Standardized Mini-Mental State Examination Research Articles

Elderly Body Movement Alteration at 2nd Experience of Digital Art Installation with Cognitive and Motivation Scores

The prevalence of advanced medical treatment has led to global population aging, resulting in increased numbers of dementia patients. One of the most intractable symptoms of dementia is apathy, or lack of interest and enthusiasm, which can accompany memory and cognitive deterioration. Development of a novel method to ameliorate apathy is desirable. In this feasibility trial, we propose a series of digital art installations as a candidate dementia intervention approach. Seven, three-minute scenes of digital images and sounds were presented to visitors either passively or in response to their reactions (motion and sound). We evaluated the potential of this application as an intervention against apathy in an elderly living home. We collected the dementia global standard Mini-Mental State Examination (MMSE) and questionnaire scores of sensory pleasure and motivation along with behavioral motion data in twenty participants. We further compared responses between the first and second experiences in the thirteen participants that were present for both days. Overall, we found a significant increase in participants’ motivation. In these subjects, head and right hand motion increased over different scenes and MMSE degrees, but was most significant during passive scenes. Despite a small number of subjects and limited evaluations, this new digital art technology holds promise as an apathy intervention in the elderly and can be improved with use of wearable motion sensors.

A feasibility randomised control trial of individual cognitive stimulation therapy for dementia: impact on cognition, quality of life and positive psychology

Objectives This study aimed to evaluate the feasibility of a 14-session programme of individual Cognitive Stimulation Therapy (iCST) for people with dementia (PWD). It addressed potential limitations in previous literature of iCST and evaluated possible impact on cognition, quality of life (QoL) and positive psychology. Method The 14-session iCST programme was developed using existing manuals for group and individual CST and consultation with experts in the field. Thirty-three PWD were recruited from care homes and randomly assigned to iCST (14, 45-min sessions) or treatment as usual (TAU) over seven weeks. Outcomes measures were assessed at baseline and follow-up after the intervention. Results The intervention appeared feasible with high attendance to sessions, minimal levels of attrition, and ease of recruitment. Analysis of covariance indicated significant improvements in cognition (Alzheimer’s Disease Assessment Scale-Cognitive subscale) for PWD receiving iCST compared to TAU. There were no significant differences between groups on follow-up scores on the standardised Mini Mental State Examination, measures of positive psychology or self- and proxy- reported QoL. Conclusion A 14-session programme of iCST delivered by professionals was feasible and acceptable to PWD and may provide benefits to cognition. A larger randomised control trial would be necessary to fully evaluate intervention impact on cognition, as well as QoL and positive psychology.

Minocycline 200 mg or 400 mg versus placebo for mild Alzheimer’s disease: the MADE Phase II, three-arm RCT

Background Minocycline is an anti-inflammatory drug and protects against the toxic effects of β-amyloid in vitro and in animal models of Alzheimer’s disease. To the best of our knowledge, no randomised placebo-controlled clinical trials in patients with Alzheimer’s disease looking at the efficacy and tolerability of minocycline have been carried out. Objectives The trial investigated whether or not minocycline was superior to placebo in slowing down the rate of decline in cognitive and functional ability over 2 years. The safety and tolerability of minocycline were also assessed. Design A Phase II, three-arm, randomised, double-blind, multicentre trial with a semifactorial design. Participants continued on trial treatment for up to 24 months. Setting Patients were identified from memory services, both within the 32 participating NHS trusts and within the network of memory services supported by the Dementias and Neurodegenerative Diseases Research Network (also known as DeNDRoN). Participants Patients with standardised Mini Mental State Examination scores of > 23 points and with Alzheimer’s disease assessed by the National Institute on Aging–Alzheimer’s Association’s criteria were identified from memory services. Intervention Patients with mild Alzheimer’s disease were randomly allocated 1 : 1 : 1 to receive one of three treatments: arm 1 – 400 mg per day of minocycline; arm 2 – 200 mg per day of minocycline; or arm 3 – placebo. Patients continued treatment for 24 months. Participants, investigators and outcome assessors were blind to treatment allocation. Main outcome measures Primary outcome measures were decline in standardised Mini Mental State Examination and Bristol Activities of Daily Living Scale scores of combined minocycline treatment arms versus placebo, as analysed by intention-to-treat repeated measures regression. Results Between 23 May 2014 and 14 April 2016, 554 participants were randomised. Of the 544 eligible participants, the mean age was 74.3 years and the average standardised Mini Mental State Examination score was 26.4 points. A total of 252 serious adverse events were reported, with the most common categories being neuropsychiatric and cardiocirculatory. Significantly fewer participants completed treatment with 400 mg of minocycline [29% (53/184)] than 200 mg [62% (112/181)] or placebo [64% (114/179)] (p < 0.0001), mainly because of gastrointestinal symptoms (p = 0.0008), dermatological side effects (p = 0.02) and dizziness (p = 0.01). Assessment rates were also lower in the 400-mg treatment arm: 68% (119 of 174 expected) for standardised Mini Mental State Examination scores at 24 months, compared with 82% (144/176) for the 200-mg treatment arm and 84% (140/167) for the placebo arm. Decline in standardised Mini Mental State Examination scores over the 24-month study period in the combined minocycline arms was similar to that in the placebo arm (4.1- vs. 4.3-point reduction; p = 0.9), as was the decline in the 400- and 200-mg treatment arms (3.3 vs. 4.7 points; p = 0.08). Likewise, worsening of Bristol Activities of Daily Living Scale scores over 24 months was similar in all trial arms (5.7, 6.6 and 6.2 points in the 400-mg treatment arm, 200-mg treatment arm and placebo arm, respectively; a p-value of 0.57 for minocycline vs. placebo and a p-value of 0.77 for 400 vs. 200 mg of minocycline). Results were similar in different patient subgroups and in sensitivity analyses adjusting for missing data. Limitations Potential limitations of the study include that biomarkers were not used to confirm the diagnosis of Alzheimer’s disease, as these and apolipoprotein E (APOE) genotyping are not routinely available within the NHS. Compliance was also worse than expected and differential follow-up rates were observed, with fewer assessments obtained for the 400-mg treatment arm than for the 200-mg treatment and placebo arms. Conclusions Minocycline does not delay the progress of cognitive or functional impairment in people with mild Alzheimer’s disease over a 2-year period. Minocycline at a dose of 400 mg is poorly tolerated in this population. Future work The Minocycline in mild Alzheimer’s DiseasE (MADE) study provides a framework for a streamlined trial design that can be usefully applied to test other disease-modifying therapies. Trial registration Current Controlled Trials ISRCTN16105064 and EudraCT 2013-000397-30. Funding This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership, and will be published in full in Efficacy and Mechanism Evaluation; Vol. 7, No. 2. See the NIHR Journals Library website for further project information.

The Association between HbA1c Levels, Olfactory Memory and Cognition in Normal, Pre-Diabetic and Diabetic Persons.

Recent data have shown that olfactory dysfunction is strongly related to Alzheimer's Disease (AD) that is often preceded by olfactory deficits suggesting that olfactory dysfunction might represent an early indicator of future cognitive in prediabetes. We have applied to a group of normal (n=15), prediabetic (n=16) and type 2 diabetic outpatients (n=15) olfactory testing, 1.5-T MRI scanner and detailed cognitive evaluation including the standard Mini-Mental State Examination (MMSE) form, Short Blessed Test (SBT), Letter Fluency Test (LFT) and the category fluency test with animal, Fruit and Vegetable Naming (CFT). We have shown that Odour Threshold (OT), Discrimination (OD), and Identification (OI) scores and most cognitive test results were significantly different in the prediabetes and diabetes group compared to those in the control group. OD and OT were significantly different between the prediabetes and diabetes group, although the cognitive test results were only significantly different in the prediabetes and diabetes group compared to those in the control group. In evaluating the association between OI, OT, OD scores and specific cognitive tests, we have found, that impaired olfactory identification was the only parameter that correlated significantly with the SBT both in the pre-diabetes and diabetes group. Although spot glucose values were only correlated with OT, HbA1c levels were correlated with OT, OD, and OI, as well as results of the letter fluency test suggesting that HbA1c levels rather than the spot glucose values play a critical role in specific cognitive dysfunction. To the best of our knowledge, this is the first prospective study to demonstrate a strong association between olfactory dysfunction and specific memory impairment in a population with prediabetes and diabetes suggesting that impaired olfactory identification might play an important role as a specific predictor of memory decline.

Comparing the Diagnostic Accuracy of Two Cognitive Screening Instruments in Different Dementia Subtypes and Clinical Depression.

Short but accurate cognitive screening instruments are required in busy clinical practice. Although widely-used, the diagnostic accuracy of the standardised Mini-Mental State Examination (SMMSE) in different dementia subtypes remains poorly characterised. We compared the SMMSE to the Quick Mild Cognitive Impairment (Qmci) screen in patients (n = 3020) pooled from three memory clinic databases in Canada including those with mild cognitive impairment (MCI) and Alzheimer’s, vascular, mixed, frontotemporal, Lewy Body and Parkinson’s dementia, with and without co-morbid depression. Caregivers (n = 875) without cognitive symptoms were included as normal controls. The median age of patients was 77 (Interquartile = ±9) years. Both instruments accurately differentiated cognitive impairment (MCI or dementia) from controls. The SMMSE most accurately differentiated Alzheimer’s (AUC 0.94) and Lewy Body dementia (AUC 0.94) and least accurately identified MCI (AUC 0.73), vascular (AUC 0.74), and Parkinson’s dementia (AUC 0.81). The Qmci had statistically similar or greater accuracy in distinguishing all dementia subtypes but particularly MCI (AUC 0.85). Co-morbid depression affected accuracy in those with MCI. The SMMSE and Qmci have good-excellent accuracy in established dementia. The SMMSE is less suitable in MCI, vascular and Parkinson’s dementia, where alternatives including the Qmci screen may be used. The influence of co-morbid depression on scores merits further investigation.

Randomized Placebo-Controlled Trial of Nabilone for Agitation in Alzheimer's Disease

ObjectiveTo investigate the efficacy and safety of nabilone for agitation in patients with moderate-to-severe Alzheimer's disease (AD). DesignThis 14-week randomized double-blind crossover trial compared nabilone to placebo (6 weeks each) with a 1-week washout between phases. SettingPatients were recruited from a long-term care facility and geriatric psychiatry clinics. ParticipantsPatients had AD (standardized Mini-Mental State Examination [sMMSE ≤24]) and agitation (Neuropsychiatric Inventory-Nursing Home version [NPI-NH]-agitation/aggression subscore ≥3). InterventionNabilone (target 1–2 mg) versus placebo. MeasurementsThe primary outcome was agitation (Cohen Mansfield Agitation Inventory [CMAI]). Secondary outcomes included NPI-NH total, NPI-NH caregiver distress, cognition (sMMSE and Severe Impairment Battery [SIB] or Alzheimer's Disease Assessment Scale of Cognition), global impression (Clinician's Global Impression of Change [CGIC]), and adverse events. ResultsThirty-nine patients (mean ± SD age = 87 ± 10, sMMSE = 6.5 ± 6.8, CMAI = 67.9 ± 17.6, NPI-NH total = 34.3 ± 15.8, 77% male, nabilone dose = 1.6 ± 0.5 mg) were randomized. There were no crossover or treatment-order effects. Using a linear mixed model, treatment differences (95% CI) in CMAI (b = −4.0 [−6.5 to −1.5], t(30.2) = −3.3, p = 0.003), NPI-NH total (b = −4.6 [−7.5 to −1.6], t(32.9) = −3.1, p = 0.004), NPI-NH caregiver distress (b = −1.7 [−3.4 to −0.07, t(33.7) = −2.1, p = 0.041), and sMMSE (b = 1.1 [0.1–2.0], t(22.6) = 2.4, p = 0.026) all favored nabilone. However, in those who completed the SIB (n = 25) treatment differences favored placebo (b = −4.6 [−7.3 to −1.8], t(20.7) = −4.8, p = 0.003). CGIC improvement during nabilone (47%) and placebo (23%) was not significantly different (McNemar's test, exact p = 0.09). There was more sedation during nabilone (45%) compared to placebo (16%) phases (McNemar's test, exact p = 0.02), but treatment-limiting sedation was not significantly different (McNemar's test, exact p = 0.22). ConclusionsNabilone may be an effective treatment for agitation. However, sedation and cognition should be closely monitored.

Validity of the Japanese Version of the Quick Mild Cognitive Impairment Screen.

Early detection of dementia provides opportunities for interventions that could delay or prevent its progression. We developed the Japanese version of the Quick Mild Cognitive Impairment (Qmci-J) screen, which is a performance-based, easy-to-use, valid and reliable short cognitive screening instrument, and then we examined its validity. Community-dwelling adults aged 65–84 in Niigata prefecture, Japan, were concurrently administered the Qmci-J and the Japanese version of the standardized Mini-Mental State Examination (sMMSE-J). Mild cognitive impairment (MCI) and dementia were categorized using established and age-adjusted sMMSE-J cut-offs. The sample (n = 526) included 52 (9.9%) participants with suspected dementia, 123 (23.4%) with suspected MCI and 351 with likely normal cognition. The Qmci-J showed moderate positive correlation with the sMMSE-J (r = 0.49, p < 0.001) and moderate discrimination for predicting suspected cognitive impairment (MCI/dementia) based on sMMSE-J cut-offs, area under curve: 0.74, (95%CI: 0.70–0.79), improving to 0.76 (95%CI: 0.72 to 0.81) after adjusting for age. At a cut-off of 60/61/100, the Qmci-J had a 73% sensitivity, 68% specificity, 53% positive predictive value, and 83% negative predictive value for cognitive impairment. Normative data are presented, excluding those with any sMMSE-J < 27. Though further research is required, the Qmci-J screen may be a useful screening tool to identify older adults at risk of cognitive impairment.

The Effect of Reminiscence Therapy With Internet-Based Videos on Cognitive Status and Apathy of Older People With Mild Dementia.

This study was carried out to assess the effects of reminiscence therapy that was supported with internet-based videos on the cognitive condition and apathy levels of older people with mild dementia living in nursing homes. This randomized controlled experimental study was conducted between May 15, 2016, and August 25, 2016, in two nursing homes in Adana, Turkey. A total of 32 people participated in this study, 16 individuals were in the intervention group and 16 individuals were in the control group. The data were collected using a Personal Information Form, the Standardized Mini-Mental State Examination (SMMSE) test, and the Apathy Rating Scale (ARS) Self-assessment Form. The individuals in the intervention group received group reminiscence therapy involving internet-based videos for 60 minutes once a week for 3 months. During this period, 25 to 30 minutes of unstructured interviews were carried out with individuals in the control group. The data were analyzed using descriptive statistics, Student t test, the Mann-Whitney U test, and Wilcoxon signed rank test. In this study, a significant difference was found between experimental and control groups' posttest mean scores on the SMMSE test and ARS ( P < .01). The experimental group's SMMSE test and ARS posttest mean scores were higher than those of the control group ( P < .01). This study found that group reminiscence therapy using internet-based videos improved the cognitive functions and apathy levels of older people with mild dementia of the Alzheimer type. It is recommended that group reminiscence therapy studies with Internet-based videos be conducted in care institutions that are responsible for managing older people with mild dementia of the Alzheimer type.

The adaptation of the Language Battery of CAT-TR into Turkish: Results from a Pilot Study

The adaptation of the Language Battery of CAT-TR into Turkish: Results from a Pilot Study

The Development Study of Smoking Stroop Test on a Turkish Sample.

The purpose of this study is to engender a language and culture specific Smoking Stroop Test (SST) in Turkish. The study is performed in three stages (N=334) with smokers and non-smokers of three age groups. On the third stage, all participants have filled STT and were administered Beck Depression Inventory. Besides, the smokers were applied Fagerström Test for Nicotine Dependence, and the elder participants were also assessed with Standardized Mini Mental State Examination Test. In the first stage, a list comprising a total of 92 words related and not related with smoking have been formed and in the second stage the participants were asked to evaluate the relatedness of these words with cigarette and smoking. As a result of this evaluation 9 related and 9 unrelated words were selected for SST. In the third stage SST was administered to a sample of 70 participants. A 3×2×2 repeated measures for last factor ANOVA was used to determine whether the variance in response times depends on age, cigarette use and word type. The results revealed that there was no significant difference among the non-smoker participants' response times towards related or unrelated words in all age groups. On the other hand, the smokers in young and adult age groups displayed longer response times towards cigarette related words. Internal consistency and test-retest reliability analysis revealed that the test is reliable. SST is a valid, reliable and original tool that can be used in studies in Turkey.

The Validity and the Reliability of Turkish Version of the Self-Stigma of Depression Scale

In this study, we aimed to the Self-Stigma of Depression Scale (SSDS), which evaluates self-stigmatization that can prevent both treatment consultation and compliance by depressed patients run Turkish adaptation, validity and reliability study of. The study included a total of 173 subjects consisting of 131 outpatients of the Psychiatry Polyclinic with past or recent major depression disorder (MDD) diagnosis and 42 non-depressed outpatients consulting the Geriatrics Polyclinics for other medical complaints. Each participant was evaluated with the Structured Clinical Interview for DSM IV Axis I Disorders (SCID-I), the Standardized Mini Mental State Examination (MMSE), the Turkish Self-Stigma of Depression Scale (SSDS-TR) and the Beck Depression Inventory (BDI). The MDD patients were further evaluated with the Internalized Stigma of Mental Illness (ISMI) scale. Test-retest reliability of the SSDS-TR was assessed with 27 participants 8-12 weeks after the first test. All analyses were carried out using the IBM-SPSS Statistics version 25 and the IBM SPSS AMOS version 25. In the exploratory factor analysis, the factor structure of SSDS TR differed from the original form. The structural validity of the 4-factor model formed after excluding one problematic item was tested by confirmatory factor analysis and proven to meet the goodness of fit criteria. The Cronbach's α coefficient of the SSDS-TR was 0.847, and a moderate correlation (r=0.436 p=0.023) was obtained by the test-retest analysis. The SSDS-TR scores moderately correlated with the ISMI scores (r=0.485, p<0.001) and weakly correlated with the BDI scores (r=0.246, p<0.001). The SSDS-TR formed by excluding one item from the original scale was demonstrated to be a valid and reliable psychometric tool and is expected to fill a gap in the assessment of self stigmatization of MDD patients in Turkey.

Apathy and health-related quality of life in nursing home residents.

To explore the association between apathy and health-related quality of life (HRQoL) from resident and proxy perspectives and whether cognition and depression moderate this relationship. Secondary analyses with baseline data from a cluster randomized trial on the effects of a care program for depression in Nursing Homes (NHs) were conducted. For HRQoL, the Visual Analogue Scale (VAS) and the Dutch version of the European Quality of Life (EQ-5D) were administered to 521 NH residents, and to professional caregivers reporting from the perspective of the NH resident (Resident-Proxy) and from their own perspective (Proxy-Proxy). Utility scores (U) were calculated for the three perspectives. Apathy, depression, and cognition were measured using the 10-item Apathy Evaluation Scale, the Cornell Scale for Depression in Dementia, and the standardized Mini-Mental State Examination, respectively. Mixed models adjusted for clustering within NH units revealed that apathy was negatively associated with HRQoL both from the Resident-Proxy perspective (EQ-5D VAS: estimated effect, - 0.31, P < 0.001; EQ-5D Utility: - 0.30, P < 0.001) and from the Proxy-Proxy perspective (VAS: - 0.29, P < 0.001; U: - 0.03, P < 0.001), but not from the Resident-Resident perspective (VAS: - 0.05, P = 0.423; Utility: - 0.08, P = 0.161). Controlling for depression and cognition and their interaction terms with apathy did not change the results. Apathy is negatively associated with NH resident HRQoL as reported by proxies. Depression and cognitive functioning do not moderate this association. NH residents do not self-report a relationship between apathy and HRQoL. More research is needed to understand caregiver and NH resident attitudes and underlying assumptions regarding apathy and HRQoL.

Amyloid blood biomarker detects Alzheimer’s disease prior to clinical onset

Alzheimer’s disease (AD) is the principal cause of dementia and impacts nearly 50 million people worldwide (1). This neurodegenerative disorder of the brain manifests as progressive loss of memory and decline in cognitive function, which may span three to twenty years. Currently diagnosis is based on clinical assessment using a standardized Mini-Mental State Examination (MMSE) (2), which may be supported by further tests, when available, including analysis of cerebrospinal fluid (CSF) and/or imaging of the brain by positron-emission tomography (PET) to quantify alterations in particular biomarkers (3).

The effect of reminiscence therapy on cognitive functions, depression, and quality of life in Alzheimer patients: Randomized controlled trial.

Alzheimer is a disease leading to various neuropsychiatric behavioral disorders, and the most common symptom observed during the prognosis of Alzheimer's disease is dysmnesia. The aim of the present study is to investigate the effect of reminiscence therapy on cognitive functions, depression, and quality of life in Alzheimer's patients. The present study was a randomized controlled single blind study with two groups, which was designed in the experimental pretest-posttest pattern in the city of Konya, Turkey. It was decided to include a total of 60 elderly individuals. Information form that evaluated socio-demographic characteristics and disease history of individuals in intervention and control groups and was developed by the researcher. Standardized Mini-Mental State Examination (SMMSE), Cornell Scale for Depression in Dementia, and the Quality of Life in Alzheimer's Disease (QOL-AD) Scale were used to collect the data. Reminiscence therapy was applied once a week and lasted for 8weeks. Every session took 60minutes. Groups consisted of six people. Mini-Mental Test, depression, and quality of life mean scores of the elderly in intervention group before reminiscence therapy program increased after the administration, and the difference was statistically significant (P<0.05). In the intergroup comparison, a significant difference was found between elderly individuals' posttest Mini-Mental Test, depression, and quality of life mean scores (P<0.05). Our results suggest that regular reminiscence therapy should be considered for inclusion as routine care for the improvement of cognitive functions, depressive symptoms, and quality of life in elderly people with Alzheimer.

A comparative study for evaluation of cognitive function in type-II diabetes mellitus patients and non-diabetics

Background: To evaluate the impact of type-II diabetes mellitus on cognitive function and to assess the factors associated with impaired function.Methods: This prospective study compared 100 type-II diabetic people attending the diabetic clinic of Tirunelveli Medical College Hospital with another 100 membered control group. The study group was selected randomly between the age group of 45-65 years. A neuro-cognitive assessment was done using Standardized Mini Mental State Examination (SMMSE), which is a simple and reliable screening test. This scale has 12 questions with time limits to assess orientation, memory, calculation, language, attention and construction. Magnitude and severity of cognitive decrement were analysed along with the possible factors affecting it.Results: Mean age of the study population was 54.6±7.24 years. Cognitive impairment was noted among 62 of cases and 48 of the control group, which means a 14% higher prevalence of cognitive impairment among the type 2 diabetics. The association of development of cognitive impairment and duration of diabetes mellitus was significant statistically (p value = 0.025443; p&lt;0.05). Other demographic variables like gender, education and domicile were also seen to affect the results.Conclusions: Mild to moderate cognitive impairment was found significantly higher among the type-II diabetics than the non-diabetics. The cognitive impairment was found to be associated with the duration of diabetes. Hence the routine screening of cognition by SMMSE should be done in all type-II diabetic patients.

Defense Automated Neurobehavioral Assessment Accurately Measures Cognition in Patients Undergoing Electroconvulsive Therapy for Major Depressive Disorder

The Defense Automated Neurobehavioral Assessment (DANA) is an electronic cognitive test battery. The present study compares DANA to the standard Mini-Mental State Examination (MMSE) in subjects undergoing electroconvulsive therapy for the treatment of major depressive disorder. Seventeen inpatient subjects in the Johns Hopkins Hospital Department of Psychiatry were administered longitudinal paired DANA and MMSE tests (7.6 ± 4.1 per patient) from January 10, 2014 to September 26, 2014. Regression analyses were conducted (with or without MMSE scores of 30) to study the impact of the MMSE upper limit, and within-subject regression analyses were conducted to compare MMSE and DANA scores over time. Statistically significant relationships were measured between DANA and MMSE scores. Relationships strengthened when MMSE scores of 30 were omitted from analyses, demonstrating a ceiling effect of the MMSE. Within-subject analyses revealed relationships between MMSE and DANA scores over the duration of the inpatient stay. Defense Automated Neurobehavioral Assessment is an electronic, mobile, repeatable, sensitive, and valid method of measuring cognition over time in depressed patients undergoing electroconvulsive therapy treatment. Automation of the DANA allows for more frequent cognitive testing in a busy clinical setting and enhances cognitive assessment sensitivity with a timed component to each test.

Screening for cognitive impairment in an Australian aged care assessment team as part of comprehensive geriatric assessment

ABSTRACTAccurate detection of mild cognitive impairment (MCI) is important to stratify and address risk. Yet, few short cognitive screening instruments are validated for this. . In Australia, all clients referred to an Aged Care Assessment Team (ACAT) receive comprehensive geriatric assessment (CGA) including the Standardized Mini-Mental State Examination (SMMSE). We compared the accuracy of the quick mild cognitive impairment (Qmci) screen to the SMMSE in 283 participants: 195 with dementia, 47 with MCI, and 41 with subjective cognitive decline (SCD) in an Australian community-based ACAT. Both had similar accuracy in identifying dementia, AUC of 0.86 for the Qmci versus 0.93 for the SMMSE (p = 0.10), but the Qmci was more accurate than the SMMSE in differentiating MCI from SCD, AUC of 0.84 versus 0.71, respectively, p = 0.046. These suggest that the new, short (3–5 min) Qmci screenis appropriate for use in an ACAT or other units conducting CGA.

Relationship of Apathy with Depressive Symptom Severity and Cognitive Functions in Geriatric Depression.

Apathy which is known as loss of primary motivation is observed more frequently in elderly depression in comparison with younger adults. It is put forth that apathy is related with depressive symptom severity and cognitive functions, that the existence of apathy may be a predictor of neurocognitive impairment. The objective of this study was to examine the apathy levels in elderly patients with major depression as well as the relationship between depressive symptom severity and cognitive functions. The study was carried out with 40 major depressive disorder patients (MDD) aged 60 and above, 40 healthy controls aged 60 and above. Sociodemographic data form, structured psychiatric interview (SCID-I), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Montgomery-Asberg Depression Rating Scale (MADRS), Standardized Mini Mental State Examination (SMMSE), Montreal Cognitive Assessment Scale (MoCA), Apathy Evaluation Scale (AES) and Sheehan Disability Scale (SDS) were applied to the participants. In our study, HAM-D, HAM-A and MADRS scale scores of MDD group was determined to be higher in comparison with those of the healthy control group. A positive correlation was determined in the MDD groups between the AES scores and depressive symptom severity, whereas a negative correlation was determined between the AES scores and cognitive functions. The SMMSE and MoCA scores of the geriatric MDD group were determined to be lower in comparison with healthy control group. Low performance was observed in the geriatric MDD group especially in the fields of orientation, visual/spatial functions, memory and language. Functionality was found to be lower in MDB group than in the control group, and functionality decreased as the level of apathy increased. Our results indicate that the apathy levels in geriatric depression are higher in comparison with the control group. Cognitive functions are affected adversely in geriatric patients in major depressive disorder, depressive symptom severity, impairment in cognitive functions and functionality are observed to be related with apathy level.

Depression in Elderly Patients Attending the Psychiatry OPD: A Prospective Hospital Based Study

Background: Cognitive impairment is a common clinical issue among elderly patients suffering with depression and has a more obscure etiology. The present study aimed to determine the prevalence of cognitive impairment and depression in geriatric patients attending Psychiatric OPD. Methods: This Prospective cross-sectional study was carried out on elderly people (n=110) attending the Psychiatry OPD of Govt Doon Medical college Dehradun (UK). The cognitive function and depression were assessed by applying standardized Mini-Mental State Examination of Folstein (MMSE) and the Geriatric Depression Scale (GDS), respectively. Results: Prevalence of cognitive impairment was 35.71% (36.41% women, 24.5% men), whereas the prevalence of depression was 45.45% (51.02% women, 39.89% men) significant differences were observed. Conclusions: Cognitive impairment and depression were found to be more prevalent in the females than in the males. Hence, psychiatrist should pay special attention for early detection and treatment of depressive symptoms in elderly people with cognitive impairment.

Can we predict a delirium after cardiac surgery? A validation study of a delirium risk checklist.

Delirium is a common temporary mental disorder that often occurs in patients who undergo cardiac surgery. It is important to prevent the negative side effects of delirium by identifying high-risk patients before surgery. Koster and colleagues designed a risk model to identify patients with an increased risk of postoperative delirium after cardiac surgery. The aim of this study was to validate the risk model for delirium and further improve the risk model. A delirium risk checklist containing predictors associated with postoperative delirium was used during the preoperative outpatient screening in 329 patients. The delirium observation screening scale was used preoperatively and postoperatively to assess delirium. Compared with the model of Koster and colleagues age greater than 70 years and a history of delirium were confirmed as statistically significant predictors of postoperative delirium, while cognitive impairment and alcohol abuse were almost significant factors. The European system for cardiac operative risk evaluation (EuroSCORE), comorbidity and type of surgery could not predict a postoperative delirium again. The area under the curve of this model was 0.79 (95% confidence interval (CI) 0.73-0.86; P<0.001). Based on the data of this study the model was improved with the following independent predictors of postoperative delirium: age, more than one comorbidity, history of delirium and a lower standardised mini mental state examination score as with an area under the curve of 0.79 (95% CI 0.73-0.85; P<0.001). The risk model could not be fully validated. It is difficult to validate a risk model over time; there are different circumstances such as the increased focus on the prevention of delirium.