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Objectives: To determine if there is an association between hearing loss and poorer cognitive scores on Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) and to determine if poor hearing acuity affects scoring on the cognitive screening tests of MMSE and MoCA.Methods: One hundred fourteen elderly patients (Singapore residents) aged between 55 and 86 years were sampled. Participants completed a brief history questionnaire, pure tone audiometry, and 2 cognitive screening tests-the MMSE and MoCA. Average hearing thresholds of the better ear in the frequencies of 0.5, 1, 2, and 4 kHz were used for data analysis.Results: Hearing loss was significantly associated with poorer cognitive scores in Poisson regression models adjusted for age. Mini-Mental State Examination scores were shown to decrease by 2.8% (P = .029), and MoCA scores by 3.5% (P = .013) for every 10 dB of hearing loss. Analysis of hearing-sensitive components of "Registration" and "Recall" in MMSE and MoCA using chi-square tests showed significantly poorer performance in the hearing loss group as compared to the normal hearing group. Phonetic analysis of target words with high error rates shows that the poor performance was likely contributed by decreased hearing acuity, on top of a possible true deficit in cognition in the hearing impaired.Conclusions: Hearing loss is associated with poorer cognitive scores on MMSE and MoCA, and cognitive scoring is likely confounded by poor hearing ability. This highlights an important, often overlooked aspect of sensory impairment during cognitive screening. Provisions should be made when testing for cognition in the hearing-impaired population to avoid over-referral and subsequent misdiagnoses of cognitive impairment. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is twofold: first, to identify cognitive trajectories of older Koreans in a population-based longitudinal panel survey and, second, to investigate the main characteristics of the identified heterogeneous classes of cognitive trajectories.Methods: Data came from 2445 cognitively healthy persons aged 60 or older in the 2006 to 2012 Korean Longitudinal Study of Aging. Using Korean-mini mental status examination (K-MMSE) as a measure of global cognitive function, the latent growth mixture modeling approach examined potential heterogeneity of longitudinal changes over the 6 years.Results: This study found that older Koreans reported an average K-MMSE score of 27 at baseline and experienced a cognitive decline every 2 years by -1.6 (2006-2008) and -1.2 (2008-2010), followed by a slight increase of 0.7 in 2012. Results from the latent growth mixture modeling analysis indicated that there were 2 heterogeneous classes of longitudinal changes in the K-MMSE over a period of 6 years: class 1 with stable cognitive function and class 2 with sharp cognitive decline over time. The sharp decline was found among those older in age and with higher level of depression at baseline. On the contrary, being male, higher education, active social engagement, and regular exercise were main characteristics of stable cognitive function.Conclusion: As the first to examine cognitive trajectories among older Koreans, this study highlighted heterogeneity of cognitive trajectories in the population that should be considered for developing differential intervention strategies aimed at both promoting healthy brain and delaying/preventing cognitive decline. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the clinical evidence for traditional medicines (TMs) used in East Asia on measures of cognition in Alzheimer disease, determine the effect sizes at different time points for the TMs and pharmacotherapies, and assess the tolerability of the TMs.Methods: We searched 12 databases in English, Chinese, and Japanese for eligible randomised controlled trials that compared orally administered TMs with pharmacotherapy and reported cognitive outcomes. Meta-analyses were conducted for Alzheimer's Disease Assessment Scale-cognitive subscale and/or Mini-Mental State Examination (MMSE). Mean differences and 95% confidence intervals were calculated to evaluate treatment effects.Results: Thirty randomised controlled trials met inclusion criteria. Twenty-nine compared TMs with donepezil. Single studies provided comparisons with galantamine, rivastigmine, or memantine. There were no significant differences between the TM and donepezil groups at 12 or 24 weeks for Alzheimer's Disease Assessment Scale-cognitive subscale or MMSE. Improvements over baseline were significant for MMSE at 12 and 24 weeks within the TM and donepezil groups and remained significant at 1 year. Effect sizes were reduced in the 3 double-blind studies. At 24 weeks, donepezil 10 mg/d generally produced greater improvements in MMSE than 5 mg/d. Tolerability reporting was incomplete and inconsistent between studies.Conclusions: The results suggested that the clinical benefits of the TMs were not less than donepezil at comparable time points, with both groups showing improvements. However, lack of blinding in most studies and other design and measurement issues are likely to have resulted in overestimation of effect sizes in both groups. Further well-designed studies are needed. [ABSTRACT FROM AUTHOR]

Introduction: In Parkinson's disease (PD), psychosis is associated with cognitive impairment that may be more profound in particular cognitive domains. Our goal was to determine whether psychosis in non-demented PD participants is associated with domain-specific cognitive impairment on the Mini-Mental State Exam (MMSE).Methods: The Morris K. Udall Parkinson's Disease Research Center of Excellence Longitudinal Study at Johns Hopkins is a prospective study that was initiated in 1998. Clinical assessments are conducted at two-year intervals at the Johns Hopkins Hospital. We analyzed data from 137 enrolled participants with idiopathic PD. Psychosis diagnoses were established by psychiatrist interview per DSM-IV criteria. An incident dementia diagnosis resulted in exclusion from analysis for that evaluation and any future evaluations in that participant. We used logistic regression with generalized estimated equations (GEE) to model the time-varying relationship between MMSE subscale scores and psychosis, adjusting for potential confounding variables identified through univariable analysis.Results: Thirty-one unique psychosis cases were recorded among non-demented participants. Fifty total evaluations with psychosis present were analyzed. In multivariable regressions, psychosis was associated with lower scores on the orientation (relative odds ratio, rOR: 0.73; 95% CI: 0.58-0.93; p = 0.011), language (rOR: 0.64; 95% CI: 0.48-0.86; p = 0.003), and intersecting pentagon (rOR: 0.43; 95% CI: 0.20-0.92 p = 0.030) subscales of the MMSE.Conclusions: In PD, executive dysfunction, disorientation, and impaired language comprehension may be associated with psychosis. Our findings suggest that the corresponding MMSE subscales may be useful in identifying participants with a higher likelihood of developing psychosis. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction: We estimated the cost effectiveness of different cognitive screening tests for use by General Practitioners (GPs) to detect cognitive impairment in England.Methods: A patient-level cost-effectiveness model was developed using a simulated cohort that represents the elderly population in England (65 years and older). Each patient was followed over a lifetime period. Data from published sources were used to populate the model. The costs include government funded health and social care, private social care and informal care. Patient health benefit was measured and valued in Quality Adjusted Life Years (QALYs).Results: Base-case analyses found that adopting any of the three cognitive tests (Mini-Mental State Examination, 6-Item Cognitive Impairment Test or GPCOG (General Practitioner Assessment of Cognition)) delivered more QALYs for patients over their lifetime and made savings across sectors including healthcare, social care and informal care compared with GP unassisted judgement. The benefits were due to early access to medications. Among the three cognitive tests, adopting the GPCOG was considered the most cost-effective option with the highest Incremental Net Benefit (INB) at the threshold of £30 000 per QALY from both the National Health Service and Personal Social Service (NHS PSS) perspective (£195 034 per 1000 patients) and the broader perspective that includes private social care and informal care (£196 251 per 1000 patients). Uncertainty was assessed in both deterministic and probabilistic sensitivity analyses.Conclusions: Our analyses indicate that the use of any of the three cognitive tests could be considered a cost-effective strategy compared with GP unassisted judgement. The most cost-effective option in the base-case was the GPCOG. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives: The Mini-Mental State Examination (MMSE) is widely used as a cognitive screening test for older adults; however, cognitive performance can be affected by age, education, and sample selection bias, including time and place. The aims of this study were to examine the distribution of scores on the Japanese version of the MMSE in an urban community sample and to provide normative data for older Japanese adults.Methods: A questionnaire survey was conducted on all residents aged 65 years and older living in an urban district in Tokyo (N = 7682). From among this population, 3000 residents were randomly selected to receive visits from trained nurses and to have their health status checked and their cognitive function examined using the MMSE.Results: Of the 2786 eligible residents, the MMSE was administered to 1341 (47%) and successfully completed by 1319 (mean age, 74.4 ± 6.4 years; mean years of formal education, 12.6 ± 2.9). The median score was 28. A total of 143 residents (10.8%) had scores below the traditional 23/24 cutoff point. Younger age and higher education were associated with better performance. Greater variation was seen among the oldest and least educated residents, especially among women.Conclusion: The results of this study confirm that age and education affect MMSE scores. To ensure the effective use of the MMSE, it is recommended to examine scores corresponding to age and education. The normative data presented are expected to be useful for assessing MMSE scores in older individuals both in and out of the clinical setting. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: Cognitive performance shows a marked deterioration in close proximity to death, as postulated by the terminal decline hypothesis. The effect of education on the rate of terminal decline in the oldest people (i.e. persons 85+ years) has been controversial and not entirely understood. In the current study, we investigated the rate of decline prior to death with a special focus on the role of education and socioeconomic position, in two European longitudinal studies of ageing: the Origins of Variance in the Old-Old: Octogenarian Twins (OCTO-Twin) and the Newcastle 85+ study.Methods: A process-based approach was used in which individuals' cognitive scores were aligned according to distance to death. In a coordinated analysis, multilevel models were employed to examine associations between different markers of cognitive reserve (education and socioeconomic position) and terminal decline using the mini-mental state examination (MMSE), controlling for age at baseline, sex, dementia incidence and time to death from the study entry to the time of death within each cohort.Results: The current findings suggest that education was positively associated with higher MMSE scores prior to death in the OCTO-Twin, but not in the Newcastle 85+ study, independent of socioeconomic position and other factors such as baseline age, sex and time to death from the study entry. However, education was not associated with the rate of terminal decline in both of these studies.Conclusions: Our results offer only partial support to the cognitive reserve hypothesis and cognitive performance prior to death. [ABSTRACT FROM AUTHOR]

Objective This study aimed to investigate the correlation between apolipoprotein E (APOE) ε4 and the mini-mental state examination (MMSE) dimension in an elderly population, using baseline data from the Bambui (Brazil) Cohort Study of Aging. Design We conducted a community-based cross-sectional study. Setting The study took place at Bambui city, Minas Gerais State, Southeast Brazil. Participants A total of 1408 (87.7%) cohort participants had complete information on the MMSE and health measures. Measurements The association between each of five dimensions (concentration, language/praxis, orientation, attention, and memory) underlying the MMSE and APOE ε4 allele was assessed using multivariate linear regression models. Potential confounding variables included sociodemographic factors and selected biomarkers. Results The main finding is a strong negative association between the presence of APOE ε4 allele and memory dimension in the MMSE (fully adjusted β coefficient = −0.14; 95% confidence interval: −0.27 to −0.04; p = 0.016). No other cognitive dimensions showed significant associations with the APOE ε4 allele. Conclusion This study is the first to investigate the association between dimensions of the MMSE, obtained from principal component analysis and APOE ε4 carrier status in community-dwelling older adults taking into account a range of potential confounding factors. We found a strong negative association between the presence of APOE ε4 allele and scores on memory dimension of the MMSE, but no effect on other dimensions. Our results reinforce previous data on the literature that APOE ε4 allele has a significant effect on cognitive performance that can be detected even in screening tests, such as the MMSE. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: The study aims to investigate whether longitudinal data on the structure of the mini mental state examination (MMSE) collected in an older Brazilian cohort support factorial invariance over time. Design: Analysis of 10-year data from a community-based cohort study was performed. Setting: The study took place in Bambuí, Brazil. Participants: The study sample comprised 1558 (89.4%) of all eligible 1742 elderly residents. Measurements: A standard Brazilian version of the MMSE was used. Results: A five-factor solution (developed on the baseline of the cohort) either with no constraints or with loadings constrained to equality across time provided a reasonable fit for the MMSE. A comparison between both models suggested that the model with no constraints was superior. However, the five absolute goodness-of-fit indices suggest that the fully constrained model was also adequate and did not differ substantively from the model without any restriction. Conclusion: The structure of the MMSE remained relatively unchanged across the 10 measurement times, thus providing evidence for the good construct validity of the scale across time. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the performance of a French version of the modified Telephone Interview for Cognitive Status (F-TICS-m) in identifying cognitive decline among elderly women. Methods: All women aged 72-86 participating in the 'Etude Epidémiologique auprès de Femmes de l'Education Nationale' (E3N) cohort and living in or near Paris constituted the target population of the validation study. Volunteer women (n = 120) underwent both a 20-min telephone interview and a face- to-face neuropsychological examination at an interval of few days (median interval: 10 days). The telephone interview included F-TICS-m, as well as a recall of key elements of a short story, arithmetic/ verbal problems and two verbal fluency tests. Neuropsychological examination consisted of a standardized battery of cognitive tests (including the Mini-Mental State Examination (MMSE), the Free and Cued Selective Reminding Test-FCSRT, Trailmaking tests A and B, the similarities subtest of the Wechsler Adult Intelligence Scale-Ill, etc.) the Instrumental Activities of Daily Living questionnaire, and the Geriatric Depression Scale. Neuropsychological examination led to classification of each subject as cognitively normal (n = 92) or impaired/demented (n = 28). Results: F-TICS-m showed satisfactory internal consistency (Cronbach's alpha = 0.69). It correlated linearly with MMSE (Pearson's r = 0.72). Concurrent validity against the gold-standard classification was satisfactory, with an area under the ROC curve (AUC) of 0.83. The combination of F-TICS-m and the other telephone tests had no additional effect on discrimination power in our sample (AUC = 0.81). Conclusion: F-TICS-m is a valid instrument for assessing the overall cognitive status of French elderly women. Its validity in men and its reproducibility warrant further studies. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this longitudinal study was to test the hypothesis that CSF biomarkers in AD patients also may be forward-looking measures that are associated not only with the degree and profile of cognitive impairment but also with changes in cognition over time. Methods: Here, we assessed the association of CSF Aß42, T-tau and P-tau with neuropsychological scores of disease severity, as well as the rate of disease progression, in 142 patients with Alzheimer's disease. All patients were part of a 3-year prospective longitudinal treatment study. Results: A more rapid progress in MMSE score reduction was seen in AD patients with T-tau levels higher than the upper quartile (800ng/L) compared with Alzheimer's disease patients with lower T-tau levels (p — 0.008). We also found that individuals with T-tau > 800ng/L performed worse in total scores and especially in memory and orientation when assessed with MMSE and ADAS cog than patients with T-tau <800ng/L. Similar results were obtained for P-tau. No associations were seen between Aß42 and cognitive scores or disease progression. Discussion: These findings support the hypothesis that increased levels of T-tau reflect the intensity of the disease and are associated with a more rapid disease progress. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background The mini-mental state exam (MMSE) has been used to address questions such as determination of appropriate cutoff scores for differentiation of individuals with intact cognitive function from patients with dementia and rate of cognitive decline. However, little is known about the relationship of performance in specific cognitive domains to subsequent overall decline. Objective To examine the specific and/or combined contribution of four MMSE domains (orientation for time, orientation for place, delayed recall, and attention) to prediction of overall cognitive decline on the MMSE. Methods Linear mixed models were applied to 505 elderly nursing home residents (mean age = 85, > 12 years education = 27%; 79% F, mean follow-up = 3.20 years) to examine the relationship between baseline scores of these domains and total MMSE scores over time. Results Orientation for time was the only domain significantly associated with MMSE decline over time. Combination of poor delayed recall with either attention or orientation for place was associated with significantly increased decline on the MMSE. Conclusions The MMSE orientation for time predicts overall decline on MMSE scores over time. A good functioning domain added to good functioning delayed recall was associated with slower rate of decline. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To derive norms for the Mini Mental State Examination (MMSE) based on age, gender and level of formal education among the elderly in Sri Lanka. Method A validated Sinhalese version of the MMSE was administered to people aged 55 years and above residing in 14 randomly selected elders' homes. Effects of age, gender and level of formal education on MMSE scores were compared using multiple linear regression analysis. Results A total of 446 subjects [male/female = 136/320] formed the final sample. Level of education and gender exerted a significant influence on MMSE scores, but not age. The median and 10th percentile scores on the Sinhalese MMSE for the education groups were as follows: education <5 years = 19 and 12; education >5 years = 24 and 16, respectively. Conclusion The findings confirm the influence of level of education on MMSE scores among the elderly living in care homes in Sri Lanka, and suggest that education stratified cut-off scores should be used while screening for cognitive impairment in this population. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between cognition and daily life functioning in dementia subtypes. Methods Cross-sectional data were used from 615 patients with dementia who were referred to the Maastricht Memory Clinic of the Maastricht University Medical Centre. Pearson correlation coefficients were calculated between the Mini-Mental State Examination (MMSE; to measure cognitive status) and the Blessed Dementia Scale (BDS; to measure daily life functioning) for the following types of dementia: Alzheimer's Disease (AD, n = 442); Vascular dementia (VaD, n = 113); frontotemporal dementia (FTD, n = 18); Parkinson's dementia (PD, n = 21); and primary progressive aphasia (PPA, n = 21). One-way ANOVA was used to test differences in age, MMSE scores and BDS scores across dementia subtypes. Results Scores on the MMSE showed strong correlation with BDS scores in cases of FTD (r = -0.80); moderate correlation in cases of AD, VaD, and PD (range r = -0.50–0.60); while no correlation was found in PPA cases. Conclusions The association between cognition and daily life functioning varied among dementia subtypes for AD, VaD, FTD and PD. Furthermore, the overall scores on both domains differ between dementia subtypes, indicating that different types of dementia are characterized by a specific pattern of cognitive status and daily life functioning. These findings underline the need for multidomain assessment in patients with dementia. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background The DVLA allows driving in early dementia contingent on regular medical assessment. GPs and psychiatrists require validated and accessible assessments. Some studies have suggested that cognitive testing has utility in the assessment of driving capacity in elderly drivers. One study raises the possibility of using a highway-code questionnaire as an adjunct to these tests. Method Two hundred drivers over the age of 65 were randomly selected from two GP surgeries. Baseline assessment comprised completion of a Highway Code questionnaire (DPHC-98), the Mini Mental State Examination (MMSE) and an abbreviated version of the Alzheimer's Disease Assessment Scale Cognitive Subsection (EURO-ADAS). A history of road traffic accidents (RTAs) over the preceding 5 years was obtained. At 12-month follow-up interview driving status of the subject and occurrence of RTAs were recorded. Predictive power of DPHC-98 and cognitive testing with regards RTAs were examined through logistic regression analysis. Results Performance on the Highway Code questionnaire was identified as the only significant regression factor in the prediction of prospective RTAs. However, none of the logistic regression models were able to identify any drivers involved in RTAs either retrospectively or prospectively. Conclusion Cognitive tests are not linked with risk of driving accidents in older adults in any useful way. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To determine whether cognitive tests predict fitness to drive in patients with dementia. Design Two group comparison of patients with dementia and healthy elderly volunteers, and comparison of patients with dementia who were found safe to drive and those found unsafe, followed by a validation study. Participants Forty-two people with dementia and 33 healthy elderly volunteers with no known memory problems who were driving. Of the 42 people with dementia 37 were assessed on the road. A second sample of 17 people with dementia was also assessed on the road. Main Measures Stroke Drivers Screening Assessment, Mini Mental State Examination, Salford Objective Recognition Test, Stroop Test, Test of Everyday Attention, Visual Object and Space Perception Battery, Behavioural Assessment of the Dysexecutive Syndrome, Adult Memory and Information Processing Battery. Results All healthy elderly volunteers were safe to drive but 10 of the 27 patients with dementia were unsafe. Discriminant function analysis identified a combination of tests, which correctly classified 92% of drivers with dementia as safe or unsafe. Validation of this prediction on an independent sample had 59% accuracy using a cut-off of 0 but 88% accuracy using a cut-off of 5. Conclusions Safety to drive in people with dementia could be predicted from a combination of six cognitive tests. These correctly identified 67% of safe drivers in a validation sample. This assessment could be used to identify those who need evaluation of their safety on the road. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of an activity treatment—mahjong—on the cognitive functioning of persons with mild-to-moderate dementia. Method Participants were 62 older persons (Mage = 83.94, SD = 7.58) who met DSM-IV diagnosis of any dementia condition, had an initial Mini-Mental State Examination (MMSE) score ≤ 24, and were able to play, yet not having played mahjong for the past six months. They were randomly assigned to play either twice (n = 33) or four times (n = 29) a week over a 16-week duration. Digit forward span, digit forward sequence, verbal memory and MMSE were measured at baseline, post-test and 1-month follow-up. Results Regardless of frequency of playing, mahjong produced consistent gains across all cognitive performance measures. It had large effect sizes on digit forward memory (1.0–1.4 for both span and sequence), moderate-to-large effect sizes on verbal memory (0.5–0.9), and a moderate effect size on MMSE (around 0.6). The effects lasted after mahjong had been withdrawn for a month, suggesting that constant practice is not necessary to achieve therapeutic effect once an initial threshold is attained. Conclusion Mahjong is a viable treatment option for dementia. Because mahjong therapy basically does not require professional supervision and can be implemented as widely as space allows at a given time, the potential benefits of integrating mahjong into the daily routines of an institution are enormous vis-à-vis minimal, if any, cost to the institution. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To examine the reliability and the validity of the Korean version of the SIB (SIB-K); and to determine its usefulness in patients with severe dementia. Methods Sixty-five patients (56 women, nine men) who lived in a nursing home and met the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edn, for the dementia of the Alzheimer's type were selected. Following clinical examination and evaluation using the Korean version of the Severe Impairment Battery (SIB-K), the Korean versions of the Mini-Mental State Examination (MMSE-K) and the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-K-cog) were applied as comparators. Results The mean scores on the SIB-K were 63.9 (SD = 29.1), with a possible maximum of 100 points. Patients with MMSE scores from 0 to 4 points showed wide range of the SIB score from 4 to 62. The internal consistency of the SIB-K obtained by the Cronbach's alpha was 0.98. The inter-rater and test–retest reliabilities of the SIB-K obtained by the Spearman's rho were 0.99 and 0.97, respectively. Correlation between the SIB-K and the MMSE-K was 0.87, while correlation between the SIB-K and the ADAS-K-cog was -0.76. Conclusions This study indicates that the Korean version of the SIB is a reliable, valid and useful test for measuring cognition of severely demented patients at a point where other conventional tests lose their sensitivity and show a floor effect. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background/Objective The Organic Brain Syndrome (OBS) Scale was developed to determine elderly patients' disturbances of awareness and orientation as to time, place and own identity, and assessment of various emotional and behavioural symptoms appearing in delirium, dementia and other organic mental diseases. The aim of the study was to examine the OBS Scale, using the eight criteria and guidelines formulated by the Scientific Advisory Committee of the Medical Outcomes Trust (SAC), and to investigate its relevance and suitability for use in various clinical settings. Method Systematic search and analysis of papers (30) on the OBS Scale were carried out using the criteria suggested by the SAC. Results The OBS Scale in many aspects satisfies the requirements suggested by the SAC: conceptual and measurement model, reliability, validity, responsiveness, interpretability, respondent and administrative burden, alternative forms of administration, and cultural and language adaptations, but there is a need for additional evaluation, especially with regard to different forms of reliability, and the translation and adaptation to other languages. Conclusions The OBS Scale is a sensitive scale which is clinically useful for the description and long-term follow-up of patients showing symptoms of acute confusional state and dementia. Although the OBS Scale has been used in several clinical studies there is need for further evaluation. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives Validation of an Italian version of the Telephone Interview for Cognitive Status (I-TICS). Methods Telephone administration of the I-TICS within 6 weeks of face-to-face testing with the Mini Mental State Examination (MMSE), in Probable Alzheimer's disease (AD) patients and healthy controls. Two hundred and seven consecutive outpatients with cognitive impairment were recruited from Dementia Clinic of University Campus BioMedico. Of these, 45 probable AD patients with complete data were analyzed. Other dementias, Mild Cognitive Impairment (MCI), and patients with incomplete data were excluded. The control sample consisted of 64 age- and sex-matched healthy subjects. For diagnosis, an extensive clinical evaluation, laboratory testing, brain imaging, EEG, neuropsychological battery and a depression scale were used. For I-TICS validation, telephone I-TICS and face-to-face MMSE were administered. Results The I-TICS correlated highly and linearly with the MMSE (Pearson's r = 0.904). Conversion equations are provided. Sensitivity and specificity were similar between tests (area under curve = 0.894 for the I-TICS; 0.966 for the MMSE). I-TICS sensitivity was 84% and specificity 86% at a cut-off score of 28. No significant difference in accuracy with the MMSE was present. Total agreement between I-TICS and MMSE was ‘substantial’ at 86% (Cohen's K = 0.717). Repeated testing in a subset of patients showed a disease progression related decrease of 4.2 points/year (t = 2.664; p = 0.018) in I-TICS scores. Conclusion The I-TICS is a valid instrument in clinical and research screening and monitoring of AD. Potential applications in other dementias and MCI are worth further studies. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To estimate the rate that subjects with Mild Memory Impairment /Not Dementia (MMI/ND) shifted to dementia in a population-based cohort and to establish simple diagnostic methods for identification of high-risk persons for dementia. Methods Subjects in a community-based elderly cohort of MMI/ND were followed longitudinally. Subjects were selected from the participants in the first Nakayama study. MMI/ND was defined as memory deficit with objective memory assessment, without dementia, impairment of general cognitive function, or disability in activities of daily living. The conversion rate was calculated using the person-year method. Results At baseline, the sample consisted of 104 subjects (59 female; 45 male) selected from 1162 community dwellers aged over 65 year. During the five-year follow-up, 14 subjects died, 13 moved to other communities, and six refused to participate further. Eleven (10.6%) subjects were diagnosed with Alzheimer's disease (AD), five (4.8%) were diagnosed with vascular dementia (VaD), and six (5.8%) were diagnosed with dementia of other etiology. The annual conversion rate that MMI/ND shifted to AD is calculated on 8.5% per 100 person-year, and shifted to dementia on 16.1% per 100 person-year in this survey. Conclusions The rate at which subjects with MMI/ND whose conditions shifted to dementia was the same as the rate that subjects with mild cognitive impairment (MCI) shifted to dementia in a previous report. It would be useful to identify groups of high-risk individuals for dementia by simple diagnostic methods. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Depression in late life is common and has serious consequences on function, medical co-morbidity, quality of life, and use of medical services. Objective To estimate the age- and gender-specific prevalence of depression among people over 60 years of age, and to examine correlates of depression, in particular the relationship between depression and cognitive impairment. Method From a total of 965 inhabitants, aged over 60 years, in Velestino, a rural town in central Greece, 608 were accessible and constituted the target population. During a five-month period in 2000, a trained health visitor interviewed all study participants. The interview covered socio-demographic characteristics, medical history, and administration of the 15-question Geriatric Depression Scale (GDS-15) and the Mini Mental Scale Examination instrument (MMSE). Results The prevalence of mild or more severe depression (GDS≥7) was 27%, while the prevalence of moderate to severe depression (GDS≥11) was 12%. Increasing age, female gender, lower education, and being currently unmarried were associated with higher risk of depression in univariate regression models, but these associations disappeared after controlling for cognitive function, except for the association with marital status. Cognitive impairment was strongly associated with increased risk for depression. The co-morbid presence of digestive, neurological and heart conditions was also associated with increased risk for depression, while cancer was not. Conclusion In a rural Greek area, the prevalence of depression in late life is high. Depression was more common among unmarried individuals, those with significant cognitive impairment, and in association with specific medical conditions. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background The MMSE is a widely-used instrument in screening for dementia in the community. The traditional cut-point of <24/30 may be unsuitable for use in some settings, due to biases in age and education. Objectives This study aimed to investigate whether cut-points derived from age- and education-specific norms would improve the performance of the MMSE as a screening tool for dementia and cognitive impairment in an Irish community setting, potentially reducing the number of onward referrals. A secondary aim was to obtain score norms in an Irish sample. Methods One thousand one hundred and fifteen people aged over 65 (mean age 74.8±6.8 years; 68% female) were assessed in their own homes, using MMSE (world) and the AGECAT computerised diagnostic system for mental illness in the elderly. The performance of the MMSE in identifying case- and sub-case-level dementia was investigated using cut-points of <24 and <23, as well as adjusted cut-points based on published norms and norms derived from the Irish sample. Results Published norms did not prove useful in improving screening accuracy. Cut-points based on 10th percentile Irish norms and the <23 cut-point performed comparably well, both yielding 93% specificity, with overall accuracy of 90% and 91% respectively (as sensitivity was higher for the <23 cut-point). Conclusions Locally-derived norms yielded better screening accuracy than did published norms or the traditional <24 cut-point. The importance of selecting an appropriate percentile cut-off when using norms is discussed. The best results were obtained with a simple <23 cut-point, and this may be optimal when screening for dementia in an Irish community setting. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To adapt the Addenbrooke's Cognitive Examination (ACE) as a dementia-screening tool in a community in south India. To establish that items in the adapted version are equivalent to that in the original. Methods The ACE was adapted into the local language, Malayalam (m-ACE), following cultural/linguistic modifications. To establish equivalence, qualitative comparisons were made (on the distribution of scores, percentage scoring at ceiling, and relative difficulty across items) between a UK sample receiving the ACE (n = 50; mean age = 67.9 ± 7.4; education ≥ 9, mean = 10.9 ± 2.5) and a community-based educationally-stratified Indian sample receiving the m-ACE: ‘India ≥ 9’ (n = 50; mean age = 67.8 ± 5.2; education ≥ 9, mean = 13.9 ± 2.7) and ‘India ≤ 8’ (n = 50; mean age = 67.1 ± 5.3; education ≤ 8, mean = 3.1 ± 2.0). Results Most ACE items were retained. The score distribution (mean ± 1SD), percentage at ceiling, and relative difficulties across items is comparable between the UK and the educationally equivalent India ≥ 9 groups. Language, Naming, Attention and Orientation are relatively easy (≥ 80% at ceiling) and Recall and Verbal fluency are relatively difficult (≤ 22% at ceiling). Although the percentage at ceiling were lower for the India ≤ 8 group, the order of relative difficulty was similar and the percentage scoring at floor was ≤ 10% on all except visuospatial item. Conclusions The m-ACE provides a culture-fair Malayalam adaptation of the ACE with component items of equivalent difficulty. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To measure rates of decline in cognition and function in patients with Alzheimer's disease (AD) and to investigate their accelerating risk factors in Korea. Methods This study presents longitudinal data on a community-based sample of 107 patients with AD, followed at 6 months and 12 months. The cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog), the Mini Mental State Examination (MMSE) and the Disability Assessment for Dementia Scale (DAD) were given. Mixed model analyses were conducted using the following independent variables: times of repeated assessment (0, 6 or 12 months), severity of dementia assessed by the Functional Assessment Staging (FAST) and individual indicators as covariates. Results Average annual rates of decline in the MMSE, the ADAS-cog and the DAD were 2.3, 11.4 and 15.1 points, respectively. Neither gender, duration of formal education, nor duration of AD since onset was significant predictors of cognitive and functional decline. Patterns of functional decline in total DAD, instrumental ADLs, planning and organization and performance subscale are linear as MMSE score declines, while those of the basic ADLs and the initiation are curvilinear. Conclusion This naturalistic observational study measured rates of cognitive and functional decline in AD, and can provide reference data for further longitudinal studies or clinical trials. Further study will be necessary to determine whether linear or curvilinear pattern in functional decline is due to progression of AD itself or statistical artifact. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives(a) To compare two different clock drawing tests (CDTs) in mild and moderate dementia of the Alzheimer's type (DAT); (b) To examine presumed correlation between these CDTs and some demographic, cognitive and activities of daily living (ADL) variables in mild and moderate DAT. MethodsCross-sectional study. Psychogeriatric outpatient clinic. 49 DAT patients, total; 26—mild, 23—moderate, mean age 77.8 and 80.6, respectively. Evaluations included the Mini-Mental State Examination (MMSE), the Cambridge Cognitive Examination (CAMCOG), the Instrumental Activities of Daily Living Scale (IADL), and a Basic Activities of Daily Living (BADL)—dressing subscale. Severity of dementia was determined with the Clinical Dementia Rating (CDR). Each clock was blindly scored by the same investigator, according to Shulman's and Freedman's methods. ResultsMild and moderate DAT groups were similar in age, gender and education. Performance on Shulman's clock was similar between groups while moderate DAT subjects performed significantly worse on Freedman's clock compared to mild DAT patients. Both clocks correlated highly in mild and moderate DAT. CDT scores correlated significantly with age and education only in mild DAT. Neither clock correlated with ADLs in either stage of dementia severity. CDTs correlated with the MMSE score, and the CAMCOG score in mild DAT, and only with the CAMCOG score in moderate DAT. These correlations were still significant after controlling for age and education. ConclusionsDifferent aspects of cognition and dementia severity are reflected depending on how a clock drawing is scored. Some scoring systems may have greater sensitivity than others in monitoring progression of cognitive deterioration. Correlation between different CDTs and the variables studied (demographic, cognitive, ADLs), when present, is not ubiqitous and changes with the dementia severity. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate five different scoring methods of the Clock Drawing Test (CDT) and to examine whether a combination of Mini Mental State Examination (MMSE) or Short Performance Test (Syndrom Kurz Test, SKT), respectively, with CDT can be used for cognitive screening. MethodsRetrospective blinded analysis of clock drawing performance using five scoring methods (Shulman et al . (1986), Sunderland et al . (1989), Wolf-Klein et al . (1989), Watson et al . (1997), Manos (1997)). A Memory Clinic at an academic psychiatric hospital (University of Frankfurt am Main, Germany). 123 consecutive patients (79 dementia patients, 44 controls). Inter-rater reliability and correlation of five different scoring methods of the CDT with established psychometric tests. Sensitivity and specificity of all five CDT's using the original and modified cut-off scores. Sensitivity, specificity and positive and negative predictive value of a combination of the CDT with MMSE and SKT, respectively. ResultsAll scoring methods of the CDT showed a highly significant interrater reliability (0.82 to 0.94). Correlation with the MMSE and the SKT was also significant (p < 0.01) for all five CDTs. Highest sensitivity was achieved by the Shulman scoring method (81% sensitivity, specificity 79%). Sensitivity of all scoring methods could be improved up to 89% by modifying the originally proposed cut-off scores at the cost of lower specificity. By combining the CDT with the MMSE or the SKT, respectively, the sensitivity of each of the tests could be improved to 92% (SKT and Shulman scale). In patients with mild dementia (GDS 3), a combination of the Shulman Scale with the SKT (92%) and the MMSE (75%) achieved the highest sensitivity. ConclusionsThe CDT in combination with the MMSE or SKT is an easily administered, non threatening and highly sensitive screening test for dementia in the setting of a memory clinic. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Although the Sri Lankan population is ageing rapidly, dementia has not been systematically investigated here. The Mini Mental State Examination (MMSE) is a brief global instrument used to assess cognitive abilities in the elderly. Objective This study aimed to develop and validate a Sinhalese translation of the MMSE, which could be used as a screening instrument to detect impaired cognition in an epidemiological investigation of dementia in Sri Lanka. Methods Due to the high literacy rate in the country, the MMSE was translated and modified slightly without having to make major changes to the original version. 380 randomly selected subjects over 65 years in a semi-urban area were screened with the translated version of the MMSE. The cut-off score for cognitive impairment was taken as 17. Of the 380 subjects screened, 33 scored ≤ 17, and were thus considered cases of suspected dementia. All 33 who scored ≤ 17 and 24 randomly selected subjects who scored > 17 on the MMSE, thus considered cognitively normal, underwent a brief clinical examination and neuropsychological assessment with the more comprehensive neuropsychiatric test battery, Cambridge Cognitive Score (CAMCOG), to determine the presence of dementia. Results Evaluated against the performance at the CAMCOG, the sensitivity and specificity of the translated MMSE were 93.5% and 84.6% respectively. Conclusion Therefore, the Sinhalese translation of the MMSE described here is a sensitive instrument to screen for dementia in Sri Lanka. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

IntroductionThe Mini-Mental State Examination (MMSE) and Cognitive Capacity Screening Examination (CCSE) are easily and rapidly administered tests for quantifying the general cognitive status of young as well as geriatric subjects. Likewise, the Hamilton Depression Rating Scale (HDRS) is a brief instrument for quantifying depression that may confound cognitive test performances. Testing by means of all three scales concurrently provides useful information for longitudinal research among the elderly. ObjectivesTo validate the combined longitudinal use of MMSE, CCSE and HDRS among a specific cohort of normal subjects with vascular headaches characterized by known well-established temporary cognitive decline occurring only during temporary intervals with headache. MethodsThe MMSE, CCSE and HDRS were serially tested at 3–12 monthly intervals among 196 healthy subjects attending our out-patient headache clinic who suffered from migraine or cluster headaches. Stability and specificity of MMSE, CCSE and HDRS were evaluated by comparing consecutive normative scores during headache-free intervals. Sensitivity of MMSE and CCSE for detecting temporary cognitive decline were evaluated by comparing scores during headache and headache-free intervals. ResultsCCSE, MMSE and HDRS gave stable headache-free normative values over intervals of 3–10 years among 182 subjects. Among 77 subjects during headache intervals, temporary cognitive decline were confirmed by both CCSE and MMSE (p < 0.0001). When cutoff points for both CCSE and MMSE normal scores were placed at ≥ 27, specificity for detecting cognitively normal values for CCSE and MMSE when headache-free were 92.2 and 89.6%, respectively (p > 0.05), while sensitivity for detecting cognitively decline during headache intervals were 83.7 and 49%, respectively (p < 0.001). Compared with scoring by a single rater, reliability estimates for all three rating scales were slightly lower when tested by different raters, but these differences were not significant. ConclusionsCCSE is reliable and more sensitive than MMSE for detecting cognitive decline. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background As elderly populations grow, dementia detection in the community is increasingly needed. Existing screens are largely unused because of time and training requirements. We developed the Mini-Cog, a brief dementia screen with high sensitivity, specificity, and acceptability. Here we describe the development of its scoring algorithm, its receiver operating characteristics (ROC), and the generalizability of its clock drawing scoring system. Sample and methods A total of 249 multi-lingual older adults were examined. Scores on the three-item recall task and the clock drawing task (CDT-CERAD version) were combined to create an optimal algorithm. Receiver operating characteristics for seven alternatives were compared with those of the MMSE and the CASI using expert raters. To assess the CDT scoring generalizability, 20 naïve raters, without explicit instructions or prior CDT exposure, scored 80 randomly selected clocks as ‘normal’ or ‘abnormal’ (20 from each of four CERAD categories). Results An algorithm maximizing sensitivity and correct diagnosis was defined. Its ROC compared favorably with those of the MMSE and CASI. CDT concordance between naïve and trained raters was >98% for normal, moderately and severely impaired clocks, but lower (60%) for mildly impaired clocks. Recalculation of the Mini-Cog's performance, assuming that naïve raters would score all mildly impaired CDTs in the full sample as normal, retained high sensitivity (97%) and specificity (95%). Conclusion The Mini-Cog algorithm performs well with simple clock scoring techniques. The results suggest that the Mini-Cog may be used successfully by relatively untrained raters as a first-stage dementia screen. Further research is needed to characterize the Mini-Cog's utility when population dementia prevalences are low. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives . The Mini-Cog, a composite of three-item recall and clock drawing, was developed as a brief test for discriminating demented from non-demented persons in a community sample of culturally, linguistically, and educationally heterogeneous older adults. Subjects . All 129 who met criteria for probable dementia based on informant interviews and 120 with no history of cognitive decline were included; 124 were non-English speakers. Methods . Sensitivity, specificity, and diagnostic value of the Mini-Cog were compared with those of the Mini-Mental State Exam (MMSE) and Cognitive Abilities Screening Instrument (CASI). Results . The Mini-Cog had the highest sensitivity (99%) and correctly classified the greatest percentage (96%) of subjects. Moreover, its diagnostic value was not influenced by education or language, while that of the CASI was adversely influenced by low education, and both education and language compromised the diagnostic value of the MMSE. Administration time for the Mini-Cog was 3 minutes vs 7 minutes for the MMSE. Conclusions . The Mini-Cog required minimal language interpretation and training to administer, and no test forms of scoring modifications were needed to compensate for the extensive linguistic and educational heterogeneity of the sample. Validation in clinical and population-based samples is warranted, as its brevity and ease of administration suggest that the Mini-Cog might be readily incorporated into general practice and senior care settings as a routine ‘cognitive vital signs’ measure. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The Mini-Mental State Examination (MMSE) is a brief global instrument used to assess cognitive abilities in the elderly, requiring literacy as a prerequisite. Such a precondition is impractical for populations with widespread illiteracy. The present study aimed to adapt the MMSE for the cultural context of Bangladesh and for use in populations irrespective of literacy skills. In the Bangla Adaptation of Mini-mental State Examination (BAMSE), the MMSE items were changed in such a way that they would be applicable for illiterate individuals, as well as being culturally relevant in Bangladesh. Altogether 672 elderly, 262 literate and 410 illiterate individuals were tested with the BAMSE. To enable comparison between the BAMSE and MMSE, the literate elderly were tested with both instruments. Test–retest reliability of the BAMSE was assessed in 54 randomly selected individuals. The results showed that, in comparison to the MMSE, the BAMSE demonstrated satisfactory test properties, although reliable differences were found on some of the individual items when the two instruments were compared. The association between the two instruments was good (r =0.57) and the test–retest reliability was satisfactory (r =0.70). More importantly, the BAMSE was found to be less sensitive to age and education than the MMSE. Finally, our results suggest that in the socio-cultural context of Bangladesh, irrespective of literacy skills, the BAMSE is an instrument that can be used to assess cognitive function of the normal elderly. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To elucidate the extent to which elderly people with cognitive impairment are able to answer questions about their quality of life. Design and setting 308 elderly residents were interviewed within 2 weeks of admission to one of 30 residential or nursing homes in north-west England. Measures The Mini-Mental State Examination (MMSE), the Lancashire Quality of Life Profile (Residential) (LQOLP(R)), the Crichton Royal Behaviour Rating Scale (CRBRS) and the HONOS-65+. Results Of the 308 subjects, LQOLP(R) interviews were attempted with 213 who scored 10 or over on the MMSE. Of the 213, 77.5% were found to be ‘interviewable’, ie able to answer the majority of questions in the LQOLP(R) and in doing so to give answers in which the interviewer had confidence. Of the seven cognitive domains measured by the MMSE, visual construction and registration were not significantly associated with interviewability. While orientation to time and recall were significantly associated with interviewability, many interviewable respondents had poor scores in these domains. No respondents were interviewable who scored less than 2 (out of 5) for orientation to place or less than 3 (out of 8) for language or less than 2 (out of 5) for attention. Conclusions A high proportion of elderly people can answer questions about their quality of life, even in the presence of significant cognitive deficits. Copyright © 1999 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine whether the type of sentence used in the repetition task included in the Mini-Mental State Examination (MMSE) affected performance in a group of 79 demented and 19 non-demented Hebrew-speaking elderly persons. The cognitive functioning of the participants was assessed using the MMSE and CAMCOG examinations. The performance of the repetition task was evaluated by using three sentences: the literal translation of the English language expression used in the original MMSE; a well-known Hebrew proverb consisting of monosyllabic words and rhythmic effects; and another well-known Hebrew proverb without such attributes. Only a third of the participants successfully repeated the literally translated expression. It showed low predictive value and was highly affected by education. The well-known Hebrew monosyllabic proverb showed moderate predictive value but no discriminatory ability. The other well-known Hebrew proverb performed the best. The translation of the repetition task in the MMSE to other languages is problematic. Strict adherence to the original language proved to be the least desirable choice. Copyright © 1999 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the value of the Mini-Mental State Examination (MMSE) for use by general practitioners (GPs) in a group of elderly patients in whom the GPs are considering a dementia diagnosis. The study population consisted of 533 elderly patients (aged 65 and older) judged by 36 GPs as suffering from ‘minimal to severe’ dementia. Cross-sectional data were used to determine the criterion validity of separate items, a set of items and the total MMSE. The GMS/AGECAT diagnosis was used as an external criterion. MMSE items were analysed and two items testing general knowledge were added. The most effective set of items was determined using a stepwise logistic regression analysis. Adjusted for age, sex and education, the differentiating ability of the set of items was compared to that of the total MMSE score. The total MMSE score was divided into three categories (cutoffs 21/22 and 26/27) and into two categories (cutoff 23/24). In total, 114 patients (21%) were diagnosed as having an ‘organic syndrome’ by the GMS/AGECAT. The differentiating ability of separate items was poor. The following combination of items had the best predictive ability: items concerning the date, the day of the week, the patient's address and the current prime minister. This set of items was just as adequate in differentiating dementia from non-dementia as the total MMSE score (sensitivity 64.9% and 64.8% respectively, specificity 96.4% and 93.3%). The value of the MMSE in diagnosing dementia in general practice is limited. The score on cognitive test items can be one aspect of the individual's overall clinical picture, on which the diagnosis should be based. © 1997 by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This study was undertaken to investigate whether it was possible to identify a ‘cutoff’ score on the Mini­Mental State Examination (MMSE) below which further cognitive assessment would be of little benefit for research or diagnostic purposes. Evaluation of cognitive assessments in 467 subjects subjects, aged 31–92 (mean 71.4 years), in whom an MMSE score was also available revealed, for those patients scoring ≤ 5 out of 30, that the majority of a further battery of tasks testing amnesia, aphasia, visuospatial ability and intellectual processing were too difficult. Half of the subjects were too severely impaired to complete 16 of the 17 tasks. When the MMSE score was 8 out of 30 or less, there were eight tasks to be able to cooperate meaningfully with further cognitive assessment, using psychometric test batteries such as that currently in use in our clinic, and similar batteries. [ABSTRACT FROM AUTHOR]

One hundred and eight patients aged 70 and older randomly chosen from those admitted to the departments of medicine and surgery in a university hospital were examined for dementia by the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) and DSM-III-R criteria. Cognitive impairment was assessed by the cognitive section of the CAMDEX (CAMCOG) and the Mini-Mental State Examination (MMSE). Fifty-one percent of the sample met DSM-III-R criteria for at least one psychiatric disorder, dementia being the most common (35%). The cut-off point of CAMCOG (60/61) was more effective (100% sensitivity and 97% specificity) than the cut-off point of MMSE (21/22) (95% sensitivity and 86% specificity) in detecting dementia, although the optimal cut-off point of CAMCOG for our sample was lower than that suggested in previous studies. [ABSTRACT FROM AUTHOR]

The criterion validity of the Italian version of the Mini-Mental State Examination was tested in a group (114) of elderly medically ill day patients. Specificity was rather disappointing (66.3%) at the conventional threshold (23/24), as well as positive predictive value (32.7%). A lower threshold (21/22) offered the best compromise between sensitivity (93.8%) and specificity (80.6%). ROC analysis evidenced a good overall performance of MMSE (area under the curve 0.938). In those subjects not affected by dementia, age, low education and depressive illness had a significant effect on MMSE scores. [ABSTRACT FROM AUTHOR]

The aim of the study is to evaluate risk factors of disability in a population of 64 patients affected by Alzheimerߣs disease. The subjects were consecutively recruited at the day hospital service of an Alzheimerߣs dementia care unit. The associations between activities of daily living and age, cognitive status, affective status, cognitive symptoms duration and number of diseases were evaluated within a multidimensional assessment programme. Cognitive performance, as detected by the Mini-Mental Status Examination, was the main independent predictor of disability; other independent predictors of disability were age and cognitive disease duration. Number of diseases—physical and mental—and self-rated depression score were not independently associated with disability. It is concluded that, in a poputation of Alzheimerߣs patients, cognitive impairment has a high impact on the aetiology of disability, but other variables such as age and disease duration should be taken into account. It is also suggested that cognitive performance is the most important indicator of performance in activities of daily living. [ABSTRACT FROM AUTHOR]

The cognitive function of 598 healthy old people aged 70 years or over resident in the community was measured by Mini-Mental State Examination (MMSE) and National Adult Reading Test (NART). The 598 subjects, who were asymptomatic and on no medication, showed no significant correlation between age and NART-predicted intelligence quotient (NARTIQ), but there were significant correlations between both age and MMSE score and NARTIQ and MMSE score. These cross-sectional data suggest that the rate of decline of cognitive function may be significantly greater in subjects with lower NARTIQs; however, longitudinal data are required to test this hypothesis. The provision of normative data from a substantial number of community-resident old people should assist later studies designed to detect the precise effects of cerebral pathology or systemic disease on cognitive function in old people. [ABSTRACT FROM AUTHOR]

Objective. To compare the validity of different instruments for screening and diagnosis of dementia and to provide threshold scores for these purposes, ie screening focusing on a high sensitivity and diagnosis focusing on a high specificity. Setting. 287 subjects from a general population sample who had completed more than one of these psychometric tests. Methods. The performances of the Structured Interview for the Diagnosis of Dementia of the Alzheimer Type, Multi-Infarct Dementia and Dementias of Other Aetiology according to ICD-10 and DSM-III-R, the Mini-Mental State Examination, the Blessed Dementia Rating Scale, the Global Deterioration Scale, the Verbal Fluency Test, the Word List Learning Task, the Trail Making Test and the Labyrinth Test were compared using receiver operating characteristics analysis. Results. The validity of composite instruments for the discrimination of dementia and cognitive health was higher than the validity of individual tests. However, some cognitive tests, ie verbal fluency and immediate recall of words, reached a high validity, making them useful and short screening instruments for dementia. Conclusion. There is no perfect instrument for screening and diagnosis of dementia. Different threshold scores for different purposes were provided in the present study. Recommendations for improving the validity of the Delayed Word List Learning Task for discriminating dementia and cognitive health include the expansion of list length and shortening of delay. © 1998 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Clock drawing is described as a novel, easily administered bedside measure of cognitive function, We examined from 77 ambulant elderly persons meeting NINCDS criteria for Alzheimer's disease their drawings of clock faces and overlapping pentagons. Interrater reliability for two previously published scoring scales for clocks and a devised ordinal scale for overlapping pentagons was high. There was moderate correlation with their total scores on the CAMCOC and Mini Mental State Exam (MMSE). However, a considerable number of patients scored within the normal range on all three drawing scales. A third (23/77) on clock drawing demonstrated their only abnormality at setting the time to 10 to 11 instead of the requested 10 past 11 For the clock drawing test to be used as a rapid screening instrument for Alzheimer's disease in the community an accurately drawn clock face must include the correct position of the hands. The pentagon test either alone or in combination did not enhance the accuracy of the clock test. [ABSTRACT FROM AUTHOR]

Method We compared performance in an Italian telephone version of the Mini-Mental Status Examination (Itel-MMSE) with performance in the standard MMSE administered face to face to 104 inpatients affected by cognitive deficit. Results Their cognitive ability varied from mildly to severely impaired. Total scores of the two MMSE versions correlated strongly for all patients (r=0.85) and for very mildly (r=0.77), mildly (r=0.79), and moderately (r=0.72) demented. A weak but statistically significant correlation was observed for severely demented patients (r=0.46). The study establishes the validity and reliability of the Itel-MMSE as well as between rater and test-retest reliability. We calculated a regression equation for use in predicting MMSE scores from Itel-MMSE scores. Data fit a linear regression model. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]