Normal Mini-Mental State Examination Research Articles

Quiescent ulcerative colitis and Crohn’s disease have potential effect on cognitive function

BackgroundUlcerative colitis (UC) and Crohn’s disease (CD) imply chronic intestinal inflammation with both local and systemic manifestations. Cognition is a lifelong process of learning and memory processing, which has been identified to be affected by chronic systemic illnesses.AimTo evaluate the cognitive functions in inflammatory bowel disease (IBD) patients in remissionPatients and methodsInclusion criteria are as follows: 70 IBD patients in remission and a group of 50 healthy control. Mini-mental state examination (MMSE) was used for assessment of global cognitive function and Trail Making Test (TMT) for assessment of executive functions. TMT consists of part A which measures attention and performance speed and part B which measures mental flexibility. Both tests have been previously validated on Arabic-speaking populations.ResultsThe study included 70 patients (50 UC and 20 CD), who have been in remission for 21 ± 9 months. Of the included cases, about 51 were already on steroids ± azathioprine, and 19 patients were on biologics. Males represented 60% (n = 42) while females 40% (n = 28), and their mean age was 34 ± 8 years. Both cases and controls were matched for age and sex. The mean score of MMSE among IBD cases was significantly worse than controls (28.5 ± 3 versus 30, P < 0.001). Also, the duration of TMT parts A and B was significantly longer in cases than controls. The cases group scored 32 ± 19.5 s in TMT part A, versus 23 s by the controls. In TMT B, the recorded scores were 255 ± 48, versus 234 s in cases and control groups respectively (P < 0.001). In the cases group, 6 patients (8%) had below normal MMSE score of less than 24, with mild (3 patients, mean score was 21) to moderate cognitive impairment (3 patients, mean score was 15). The presence of extraintestinal manifestation was the only disease-related factor that was associated with cognitive impairment. Of the patient-related factor: older age, being divorced, and living in rural areas were associated with poorer cognitive functions.ConclusionIBD patients potentially suffer from cognitive impairment. In our study, factors as extraintestinal complications, older age, marital status, and residence in rural areas could be contributing factors to this impairment.

Mild cognitive impairment in novel SPG4/SPAST mutation‐related sporadic late onset hereditary spastic paraplegia: case series

AbstractBackgroundMutations and deletions in the SPG4/SPAST gene cause for up to 50% of the autosomal dominant forms of hereditary spastic paraplegia (HSP) and for up to 15% of the sporadic cases. Affected individuals have pyramidal signs in the lower limbs and some present additional features. Cognitive impairment is common in late‐onset forms of HSPs.MethodsThis study examined the cognitive abilities of 20 sporadic late‐onset patients with HSP using next‐generation sequencing. We also used a combination of the Mini‐Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to assess their cognition.ResultsThe present study led to the discovery of three new pathogenic mutations of the SPG4 gene through evolutionary conservation and analysis of structural models. We also confirmed mild cognitive impairment (MCI) with normal MMSE scores (≥27) and reduced MoCA scores (&lt;26) in these HSP‐SPG4 mutant patients. Such individuals mainly present with impaired executive function, delayed memory, abstraction and language.ConclusionsThe results broaden the mutational space of SPG4‐associated HSP with sporadic late‐onset modality and indicate a combination of reduced MoCA and normal MMSE for diagnosis, indicating that clinicians should consider performing a MoCA to detect MCI in patients with HSP, particularly those with sporadic onset SPG4/SPAST‐HSP.

Evaluating cognitive impairment in the early stages of Parkinson’s disease using the Cambridge brain sciences-cognitive platform

BackgroundNon-motor symptoms (NMS) such as cognitive impairment are among common presentations in patients with Parkinson’s disease (PD). In parallel with motor symptoms, these impediments can affect PD patients’ quality of life. However, cognitive impairment has received less attention in early PD. On the other hand, the relationship between olfactory symptoms and cognitive impairment is unclear in early PD. Considering the importance of accurate and timely assessment of cognitive function in PD patients using readily available/validated tests, this study has employed the Cambridge Brain Sciences-Cognitive Platform (CBS-CP) as a computer-based tool to assess cognitive presentations in early PD patients. MethodsThirty-four eligible males and females were assigned to PD and healthy controls (HCs). The cognitive performance was assessed using CBS-CP and Mini-Mental State Examination (MMSE), and olfactory function was measured through the standardized olfactory Quick Smell test (QST). ResultsPD patients had poorer performance in all CBS-CP tasks, including short-term memory, attention, and reasoning domains than HCs. Meanwhile, the verbal domain task scores showed no significant difference between groups. PD MMSE results were in the normal range (mean=26.96), although there was a significant difference between the PD and HCs groups (P = 0.000). Our results revealed no correlation between cognitive impairment and olfactory function in PD patients. ConclusionGiven the widely studied features of CBS-CP and its reliability across published evidence, CBS-CP appears to be a suitable measurement to evaluate cognitive impairment in early PD with normal MMSE scores. It seems cognitive and olfactory impairments are independent in early PD. Data availability statementThe datasets generated during the current study are available from the corresponding author upon reasonable request.

The clock drawing test is an important contribution to the Mini Mental State Examination in screening for cognitive impairment

The clock drawing test (CDT) and the Mini Mental State Examination (MMSE) are frequently used screening instruments for cognitive impairment, however, the precise contribution of the CDT to the MMSE is largely unknown. We studied patients with subjective cognitive impairment (SCI, n=481), mild cognitive impairment (MCI, n=628) and Alzheimer's disease (AD, n=1099). Discrimination between patients was examined with multiple logistic regression, adjusted for age, sex, and education. Four groups were constructed based on a normal/abnormal MMSE (cut-off <24/30) versus normal/abnormal CDT (cut-off ≤2/3). Visually rated medial temporal lobe atrophy (MTA) on CT was used as parameter of neurodegeneration. The CDT significantly contributed to the MMSE in discriminating SCI from both MCI and AD patients. Our four group analyses showed that of those patients with a normal MMSE and incorrectly classified as SCI, an abnormal CDT could significantly identify 10.0% as MCI and 13.2% as AD. Among those with an abnormal MMSE, the percentage AD patients shifted from 53.1% to 82.1% due to an abnormal CDT. Presence of an abnormal CDT was significantly related to MTA increase, regardless of the MMSE score. The CDT is an important additional screening tool to the MMSE. An abnormal CDT with a normal MMSE is an indicator for cognitive impairment. An abnormal CDT in combination with an abnormal MMSE can be considered as an indicator of disease progression.

Spinocerebellar Ataxia Type 35 Caused by a New TGM6 Variant: Video Documentation of a German Family.

Spinocerebellar Ataxia Type 35 Caused by a New TGM6 Variant: Video Documentation of a German Family.

White matter damage in patients with mild cognitive impairment in Parkinson's disease.

This study investigates the correlation between white matter structural damage and cognitive impairment in patients with Parkinson's disease (PD) and mild cognitive impairment (MCI). A total of 40 patients with PD were divided into two groups, i.e., a mild cognitive impairment (PD-MCI) and a normal cognitive (PDN) group, and 20 healthy patients were enrolled as the control group. Changes in the white matter structure of patients with PD were evaluated using diffusion tensor imaging (DTI), and cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) scale and Mini-Mental State Examination (MMSE). Finally, the correlations between the two groups were analyzed. The Unified Parkinson's Disease Rating Scale score was significantly higher in the PD-MCI than in the PDN group (P=0.008). The total MoCA and MMSE scores in the PD-MCI group were significantly lower than in the PDN and control groups (P<0.01). Patients in PDMCI group were tested by MMSE scale, and the abnormal score rate was 60.0%. Among them, 8 PD patients with normal MMSE total score were found to have mild cognitive impairment by MoCA evaluation. When compared with the PDN and control groups, the MoCA scores for visual space, which is assessed as part of the MoCA scale and generally represents bilateral parietal function; naming; memory; and attention were significantly lower in the PD-MCI group (P<0.001). When compared with the PDN group, the fractional anisotropy (FA) values for the right parietal and left occipital lobes were significantly lower in the PD-MCI group (P=0.005; P=0.018). The relationship between MoCA value and right parietal white matter and left occipital white matter was 0.555, 0.474, respectively. A Pearson's correlation test was conducted to compare the FA values and MoCA scores of the various brain areas in the PD-MCI group and revealed a significant positive correlation between the MoCA score and the white matter of the right parietal and left occipital lobes (P<0.01). Patients with PD experience early cognitive impairment, and the MoCA scale can be used for early screening. In addition, the DTI of white matter can highlight early white matter damage. In the current study, the damaged brain areas displayed by DTI were consistent with areas showing decreased MoCA scores and were positively correlated with the severity of PD.

Characteristics and Outcome Determinants of Hospitalized Older Patients with Cognitive Dysfunction.

Cognitive dysfunction commonly occurs among older patients during admission and is associated with adverse prognosis. This study evaluated clinical characteristics and outcome determinants in hospitalized older patients with cognitive disorders. The main outcomes were length of stay, readmission within 30 days, Barthel index (BI) score at discharge, BI score change (discharge BI score minus BI score), and proportion of positive BI score change to indicate change of activities of daily living (ADL) change during hospitalization. A total of 642 inpatients with a mean age of 79.47 years (76–103 years) were categorized into three groups according to the medical history of dementia, and Mini-Mental State Examination (MMSE) scores at admission. Among them, 74 had dementia diagnosis (DD), 310 had cognitive impairment (CI), and 258 had normal MMSE scores. Patients with DD and CI generally had a higher risk of many geriatric syndromes, such as multimorbidities, polypharmacy, delirium, incontinence, visual and auditory impairment, fall history, physical frailty. They had less BI score, BI score change, and proportion of positive BI score change ADL at discharge. (DD 70.0%, CI 79.0%), suggesting less ADL change during hospitalization compared with those with normal MMSE scores (92.9%; p < 0.001). Using multiple regression analysis, we found that among patients with DD and CI, age (p = 0.008) and walking speed (p = 0.023) were predictors of discharge BI score. In addition, age (p = 0.047) and education level were associated with dichotomized BI score change (positive vs. non-positive) during hospitalization. Furthermore, the number and severity of comorbidities predicted LOS (p < 0.001) and readmission (p = 0.001) in patients with cognitive disorders. It is suggested that appropriate strategies are required to improve clinical outcomes in these patients.

Random Forest Model in the Diagnosis of Dementia Patients with Normal Mini-Mental State Examination Scores.

Background: Mini-Mental State Examination (MMSE) is the most widely used tool in cognitive screening. Some individuals with normal MMSE scores have extensive cognitive impairment. Systematic neuropsychological assessment should be performed in these patients. This study aimed to optimize the systematic neuropsychological test battery (NTB) by machine learning and develop new classification models for distinguishing mild cognitive impairment (MCI) and dementia among individuals with MMSE ≥ 26. Methods: 375 participants with MMSE ≥ 26 were assigned a diagnosis of cognitively unimpaired (CU) (n = 67), MCI (n = 174), or dementia (n = 134). We compared the performance of five machine learning algorithms, including logistic regression, decision tree, SVM, XGBoost, and random forest (RF), in identifying MCI and dementia. Results: RF performed best in identifying MCI and dementia. Six neuropsychological subtests with high-importance features were selected to form a simplified NTB, and the test time was cut in half. The AUC of the RF model was 0.89 for distinguishing MCI from CU, and 0.84 for distinguishing dementia from nondementia. Conclusions: This simplified cognitive assessment model can be useful for the diagnosis of MCI and dementia in patients with normal MMSE. It not only optimizes the content of cognitive evaluation, but also improves diagnosis and reduces missed diagnosis.

Assessment of the Risk of Depression in Residents Staying at Long-Term Care Institutions in Poland During the COVID-19 Pandemic Depending on the Quality of Cognitive Functioning.

Background: The development of the COVID-19 pandemic has prompted the implementation of many procedures to safeguard against further increases in illness. Unfortunately, this has drastically reduced residents’ contact with their families, which has increased feelings of loneliness and isolation. This is particularly difficult in long-term care facilities, where the risk of developing depression is higher than in the general population.Objectives: The aim of the study was to assess the risk of depression among the residents of long-term care institutions in Poland during the COVID-19 pandemic and to determine the relationship between the risk of depression and the occurrence of cognitive impairment in the study group.Methods: The study included 273 residents from long-term care institutions in Poland. The risk of depression was determined based on an originally designed questionnaire. The cognitive state of the subjects was assessed using the screening test Mini-Mental State Examination (MMSE). Both the depression risk assessment and the MMSE test were conducted twice: in March and December 2020.Results: In March, severe dementia was present in 28.2% of the residents and normal MMSE scores were observed in 16.1% of the subjects; in December, the prevalence of severe dementia increased to 31.1% and that of normal scores decreased to 10.3%. In March, no participant was found to be at high risk of depression and moderate risk was observed in 14.3% of the subjects; in December, 2.6% of the residents had a high risk score and 45.4% had a moderate risk score. Statistical analysis revealed that higher MMSE scores correspond with a higher risk of depression.Conclusion: A higher risk of depression was observed with the development of the pandemic. Residents with cognitive impairment were characterised by a lower risk of depression compared to individuals with normal MMSE scores. During the study, progression of cognitive impairment was observed in the residents.

Post-stroke cognitive impairment: screening with MMSE and MoCA and predictors of their persistence after treatment at the Stroke Center

Objective — to analyze the results of screening for post‑stroke cognitive impairment (PCI) in patients with cerebral stroke (CS) admitted to the Stroke Center (SC) in different disease phases, and to determine independent predictors of the PCI persistence at discharge.&#x0D; Methods and subjects. 399 patients were enrolled, including 242 (60.7 %) men and 157 (39.3 %) women with the median age was 66.2 years (IQR 58.5 — 76.3). IS was diagnosed in 331 (82.9 %), and ICH in 68 (17.1 %) patients. Among patients with IS, 137 (41.4 %) had an atherothrombotic subtype, 152 (46.0 %) had a cardioembolic subtype, 21 (6.3 %) had a lacunar subtype, another 21 (6.3 %) had another or unknown cause of stroke. Patients were screened for PCI using the Mini‑Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) on admission and at discharge. Participants with MMSE score of 0 — 24 or a MoCA score of 0 — 25 were considered having PCI. Upon admission, all patients were assessed using the National Institutes of Health Stroke Scale (NIHSS), Bartel Index, and Modified Rankine Scale (mRS). The method of constructing and analyzing logistic regression models was used to determine independent predictors of the preservation of PCI at discharge. The analysis was carried out using the MedCalc v. 19.1.&#x0D; Results. The baseline NIHSS score ranged from 0 to 39 (median 11, IQR 6 — 18). The majority (64.2 %) of the subjects were hospitalized within the first 30 days from the CS onset. The MMSE score on admission ranged from 0 to 30 (median 20, IQR 2 — 27), and in 179 (44.9 %) of the patients the initial score was 0 to 17 (severe PCI), whereas in 61 (15 3 %) of the participants it was 18 to 24 (moderately severe PCI) and only 159 (39.8 %) persons scored 25 to 30 (no PCI). The baseline MoCA score ranged from 0 to 30 (median 15, IQR 1 — 24), and 356 (89.2 %) patients were shown to have PCI (score 0 to 25). According to screening with MMSE at discharge, 125 (31.4 %) patients had severe PCI, and 67 (16.8 %) had moderately severe PCI. The MoCA assessment before discharge indicated PCI in 324 (81.2 %) patients. According to both MMSE and MoCA, the rate of PCI on admission was significantly higher than at discharge (p &lt; 0.001). Among the 240 patients who had PCI according to MMSE score, 239 (99.6 %) had PCI according to the MoCA score. However, among 159 patients who screened negative for PCI with MMSE at admission, 117 (73.6 %) screened positive with MoCA. Screening results using both MMSE and MoCA were not significantly associated with affected hemisphere. ICH was associated with lower (p &lt; 0.0001) MMSE and MoCA scores compared with IS. Predictors of PCI according to MMSE score at discharge were a longer time interval from CS onset to SC admission, and a lower baseline MMSE score. However, with MoCA, the predictors were AT subtype IS, lesions in the distribution of the right or both middle cerebral arteries, older patient age, and a lower baseline MoCA score.&#x0D; Conclusions. In patients with MI, a high rate of PCI was documented on admission, but was significantly lower at discharge. In patients with established PCI, according to MMSE score, the use of MoCA for screening seems useless, however, screening with MoCA identified PCI in 3/4 in patients with a normal MMSE score. The independent predictors of scores on these two scales, indicating PCI, were significantly different, so they should not be considered interchangeable.

DOUBLE JEOPARDY: UNTANGLING DEPRESSION, PARKINSON'S DISEASE & FRONTOTEMPORAL DEMENTIA IN CLINICAL PRACTICE WITH BEDSIDE COGNITIVE TESTING

Introduction Progressive supranuclear palsy is a taupathy disorder often mistaken on diagnosis by other neurocognitive disorders such as Parkinson's (PD) and Alzheimer's (AD) disease amongst other. PSP tends to be diagnosed in the later course of the disease and by time of diagnosis, individuals have a median survival of 7?years. PSP is a disease in which a diagnosis and treatment is done in a multidisiplinary approach involving collaboration of Psychiatry and Neurology. As it was seen in this clinical case which describes a patient with undetected progressive supranuclear palsy who were referred to a university hospital psychiatric emergency services facility for treatment of late onset symptoms and signs attributed to primary psychopathology related to behavioral variant of frontotemporal lobar degeneration (FTLDbv). Methods The patient described in the clinical vignette underwent a comprehensive neuropsychiatric assessment, given that the accuracy of the diagnosis of FTLDbv was in doubt. The clinical interview identified no significant prior developmental, medical, neurological, psychiatric, or substance use disorders; no family history of neuropsychiatric disturbance; and no significant psychosocial stressor before the onset of his neuropsychiatric condition at age 59. Bedside cognitive testing showed a Geriatric Depression Scale (GDS) score suggestive of mild symptoms of depression, and would be unlikely to explain his new onset psychosis. His subclinical Executive Interview 25 (EXIT 25) score and normal Mini Mental State Examination (MMSE) were not indicative of a dementia syndrome. Given the strong temporal relationship between the onset of his behavioral changes and perceptual disturbances and the start of levodopa/carbidopa, this medication was discontinued. He was admitted to the inpatient psychiatric service for observation. He was started initially on an atypical antipsychotic, but had this medication discontinued, as he no longer exhibited symptoms of psychosis. His citalopram was titrated to 40mg daily to optimize treatment of his major depressive disorder. Patient was discharge with complete resolution of psychotic symptoms and with diagnosis of Depressive disorder, unspecified and medication-induced psychotic disorder with delusions and hallucinations. A dopamine transporter (DaT) protein scan, a marker for presynaptic terminals in dopaminergic nigrostriatal neuros (marker for PD) and or iodine-123-metaiodobenzylguanadine (MIBG) myocardial scintigraphy (marker for DLB), was not performed. Results CASE REPORT: A 59-year-old, left handed, previously healthy gentleman was brought by police to a university hospital psychiatry emergency services for evaluation of acute safety concerns, regarding behavioral and personality changes. Patient was admitted to the hospital displaying motor symptoms with appearance of jaw tremor, ataxia, and urinary incontinence. After a negative brain MRI and head CT scan, the neurology team concluded that he had Parkinson`s disease and patient was discharged on levodopa/carbidopa (25?mg/?100 mg) QID and citalopram 20?mg daily for associated depressive symptoms with no benefit. After discharge from the hospital, he had become increasingly impulsive, hypersexual and engaging in risky behaviors with firearms. Persistent and progressive change in personality and behavior were the earliest displayed signs and they remained the most prominent features of his condition. All of these disturbances worsened after patient was started on levodopa/carbidopa. After evaluation by the psychiatry consultation and liaison service, a Mental status examination revealed cognitive and neurovegetative symptoms of depression as well as auditory illusions and concerns that a stranger had invaded his home. He denied manic symptoms. No suicidal and homicidal thoughts. Despite extensive neurological and neuropsychological evaluation 10-months later, surprisingly, it was established the diagnosis of progressive supranuclear palsy (PSP), as at that visit the patient presented with predominantly delay axial Parkinsonism, supranuclear gaze palsy, and increased falls due to postural instability. A neuropsychological assessment provided evidence of an executive syndrome of subcortical frontal type. Conclusions Progressive supranuclear palsy is a debilitating taupathy disorder that often is mistaken on diagnosis by other neurocognitive disorders such as Parkinson's dementia, Alzheimer's dementia and Frontotemporal lobar degeneration amongst others. Thus, making PSP diagnosis difficult at initial presentation and often presenting later in life. PSP diagnosis requires a multidisciplinary approach, a collaboration between Psychiatry and Neurology to piece together the complex problems that often manifest in challenging neuropsychiatric syndromes. The possibility of PSP should be considered in the differential diagnosis of late onset psychiatric syndromes. Early PSP diagnosis is imperative for both patients and physicians, as proper treatment will be started without delay to address PSP symptomatology. Thus, reducing the burden of patient and family, as well as reducing unnecessary diagnostic tests, hospitalizations and sub-optimal psychiatric treatment. It is imperative that providers from all specialties be aware of PSP early presentation and how it can be mistaken, specially in early stages, with other neurocognitive disorders in order to make proper referrals for the most effective treatment available. This research was funded by: N/A

Early Cognitive Assessment Following Acute Stroke: Feasibility and Comparison between Mini-Mental State Examination and Montreal Cognitive Assessment

Objectives: Cognitive assessment is not performed routinely in the acute stroke setting. We investigated factors associated with cognitive impairment and the differences between the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores in patients with acute stroke. Methods: In this prospective study, 881 consecutive patients (median age, 73 years) with acute stroke were enrolled. Clinical characteristics, such as education, vascular risk factors, premorbid cognitive status using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), and stroke severity, were assessed. Cognitive performance was measured using MMSE and MoCA within 5 days of stroke onset. Results: Both MMSE and MoCA were feasible in 621 (70.5%) patients. Factors independently associated with nonfeasibility were age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.02-1.08), IQCODE score (OR: 1.02; 95%CI: 1.00-1.04), and National Institutes of Health Stroke Scale (NIHSS) score (OR, 1.16; 95%CI, 1.12-1.20). Impaired MoCA (with a cut-off <26/30) performance was observed in 544 of 621 (87.6%) patients. Factors independently associated with cognitive impairment were age (OR: 1.06; 95%CI: 1.03-1.10) and NIHSS score (OR: 1.34; 95%CI: 1.14-1.57). Eighty percent of patients with normal MMSE scores had an impaired MoCA score (MMSE-MoCA mismatch). The differences were highest in the visuospatial (94.8% versus 65.3%; P < .0001), recall (76.6% versus 35.6%; P < .0001), abstraction (82.5% versus 49.8%; P < .0001), and language (72.3% versus 65.9%; P < .0001) domains between the normal MMSE and MoCA group and MMSE-MoCA mismatch group. Conclusions: The MoCA can be particularly useful in patients with cognitive deficits undetectable on the MMSE in the acute stroke phase.

Abstract P2-14-08: Use of systemic therapy for early stage breast cancer in older adults: Results from the Bridging the Age Gap study

Abstract Background: Older patients with early breast cancer (EBC) are a heterogenous population which is often treated less aggressively than their younger counterparts. This may lead to increased variance in the use of adjuvant systemic therapy and consequent inferior outcomes.Use of adjuvant systemic therapy in a population of older EBC patients was evaluated within a large UK prospective multicentre cohort study (Bridging the Age Gap). Methods: A prospective, multicentre, observational study of women aged over 70 with EBC was conducted between 2013 and 2018 at 57 Institutions in the UK. Women were recruited at diagnosis and baseline demographics, patient and tumour characteristics, treatment details, adverse events and quality of life were recorded for up to 24 months. Simple statistics, Fisher’s exact test, chi-squared and Cox regression were used as appropriate. The interaction between systemic therapy use, tumour and patient characteristics and survival and toxicity outcomes were evaluated using uni- and multivariate analysis and propensity score matching. Results: 3,649 patients were enrolled in the study of whom 3416 were eligible. 2,816 (82.4%) underwent surgery within 6 months of diagnosis. Of those patients undergoing surgery, 2,554 (90.7%) had Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) 0-1 and 2,710 (96.2%) had a modified Charlson comorbidity Index ≥2. Activities of Daily Living (ADL) were impaired in 568 cases (20.2%) and Instrumental Activities of Daily Living (IADL) in 498 (17.7%). 1,876 patients (66.2%) had normal Mini-Mental State Examination (MMSE). In the overall population, 382 patients (13.6%) received chemotherapy. Its use increased substantially in patients with tumours larger than 50 mm (25.2%), involving axillary lymph nodes (23.6%) and grade 3 (27.4%). Chemotherapy was given in 34.6% of patients with ER-negative and in 47.76% of patients with HER2-positive disease. However, its use decreased with age from 20.7% in patients aged 70-74 to 3.6% in those aged ≥80. Chemotherapy was used in 14.1% of patients with ECOG PS 0-1, 15.6% of those with normal ADL score, 15.6% of those with normal IADL score and 14.2% of those with normal MMSE.Of the total cohort of 3416 women, 1520 (44.5%) had high recurrence risk cancer and 381 (25.0%) patients subsequently underwent chemotherapy. The chemotherapy and no chemotherapy groups differed significantly in age, fitness and frailty. Unadjusted all cause mortality was 17.6% for no chemotherapy and 9.3% for chemotherapy patients. Baseline variation in health status was propensity score adjusted yielding a matched cohort of 381 no chemotherapy and 225 chemotherapy patients. Matched all cause mortality was 10.8% for no chemotherapy versus 10.7% for chemotherapy. EBC specific mortality was 7.0% for no chemotherapy and 8.1% for chemotherapy patients. These data suggest that chemotherapy confers little survival benefit in this age group. Conclusions: The use of chemotherapy in this population is consistent with published data, with a substantial proportion of fit older patients with high-risk breast cancer not receiving it. However, undertaking a matched analysis of outcomes suggests that there is little benefit in this age group at short follow-up. Incorporating geriatric assessment may better inform the management of these complex patients in a multidisciplinary setting. Table 1 - Chemotherapy use based on tumour and patient characteristics.CharacteristicsChemotherapy givenYesNoN (%)N (%)Tumour size (mm)≤2093 (7.3)1,182 (92.7)21-50 233 (17.7)1,085 (82.3)≥5050 (25.2)148 (74.7)Unknown6 (24.0)19 (76.0)pN stagepN0 (incl. micrometastases)174 (9.0)1,751 (91.0)pN1116 (18.7)504 (81.3)pN254 (33.5)107 (66.5)pN334 (40.5)50 (59.5)Unknown4 (15.4)22 (84.6)Grade15 (1.3)384 (98.7)2129 (8.6)1,378 (91.4)3239 (27.4)632 (72.6)Unknown9 (18.4)40 (81.6)HistologyInvasive ductal carcinoma287 (14.4)1,701 (85.6)Invasive lobular carcinoma59 (14.6)345 (85.4)Tubular0 (0.0)31 (100.0)Mucinous2 (2.5)78 (97.5)Other29 (10.1)257 (89.9)Unknown5 (18.5)22 (81.5)Receptor statusER statusPositive247 (10.3)2,144 (89.7)Negative129 (34.6)244 (65.4)Unknown6 (11.5)46 (88.5)HER2 statusPositive160 (47.8)175 (52.2)Negative210 (9.1)2,095 (90.9)Inconclusive4 (17.4)19 (82.6)Unknown8 (5.2)145 (94.8)Oncotype DX testYes6 (14.6)35 (85.4)No376 (13.5)2,399 (86.4)Age70-74242 (20.7)928 (79.3)75-79120 (13.4)777 (86.6)80-8418 (3.6)487 (96.4)≥851 (0.4)11 (91.7)ECOG Performance status0301 (15.5)1,646 (84.5)160 (9.9)547 (90.1)23 (3.7)77 (96.2)32 (5.6)34 (94.4)40 (0.0)1 (100.0)Unknown16 (11.0)129 (89.0)ADL score20309 (15.6)1,669 (84.4)1932 (10.6)270 (89.4)≤1815 (5.6)251 (94.4)Unknown26 (9.6)244 (90.4)IADL score8315 (15.6)1,699 (84.4)727 (10.8)222 (89.2)≤67 (2.8)242 (97.2)Unknown33 (10.9)271 (89.1)Modified Charlson comorbidity index0-10 (0.0)0 (0.0)≥2371 (13.7)2,339 (86.3)Unknown11 (10.4)95 (89.6)MMSE&amp;gt;24267 (14.2)1,609 (85.8)20-247 (17.5)33 (82.5)&amp;lt;204 (12.9)27 (87.1)Unknown104 (12.0)765 (88.0) Citation Format: Nicolò Matteo Luca Battisti, Alistair Ring, Mike Bradburn, Lynda Wyld, Age Gap Trial Steering Group. Use of systemic therapy for early stage breast cancer in older adults: Results from the Bridging the Age Gap study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-14-08.

ACTR-07. LONG-TERM OUTCOMES FROM INTERGROUP NCCTG 86-72-51 (ALLIANCE): FINAL REPORT OF A PHASE III PROSPECTIVE RANDOMIZED TRIAL OF HIGH DOSE VERSUS LOW DOSE RADIATION IN ADULT SUPRATENTORIAL LOW-GRADE GLIOMA

Abstract PURPOSE To provide a final update on oncologic and cognitive outcomes of high dose versus low dose radiation for low-grade glioma. METHODS Between 1986 and 1994, 203 patients with supratentorial low grade glioma were randomized to 50.4 Gy in 28 fractions versus 64.8 Gy in 36 fractions after any degree of resection. Histologic subtype was oligodendroglioma (71%) or astrocytoma (29%). Primary outcome was overall survival (OS). Cognitive status was followed using Folstein Mini-Mental State Examination (MMSE). RESULTS For the entire cohort of 203 patients, median OS was 8.4 years (95% CI: 7.2 – 10.8). Median progression-free survival (PFS) was 5.2 years (95% CI: 4.3 – 6.6). Median follow-up is 17.2 years for the 33 patients still alive. High-dose radiation did not improve OS (15-yr OS: 22.4% vs. 24.9%, log rank p=0.978) or PFS (15-yr PFS: 15.2% vs. 9.5%, p=0.7142). OS was significantly better for patients with pre-operative tumor diameter &lt; 5 cm (15-yr OS: 39.4% vs. 15.2%, p&lt; 0.001), baseline MMSE &gt; 27 (15-yr OS: 27.3% vs. 9.8%, p=0.001), and for patients who underwent gross total resection (GTR) (15-yr OS: 39.3% GTR vs. 16.4% subtotal resection vs. 24.5% biopsy only, p=0.0119). PFS was improved for patients with oligodendroglioma versus astrocytoma (15-yr PFS: 13.8% vs. 8.6%, p=0.0221). PFS was also improved for patients with pre-operative tumor diameter &lt; 5 cm, patients who had GTR, and patients with baseline MMSE &gt; 27. For patients who had normal MMSE at baseline, at 7 years only 1 patient (5%) had a clinically significant decrease in MMSE from the previous time point, with the remainder (95%) stable. None had decrease in MMSE at 10, 12, or 15 years. CONCLUSIONS Long-term follow-up indicates no benefit to high-dose over low-dose radiation for low-grade gliomas. Minimal late decline in cognitive function after radiation was seen by MMSE. SUPPORT: U10CA180821,U10CA180882. https://acknowledgments.alliancefound.org

76 An Incorrectly Set Watch may Suggest Cognitive Impairment in the Older Patient

Abstract Background Disorientation to time can be used as a guide to determining the presence and severity of dementia. The inability to maintain one’s wrist watch at the correct time is assessed as a possible marker of dementia. Methods Inpatients in a post-acute care unit with a mean age of 76.2 (±12.4 years) were assessed with regard to the time on their wristwatch. The time was recorded as correct or incorrect with a permitted discrepancy of 15 minutes. A current Mini-Mental State Examination (MMSE) score was obtained and patients were divided into two groups: MMSE above/equal to or below 24, with the latter defined as an abnormal result. Results The most striking finding of this study was that any patient with an incorrectly set watch had an abnormal MMSE. The majority of patients with an abnormal MMSE had their watch set correctly (n=17, 38%), while only 10 (22%) were found to have an incorrectly set watch. All patients with a normal MMSE had their watch set correctly, n=18 (40%). Acknowledging the fact that conclusions of statistical methods used on a small sample size should be interpreted with caution, we report that the two-tailed Z score for 2 population proportions was 2.9277 (p=0.00338), significant at p&lt;0.05. Conclusion This study presents evidence to suggest a relationship between the correctness of the older patient’s watch and their cognitive status. Assessment of time on the patient’s watch could be considered as an instantaneous, approximate “test” for dementia in clinical practice. This test would have a sensitivity of 37% and specificity of 100%.

Retentissement des troubles cognitifs sur la récupération fonctionnelle et autonomie motrice des patients hémiplégiques vasculaires en cours de rééducation

ObjectiveTo determine the level of these cognitive disorders and evaluate its impact on motor recovery and autonomy as a function of age and sex. Material and methodWe opted for the descriptive method and conducted a cross-sectional study that consisted in evaluating the impact of cognitive disorders on the functional recovery and autonomy of the 40 patients in post stroke with an average age of 58, 4±10.1 divided according to level of cognitive impairment, age and sex. It was conducted for a period of 3 months from January to March 2018. The Folstein index of motor home (IMD), barthel index and mini mental state examination (MMSE) were used to evaluate the influence of cognitive disorders on functional recovery. ResultsAfter 3 months of evaluation, we found a significant difference between the level of cognitive deterioration and that of autonomy for all patients (P=0.004.) Older patients who had a normal MMSE score had an IMD better than those with mild cognitive impairment (P=0.03) In men, there was a significant difference in levels of motor development between patients at different levels of cognitive impairment (P=0.01). A significant relationship between the level of cognitive deterioration and motor development was noted (P=0.000). The same relationship was observed between the overall MMSE score and IMD (P=0.03). ConclusionIt appears from this study that cognitive disorders have a positive influence on the motor and functional recovery of hemiplegic patients ; however, the disorders had more influence in the lower ages and men.

Semantic and Phonemic Verbal Fluency Performance in Patients with General Anxiety Disorders and Allostatic Load under Alprazolam Treatment

Purpose: Anxiety disorders are frequently associated with chronic stress with possible cognitive consequences. The aim of this study was to determine the verbal fluency performance in a cohort of patients with anxiety disorders and allostatic load, treated with alprazolam during 12 weeks. Methods: Patients with GAD (general anxiety disorders, DSM IV), with >6 in Hamilton Anxiety Rating Scale (HAM-A), neuroticism > 18 (NEO-FFI inventory), and normal Mini-Mental State Examination were included. Clinical and Psychiatric examination, Allostatic Load Index and cognitive assessment were analyzed before and after 12 weeks of treatment. The phonemic and semantic verbal fluency tests were determined in all patients. The scoring for each fluency task was determined by counting the number of correct words. The total score from each semantic and phonemic verbal task was analyzed comparing the individual score with normal data controlled by age and sex. Patients with scores > ?2 standard deviation (SD) from normative data were considered impaired. Results: Fifty-four patients completed the semantic verbal fluency test before treatment and fifty patients completed after treatment. According to the z-scores before treatment 7 patients of 54 (12.9%) had verbal fluency impairments. After treatment none patients showed semantic verbal fluency deficits but 3 patients of 50 (6%) showed phonemic impairments. Impaired group was significantly associated with an older age before treatment (p = 0.033) and with a similar tendency but not significant (p = 0.09) after treatment (Student t test). Conclusion: In this study older age factor was associated with verbal fluency impairment in GAD patients. Stratified treatments analyzing age and sex factors, including allostatic load measurements and cognitive assessments may be useful tools to determine the effectiveness and the safety of psychopharmacological treatments.

Using the Oxford Cognitive Screen to Detect Cognitive Impairment in Stroke Patients: A Comparison with the Mini-Mental State Examination.

The Oxford Cognitive Screen (OCS) was recently developed with the aim of describing the cognitive deficits after stroke. The scale consists of 10 tasks encompassing five cognitive domains: attention and executive function, language, memory, number processing, and praxis. OCS was devised to be inclusive and un-confounded by aphasia and neglect. As such, it may have a greater potential to be informative on stroke cognitive deficits of widely used instruments, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment, which were originally devised for demented patients. The present study compared the OCS with the MMSE with regards to their ability to detect cognitive impairments post-stroke. We further aimed to examine performance on the OCS as a function of subtypes of cerebral infarction and clinical severity. 325 first stroke patients were consecutively enrolled in the study over a 9-month period. The OCS and MMSE, as well as the Bamford classification and NIHSS, were given according to standard procedures. About a third of patients (35.3%) had a performance lower than the cutoff (<22) on the MMSE, whereas 91.6% were impaired in at least one OCS domain, indicating higher incidences of impairment for the OCS. More than 80% of patients showed an impairment in two or more cognitive domains of the OCS. Using the MMSE as a standard of clinical practice, the comparative sensitivity of OCS was 100%. Out of the 208 patients with normal MMSE performance 180 showed impaired performance in at least one domain of the OCS. The discrepancy between OCS and MMSE was particularly strong for patients with milder strokes. As for subtypes of cerebral infarction, fewer patients demonstrated widespread impairments in the OCS in the Posterior Circulation Infarcts category than in the other categories. Overall, the results showed a much higher incidence of cognitive impairment with the OCS than with the MMSE and demonstrated no false negatives for OCS vs MMSE. It is concluded that OCS is a sensitive screen tool for cognitive deficits after stroke. In particular, the OCS detects high incidences of stroke-specific cognitive impairments, not detected by the MMSE, demonstrating the importance of cognitive profiling.

Transitions across cognitive states and death among older adults in relation to education: A multistate survival model using data from six longitudinal studies

IntroductionThis study examines the role of educational attainment, an indicator of cognitive reserve, on transitions in later life between cognitive states (normal Mini-Mental State Examination (MMSE), mild MMSE impairment, and severe MMSE impairment) and death. MethodsAnalysis of six international longitudinal studies was performed using a coordinated approach. Multistate survival models were used to estimate the transition patterns via different cognitive states. Life expectancies were estimated. ResultsAcross most studies, a higher level of education was associated with a lower risk of transitioning from normal MMSE to mild MMSE impairment but was not associated with other transitions. Those with higher levels of education and socioeconomic status had longer nonimpaired life expectancies. DiscussionThis study highlights the importance of education in later life and that early life experiences can delay later compromised cognitive health. This study also demonstrates the feasibility and benefit in conducting coordinated analysis across multiple studies to validate findings.

Low Sensitivity of the Mini-Mental State Examination for Cognitive Assessment of Brazilian Patients With Parkinson Disease.

Recent publications have highlighted the low sensitivity of the Mini-Mental State Examination (MMSE) for the cognitive assessment of patients with Parkinson disease (PD). The Montreal Cognitive Assessment (MoCA), otherwise, has shown greater sensitivity when compared to the MMSE. Based on this, we have searched for the cognitive impairment measurable by the MoCA and the functional performance on activities of daily living in a sample of Brazilian patients with PD and normal MMSE. We hypothesized that the low sensitivity of the MMSE, already shown by other authors, could be replicated in a low-income country. To describe the performance on the MoCA and the dependence on third parties for activities of daily living in a sample of Brazilian patients with PD and normal MMSE. We evaluated 43 volunteers with PD and normal MMSE considering the Brazilian cutoffs. Cognitive performance was assessed through the MoCA and functional performance through a modified version of the Disability Assessment for Dementia Scale. Despite normal score on the MMSE, considering the Brazilian cutoffs, 62.7% of the volunteers performed below the literature cutoff for the MoCA (26 points). Furthermore, 30.2% had dependence on third party for activities of daily living. By using a strict cutoff for the MMSE (26 points), 56.7% performed below the MoCA cutoff and 24.3% had dependence for activities of daily living. Our findings confirm the limitations of the MMSE for the cognitive screening of patients with PD in a low-income country.