Life among People with Dementia Living in Residential Aged Care Facilities

Background: Use of potentially harmful medications (PHMs) is common in people with dementia living in Residential Aged Care Facilities (RACFs) and increases the risk of adverse health outcomes. Debate persists as to how PHM use and its association with quality of life should be measured. We designed this study to determine the association of exposure to PHM, operationalized by three different measures, with self-reported Health-Related Quality of Life among people with dementia residing in RACFs. Methods: Cross-sectional study of 351 people aged >65 years diagnosed with dementia residing in RACFs and with MMSE ≤24. The primary outcome measure was the self-rated Quality of Life – Alzheimer’s disease questionnaire (QoL-AD). We collected data on patients’ medications, age, gender, MMSE total score, Neuropsychiatric Inventory total score, and comorbidities. Using regression analyses, we calculated crude and adjusted mean differences between groups exposed and not exposed to PHM according to potentially inappropriate medications (PIMs; identified by Modified Beers criteria), Drug Burden Index (DBI) >0 and polypharmacy (i.e. ≥5 medications). Results: Of 226 participants able to rate their QoL-AD, 56.41% were exposed to at least one PIM, 82.05% to medication contributing to DBI >0, and 91.74% to polypharmacy. Exposure to PIMs was not associated with self-reported QoL-AD ratings, while exposure to DBI >0 and polypharmacy were (also after adjustment); exposure to DBI >0 tripled the odds of lower QoL-AD ratings. Conclusion: Exposure to PHM, as identified by DBI >0 and by polypharmacy (i.e. ≥5 medications), but not by PIMs (Modified Beers criteria), is inversely associated with self-reported health-related quality of life for people with dementia living in RACFs.

The Erlangen Instrument of Alternating Word Fluency in Dementia (EAWF-D)

The Erlangen Instrument of Alternating Word Fluency in Dementia (EAWF-D) is a new alternating word fluency task that combines set-shifting and semantic word fluency based on psycholinguistic theory that the ability to switch between two different semantic categories should already be impaired in beginning dementia. N = 138 (58.7% female; age: M = 73.9; SD = 7.03) outpatients of a memory clinic were diagnosed according to the ICD-10 criteria: subjective memory complainers (N = 60), mild cognitive impairment (N = 37), and mild to moderate dementia (N = 41). An analysis of variance of the EAWF-D revealed a significant main effect of diagnosis (F(2, 135) = 46.7; p < .001; η² = .41). The EAWF-D score correlates significantly with the MMSE total score (r = .54, p < .001) as well as with MMSE subscores “Orientation” (r = .41, p < .001) and “Recall” (r = .53, p < .001). Ordinal logistic regression analysis confirmed the potential for diagnosis of beginning dementia.

P01-105 Saccadic eye movements in dementia, major depression and healthy controls - relationship with cognitive functions

We compared horizontal saccadic eye movements in patients with dementia (n=18), and age-matched patients with major depression (n=18) or healthy controls (n=18). Cognitive functions were evaluated using Mini-Mental-State-Examination (MMSE) and ADAS-cog.Results:Saccadic latency and number of saccadic intrusions were significantly (p< 0.001) higher in patients with dementia relative to healthy controls and depressed patients. There were significant correlations between MMSE total score and latency (r = -0.78, p< 0.01) or number of saccadic intrusions (r = -0.80, p< 0.001) in the demential group. In addition, both saccadic parameters were significantly associated with ADAS-cog total score of patients with dementia, whereas the subscale “orientation” showed the strongest correlation with latency (r = 0.71, p< 0.01) and intrusions (r = 0.74, p< 0.01).There were no significant differences in saccadic eye movements between healthy controls and patients with major depression as a whole, or a subgroup of depressed patients with the worst cognitive performance (n=9).Conclusions:It seems that disturbances in horizontal saccadic eye movements in patients with dementia are related to the degree of cognitive deficits in these patients. On the other hand, the lack of alterations in horizontal saccadic eye movements in depressed patients despite poor cognitive performance indicates different mechanism.

PW08-01 Saccadic eye movements in dementia, major depression and healthy controls - relationship with cognitive functions

We compared horizontal saccadic eye movements in patients with dementia (n=18), and age-matched patients with major depression (n=18) or healthy controls (n=18). Cognitive functions were evaluated using Mini-Mental-State-Examination (MMSE) and ADAS-cog.Results:Saccadic latency and number of saccadic intrusions were significantly (p< 0.001) higher in patients with dementia relative to healthy controls and depressed patients. There were significant correlations between MMSE total score and latency (r = -0.78, p< 0.01) or number of saccadic intrusions (r = -0.80, p< 0.001) in the demential group. In addition, both saccadic parameters were significantly associated with ADAS-cog total score of patients with dementia, whereas the subscale “orientation” showed the strongest correlation with latency (r = 0.71, p< 0.01) and intrusions (r = 0.74, p< 0.01).There were no significant differences in saccadic eye movements between healthy controls and patients with major depression as a whole, or a subgroup of depressed patients with the worst cognitive performance (n=9).Conclusions:It seems that disturbances in horizontal saccadic eye movements in patients with dementia are related to the degree of cognitive deficits in these patients. On the other hand, the lack of alterations in horizontal saccadic eye movements in depressed patients despite poor cognitive performance indicates different mechanism.

Predictability of clinical assessments for driving performance

ProblemAs the number of older drivers grows, it is increasingly important to accurately identify at-risk drivers. This study tested clinical assessments predictive of real-time driving performance. MethodSelected assessment tools considered important in the identification of at-risk older drivers represented the domains of vision, cognition, motor performance, and driving knowledge. Participants were administered the battery of assessments followed by an on-road test. A univariate analysis was conducted to identify significant factors (<.05) to be included in a multivariate regression model. ResultsAssessments identified as independently associated with driving performance in the regression model included: FACTTM Contrast sensitivity slide-B, Rapid Pace Walk, UFOV® rating, and MMSE total score. DiscussionThe domains of vision, cognitive, and motor performance were represented in the predictive model. SummaryDue to the dynamic nature of the driving task, it is not likely that a single assessment tool will identify at risk drivers. Impact on IndustryBy standardizing the selection of clinical assessments used in driving evaluations, practitioners should be able to provide services more efficiently, more objectively, and more accurately to identify at-risk drivers.

Brain perfusion effects of cholinesterase inhibitors in Parkinson’s disease with dementia

Several evidences suggest that cholinergic deficits may significantly contribute to dementia in Parkinson's disease (PDD) and acetylcholinesterase inhibitors (ChEIs) have been reported to improve cognitive symptoms in PDD, without worsening parkinsonism. Nineteen PDD patients underwent brain perfusion SPECT with (99m)Tc-ethyl cysteinate dimer after 6 months ChEIs treatment in order to evaluate the functional correlates of clinical improvement. A clear-cut cognitive improvement was reported in PDD patients with a significant improvement of ADAS-cog total score as well as of subscores exploring executive functions (p<0.01). MMSE total score did not significantly change after ChEIs but the subscore of attention significantly improved after therapy (p<0.01). No difference in motor performance as evaluated by UPDRS was reported. SPM analysis showed a significant increase of perfusion (p < 0.0001) in bilateral cingulate, and frontal regions after ChEIs. Our data confirm the efficacy of ChEIs in the treatment of dementia associated with PD mainly on attention and executive functions, and the functional findings indicate that this cognitive improvement could be associated with a sort of pharmacological frontal "re-afferentation".

Effects of memantine on behavioural symptoms in Alzheimer's disease patients: an analysis of the Neuropsychiatric Inventory (NPI) data of two randomised, controlled studies

Behavioural symptoms are common in moderate to severe Alzheimer's disease (AD). We have analysed the databases of two randomised studies with regard to the effects of memantine treatment on behavioural symptoms, measured using the 12-item version of the Neuropsychiatric Inventory (NPI). The monotherapy study (memantine only) reported by Reisberg et al. (2003) involved 252 patients with baseline MMSE total score of between 3 and 14, whereas the combination study (memantine and donepezil) reported by Tariot et al. (2004) comprised 404 patients with MMSE scores of between 5 and 14. In both studies, patients received 10 mg memantine b.i.d. or matching placebo, and lived in the community. For both studies NPI total and individual domains scores were analysed in the ITT population. For the monotherapy study a dichotomised analysis was performed separately for patients who had behavioural symptoms at baseline and for those without pre-existing symptoms. Furthermore, a factor analysis was used to identify any behavioural clusters within the patient population. In both studies, the change in NPI total scores at endpoint was consistently in favour of memantine treatment, reaching statistical significance in the combination study (p = 0.002). Memantine treatment showed a significant beneficial effect in comparison to placebo treatment in the NPI agitation/aggression domain in both studies (p = 0.008; p = 0.001). The dichotomised analysis of the monotherapy study showed that there was significantly less agitation/aggression emerging in the memantine-treated group compared to placebo (p = 0.003). Factor analysis showed that hyperactivity accounted for 27% of the data variance. Memantine has a beneficial effect on the behavioural symptoms of patients with moderate to severe AD, with the most pronounced effect on agitation/aggression.

Nimodipine in the Treatment of Probable Alzheimerʼs Disease

The results of both in vitro and animal studies suggest that calcium dysregulation plays an important role in neuronal cell degeneration, and thus support the use of calcium antagonists for the treatment of Alzheimer’s disease (AD). The aim of this pooled analysis of 2 multicentre randomised trials was to assess the efficacy and tolerability of nimodipine administered for 6 months in a total of 1648 patients with probable AD. There were no statistically significant differences between nimodipine and placebo for any of the primary outcome variables. However, significant improvements in the secondary variable, Mini Mental State Examination (MMSE; p = 0.004) score, compared with the placebo group, were noted when the individual study data were pooled. Differences favouring nimodipine also emerged when patients were stratified according to their baseline MMSE scores. In more severely impaired patients (MMSE scores 12 to 18), nimodipine 180 mg/day was significantly superior to placebo for Alzheimer’s Disease Assessment Scale (ADAS) total (p = 0.01) and cognitive (p = 0.035) scores as well as MMSE total score (p = 0.006). Secondary analyses of these data indicated that patients with more severe cognitive disturbances, yet able to recall ≥ 1 word twice in succession (BSR test), demonstrated the greatest response to nimodipine 180 mg/day treatment. Nimodipine was well tolerated when administered at either 90 or 180 mg/day.