Short Portable Mental Status Questionnaire Research Articles

Alzheimer's Video Is Worth 1,000 Words in Care Planning

CHICAGO — Elderly persons shown a video depiction of advanced Alzheimer's disease are less likely to opt for life-prolonging care, compared with those who listen to a verbal description. A multicenter, prospective trial randomized 200 community-dwelling adults aged at least 65 years (mean 75 years) to one of two interventions and then compared their preferences for advanced care if they were in a state of dementia. In all, 106 participants listened to a standardized verbal description of stage 7 Alzheimer's. The other 94 participants listened to the verbal description and viewed a 2-minute video of a real patient with features of stage 7 Alzheimer's and her family. (The video can be viewed online at www.ACPdecisions.com.) Among those hearing only the verbal description, 68% preferred comfort care, 17% chose limited care, 13% wanted care that would prolong their life, and 2% were uncertain. Among those receiving both the verbal narrative and the video, 87% preferred comfort care, 8% chose limited care, 4% desired life-prolonging care, and 1% were undecided, Angelo E. Volandes, MD, said at the annual meeting of the American Geriatrics Society. “Most patients don't have experience with advanced disease,” he said. “Video may promote preferences for comfort care by providing more realistic expectations of dementia.” Preferences also appear more stable when made with the assistance of video. After 6 weeks, 27 (29%) of 94 participants interviewed in the verbal group changed their preferences, compared with only 5 (6%) of 84 participants in the video group said Dr. Volandes, an internal medicine physician with Massachusetts General Hospital and Harvard University Medical School, both in Boston. “The use of innovative videos in end-of-life decision-making and advance care planning discussions is relatively new,” Dr. Volandes said in an interview. “Further work and studies are needed to examine the implementation of these videos in clinical practice before they can become the standard of care for advance care planning.” Dr. Volandes acknowledged that the study did not use real patients with a dementia diagnosis, and did not include Hispanics or Asians, although he said that similar findings have been observed in his previous research with Hispanics. The convenience sample, selected from two primary care and two geriatric clinics, was 58% female, 29.5% African American, and had a score of 7 or higher on the Short Portable Mental Status Questionnaire. Overall, 68% of the verbal group and 73% in the video group had a 9th-grade or higher level of health literacy on the Rapid Estimate of Adult Literacy in Medicine test. Dr. Volandes, who received a new investigator award for his work by the American Geriatrics Society, disclosed no conflict of interest for himself or his associates. The study was sponsored by the Alzheimer's Association, John A. Hartford Foundation, and the Foundation for Informed Medical Decision Making. Patrice Wendling is with the Chicago bureau of Elsevier Global Medical News.

Prediction of Mortality in Elderly Patients with Hip Fractures: A Two-Year Prospective Study of 1,944 Patients

Background: Hip fracture patients are reported to have an increased mortality rate compared to the general population. In order to be able to reduce the morbidity and mortality after a hip fracture, our efforts to identify the patients at risk already upon admission to the hospital need to be increased. For such a risk assessment, robust, validated, and reproducible criteria are mandatory. Objective: To determine preoperative factors associated with mortality and to evaluate the combined use of the American Society of Anesthesiologists (ASA) and the Short Portable Mental Status Questionnaire (SPMSQ) to identify patients with an increased mortality rate and to create a predictive model to assess the mortality risk after hip fracture surgery. Methods: A total of 1,944 consecutive patients aged 66 years or older admitted for a hip fracture were included in a prospective cohort study with a 24-month follow-up. The patients were assessed with regard to gender, age, type of hip fracture, smoking habits, comorbidities, general physical health according to the ASA classification, and cognitive function according to the SPMSQ. A higher ASA score indicates an increasingly severe systemic disease and a lower SPMSQ score indicates an increasingly severe cognitive dysfunction. We used Cox proportional hazard models and classification trees to identify the factors associated with mortality. The predictive model was created based on factors that were significantly associated with death and all readily accessible upon admission. Results: The mortality rate during the acute hospitalization period was 4%, at 4 months 16%, and at 24 months 38%. The most prominent factors associated with mortality were high ASA scores, low SPMSQ scores, high age and male gender. The SPMSQ score provided additional information about the survival time, compared to when the ASA score was used alone. Conclusion: The combined use of the ASA classification for assessing physical health and the SPMSQ for assessing cognitive function effectively identified hip fracture patients with an increased mortality rate. We present a predictive model including age, gender, ASA, and SPMSQ that can be used to assess the mortality risk after hip fracture surgery.

Validation of a German Version of the Confusion Assessment Method for Delirium Detection in a Sample of Acute Geriatric Patients with a High Prevalence of Dementia

Objectives: To assess validity and interrater reliability of an operationalized German version of the Confusion Assessment Method (CAM) in geriatric patients with comorbid dementia and high delirium risk. Design: Prospective cross-sectional cohort study with double CAM assessment by a medical and nonmedical rater. Setting: Random sample of frail, cognitively impaired elderly with acute disease requiring hospital care. Participants: A total of 39 frail elderly, mean age 83 ± 7 years, 72% (n = 28) female, with cognitive impairments, a high prevalence of dementia (86%, n = 33) and a significant risk of delirium. Of these, 13 revealed delirium, which was superimposed on dementia in 11. Measurements: A translated and operationalized version of the CAM was validated against a neuropsychiatric and geriatric consensus reference standard based on DSM-IV. Additional measures included the Short Portable Mental Status Questionnaire, the Mini-Mental State Examination and the Delirium Index for cognitive impairment severity, the Informant Questionnaire on Cognitive Decline for dementia diagnosis and the Barthel Index, illness severity (Cumulative Illness Rating Scale) and medication. Results: Delirium was correctly detected by CAM algorithm in 10 out of 13 delirious patients resulting in a high sensitivity of 0.77 and a specificity of 0.96–1.00 for both raters. Likelihood ratio revealed an almost 20-fold risk of delirium with positive CAM testing. Interrater reliability was excellent with a Cohen’s ĸ of 0.95 (CI 0.74–1.0) for the algorithm, single items’ ĸ values varied between 0.5 and 1. Conclusions: The German CAM is a reliable and valid measure of delirium, even in frail, acutely diseased elderly with concomitant dementia.

Recovery of Functional Impairment after Acute Illness and Mortality: One-Year Follow-Up Study

Background: Functional status in older people is a dynamic situation, which makes it necessary to evaluate functional capacity at different times to determinate their prognostic value. Objective: To examine the association between functional status (baseline and change after acute illness) and mortality and functional changes at 1 year. Methods: Hospital-based prospective longitudinal cohort study of all patients over 65 years old, admitted for multidisciplinary treatment of functional impairment after acute illness in a medium-stay unit (post-acute geriatric unit) of a teaching hospital ascribed to the Spanish National Health Service from Spain during 15 consecutive months. Functional status (Barthel Index, BI) was assessed prior to the acute illness, at admission in a post-acute unit, at discharge and 1 year later. At admission, other variables were collected: sociodemographic, main diagnostic for hospitalization (stroke, orthopedic process, or deconditioning), serum albumin, comorbidity (Charlson Index), cognitive status (Pfeiffer´s Short Portable Mental Status Questionnaire). In order to analyze mortality 1 year after discharge, a Cox regression analysis was performed. Results: Three hundred and sixty-nine patients consituted the study population, mean age was 80.74 years (SD 7.4), 66.6% were female and 1 year after discharge mortality was 20%. In the multivariate analysis, variables associated with a higher 1-year mortality were age (HR 1.06; 95% CI = 1.00–1.07) male gender (HR 2.11; 95% CI = 1.26–3.55), worse prior functional status (HR 0.98; 95% CI = 0.96–0.99), and higher functional loss in BI at admission (HR 1.02; 95% CI = 1.00–1.04). On the other hand, a greater functional gain in BI at discharge was associated with a lower 1-year mortality (HR 0.98; 95% CI = 0.96–0.99). Conclusions: The main functional gain obtained after treatment in a multidisciplinary post-acute geriatric unit is independently associated with a reduction in long-term mortality. In addition to baseline functional status and after acute illness, the subsequent potential recovery is very important to predict poor long-term outcomes.

Psychomotor, cognitive and social interactions in elderly and old Italians. Preliminary report

It was the aim of this pilot study to investigate effects of motor activity on psychosocial and functional-physical conditions (using an assisted multidimensional questionnaire) of 53 (39 female, 14 male) free living elderly and old subjects in Florence, Italy. In addition, ADL (test of Activities of Daily Living) and Pfeiffer test (short portable mental status questionnaire) were applied to test autonomy of everyday life and presence of intellectual disturbance of organic origin. Motor activity appeared to influence significantly psychosocial and functional-physical conditions, i. e. motor activity was significantly correlated with subjective feeling of autonomy and independence, and with the variable to have hobbies, as well as with good posture and walking. From ADL and Pfeiffer tests resulted absence of respective pathologies.

Sleep quality, depression state, and health status of older adults after silver yoga exercises: Cluster randomized trial

Background Sleep disturbances, depression, and low perception of health status are commonly seen in elderly population; however, clinicians tend to underestimate or overlook the presence of these symptoms and assume them to be a part of normal aging. Non-pharmacological methods that promote a mind–body interaction should be tested to enhance the mental health of older adults. Objective To test the effects of 6 months of silver yoga exercises in promoting the mental health of older adults in senior activity centers, especially their sleep quality, depression, and self-perception of health status. Design Cluster randomized trial. Settings Eight senior activity centers, southern Taiwan. Participants A sample of 139 participants was recruited, and 128 of them completed the study. Inclusion criteria: (1) community-dwelling older adults ages 60 and over, (2) no previous training in yoga, (3) able to walk without assistance, (4) cognitively alert based on the Short Portable Mental Status Questionnaire (SPMSQ) score of eight or higher, and (5) independent or mildly dependent in self-care based on a Barthel Index (BI) score of 91 or higher. The mean age of the participants was 69.20 ± 6.23 years, and the average number of chronic illness was 0.83 ± 0.90. The average BI score of the participants was 99.92 ± 0.62, and the mean SPMSQ score was 9.90 ± 0.30. Methods Participants were randomly assigned into either the experimental ( n = 62) or the control ( n = 66) group based on attendance at selected senior activity centers. A 70-min silver yoga exercise program was implemented three times per week for 6 months as the intervention for the participants in the experimental group. Results Most of the mental health indicators of the participants in the experimental group had significantly improved after the silver yoga interventions, and many of the indicators improved after 3 months of intervention and were maintained throughout the 6 months study. The mental health indicators of the participants in the experimental group were all better than the participants in the control group (all p < .05). Conclusions After 6 months of silver yoga exercises, the sleep quality, depression, and health status of older adults were all improved.

Predictors of falls and hospitalization outcomes in elderly patients admitted to an acute geriatric unit

We aimed to identify fall incidence, predictors and characteristics and to investigate hospitalization outcomes for elderly inpatients. In 340 men and 280 women consecutively admitted to a Acute Geriatric Ward of a University Hospital the following variables were evaluated: demographics, clinical history, main disease responsible for hospitalization, comorbidity (cumulative illness rating scale: CIRS 1 and 2) gait and balance deficit (Tinetti's scales), cognition/function (short portable mental status questionnaire: SPMSQ); activities of daily living: ADL; instrumental activities of daily living: IADL; delirium (confusion assessment method: CAM), drugs administered during hospitalization. Overall 80 falls occurred in 70 patients. The incidence rate of falls was of 6.0 per 1000 patient-days with 2.0 falls per bed/year. Age (relative risk = RR = 1.050; 95% confidence interval = CI = 1.013–1.087), delirium (RR = 3.577; 95% CI 1.096–11.672), diabetes (RR = 5.913; 95% CI 1.693–20.644), balance deficit (RR = 0.914; 95% CI 0.861–0.970) and polypharmacy (RR = 1.226; 95% CI 1.122–1.340) were independently predictive of falling. Fallers had a prolonged length of stay (LOS) (35.5 ± 47.8 days vs. 23.2 ± 27.2; p = 0.01) and more frequent nursing home placements (12.9% vs.5.6%; p < 0.005). The knowledge of falling predictors might help in planning specific preventive strategies to improve the patients’ global health status and to reduce the costs of medical care.

Evaluating brief cognitive impairment screening instruments among African Americans

This article compared and contrasted the Telephone Interview of Cognitive Status (TICS) to the racially-sensitive Short Portable Mental Status Questionnaire (SPMSQ). The empirical questions addressed was whether the TICS over-represented African American (AA) cognitive impairment (CI) relative to the SPMSQ, if there were age differences in CI prevalence between younger subjects (ages 50–64) and older ones (>64 years) and on accuracy to detect CI in individuals with higher levels of educations (≥13 years) versus those with lower education levels (<13 years). A secondary data analysis was performed on 396 AA participants from the Carolina African American Twin Study on Aging (CAATSA). The SPMSQ measured CI prevalence at 10.3% and the TICS at 45.0%. Within the younger group, TICS and CI prevalence was 49.3 and 80% among the older group. Within the younger group SPMSQ and CI prevalence was 14.5 and 53.8% among the older group. Within the higher educated group, TICS and CI prevalence was 36.7 and 51.4% among the lower educated. Within the higher educated group, SPMSQ and CI prevalence was 7.7 and 14.5% among the lower educated. Findings are consistent with our hypotheses that the TICS would be a less accurate assessor of CI among AAs.

Reliability of body temperature measurements in hospitalised older patients

To compare different body temperature assessment methods in older people and to assess the role of cognitive and functional characteristics in temperature recordings. Axillary gallium-in-glass thermometers are commonly used. Their accuracy depends on the proper placement of the device and their permanence in place for eight minutes. With adequate instruction, well-functioning patients can measure their axillary temperature by themselves, while in cognitively and functionally impaired older people, inadequate understanding of instructions and misplacement of the thermometer might determine significant recording errors. Electronic ear and axillary temperature measurements are faster, but their accuracy has not been demonstrated convincingly with older people. Patients (n = 107; aged 65-104 years) were recruited. Barthel Index and Short Portable Mental Status Questionnaire (SPMSQ) scores were obtained for each patient. Temperature readings were obtained using: the axillary gallium-in-glass thermometer, with (T(nurse)) and without (T(self)) the nurse's assistance; the electronic axillary thermometer (T(el)) and the infrared tympanic thermometer (T(tymp)). The T(nurse) was considered as the reference method. Mean difference and standard deviation (mean +/- SD) in temperature recordings between the different techniques and T(nurse) differed significantly from zero for T(self) (-0.40 SD 0.42) and T(tymp) (+0.19 SD 0.48). No significant differences in temperature recordings emerged between T(nurse) and T(el). In simple linear regression models, the difference between T(self) and T(nurse) significantly correlated with age, gender, SPMSQ score and Barthel Index. Multiple linear regression analysis showed an underestimation of body temperature in older patients with cognitive impairments. Unassisted gallium-in-glass axillary temperature assessment is inadequate, in older patients. The differences between T(self) and T(nurse) are significantly influenced by age and mental decline. T(el) provides adequate accuracy. Relevance to clinical practice. In geriatric settings, the electronic axillary thermometer is a safe and accurate alternative to the more traditional gallium-in-glass thermometer, with the advantage of saving time (five seconds in recording vs. eight minutes).

Seemingly paradoxical seasonal influences on vitamin D status in nursing-home elderly people from a Mediterranean area

Objective We investigated vitamin D status in institutionalized elderly subjects by measuring serum 25-hydroxyvitamin D (25[OH]D) and its association with season and other factors: age, gender, nutritional status, cognitive function, functional ability, dietary intake, vitamin D supplement consumption, and disease. Methods The cross-sectional study included 86 subjects, 65–94 y of age (29 men and 57 women), who lived in three nursing homes in Murcia, a Spanish Mediterranean area. The Mini Nutritional Assessment, Short Portable Mental Status Questionnaire, and BI were used to evaluate nutritional status, functional ability, and cognitive function, respectively. Serum 25(OH)D concentrations were used to assess vitamin D status. The thresholds of inadequacy were considered to be <25 nmol/L (vitamin D deficiency) and <50 nmol/L (vitamin D insufficiency). Results Body mass index was 28.8 ± 5.8 kg/m 2 (mean ± SD). Vitamin D dietary intake was very much below the recommended dietary intake. The Mini Nutritional Assessment was 23.6 ± 4.0, cognitive function was 7.8 ± 1.9, and functional ability 82.9 ± 23.1. The percentages of subjects with inadequate serum 25(OH)D concentrations were 58.2% and 32.6%, taking into consideration cutoffs of 50 and 25 nmol/L, respectively. Vitamin D deficiency was more common in women (40.3%) than in men (20.7%). Serum 25(OH)D concentrations varied significantly with the season in which the samples were taken, but not with the other factors analyzed. Conclusion In this Mediterranean area, a substantial percentage of institutionalized subjects showed an inadequate vitamin D status, which could be remedied by the consumption of vitamin D–fortified foods and/or vitamin D supplements, especially during the summer months.

State and trait anxiety and depression in patients with primary brain tumors before and after surgery: 1-year longitudinal study

The aim in this study was to assess the state and trait types of anxiety as well as current depression before and after surgery in patients affected by brain tumors. The relationships between these affective disorders and the patient's sex, tumor histology, and laterality of the tumor were also evaluated. A total of 72 patients affected by a primary brain tumor were enrolled in the study. Histological grades were assigned according to the World Health Organization classification. State and trait anxiety were assessed using the State and Trait Anxiety Inventory; current depression was assessed using the Zung Self-Rating Depression Scale. Cognitive impairment was assessed using the 10-item Short Portable Mental Status Questionnaire. Psychometric evaluation was assessed before surgery and at 1, 3, 6, and 12 months after surgery. Before brain surgery, 62.5% of patients showed state anxiety, 50% of patients showed trait anxiety, and 9.7% of patients showed current depression. During the follow-up period there was no significant variation in the percentage of patients with state anxiety (p=0.416) and trait anxiety (p=0.7), whereas a significant increase in the percentage of those with current depression was found (p<0.0001), in particular at 1 month (p=0.002) and 3 months (p=0.039) after surgical treatment. The tumor's laterality and histology showed no correlation with psychometric variables, whereas a relationship between the presence of trait anxiety at the enrollment and current depression after surgery (p<0.0001) was found. Patients affected by brain tumors frequently experience affective disorders. After brain surgery, a depressive state can develop. The psychometric assessment could be useful in these patients for quick recognition of psychological disorders.

Inflammation and Rate of Cognitive Change in High-Functioning Older Adults

Inflammatory proteins including interleukin-6 (IL-6) and C-reactive protein (CRP) have been associated with incident cognitive impairment, but little research has addressed their effects on the rate of cognitive change, and findings are mixed. The purpose of this study was to examine the relationship between serum levels of IL-6 and CRP and the rate of cognitive change across a range of cognitive domains in a sample of healthy older persons. Growth curve analysis was performed on data from the MacArthur Study of Successful Aging, a longitudinal cohort study of high-functioning older adults aged 70-79 years at baseline in 1988 and reinterviewed in 1991 and 1995 (N = 851). Individual growth curve parameters were derived from baseline and follow-up performance in abstraction, language, spatial ability, verbal recall, spatial recognition, and global cognitive function based on age, IL-6, CRP, and covariates. Cross-sectionally, there is a generally linear negative relationship between inflammation and cognition, such that higher levels of inflammation are associated with lower levels of baseline cognitive function. After controlling for potential confounders, there was no effect of inflammation on baseline cognitive function or the rate of longitudinal cognitive change. However, persons in the top tertile on IL-6 were at an increased risk of incident declines on the Short Portable Mental Status Questionnaire (SPMSQ). Although high levels of inflammation are associated with incident cognitive impairment, these results do not generalize to the full range of cognitive changes, where the role of inflammation appears to be marginal.

Psychometric attributes of the SCOPA‐COG Brazilian version

Cross-cultural adaptation and independent psychometric assessment of the Scales for Outcomes in Parkinson's disease-Cognition (SCOPA-COG), Brazilian version was performed. Parkinson's disease (PD) patients were evaluated by means of the SCOPA-Motor scale, Hoehn and Yahr staging (HY), Clinical Impression of Severity Index-PD (CISI-PD), Parkinson Psychosis Rating Scale, and Hospital Anxiety and Depression Scale. Cognition was evaluated using the Mini-Mental State Examination (MMSE), Short Portable Mental Status Questionnaire (SPMSQ), and SCOPA-COG. The following attributes were explored: acceptability, scaling assumptions, reliability, precision, and construct validity. One hundred fifty-two patients were assessed (mean age, 63.2 years; disease duration, 7.8 years; median HY stage, 3). Mean SCOPA-COG and MMSE were 18.2 and 25.7, respectively. The internal consistency of the SCOPA-COG (Cronbach's alpha = 0.81; item-total correlation, 0.38-0.62) was satisfactory. While the intraclass correlation coefficient value was 0.80, weighted kappa ranged from 0.30 (dice task) to 0.72 (animal fluency task). The standard error of measurement value for the SCOPA-COG was 3.2, whereas the smallest real difference was 8.9. SCOPA-COG total scores significantly decreased as the HY stage increased (Kruskal-Wallis, P < 0.0001). Age, years of education, and PD duration (all, P < 0.001) were observed to have an independent, significant effect on the SCOPA-COG. The SCOPA-COG is a short, reliable, valid instrument that is sensitive to cognitive deficits specific to PD.

A multilevel analysis of the influence of Apolipoprotein E genotypes on depressive symptoms in late-life moderated by the environment

Objective This study aimed to clarify the relationship between the APOE alleles and depressive symptoms of older adults, considering individual characteristics and the effect of neighborhood environment. Methods Using a multilevel, stratified sampling strategy, 500 elders were recruited from official household records. Depressive symptoms were assessed using the Taiwanese Depression Questionnaire [TDQ]. Cognitive function was assessed by the Short Portable Mental Status Questionnaire [SPMSQ]. Blood samples were collected for the determination of the Apolipoprotein E [APOE] polymorphism. Perceived neighborhood experience was brought together using the Neighborhood Quality Index [NQI]. Results Three hundred and three subjects (58.8% male, with a mean age of 69.2 [SD = 2.7] years) completed all questionnaires and the collection of blood samples. Risk factors for depressive symptoms of elders included lower educational level, cognitive impairment, having 2 or more chronic diseases, and having the APOE ɛ4 allele. In the 2-level model with individual characteristics and neighborhood environmental factors, the effect of the APOE ɛ4 allele on depressive symptoms was significantly attenuated. Conclusions The APOE ɛ4 allele is correlated with depressive symptoms among older adults, but moderated by neighborhood environmental factors.

ApoE4 Allele Is Associated With Late-Life Depression: A Population-Based Study

This study aimed to clarify the relationship between the epsilon4 allele and late-life depression, taking into account lipid profile, vascular diseases, and sociodemographics. Using a multilevel stratified random sampling strategy, a total of 500 subjects aged 65 to 74 years were recruited for this cross-sectional study from the official household records of an entire county in southern Taiwan. Depressive symptoms were assessed by the Taiwanese Depression Questionnaire (TDQ). Cognitive function was assessed by the Short Portable Mental Status Questionnaire. Blood samples were collected for the determination of the apolipoprotein E (ApoE) polymorphism and the lipid profile. A total of 283 subjects (58.7% male, with a mean age of 69.2 +/- 2.7 years) completed all questionnaires and collection of blood samples. Using the chi(2) test, the overall difference for frequency of the presence of the epsilon4 allele was significant among the severe group (TDQ score >18), moderate group (TDQ score 9-18), and mild group (TDQ score <9). The proportion of history of heart disease was significantly higher in the severe group than in the mild or moderate group. Kruskal-Wallis statistics revealed that the mean total and low-density lipoprotein cholesterol levels were significantly higher in the severe group than in the moderate or mild group. With our two-level four-class latent class regression model, the presence of the epsilon4 allele was significantly associated with the severely depressed group as compared to the nondepressed group, adjusting for vascular diseases and lipid profile. The ApoE epsilon4 allele may be correlated with severe depression in the elderly through ways other than the "vascular depression" hypothesis.

Two questionnaires for Parkinson’s disease: are the PDQ-39 and PDQL equivalent?

Although there is a wide range of specific health-related quality of life (HRQoL) measures for Parkinson's disease (PD), their psychometric attributes have never been compared. To compare the psychometric characteristics of the Parkinson's Disease Questionnaire-39 items (PDQ-39) and Parkinson's Disease Quality of Life Questionnaire (PDQL). The PDQ-39 and PDQL were simultaneously applied to 187 PD patients. Additional assessments included Hoehn and Yahr staging, Schwab and England Scale (SES), Unified Parkinson's Disease Rating Scale, Pfeiffer's Short Portable Mental Status Questionnaire (SPMSQ) and Hospital Anxiety and Depression Scale (HADS). Criteria for acceptability, scaling assumptions, reliability, construct validity and precision were drawn up. Both the PDQ-39 and PDQL proved very similar in the following aspects: acceptability (no floor or ceiling effect); scaling assumptions (79.5% and 80% respectively of item-total correlations fitted the standard); internal consistency (PDQ-39 domains, alpha = 0.43-0.93; PDQL domains, alpha = 0.70-0.88); stability (intraclass correlation coefficient = 0.76-0.90); and internal validity (PDQ-39, r = 0.09-0.70; PDQL, r = 0.52-0.71). Convergent validity between the two questionnaires was moderate to high (r = -0.91 for summary indices). Precision was higher for the PDQ-39 Summary Index, and predictors were the same for both measures (mood disorders and disability). Although the psychometric properties tested are quite similar in both measures, mainly insofar as summary indices are concerned, differences in some attributes and structural content should nevertheless be considered when comparing both instruments.

Depressive Symptoms as a Predictor of Cognitive Decline: MacArthur Studies of Successful Aging

The prevalence of dementia continues to rise, and yet, there are few known modifiable risk factors. Depression, as a treatable condition, may be important in the development of dementia. Our objective was to examine the association between depressive symptoms and longitudinal cognitive changes in older adults who were high-functioning at baseline. The authors analyzed data from a community-based cohort (aged 70-79 at baseline), who, at study entry, scored 7 or more (out of 9) on the Short Portable Mental Status Questionnaire (SPMSQ). Depressive symptoms were assessed at baseline using the depression subscale of the Hopkins Symptom Check List. Cognitive performance was measured at baseline and at seven-year follow up by the SPMSQ and by summary scores from standard tests of naming, construction, spatial recognition, abstraction, and delayed recall. After adjusting for potential confounders, including age, education, and chronic health conditions such as diabetes, heart attack, stroke, and hypertension, a higher number of baseline depressive symptoms were strongly associated with greater seven-year decline in cognitive performance and with higher odds of incident cognitive impairment, i.e., decline in SPMSQ score to < or = 6 (adjusted odds ratio per quartile of depressive symptoms score: 1.34, 95% confidence interval: 1.10-1.68). Depressive symptomatology independently predicts cognitive decline and incident cognitive impairment in previously high-functioning older persons.

El recuerdo de las tres palabras. ¿Es útil en el cribado del deterioro cognitivo en las personas mayores?

Introduction Objective To determine the validity of three-word recall (TWR) for the screening of cognitive impairment, using the Short Portable Mental Status Questionnaire (SPMSQ) as the gold standard. Material and methods Design: descriptive cross-sectional study with a 1-year follow-up. Setting: 3 primary care centres attending an urban population. Participants: outpatients aged 65 or more were included. The initial sample consisted of 172 patients (precision = 5%, confidence level = 95%, expected percentage with cognitive impairment = 10%) Main measurements: measurements were estimated on April 1 2004/May 31 2004 and April 1 2005/May 31 2005. We administered TWR initially and 1 year later to determine its sensitivity, specificity and probability quotients with respect to the SPMSQ. Results The baseline evaluation (2004) included 172 subjects. One hundred subjects (58%) were women. The mean age was 76.4 years (SD = 6.3). Nine subjects (5%) were illiterate. The results of examination with the SPMSQ showed normal memory in 155 subjects (90.1%) and memory impairment in 17 subjects (9.9%). When the TWP was used, 73 subjects (42.4%) reca-lled 3 words, 68 (39.5%) recalled 2 words, 23 (13.4%) recalled 1 word and eight subjects (4.7%) recalled none. The 1-2 word recall cut-off point had a sensitivity of 58.5% (95% CI, 36.0-78.4), a specificity of 86.5% (95% CI, 80.2-91%) and a negative predictive value of 95% (95% CI, 90.1 -97.6). Conclusions The ability to recall 2 or 3 words does not reasonably rule out a diagnosis of cognitive impairment. Subjects able to recall 0 or 1 should undergo neuropsychological tests to confirm cognitive impairment.

Usefulness of the Comprehensive Geriatric Assessment in Older Patients with Upper Gastrointestinal Bleeding: A Two-Year Follow-Up Study

Background: The potential usefulness of standardized comprehensive geriatric assessment (CGA) in evaluating treatment and follow-up of older patients with upper gastrointestinal bleeding is unknown. Aim: To evaluate the usefulness of the CGA as a 2-year mortality multidimensional prognostic index (MPI) in older patients hospitalized for upper gastrointestinal bleeding. Materials and Methods: Patients aged ≧65 years consecutively hospitalized for acute upper gastrointestinal bleeding were included. Diagnosis of bleeding was based on clinical and endoscopic features. All patients underwent a CGA that included six standardized scales, i.e., Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Short Portable Mental Status Questionnaire (SPMSQ), Mini Nutritional Assessment (MNA), Exton-Smith Score (ESS) and Comorbity Index Rating Scale (CIRS), as well as information on medication history and cohabitation, for a total of 63 items. A MPI was calculated from the integrated total scores and expressed as MPI 1 = low risk, MPI 2 = moderate risk, and MPI 3 = severe risk. The predictive value of the MPI for mortality over a 24-month follow-up was calculated. Results: 36 elderly patients (M 16/F 20, mean age 82.8 ± 7.9 years, range 70–101 years) were included in the study. A significant difference in mean age was observed between males and females (M 80.1 ± 4.8 vs. F 84.9 ± 9.3 years; p < 0.05). The causes of upper gastrointestinal bleeding were duodenal ulcer in 38.8%, gastric ulcer in 22.2%, and erosive gastritis in 16.6% of the patients, while 16.6% had gastrointestinal bleeding from unknown origin. The overall 2-year mortality rate was 30.5%. 18 patients (50%) were classified as having a low-risk MPI (mean value 0.18 ± 0.09), 12 (33.3%) as having a moderate-risk MPI (mean value 0.48 ± 0.08) and 6 (16.6%) as having a severe-risk MPI (mean value 0.83 ± 0.06). Higher MPI grades were significantly associated with higher mortality (grade 1 = 12.5%, grade 2 = 41.6%, grade 3 = 83.3%; p = 0.001). Adjusting for age and sex, the prognostic efficacy of MPI for mortality was confirmed and highly significant (odds ratio 10.47, 95% CI 2.04–53.6). Conclusion: CGA is a useful tool for calculating a MPI that significantly predicts the risk of 2-year mortality in older patients with upper gastrointestinal bleeding.

Time-dependent prognostic factors of 6-month mortality in frail elderly patients admitted to post-acute care

To determine the association between functional and nutritional changes caused by an acute illness requiring hospitalisation and 6-month mortality. Hospital-based prospective longitudinal cohort study. Acute care centre (Hospital General de Vic, Barcelona Province, Spain). Post-acute care centre (Hospital de la Santa Creu de Vic, Barcelona Province, Spain). Hundred sixty five patients aged 75 years and older, hospitalised for an acute event. Functional status (Barthel and Lawton Indices), cognitive status (Short Portable Mental Status Questionnaire), nutritional status (Mini Nutritional Assessment, albumin, cholesterol), depressive symptoms (Geriatric Depression Scale), co-morbidity (Charlson Index) and self-rated health status were collected upon admission to the post-acute care centre. Functional and nutritional status were assessed 1, 3 and 6 months after admission by a trained staff of geriatricians. Six-month mortality was the main outcome variable. Survival analysis was performed with functional and nutritional status as time-dependent variables. The mean age of the cohort was 83.3 years (SD 5.1) and 68.5% were female. Six-month mortality was 29.1% (95% CI: 22.2-36.7). The variables associated with mortality in bivariate analysis were: gender, Barthel Index (2 weeks before admission), Lawton Index (2 weeks before admission), Charlson Index, Barthel Index (time-dependent), Mini Nutritional Assessment (MNA) (time-dependent) and cognitive status. The variables associated with mortality in multivariate analysis were: gender, Barthel Index (2 weeks before admission), Charlson Index and MNA (time-dependent). Functional and nutritional changes due to an acute illness have a statistical and clinical prognostic value and should be assessed along with other well-known relevant prognostic factors.