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Objective: To compare the effects of total intravenous anesthesia (TIVA) and inhalation anesthesia (IA) used in lumbar disc herniectomy on postoperative cognitive recovery based on the mini-mental state examination (MMSE) score and neuron-specific enolase (NSE) levels. Material and methods: The study sample consisted of 80 patients aged 18–65 years who were scheduled for elective lumbar disc herniectomy. The patients were divided into two groups according to the anesthesia technique applied, such as TIVA or IA. The patients in the TIVA group were administered remifentanil and propofol and those in the IA group were administered sevoflurane for maintenance. The MMSE was applied to the patients before the operation and 1h and 24 h postoperatively. Venous blood samples were obtained for the measurement of NSE before the operation and on the 24 h postoperatively. Results: The mean preoperative MMSE scores were similar in the two groups. In the TIVA group, the preoperative and postoperative MMSE scores at 1 h were similar but were higher at 24 h postoperatively compared to the previous two scores (p = 0.001 and p < 0.001, respectively). In the IA group, the preoperative and postoperative 24 h MMSE scores were similar but lower at 1h postoperatively than the other two scores (p = 0.006 and p < 0.001, respectively). In the TIVA group, there was a significant decrease in the postoperative serum NSE levels than the preoperative values (p = 0.038). Conclusion: The use of IA may result in higher cognitive dysfunction 1h after the operation compared to TIVA. The effects of both methods on cognitive functions were similar at 24 h postoperatively. [ABSTRACT FROM AUTHOR]

The majority of cognitive virtual reality (VR) applications have been used for therapy, not cognitive stratification / scoring. This paper describes the BrightScreener™ and its first pilot feasibility study for evaluating elderly with various degrees of cognitive impairment. BrightScreener is a portable (laptop-based) serious-gaming system which incorporates a bimanual game interface for more ecological interaction with virtual worlds. The purpose is to determine if BrightScreener is able to differentiate levels of cognitive impairment based on game performance, as well as to evaluate the technology acceptance by the target population. Eleven elderly subjects were recruited by the Clinical Coordinator at the Memory Enhancement Center of America MECA (Eatontown, NJ) site. They had an average age of 73.6 years, and averaged 14.5 years of education. Subjects underwent clinical scoring with the standardized Mini Mental State Exam (MMSE). During the same visit they underwent a familiarization session and then an evaluation session on the BrightScreener. At the end of their visit, each subject filled a subjective evaluation exit form. Group analysis of the Pearson correlation coefficient showed a high degree of correlation between the subjects' MMSE scores and their Composite Game Scores (0.90, ΙP Ι < 0.01). Despite the small sample size, results suggest that serious-gaming strategies can be used as a digital technique to stratify levels of cognitive impairment. This may be an alternative to conventional standardized scoring for Mild Cognitive Impairment and Dementia. [ABSTRACT FROM AUTHOR]

Because hypoactive delirium is especially under-recognized, we analyzed which Mini-Mental State Examination (MMSE) items predicted incident delirium and its hypoactive motor presentation. Over a 1-year period, older medical inpatients ( n =291) were consecutively screened on admission with the Confusion Assessment Method-Spanish (CAM-S) to exclude prevalent delirium. Nondelirious patients were evaluated the same day with the MMSE, followed by daily ratings with the CAM-S. Those who became CAM-S positive were rated using the Delirium Rating Scale—Revised-98 to assess severity and motor subtype. Disorientation to time (OR 4.4, 95% CI 1.7–11.1) and place (OR 3.8, 95% CI 1.7–8.2) at admission were risk factors for delirium at follow-up and together correctly classified 88.3% of subjects as to delirium status. Disorientation to time and place, and visuoconstructional impairment were each associated with either hypoactive or mixed subtype ( p <0.05 χ 2 test). Simple bedside evaluation of cognitive function in nondelirious patients revealed deficits that detected patients at risk for developing incident delirium at follow-up (especially hypoactive or mixed). We recommend patients with orientation deficits be monitored closely for emergence of delirium. A separate evaluation for possible dementia or other causes of cognitive impairment at admission should be considered too. [ABSTRACT FROM AUTHOR]

The purpose was to compare the Spanish language picture version of the Free and Cued Selective Reminding Test with Immediate Recall (pFCSRT+IR) and the Mini Mental State Exam (MMSE) in identifying very mild dementia among Spanish speaking Latino patients. The tests and an independent diagnostic assessment were administered to 112 Latino patients free of medically diagnosed dementia from an urban primary care clinic. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to examine differences in the operating characteristics of the pFCSRT+IR and the MMSE. Cut scores were manipulated to equate sensitivities (specificities) at clinically relevant values to compare differences in specificities (sensitivities) using the Pearson Chi Square test. Youden’s index was used to select the optimal cut scores. Twenty-four of the 112 primary care patients (21%) received a research dementia diagnosis, indicating a substantial burden of unrecognized dementia. MMSE scores but not free recall scores were associated with years of education in patients free of dementia. AUC was significantly higher for free recall than for MMSE. Free recall performed significantly better than the MMSE in sensitivity and in specificity. Using optimal cut scores, patients with impaired free recall were 10 times more likely to have dementia than patients with intact recall, and patients with impaired MMSE scores were 4.5 times more likely to have dementia than patients with intact scores. These results suggest that the Spanish language pFCSRT+IR may be an effective tool for dementia screening in educationally diverse Latino primary care populations. (JINS, 2014, 20, 1–8) [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of 109 days of caprylic triglyceride (CT) in a 70-year-old male with mild Alzheimer's disease (AD). Background: Cerebral metabolism is limited to glucose under most conditions, and diminished cerebral glucose metabolism is a characteristic feature of AD. Another substrate available for cerebral metabolism is ketone bodies. Ketone bodies (KB) are normally derived from fat stores under conditions of low glucose availability as an alternative energy substrate to glucose. KB can also be produced by oral administration of CT. Prior studies suggest that the alternative energy source of CT may improve cognitive function due to mild to moderate AD, by circumventing the diminished glucose metabolism. Method: The effect of CT was analyzed in a single-case of mild AD with cognitive alterations in an open label study. Study outcomes included the Montreal cognitive assessment (MoCA), mini mental state exam (MMSE), and 18-fluorodeoxyglucose (18F) positron emission tomography (FDG PET) scans. Results: After 109 days of CT, MoCA scores changed from a baseline value of 24-28, and MMSE scores changed from 23 to 28. No changes were observed on FDG PET scans. Conclusion: The results suggest that, in a case of mild AD, CT may have affected cognitive function, assessed by means of MMSE and MoCA, although glucose uptake and metabolism remained unchanged. [ABSTRACT FROM AUTHOR]

Abstract: Today, high-resolution MRI scans are able to reveal even the fine details of brain structure. Several methods have been developed to quantify shape differences specific to scans of diseased brains. We have developed a novel method for quantifying shape information based on multidimensional scaling (MDS), a well-known statistical tool. Multidimensional scaling uses distance measures computed from pair-wise image registration of the training set. Image registration establishes spatial correspondence between scans in order to compare them in the same spatial framework. Our novel method has several advantages, including robustness to errors in registrations. Applying our method to 44 brain MRIs showed clear separation between normal and Alzheimer scans. Using our method as basis for classification between normal and Alzheimer scans yielded better performance results compared with using the volume of hippocampus as basis for classification. We also devised a simple measure derived from the MDS approach that was shown to correlate with the Mini Mental State Examination (MMSE), a well-known cognitive test for Alzheimer''s disease. [Copyright &y& Elsevier]

Background/Aims: Having dementia increases patients’ risk for accidental falls. However, it is unknown if having mild cognitive deficits also elevates a person’s risk for falls. This study sought to clarify the relationship between subtle cognitive impairment, measured with a widely-used, clinic-based assessment, the Mini Mental State Exam (MMSE), and risk for falls. Methods: In a secondary analysis of the Kenosha County Falls Prevention Study, a randomized controlled trial targeting older adults at risk for falls, we examined the association between baseline MMSE and prospective rate of falls over 12 months in 172 subjects randomized to control group. Results: Using univariate analysis, the rate of falls increased with each unit decrease in MMSE score down to at least 22 (rate ratio 1.25, 95% confidence interval (CI) 1.09–1.45, p = 0.0026). Using stepwise multivariate regression, controlling for ability to perform activities of daily living, use of assistive device, current exercise, and arthritis, the association between MMSE score and falls rate persisted (rate ratio 1.20, 95% CI 1.03–1.40, p = 0.021). Conclusion: Minimal decrements on the MMSE were associated with elevations in rate of falls, suggesting that subtle cognitive deficits reflected in MMSE scores above a cut-off consistent with a diagnosis of dementia, can influence risk for falls. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract : Telehealth could be a medium for the provision of cognitive assessments to distant sites. : The aims of the present study were to determine the interrater reliability of the Standardized Mini Mental State Exam (SMMSE) and the Geriatric Depression Scale (GDS) through Telehealth as compared to face-to-face administration. : Duplicate interviews of subjects with cross-over of interview modality were carried out. Twenty patients were interviewed between two sites 11 km apart. Subjects were persons older than 65 years (mean age 82 years) who consented to Telehealth assessments. The outcome measures were the differences in assessment scores between the two media. : The average SMMSE score by remote assessment was 24.0 (range 11.0−30.0) and by direct assessment was 24.3 (range 9.0−30.0). The correlation between direct and remote SMMSE scores was 0.90. The mean difference between direct and remote SMMSE scores was −0.3 (95% confidence interval (CI): −4.6 to 4.0). In 8 of 20 participants (40%) the difference between Telehealth and direct assessments was two points or more on the SMMSE. The average GDS by remote assessment was 6.1 (range 1.0−14.0) and by direct assessment was 5.8 (range 2.0−13.0). The correl­ation between direct and remote GDS scores was 0.78. The mean difference between direct and remote GDS assessment was 0.3 (95% CI: −3.8 to 4.4). : Remote assessments with SMMSE and GDS using Telehealth methods yielded similar results to direct assessments. However, there was a moderate ­difference between face-to-face and Telehealth assessments in some subjects, which could influence clinical ­decision-making. (Intern Med J 2004; 34: 239−242) [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of total intravenous anesthesia (TIVA) and inhalation anesthesia (IA) used in lumbar disc herniectomy on postoperative cognitive recovery based on the mini-mental state examination (MMSE) score and neuron-specific enolase (NSE) levels.The study sample consisted of 80 patients aged 18–65 years who were scheduled for elective lumbar disc herniectomy. The patients were divided into two groups according to the anesthesia technique applied, such as TIVA or IA. The patients in the TIVA group were administered remifentanil and propofol and those in the IA group were administered sevoflurane for maintenance. The MMSE was applied to the patients before the operation and 1h and 24 h postoperatively. Venous blood samples were obtained for the measurement of NSE before the operation and on the 24 h postoperatively.The mean preoperative MMSE scores were similar in the two groups. In the TIVA group, the preoperative and postoperative MMSE scores at 1 h were similar but were higher at 24 h postoperatively compared to the previous two scores (p = 0.001 and p < 0.001, respectively). In the IA group, the preoperative and postoperative 24 h MMSE scores were similar but lower at 1h postoperatively than the other two scores (p = 0.006 and p < 0.001, respectively). In the TIVA group, there was a significant decrease in the postoperative serum NSE levels than the preoperative values (p = 0.038).The use of IA may result in higher cognitive dysfunction 1h after the operation compared to TIVA. The effects of both methods on cognitive functions were similar at 24 h postoperatively.Material and methods: To compare the effects of total intravenous anesthesia (TIVA) and inhalation anesthesia (IA) used in lumbar disc herniectomy on postoperative cognitive recovery based on the mini-mental state examination (MMSE) score and neuron-specific enolase (NSE) levels.The study sample consisted of 80 patients aged 18–65 years who were scheduled for elective lumbar disc herniectomy. The patients were divided into two groups according to the anesthesia technique applied, such as TIVA or IA. The patients in the TIVA group were administered remifentanil and propofol and those in the IA group were administered sevoflurane for maintenance. The MMSE was applied to the patients before the operation and 1h and 24 h postoperatively. Venous blood samples were obtained for the measurement of NSE before the operation and on the 24 h postoperatively.The mean preoperative MMSE scores were similar in the two groups. In the TIVA group, the preoperative and postoperative MMSE scores at 1 h were similar but were higher at 24 h postoperatively compared to the previous two scores (p = 0.001 and p < 0.001, respectively). In the IA group, the preoperative and postoperative 24 h MMSE scores were similar but lower at 1h postoperatively than the other two scores (p = 0.006 and p < 0.001, respectively). In the TIVA group, there was a significant decrease in the postoperative serum NSE levels than the preoperative values (p = 0.038).The use of IA may result in higher cognitive dysfunction 1h after the operation compared to TIVA. The effects of both methods on cognitive functions were similar at 24 h postoperatively.Results: To compare the effects of total intravenous anesthesia (TIVA) and inhalation anesthesia (IA) used in lumbar disc herniectomy on postoperative cognitive recovery based on the mini-mental state examination (MMSE) score and neuron-specific enolase (NSE) levels.The study sample consisted of 80 patients aged 18–65 years who were scheduled for elective lumbar disc herniectomy. The patients were divided into two groups according to the anesthesia technique applied, such as TIVA or IA. The patients in the TIVA group were administered remifentanil and propofol and those in the IA group were administered sevoflurane for maintenance. The MMSE was applied to the patients before the operation and 1h and 24 h postoperatively. Venous blood samples were obtained for the measurement of NSE before the operation and on the 24 h postoperatively.The mean preoperative MMSE scores were similar in the two groups. In the TIVA group, the preoperative and postoperative MMSE scores at 1 h were similar but were higher at 24 h postoperatively compared to the previous two scores (p = 0.001 and p < 0.001, respectively). In the IA group, the preoperative and postoperative 24 h MMSE scores were similar but lower at 1h postoperatively than the other two scores (p = 0.006 and p < 0.001, respectively). In the TIVA group, there was a significant decrease in the postoperative serum NSE levels than the preoperative values (p = 0.038).The use of IA may result in higher cognitive dysfunction 1h after the operation compared to TIVA. The effects of both methods on cognitive functions were similar at 24 h postoperatively.Conclusion: To compare the effects of total intravenous anesthesia (TIVA) and inhalation anesthesia (IA) used in lumbar disc herniectomy on postoperative cognitive recovery based on the mini-mental state examination (MMSE) score and neuron-specific enolase (NSE) levels.The study sample consisted of 80 patients aged 18–65 years who were scheduled for elective lumbar disc herniectomy. The patients were divided into two groups according to the anesthesia technique applied, such as TIVA or IA. The patients in the TIVA group were administered remifentanil and propofol and those in the IA group were administered sevoflurane for maintenance. The MMSE was applied to the patients before the operation and 1h and 24 h postoperatively. Venous blood samples were obtained for the measurement of NSE before the operation and on the 24 h postoperatively.The mean preoperative MMSE scores were similar in the two groups. In the TIVA group, the preoperative and postoperative MMSE scores at 1 h were similar but were higher at 24 h postoperatively compared to the previous two scores (p = 0.001 and p < 0.001, respectively). In the IA group, the preoperative and postoperative 24 h MMSE scores were similar but lower at 1h postoperatively than the other two scores (p = 0.006 and p < 0.001, respectively). In the TIVA group, there was a significant decrease in the postoperative serum NSE levels than the preoperative values (p = 0.038).The use of IA may result in higher cognitive dysfunction 1h after the operation compared to TIVA. The effects of both methods on cognitive functions were similar at 24 h postoperatively. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is one of the most common forms of dementia in the world. The Mini-Mental State Examination, a tool developed to detect AD, is composed of various tests that evaluate functional performance in several fields, one of which is language. Several symptoms are manifested in voices as a result of language and speech problems caused by AD, including frequent involuntary pauses during conversations and diction and vocabulary difficulties. Speech fluency is considered a key feature for AD detection in this research, for which two algorithms are proposed. The first algorithm is a paralinguistic system that is independent of the language and task and whose low-dimension feature vectors facilitate the training stage. This algorithm is tested on two databases (AcceXible and ADReSS), on two languages (Spanish and English) and on several tests. The second algorithm is based on analysing temporal patterns of silence between words and errors in spoken words. This approach, based on verbal fluency tests, is tested on the AcceXible database. To benchmark these algorithms, two baseline algorithms are used: the i-vector framework, a speaker modelling algorithm that has been effectively used for speech-related tasks such as speaker recognition, language identification, speaker diarization and speech-related health tasks; and a classic counting-terms algorithm, which processes transcriptions of speech. The paralinguistic system yields promising results for different tests and languages, while the silence-based system achieves high accuracy in verbal fluency tests. [ABSTRACT FROM AUTHOR]

Abstract Memory and other cognitive complaints are common in the elderly population. However, the clinical meaning of these complaints remains controversial. Objectives: The goal of this study was to investigate the association between cognitive complaints and performance on a mental state screening test in elderly patients attended for the first time at the Neurogeriatric and Dementia (NGA) Outpatient Clinic within a major University hospital. Methods: Two hundred patients referred to the NGA Clinic during 2005, 2006 and 2007 first semesters participated in the study. The variables of interest were: (a) source of and reason for referral; (b) whether or not they had previously been evaluated with the screening test (Mini Mental State Exam - MMSE) by their physicians before referral to our specialized clinic; (c) cognitive complaints; and (d) performance on the screening test (MMSE) at the NGA Clinic. Results: The main reason for referral to the NGA clinic was cognitive complaints 63% (N=126), where only 5% (N=10) of the referred patients had been previously evaluated by the cognitive screening test (MMSE or equivalent). Of the 135 patients who presented cognitive complaints during the first appointment, 52 (38%) presented MMSE scores below the education-adjusted cut-off. No association between cognitive complaint and performance on the MMSE during the first evaluation at the NGA Clinic was observed (c²=3.04, p=0.1). Conclusions: Although cognitive complaints among elders should not be disregarded, the mental state screening evaluation is crucial for the detection of clinically significant cognitive impairment.