Standardized Mini-Mental State Examination Research Articles

The association between selenium status and global and attention-specific cognition in very old adults in the Newcastle 85+ Study: cross-sectional and longitudinal analyses

BackgroundSelenium has potential safeguarding properties against cognitive decline, because of its role in protecting DNA, proteins, and lipids in the brain from oxidative damage. However, acute and chronic overexposure to selenium can be neurotoxic. ObjectiveThe aim of this analysis was to explore the association between selenium status [serum selenium and selenoprotein P (SELENOP) concentrations and glutathione peroxidase 3 (GPx3) activity] and cognitive function in 85-y olds living in Northeast England at baseline and ≤5 y of follow-up. MethodsGlobal cognitive performance was assessed in 755 participants from the Newcastle 85+ study using the standardized Mini-Mental State Examination and attention-specific cognition was assessed using composite scores derived from the Cognitive Drug Research System. Serum selenium, SELENOP, and GPx3 activity were measured at baseline by total reflection X-ray fluorescence, enzyme-linked immunosorbent assay, and coupled-enzyme reaction, respectively. Regression analyses explored linear and nonlinear associations between continuous values and tertiles of selenium status biomarkers, respectively, and cognitive function at baseline. Generalized linear mixed models explored associations between continuous values and tertiles of selenium status biomarkers, and global cognitive decline over 5 y, and attention-specific cognitive decline over 3 y. ResultsOver 3 and 5 y, none of the selenium biomarkers were associated with the rate of cognitive decline. At baseline, in fully adjusted models, higher serum selenium was nonlinearly associated with global cognition (β = 0.05 ± 0.01, P = 0.387 linear, β = 0.04 ± 0.01, P = 0.002 nonlinear). SELENOP and GPx3 activity were not associated with any cognitive outcomes. ConclusionsThere were no associations between selenium status and cognitive decline. However, serum selenium, but not SELENOP or GPx3 activity, was positively associated nonlinearly with global cognition at baseline. Furthermore, these associations were not evident during follow-up, potentially because of residual confounding and reverse causation.

The association between selenium status and cognitive decline in very old adults: The Newcastle 85+ Study

The trace element selenium is known to protect against oxidative damage which is known to contribute to cognitive impairment with ageing (1,2). The aim of this study was to explore the association between selenium status (serum selenium and selenoprotein P (SELENOP)) and global cognitive performance at baseline and after 5 years in 85-year-olds living in the Northeast of England.Serum selenium and SELENOP concentrations were measured at baseline by total reflection X-ray fluorescence (TXRF) and enzyme-linked immunosorbent assay (ELISA), respectively, in 757 participants from the Newcastle 85+ study. Global cognitive performance was assessed using the Standardized Mini-Mental State Examination (SMMSE) where scores ≤25 out of 30 indicated cognitive impairment. Logistic regressions explored the associations between selenium status and global cognition at baseline. Linear mixed models explored associations between selenium status and global cognition prospectively after 5 years. Covariates included sex, body mass index, physical activity, high sensitivity C-reactive protein, alcohol intake, self-rated health, medications and smoking status.At baseline, in fully adjusted models, there was no increase in odds of cognitive impairment with serum selenium (OR 1.004, 95% CI 0.993-1.015, p = 0.512) or between SELENOP (OR 1.006, 95% CI 0.881-1.149, p = 0.930). Likewise, over 5 years, in fully adjusted models there was no association between serum selenium and cognitive impairment (β 7.20E-4 ± 5.57E-4, p = 0.197), or between SELENOP and cognitive impairment (β 3.50E-3 ± 6.85E-3, p = 0.610).In this UK cohort of very old adults, serum selenium or SELENOP was not associated with cognitive impairment at baseline and 5 years. This was an unexpected finding despite SELENOP’s key role in the brain and the observed associations in other studies. Further research is needed to explore the effect of selenium on global cognition in very old adults.

Prospective Randomized Pilot Trial on the Effects of Mild Hypercapnia on Cerebral Oxygen Saturation in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

A single-center prospective randomized controlled study was conducted to assess the effect of targeted mild hypercapnia (TMH) on cerebral oxygen saturation (rSO2) in patients undergoing off-pump coronary artery bypass grafting (CABG). A prospective randomized controlled study involving 100 patients undergoing off-pump CABG at U. N. Mehta Hospital, Ahmedabad, Gujarat, India. Patients were randomized to either the TMH (PaCO2 45-55 mmHg) or the targeted normocapnia (TN; PaCO2 35-45 mmHg) group, containing 50 patients in each group. Monitoring of rSO2, heart rate, mean arterial pressure (MAP), PaCO2, and peripheral oxygen saturation was done at baseline, after induction, after left internal mammary artery harvesting, at each grafting (distal and proximal), after protamine, and after shifting to the intensive care unit. The standardized minimental-state examination (SMMSE) was performed preoperatively and at 8, 12, and 24 hours postextubation. Data were analyzed using an independent sample t test. The TMH group had higher MAP during grafting (p < 0.001) and higher rSO2 on both sides during distal and proximal grafting (p < 0.001) and after protamine (p < 0.05), as compared to the TN group. Compared to preoperative values, SMMSE scores in the TN group were significantly lower at 12 and 24 hours postextubation (p < 0.001). TMH during grafting increased the cerebral blood flow and rSO2 when hemodynamic instability was very common. It has a protective role on the brain and helps maintain cognition postoperatively.

The relationship between metacognitive processes and cognitive performances in older adults with no significant impairment: a cross-sectional study.

Metacognitive dysfunctions have been implicated in several neuropsychiatric conditions, while cognitive performances have been evaluated by measuring cognitive domains in older adults. This study investigated a relationship between metacognitive processes and cognitive performances in older adults. A sociodemographic form, the Standardised Mini-Mental State Examination (SMMSE) and the Metacognitions Questionnaire-30 (MCQ-30) were applied to participants aged >65 years who had no significant cognitive decline defined as normal or with mild cognitive impairment. 'Negative beliefs about worry' and 'need to control thoughts' domains of MCQ-30 were related to cognitive performance measured with SMMSE. Increased negative beliefs about worry were a predicting factor for total cognitive performance as a means of contributing to cognitive impairment, whereas an increased need to control thoughts was related to having a less likely cognitive impairment. Metacognitive dysfunctional processes, in particular about worry, might contribute to determining more decent outcomes for cognitive conditions in older adults with no significant cognitive dysfunction.

A pilot study for a practical screening tool for dementia: validation of 5-minute cognitive test in a geriatric population.

The aim of this study is to validate the Turkish version of the 5-minute cognitive test (FCT) in a geriatric population. In total, 61 participants aged ≥65 years with normal cognitive functions, mild cognitive impairment (MCI), and early stage dementia were included. The FCT was compared to the standardised Mini Mental State Examination (MMSE) and the Qmci-TR (quick mild cognitive impairment) test. Test reliability for the FCT was strong (Cronbach's α = 0.747). We demonstrated a strong correlation of FCT scores with MMSE and Qmci-TR scores (respectively, r = 0.730, P < 0.001, r = 0.723, P < 0.001). The fact that the scores obtained in the dementia group were significantly lower also showed that the test can be used reliably in the differentiation of MCI and early dementia (P < 0.001). The FCT is a brief, reliable, and valid cognitive screening test for screening dementia at early stages in a Turkish geriatric population.

Validity and reliability of the Turkish version of the Holden Communication Scale.

The communication skills of individuals with dementia are affected even in the early stages of the condition. To date, there is no scale for the evaluation of communication abilities in Turkish-speaking populations with dementia that can be used in clinical practice and research. The present study aimed to determine the validity and reliability of the Turkish version of the Holden Communication Scale (HCS-TR). The study was carried out with 141 participants (77 female and 64 male). Psychometric analyses were conducted to assess the internal consistency, construct and criterion validity, test-retest reliability, and inter-rater reliability of the HCS-TR. The Standardized Mini-Mental State Examination (SMMSE) test was used for criterion validity. For the inter-rater reliability of the scale, the two different caregivers of individuals with dementia were administered the scale separately at the same time. For test-retest reliability, 2 weeks later, the same caregivers who filled out the HCS-TR the first time were administered to fill out the scale again. To test the validity of the scale, an item factor analysis was performed, and the correlations between the items and subsections were determined. The factor loadings indicating the adequate contribution of the scale items to the relevant dimension were within the 0.700-0.831 range. There were positive relationships between all the items of the HCS-TR, and there was a significant negative relationship (r=-.842) between HCS-TR and MMSE. The corrected item-total correlation values were found to be within the .676-.794 range. Cronbach's alpha values for the HCS-TR subsection and total scores in the first and second measurements were found to be in the range of .718-.944. There was no statistically significant difference (p=.709) between the mean total scores in the first and second measurements. The HCS-TR is a valid and reliable tool that can be used for clinical and research purposes to assess the strengths and limitations of the communication skills of Turkish individuals with dementia.

How do older adults receiving aged care services understand and respond to the EQ-5D-5L? A think-aloud study in residential care

PurposeThe EQ-5D-5L is a preference-based instrument for measuring and valuing health-related quality of life (HRQoL). The EQ-5D-5L has been used extensively in economic evaluation, including in aged care. However, older adults’ understanding of the EQ-5D-5L has not been comprehensively investigated to date. This research aimed to assess older adults’ understanding of the EQ-5D-5L using a think-aloud protocol with two cognition groups: no cognitive impairment and mild/moderate cognitive impairment.MethodsParticipants’ cognition was assessed using the Standardised Mini-Mental State Examination (SMMSE). Face-to face interviews were conducted with concurrent and retrospective think-aloud encouraged through verbal probing. Audio recordings were transcribed, and qualitative analysis, informed by the Tourangeau four-stage Response Model (comprehension, retrieval, decision process, response process) was conducted in NVivo.ResultsIn total, 46 older adults (age 65 +) were recruited from 10 residential care facilities across South Australia (n = 25 no cognitive impairment, n = 21 mild/moderate cognitive impairment). Comprehension, retrieval, judgement and response mapping issues were common across all cognition levels and EQ-5D-5L dimensions. The two dimensions resulting in the most response issues were usual activities and personal care.ConclusionOlder adults may bring a different understanding to the EQ-5D-5L descriptive system than that expected given testing with general population samples. Dimension descriptors that are more relevant to this population may facilitate responses that better align with the underlying EQ-5D-5L concept model.

The relationship between activities of daily living and abuse in the elderly: cross-sectional study during covid 19

ABSTRACT To determine the relationship between activities of daily living in the elderly and elder abuse, the research was conducted during the COVID-19 process. This study was performed as descriptive and cross -sectional. For data collection, the Standardized Mini-Mental State Examination (SMMSE), Personal Information Form, Barthel Index of Activities of Daily Living (BIADL) and Hwalek-Sengstock Elder Abuse Screening Test (HS/EAST) were used. It was determined that 43.8% of the elderly participants were moderately dependent while performing activities of daily living, and 63.4% were exposed to some kind of abuse. The HS/EAST total mean scores of elderly people who were highly dependent while performing activities of daily living were found to be higher. It was determined that as the dependency levels of the elderly in their activities of daily living increased, the rate of exposure to abuse increased.

Serum zonulin levels are increased in Alzheimer’s disease but not in vascular dementia

BackgroundZonulin is involved in the integrity and functioning of both intestinal-epithelial barrier and blood–brain barrier (BBB) by regulating tight junction molecular assembly.AimSince changes in microbiota and BBB may play a role in neurodegenerative disorders, we aimed to determine whether serum zonulin levels change in older patients affected by different types of dementia or mild cognitive impairment (MCI).MethodsWe evaluated serum zonulin levels in patients with late-onset AD (LOAD), vascular dementia (VAD), MIXED (AD + VAD) dementia, amnestic MCI, and in healthy controls.ResultsCompared with controls, serum zonulin increased in LOAD, MIXED dementia, and aMCI but not in VAD, independent of potential confounders (ANCOVA p = 0.01; LOAD vs controls, p = 0.01; MIXED vs. controls, p = 0.003; aMCI vs. controls, p = 0.04). Notably, aMCI converting to dementia showed significantly higher levels of zonulin compared with stable aMCI (p = 0.04). Serum zonulin inversely correlated with the standardized Mini-Mental State Examination (MMSE) score (p < 0.05), regardless of potential confounders.DiscussionWe found increased serum zonulin levels in patients with aMCI, LOAD and MIXED dementia, but not in VAD; moreover, zonulin levels were higher in aMCI converting to AD compared with stable ones.ConclusionsOur findings suggest that a dysregulation of intestinal-epithelial barrier and/or BBB may be an early specific event in AD-related neurodegeneration.

Association between 18F – FDG uptake and global cognitive performance in individuals at risk of dementia

AbstractBackgroundCardiometabolic disorders (CMD) and Mild Cognitive Impairment (MCI) have been associated with an increased risk of developing dementia. However, brain glucose metabolism has not been compared between patients with CMD and MCI, and little is known about its associations with global cognitive performance. Here we examined regional brain 18F – FDG uptake in patients with CMD and MCI, and analyzed its potential associations with global cognitive performance.Methods55 patients with increased risk for developing dementia were recruited (MCI = 22; CMD = 33) in this cross‐sectional study. As a measure of brain glucose metabolism, PET/CT was performed and the mean uptake value in brain regions of interest (ROI) was obtained and standardized by whole brain uptake. Global cognitive performance was examined using the Mini‐Mental State Examination (MMSE). Group differences in brain metabolism and cognitive performance were examined. We conducted separate linear regression models considering standardized MMSE as the dependent variable, and mean 18F – FDG uptake in each of the ROI (and its CMD/MCI group‐interactions) as independent variables. Our models were adjusted by age, gender, years of education, and presence of at least one APOE e4 allele, and corrected for multiple testing with the False Discovery Ratio (FDR &lt; 0.01).ResultsThe CMD and MCI groups were comparable in age, gender, education, and mean 18F‐FDG uptake across all the ROIs, but significantly different in MMSE (Table 1). Adjusted models for global cognitive performance showed significant group interactions with the mean 18F – FDG uptake in bilateral caudate and hippocampus, as well as in left‐hemisphere amygdala, cuneus, fusiform gyrus, and opercular part of the inferior frontal gyrus. Thus, significant negative associations of 18F – FDG uptake in the above ROIs and cognitive performance was observed in the MCI group (Figure 1 &amp; Table 2).ConclusionsIn MCI patients, reduced global cognitive performance was significantly associated with high brain glucose metabolism in bilateral caudate and hippocampus, and with the left fusiform gyrus, cuneus, and inferior frontal gyrus (opercular part). These asymmetric associations between high metabolism and low cognitive performance could suggest compensatory effects in MCI patients but further research is needed to confirm this hypothesis.

Associations of Baseline Sleep Microarchitecture with Cognitive Function After 8 Years in Middle-Aged and Older Men from a Community-Based Cohort Study.

Prospective studies examining associations between baseline sleep microarchitecture and future cognitive function recruited from small samples with predominantly short follow-up. This study examined sleep microarchitecture predictors of cognitive function (visual attention, processing speed, and executive function) after 8 years in community-dwelling men. Florey Adelaide Male Ageing Study participants (n=477) underwent home-based polysomnography (2010-2011), with 157 completing baseline (2007-2010) and follow-up (2018-2019) cognitive assessments (trail-making tests A [TMT-A] and B [TMT-B] and the standardized mini-mental state examination [SMMSE]). Whole-night F4-M1 sleep EEG recordings were processed following artifact exclusion, and quantitative EEG characteristics were obtained using validated algorithms. Associations between baseline sleep microarchitecture and future cognitive function (visual attention, processing speed, and executive function) were examined using linear regression models adjusted for baseline obstructive sleep apnoea, other risk factors, and cognition. The final sample included men aged (mean [SD]) 58.9 (8.9) years at baseline, overweight (BMI 28.5 [4.2] kg/m2), and well educated (75.2% ≥Bachelor, Certificate, or Trade), with majorly normal baseline cognition. Median (IQR) follow-up was 8.3 (7.9, 8.6) years. In adjusted analyses, NREM and REM sleep EEG spectral power was not associated with TMT-A, TMT-B, or SMMSE performance (all p>0.05). A significant association of higher N3 sleep fast spindle density with worse TMT-B performance (B=1.06, 95% CI [0.13, 2.00], p=0.026) did not persist following adjustment for baseline TMT-B performance. In this sample of community-dwelling men, sleep microarchitecture was not independently associated with visual attention, processing speed, or executive function after 8 years.

Potential overestimation of cognitive impairment due to hearing loss: Impact of test modalities on cognitive test scores.

Hearing impairment in older adults may affect cognitive function and increase the risk of dementia. Most cognitive tests are delivered auditorily, and individuals with hearing loss may fail to hear verbal instructions. Greater listening difficulty and fatigue in acoustic conditions may impact test performance. This study aimed to examine the effect of decreased audibility on cognitive screening test performance in older adults. Older adults (n = 63) with different levels of hearing loss completed a standard auditory Mini-Mental State Examination test and a written version of the test. Individuals with moderate to moderately severe hearing loss (41-70 dB) performed significantly better on the written (24.34 ± 4.90) than on the standard test (22.55 ± 6.25), whereas scores were not impacted for mild hearing loss (less than 40 dB). Hearing evaluations should be included in cognitive assessment, and test performance should be carefully interpreted in individuals with hearing loss to avoid overestimating cognitive decline.

Monitoring of regional cerebral oximetry by near-infrared spectroscopy during off-pump coronary artery bypass grafting to evaluate the impact on postoperative neurocognitive dysfunction – A prospective study

Abstract Background and Aims: Postoperative neurological dysfunction is a common noncardiac complication following cardiac surgery. Primary objective of our study was to evaluate the effects of cerebral oxygen desaturation on the neurological outcome in the postoperative period by monitoring regional cerebral oxygen saturation in off-pump coronary artery bypass grafting (OPCABG). Secondary objective was to study the correlation between regional cerebral oxygen saturation and mean arterial pressure (MAP) during grafting. Setting and Design: It was a prospective observational study in 100 patients of the American Society of Anesthesiologists physical status grading II-III of either sex, having triple vessel coronary artery disease undergoing OPCABG. Patient, having left ventricular ejection fraction (LVEF) &lt;35%, carotid artery disease, on extracorporeal membrane oxygenator or intra-aortic balloon pump, preexisting neurological disorder with standardized mini-mental state examination (SMMSE) score &lt;23, undergoing emergency surgery, re-do surgery, and co-existing valvular diseases were excluded from the study. Surgeries were conducted under general anesthesia with midazolam 0.1 mg/kg, fentanyl 5 μg/kg, and vecuronium 0.1 mg/kg. Anesthesia was maintained with intermittent boluses of fentanyl, vecuronium, and isoflurane. Materials and Methods: The SMMSE was performed preoperatively, 8 and 12 h after extubation. Patients with postoperative SMMSE score of 24–30 were allocated to Group A and patients with SMMSE score ≤ 23, were allocated to Group B. The cerebral oxygen saturation (rSO2), heart rate, MAP, and arterial blood gas were monitored perioperatively. Statistical Analysis: The Chi-square test was used to compare categorical variables and independent Samples t-test was used to compare continuous variables. Pearson bivariate correlation test was used to correlate between the continuous variables. Results: The mean difference of right and left rSo2, between baseline value, and during saphenous vein graft (SVG) to obtuse marginal grafting were 8.70 ± 3.38, 8.78 ± 3.19 in group A and 18.8 ± 2.40, 18.91 ± 1.88, respectively, in group B and were found to be statistically significant. The mean difference of right and left rSO2, between baseline value and during SVG to posterior descending artery grafting were 6.48 ± 3.91, 7.10 ± 3.67 in group A and 18.1 ± 3.57, 17.9 ± 3.60 in group B and were found to be statistically significant. Mean difference and percentage variation from baseline of right and left rSo2 and MAP from preinduction to grafting from left internal mammary artery to left anterior descending artery were found to be statistically insignificant. Conclusion: A decrease of regional cerebral saturation value by 25% from baseline or an absolute reduction of rSO2 value by 50% and reduction in MAP from baseline, during the period of grafting was associated with postoperative neurocognitive dysfunction.

Alcohol Use Disorder and Associated Factors Among Elderly in Ethiopia.

The aim of this study was to investigate the magnitude and associated factors of alcohol use disorder among the elderly living in 3 towns in South West Ethiopia. Cross-sectional community-based study was done among 382 elderly people aged 60 or more from February to March 2022 in South West Ethiopia. The participants were selected by a systematic random sampling method. Alcohol use disorder, quality of sleep, cognitive impairment, and depression were assessed by using AUDIT, Pittsburgh Sleep Quality Index, Standardized Mini Mental State Examination, and geriatric depression scale, respectively. Also, suicidal behavior, elder abuse, and other clinical and environmental factors were assessed. The data was entered into Epi Data Manager Version 4.0.2 before being exported to SPSS Version 25 for analysis. A logistic regression model was used, and variables with a P-value less than .05 in the final fitting model were stated as independent predictors of alcohol use disorder (AUD). The magnitude of alcohol use disorder, current alcohol use, and life-time alcohol use among the elderly was 27.5%, 52.4%, and 89.3%, respectively. Also, 7%, 23%, 8.9%, and none of the elderly had nicotine, khat, inhalants, and cannabis use disorder, respectively. Furthermore, AUD was associated with cognitive impairment (AOR, 95% CI; 2.79 (1.47-5.30)), poor sleep quality (AOR, 95% CI; 3.27 (1.23-8.69)), chronic medical illness (AOR, 95% CI; 2.12 (1.20-3.74)), and suicidal ideation (AOR, 95% CI; 5.27 (2.21-12.60)). Problematic alcohol use was higher among the elderly, and cognitive impairment, poor sleep quality, having chronic medical illness, and suicidal ideation were risk factors for AUD. Therefore, community level screening for AUD and comorbid risk factors among this particular age group and managing them is crucial to prevent further complications due to AUD.

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

Breast cancer is the most frequently diagnosed cancer in women worldwide. Aromatase inhibitors (AIs) are effective treatment options for both early-stage and advanced hormone receptor-positive breast cancer. Because of AIs are used long term in adjuvant therapy, side effects are also very important. It is considered that AIs may affect cognitive functions by decreasing the level of estrogen in the brain. The purpose of our study is that evaluate the relationship between duration of treatment and cognitive functions in patients with breast cancer who use AIs in adjuvant therapy. Two-hundred patients diagnosed with breast cancer who were treated with AIs as adjuvant treatment were included. The patients were surveyed for demographic characteristics. Montreal Cognitive Assessment (MoCA) and Standardized Mini-Mental State Examination (SMMT) tests were performed to evaluate patients' cognitive functions. The total scores of the tests and the orientation, short-time memory, visuospatial functions, attention, language, executive functions which are the MoCA subscales were evaluated separately. Patients were grouped as 0-6, 6-12, 12-24, 24-36, 36, and more months according to the duration of AIs using time. The total MoCA and SMMT scores were affected by factors such as age, education level, and employment status. There was no relationship between duration of treatment and cognitive functions in patients with breast cancer who use AIs in adjuvant therapy (P > 0.05). In addition, no statistically relationship was found in the evaluation of MoCA subscales (P > 0.05). Prolonged adjuvant treatment with AIs does not affect cognitive functions in hormone receptor-positive breast cancer patients.

Exploring Hospital Inpatients' Awareness of Their Falls Risk: A Qualitative Exploratory Study.

Patient falls in hospital may lead to physical, psychological, social and financial impacts. Understanding patients' perceptions of their fall risk will help to direct fall prevention strategies and understand patient behaviours. The aim of this study was to explore the perceptions and experiences that influence a patient's understanding of their fall risk in regional Australian hospitals. Semi-structured, individual interviews were conducted in wards across three Australian hospitals. Participants were aged 40 years and over, able to communicate in English and were mobile prior to hospital admission. Participants were excluded from the study if they returned a Standardised Mini-Mental State Examination (SMMSE) score of less than 18 when assessed by the researcher. A total of 18 participants with an average age of 69.8 years (SD ± 12.7, range 41 to 84 years) from three regional Victorian hospitals were interviewed for this study. Data were analysed using a reflexive thematic analysis identifying three major themes; (1) Environment (extrinsic) (2) Individual (intrinsic), and (3) Outcomes, as well as eight minor themes. Participants recognised the hazardous nature of a hospital and their personal responsibilities in staying safe. Falls education needs to be consistently delivered, with the focus on empowering the patient to help them adjust to changes in their clinical condition, whether temporary or permanent.

Association of Psychotropic Education with Quality of Life: A Before-After Study in Residential Aged Care Facilities.

Improving or maintaining quality of life (QoL) is an important aim for caring for people with dementia living in residential aged care facilities (RACFs). This study aimed to investigate the effect of a specific intervention, the Medication Management Consultancy (MMC), on the QoL of residents of RACFs in Western Australia, and to examine the association between psychotropic medications and QoL. A before-after study was conducted. Staff from four RACFs participated in the MMC, and 56 residents with dementia from these RACFs were included. The MMC consisted of an online interactive staff education training course comprising educational videos, and a case study encompassing non-pharmacological strategies, person-centred care for behavioural and psychological symptoms of dementia (BPSD), and strategies to reduce the use of antipsychotics. Following the training, posters, reference cards, reminder stickers, administration of the Older Age Psychotropic Quiz (OAPQ), and 30-min video conferences with action groups in RACFs were utilised. At baseline (T0), QoL, neuropsychiatric symptoms (NPS) and staff distress, cognition, and activities of daily living were assessed by QoL in Alzheimer's Disease (QoL-AD), Neuropsychiatric Inventory-Questionnaire (NPI-Q), Standardised Mini-Mental State Examination (SMMSE) and Bristol Activity of Daily Living Scale (BADLS), respectively, and repeated at 6 (T1) and 12 months (T2). Medication data were obtained from residents' medication charts. At baseline, of the 56 participants, 33 completed the study. Compared with baseline (31.2, 95% confidence interval [CI] 28.9-33.6), QoL significantly improved at 6 months (33.5, 95% CI 30.9-36.0; p<0.001) but not from baseline to 12 months (31.09, 95% CI 28.5-33.7; p=0.58). The NPI-Q severity (residents) significantly improved from 9 (interquartile range [IQR] 11) at T0 to 6 (IQR 9.5) at T1 (p=0.014) and to 7 (IQR 11) at T2 (p=0.026). The medians of NPI-Q distress (staff) significantly improved from 12 (IQR 13.5) at T0 to 8 (IQR 9) at T1 (p=0.013) and to 6 (IQR 11.5) at T2 (p=0.018). Monthly doses of antipsychotics declined significantly by 51.8% at 6 months (p=0.003) and by 43.5% at 12 months (p=0.003); antidepressant doses declined significantly by 25.4% at 6 months (p=0.013) and by 39.4% at 12 months (p=0.016); benzodiazepines doses remained stable. QoL and use of psychotropics, age, sex, NPI-severity, and BADLS were not correlated. The MMC was associated with improvement in QoL, NPS, staff distress, and reduction in monthly use of antipsychotics and antidepressants among RACF residents. There was no correlation between improved QoL and reduction in use of psychotropic medications, but due to the limitations of our study, this should be confirmed in additional studies.

Executive Functions, Intellectual Capacity, and Psychiatric Disorders in Adults with Type 1 Chiari Malformation

Contrary to popular belief, the cerebellum is involved not only in motor planning, balance, and coordination but also in cognitive processes. The present study aimed to investigate executive functions (EFs), intellectual capacity, and psychiatric disorders in adults with type 1 Chiari malformation, which is defined as a hindbrain anomaly that involves the cerebellum. The study included 62 adults, with 29 in the CM group and 33 in the control group. EFs were evaluated using the Stroop test, number sequence learning test, and standardized mini-mental state examination (SMMSE). The intelligence quotient (IQ) was measured using the Kent EGY and Porteus maze tests, and psychiatric disorders were evaluated using the Structured Clinical Interview for DSM-5, Clinician Version (DSM-5-CV). The CM group took longer than the control to complete the Stroop test for each section (P<0.005). Although the mean IQ scores of both groups were within the normal range, the CM group had a lower mean IQ score than the control group (P<0.005). Although the mean SMMSE scores of both groups were within the normal range, the CM group had a lower mean SMMSE score than the control group (P<0.005). The CM group had a higher rate of psychiatric comorbidities than the control group (P<0.005). The study found that subjects with type 1 Chiari malformation performed worse in EFs than healthy controls and had a higher prevalence of psychiatric disorders.

Cognitive impairment and associated factors among mature and older adults living in the community of Gondar town, Ethiopia, 2020

Cognitive impairment and dementia are age-related major public health concerns in the elderly population. It is a major cause of disability, dependency, and poor quality of life. However, in Ethiopia, the magnitude of this cognitive impairment among the elderly community was not investigated. Hence, this study sought to determine the prevalence of cognitive impairment and associated factors among mature and older adults living in the community of Gondar town, Ethiopia, in 2020. A community-based cross-sectional study was conducted at Gondar town, from February 20 to April 30, 2020. Using a single-stage cluster sampling technique, 403 study participants were recruited. Data was collected by a pretested interviewer-administered structured questionnaire which consisting of sociodemographic variables, the Oslo Social Support Scale, and a Standardized Mini-mental State Examination (SMMSE) tool. Epi data version 3.0 was used to enter coded data and then exported into STATA 14 for analysis. Variables with a p-value < 0.25 in the bi-variable logistic regression were included in the multivariable regression. From multivariable logistic regression, variables having a p-value ≤ 0.05 were declared as statistically significant variables. In this study, a total of 403 study participants were involved, and 393 (97.5%) of them completed the survey. Among older participants screened for cognitive impairment, 43.8% was positive for cognitive impairment with a 95% CI (38.8–48.7%). The majority of the participants were (57.5%) male and (44.8%) aged over 60 years. After adjustment, the variables associated with cognitive impairment were age ≥ 75 years [odds ratio (OR) = 7.03, 95% CI 2.78–17.77] and between 61 and 74 years [OR = 3.18, 95% CI 1.81–5.59], and unable to read and write [OR = 5.05, 95% CI 2.04–12.50], low income level [OR = 2.60, 95% CI 1.26–5.20], being female [OR = 2.52, 95% CI 1.50–4.26], poor social support [OR = 2.50, 95% CI 1.30–4.81], and rural residence [OR = 2.39, 95% CI 1.26–4.51]. The prevalence of older participants who screened positively for cognitive impairment was high at Gondar town. The independent predictors of cognitive impairment among older individuals were older age, being unable to read and write, being female, low income, poor social support, and rural dwelling. Therefore, routine screening and social support, as well as free healthcare services for the mature and older community, are needed. Moreover, we strongly recommend the next researcher to use a diagnosis tool to estimate the actual prevalence of the problems among older people.

Dysphagia in patients in acute period of ischemic stroke: What is the relationship of dysphagia with infarct localization, cognition, malnutrition, and independence level?

Background and Objective: Swallowing and nutritional disorders can occur for many different reasons after stroke. This study aimed to evaluate dysphagia, malnutrition, and independence in patients with an acute period of ischemic stroke, and to examine the relationship between dysphagia and lesion location, cognition, malnutrition, and dependence. Methods: Ischemic stroke patients (n: 109, mean age: 72.91 ± 11.78 year) were evaluated within the first 5 days after stroke. Standardized Mini-Mental State Examination (SMMSE), Combining pulse oximetry with a 10 milliliter (ml) Bedside Water Drinking Test (CPOBWDT), Mini Nutritional Assessment (MNA), and Barthel Index (BI) were performed. Results: Dysphagia was detected in 57.8% of the patients; malnutrition was present in 19.27% and 55.96% were at risk of malnutrition. In patients with dysphagia, it was observed that the most common site of infarct involved the superior cortical division of the middle cerebral artery. SMME (p&lt;0.001) and BI (p=0.001) were significantly worse in patients with dysphagia than patients without dysphagia. Conclusion: This study showed that more than half of the ischemic stroke patients are at risk of dysphagia and malnutrition in the acute period after stroke. The localization of the infarct and a decrease in the cognitive level are among the factors that are associated with dysphagia. Dysphagia is associated with increased dependence for functional activities. Therefore, in patients with ischemic stroke, swallowing and malnutrition should be evaluated during the acute phase.