Search

Background: Alzheimer’s disease (AD) increases societal costs and decreases the activities of daily living (ADL) and quality of life (QoL) of the affected individuals. Objective: We assess the impact of AD severity on ADL, QoL, and caregiving costs in Japanese facilities for the elderly. Methods: Patients with AD in facilities for the elderly were included (47 facilities, N = 3,461). The QoL, ADL, and disease severity of patients were assessed using Barthel Index (BI), EuroQoL-5D-5L (EQ-5D-5L), and Mini-Mental State Examination (MMSE), respectively. Annual caregiving costs were estimated using patients’ claims data. The patients were subcategorized into the following three groups according to the MMSE score: mild (21≤MMSE≤30), moderate (11≤MMSE≤20), and severe (0≤MMSE≤10). Changes among the three groups were evaluated using the Jonckheere-Terpstra test. Results: Four hundred and one participants were on anti-AD medicines, of whom 287 (age: 86.1±6.4 years, 76.7% women) in the mild (n = 53, 84.0±6.9 years, 71.7%), moderate (n = 118, 86.6±5.9 years, 76.3%), and severe (n = 116, 86.6±6.5 years, 79.3%) groups completed the study questionnaires. The mean BI and EQ-5D-5L scores for each group were 83.6, 65.1, and 32.8 and 0.801, 0.662, and 0.436, respectively. The mean annual caregiving costs were 2.111, 2.470, and 2.809 million JPY, respectively. As AD worsened, the BI and EQ-5D-5L scores decreased and annual caregiving costs increased significantly. Conclusion: AD severity has an impact on QoL, ADL, and caregiving costs.

Background Malnutrition in the elderly people is frequent and serious. Management of malnutrition at home after hospitalization is unsatisfactory. The objective of the study is to evaluate the feasibility and participation of a new collaborative and participative program involving the patient, the general practitioner and the dietician nutritionist, to fight against malnutrition in the elderly people at home after hospitalization. Methods This was a prospective and non-randomized study performed from May 2015 to February 2016, in subjects aged 75 and more, malnourished, with an MMSE score > 20 and returning homes after hospitalization. At home, a dietician worked with the patients and their general practitioner for 3 months. Patient participation and satisfaction of the 3 actors were assessed. Results Forty-four patients were included and 11.9% (n=8) benefited from the entire program. Present entourage (p=0.001), dietary education to the entourage (p=0,003), a high MMSE score (p=0.04), having an ulcer (p=0.0097), and a high weight at discharge (p=0.03) increased patients' participation. Patients (78.6%) and general practitioners (75%) were satisfied with the program. Patients criticized the lack of involvement of the general practitioner. General practitioners felt they had not acquired any knowledge of dietetics. Conclusion Patient participation and collaboration between actors of the program of management of malnutrition in elderly people were considered weak.

Biomarkers to discriminate the main pathologies underlying frontotemporal lobar degeneration (FTLD-Tau, FTLD-TDP) are lacking. Our previous FTLD cerebrospinal fluid (CSF) proteomestudy revealed that sex hormone-binding globulin (SHBG) was specifically increased in FTLD-Taupatients. Here we investigated the potential of CSF SHBG as a novel biomarker discriminating themain FTLD pathological subtypes. SHBG was measured in CSF samples from patients with FTLDTau (n = 23), FTLD-TDP (n = 29) and controls (n = 33) using an automated electro-chemiluminescentimmunoassay. Differences in CSF SHBG levels across groups, as well as its association with CSFYKL40, pTau181/total-Tau ratio and cognitive function were analyzed. CSF SHBG did not differacross groups, though a trend towards elevated levels in FTLD-Tau cases compared to FTLD-TDPand controls was observed. CSF SHBG levels were not associated with either CSF YKL40 or thep/tTau ratio. They, however, inversely correlated with the MMSE score (r = −0.307, p = 0.011), anassociation likely driven by the FTLD-Tau group (r FTLD-Tau = −0.38; r FTLD-TDP = −0.02). CSFSHBG is not a suitable biomarker to discriminate FTLD-Tau from FTLD-TDP

Background The Montreal Cognitive Assessment (MoCA) is known to have discriminative power for patients with Mild Cognitive Impairment (MCI). Recently Cognitive Reserve (CR) has been introduced as a factor that compensates cognitive decline. We aimed to assess whether the MoCA reflects CR. Furthermore, we assessed whether there were any differences in the efficacy between the MoCA and the Mini-Mental State Examination (MMSE) in reflecting CR. Methods MoCA, MMSE, and the Cognitive Reserve Index questionnaire (CRIq) were administered to 221 healthy participants. Normative data and associated factors of the MoCA were identified. Correlation and regression analyses of the MoCA, MMSE and CRIq scores were performed, and the MoCA score was compared with the MMSE score to evaluate the degree to which the MoCA reflected CR. Results The MoCA reflected total CRIq score (CRI; B = 0.076, P

Alzheimer's disease (AD) is a progressive neurodegenerative disease that has no cure at present. This study was carried out to evaluate whether the combination of β-asarone and tenuigenin could improve the efficacy of memantine as a monotherapy in the treatment of AD. Patients with AD were recruited and assigned to two groups. Patients in the control group received memantine (5-20 mg/day) and those in the experimental group received memantine (5-20 mg/day), β-asarone (20 mg/day), and tenuigenin (20 mg/day). The Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL), Clinical Dementia Rating Scale (CDR) scores and drug-related side-effects were assessed. Treatment was continued for 12 weeks. In total, 93 AD patients (45 in the control group and 48 in the experimental group) were recruited. Before treatment, both the groups had similar average MMSE scores, ADL scores, and CDR scores, whereas all the average scores improved significantly after treatment. However, compared with the control group, the experimental group had a significantly higher average MMSE score (P=0.00001) and lower average ADL (P=0.00604) and CDR (P=0.00776) scores after treatment. Moreover, the two groups had similar rates of drug-related side-effects. These results indicated that the combination of β-asarone and tenuigenin was an effective augmentation for memantine in the treatment of AD and did not cause more drug-related side-effects. This novel method is worthy of further investigation.

Background: The status of vitamin B12 and folate has been implicated in the development and progression of Alzheimer's disease.Methods: The study explored this issue through a retrospective case-control study design, with follow up of the case group for 18 months. The case group (n = 136) comprised patients 65 years or older diagnosed with Alzheimer's disease and having a Mini-mental State Examination score (MMSE) of ≤ 27. The control group comprised healthy adults 65 years or older (n = 338) with a MMSE score of >27.Results: Vitamin B12 and folate levels were not found to differ between case and control groups. B12 and folate status at baseline was not predictive of disease progression in the case group.Discussion: This lack of association differs from other studies which have shown a protective effect of vitamin B12 and folate on cognitive decline.KEY POINTSThe findings of this study do not confirm evidence suggesting an effect of vitamin B12 and folate levels on development and progression of Alzheimer's disease.Folate and B12 levels were similar in the Alzheimer's group to those of healthy controls.Folate and B12 levels at initial assessment were not predictive of disease progression.

BACKGROUND Supplementation with medium-chain triglycerides (MCTs) was previously shown to increase muscle function in frail elderly individuals. OBJECTIVE We aimed to assess effects of MCTs on cognition in such individuals. METHODS We enrolled 64 elderly nursing home residents (85.5 ± 6.8 y; 13 men, 51 women; BMI 18.6 ± 2.5 kg/m2) in a 3-mo randomized, controlled, single-blinded, intervention trial. Participants were randomly allocated to 3 groups: the first group received supplemental L-leucine (1.2 g) and cholecalciferol (20 μg) enriched with 6 g/d of MCTs (LD + MCT group) as a positive control, the second group received 6 g/d of MCTs (MCT group) as the test nutrient, and the third group received 6 g/d of long-chain triglycerides (LCT group) as a negative control. Cognition (secondary outcome) was monitored 4 times: baseline, 1.5 and 3 mo after initiation of the intervention (intervention), and 1.5 mo after termination of the intervention (postintervention follow-up). Cognition scores were assessed by a linear mixed model (intention-to-treat analysis). RESULTS MCT supplementation increased the Mini-Mental State Examination (MMSE) score by 3.5 points at the 3-mo intervention from baseline (P

OBJECTIVE This study aimed to investigate the effects of dexmedetomidine on cerebral oxygen saturation [Sct(O2)] and postoperative cognitive function in elderly patients undergoing minimally invasive coronary artery bypass graft surgery. METHODS Sixty elderly patients who received minimally invasive coronary artery bypass graft surgery were randomly equally divided into dexmedetomidine group (group D) and control group (group N). The patients in group D were pumped with 1 μg/kg dexmedetomidine for 15 min before incision, followed by continuous pumping at 0.3-0.5 μg/(kg·h) till the end of the operation. The patients in group N received same dose of normal saline during the operation. Sct(O2) was monitored at pre-induction (T0), post-induction (T1), 30 min (T2) after single-lung ventilation, and after surgery (T3). Mini-mental state examination (MMSE) was used to assess the cognitive function at 1 day before, 72 hour and 7 days after surgery. RESULTS Sct(O2) level in group D was significantly higher than that in group N at T2 (P

PurposeUsing PET imaging in a group of patients with Alzheimer’s disease (AD), we investigated whether level of education, a proxy for resilience, mitigates the harmful impact of tau pathology on neuronal function.MethodsWe included 38 patients with mild-to-moderate AD (mean age 67 ± 7 years, mean MMSE score 24 ± 4, mean years of education 14 ± 4; 20 men, 18 women) in whom a [18F]AV-1451 scan (a measure of tau pathology) and an [18F]FDG scan (a measure of neuronal function) were available. The preprocessed PET scans were z-transformed using templates for [18F]AV-1451 and [18F]FDG from healthy controls, and subsequently thresholded at a z-score of ≥3.0, representing an one-tailed p value of 0.001. Next, three volumes were computed in each patient: the tau-specific volume (tau pathology without neuronal dysfunction), the FDG-specific volume (neuronal dysfunction without tau pathology), and the overlap volume (tau pathology and neuronal dysfunction). Mean z-scores and volumes were extracted and used as dependent variables in regression analysis with years of education as predictor, and age and MMSE score as covariates.ResultsYears of education were positively associated with tau-specific volume (β = 0.362, p = 0.022), suggesting a lower impact of tau pathology on neuronal function in patients with higher levels of education. Concomitantly, level of education was positively related to tau burden in the overlap volume (β = 0.303, p = 0.036) implying that with higher levels of education more tau pathology is necessary to induce neuronal dysfunction.ConclusionIn patients with higher levels of education, tau pathology is less paralleled by regional and remote neuronal dysfunction. The data suggest that early life-time factors such as level of education support resilience mechanisms, which ameliorate AD-related effects later in life.

Introduction The study aimed to determine the prevalence and documentation of delirium among the elderly and if the Clock Drawing Test (CDT) can be used to predict which patients had delirium on admission and those who may develop delirium during their stay in acute medical wards. Methods A single researcher performed the Mini-Mental State Examination (MMSE) and CDT on admission and discharge of 57 elderly adults at the National University Hospital, Singapore. Delirium was defined as a ≥ 3-point improvement or ≥ 2-point decline in MMSE scores from admission to discharge, where a fall denotes development of delirium and a rise denotes resolution. The case notes of the same patients were reviewed for documentation of delirium. All inpatients from two acute medical wards were examined. One CDT score and a pair of MMSE scores were collected from each patient. Results A total of 57 patients (28 male, 29 female) were involved in the study. Their mean age was 76.0 ± 8.7 years. The prevalence of delirium based on MMSE scores was 40.4%; 16 patients had delirium on admission while seven developed delirium during their inpatient stay. However, delirium was documented in the case notes of only 7 (30%) of the 23 patients. CDT score was better than baseline MMSE score at predicting a decline in MMSE score. Conclusion The prevalence of delirium in the acute medical setting is high but underdiagnosed. The CDT may be a good screening tool to identify patients at risk of delirium during their inpatient stay. Baseline cognition screening should be performed in every elderly patient admitted to hospital.

The aim of this paper was to investigate the evolution of mortality and life expectancy according to dementia in two French populations 10 years apart. Two different populations of subjects aged 65 or older included in PAQUID from 1988 to 1989 (n = 1342) and 3C from 1999 to 2000 (n = 1996) and initially not demented were followed over 10 years. Dementia was assessed using an algorithmic approach, and participants were considered to have dementia if they had an MMSE score < 24 AND a 4IADL score > 1. Illness-death models were used to compare mortality with and without dementia and to provide total life expectancy (LE), dementia-free life expectancy (DemFreeLE), life expectancy with dementia (DemLE), and survival with dementia. Mortality without dementia has decreased between the two populations among men [HR = 0.63 (0.49-0.81)] and women [HR = 0.67 (0.50-0.90)], whereas mortality with dementia has decreased for women only [HR = 0.59 (0.41-0.87)]. Total LE and DemFreeLE have increased between the 1990s and the 2000s populations (total LE: + 2.5 years; DemFreeLE: + 2.2 years); DemLE only slightly increased between the populations (DemLE: + 0.3 years). For survival with dementia, an increase in survival has been evidenced (mean survival: + 1.3 years) for women only. The improvement in DemFreeLE is promising. However, as the duration of life with dementia tends to increase for women, efforts to delay the onset of dementia should be reinforced.

At present, it is recognized that screening for frailty in the elderly is a major public health issue. Numerous scales have emerged for the purpose of detecting/measuring frailty. Methods A prospective, observational study was performed in subjects aged over 75 years, coming from the first neuro-geriatric consultation, from July 3, 2017 to August 18, 2017, included in the CHU Rouen, and benefiting from frailty screening through the use of the grid SEGAm (part A); this correlated with the subjective opinion of the nurse. Results 58 patients were included, with an average age of 82.1±3.87 (extreme age: 75-95) and a slight female predominance (37 subjects, 63.8%). The mean Charlson score was 2.31±1.75. Home helpers were present for 34 patients. The elderly were in a couple for 35 patients. The mean weight of the series is 74.5±14.67. The mean BMI of the series is 26.85±4.79. The mean MMSE score is 22.8±3.28. Non-frail elderly subjects, according to the SEGAm scale, represent 45 patients, while the frail elderly represent 13 patients (22.4%). The average SEGAm score is 6.3±3.59. SEGAm achievement time is about 6.2 min. According to the feeling of the nursing team, 36 elderly patients (62%) were not frail, 15 elderly patients (26%) were frail, while 7 elderly patients were very frail (12%). Cohen's kappa was estimated at 0.56 (IC95: 0.33-0.79). Thus the agreement, according to Cohen's kappa, is estimated as average. Conclusion The SEGAm score appears to be a suitable outpatient score. It is easy to use, allows an overall assessment of the patient and is not time consuming. The objective of this work is to be able to develop at best frailty consultations or even a day hospital, the real objective of the main hospitals.

To investigate the effects of variability in self-measured systolic blood pressure at home on the progression of cognitive impairment and white matter lesions in the oldest old. Between April 2009 and October 2009, 248 oldest old aged 80 years or older were eligibly enrolled from geriatric practices and community-dwelling areas of Shandong, China. Self-measured blood pressure at home (HBP) was measured for 7 consecutive days at the baseline, and the Mini-Mental State Examination (MMSE) score and brain white matter hyperintensities (WMH) were assessed at the baseline and during the final follow-up visit. Variability in systolic HBP was evaluated using coefficient of variation (CV) in serial daily systolic HBP measurements of the last 6 consecutive days. After an average of 2.3 years of follow-up visits, 232 oldest old were included in and 16 were excluded from the analysis. The MMSE score declined -4.76 (interquartile ranges: -10.71, -0.83) %, the periventricular WMH, deep WMH, total WMH and WMH fraction increased 16.46 (s.d.: 6.72)%, 10.05 (s.d.: 6.40)%, 14.69 (s.d.: 6.07)% and 15.95 (s.d.: 6.32)%, respectively, in the total oldest old. A declined percentage of the MMSE score and increased percentages of the periventricular WMH, deep WMH, total WMH and WMH fraction in the high group divided by tertile of the CV of the systolic HBP at baseline were greater than those in the low group (P

Objectives To investigate the association between hearing loss, hearing aid use, and cognitive decline. Design Prospective population-based study. Setting Data gathered from the Personnes Agees QUID study, a cohort study begun in 1989–90. Participants Individuals aged 65 and older (N = 3,670). Measurements At baseline, hearing loss was determined using a questionnaire assessing self-perceived hearing loss; 137 subjects reported major hearing loss, 1,139 reported moderate problems (difficulty following the conversation when several persons talk at the same time or in a noisy background), and 2,394 reported no hearing trouble. Cognitive decline was measured using the Mini-Mental State Examination (MMSE), administered at follow-up visits over 25 years. Results Self-reported hearing loss was significantly associated with lower baseline MMSE score (β = −0.69, P < .001) and greater decline during the 25-year follow-up period (β = −0.04, P = .01) independent of age, sex, and education. A difference in the rate of change in MMSE score over the 25-year follow-up was observed between participants with hearing loss not using hearing aids and controls (β = −0.06, P < .001). In contrast, subjects with hearing loss using a hearing aid had no difference in cognitive decline (β = 0.07, P = .08) from controls. Conclusion Self-reported hearing loss is associated with accelerated cognitive decline in older adults; hearing aid use attenuates such decline.

Objectives To examine level of and change in cognitive status using the Mini-Mental State Examination (MMSE) in relation to dementia, mortality, education, and sex in late nonagenarians. Design Three-year longitudinal study with examinations at ages 97, 99, and 100. Setting Trained psychiatric research nurses examined participants at their place of living. Participants A representative population-based sample of 97-year-old Swedes (N = 591; 107 men, 484 women) living in Gothenburg, Sweden. Measurements A Swedish version of the MMSE was used to measure cognitive status. Geriatric psychiatrists diagnosed dementia according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Mixed models were fitted to the data to model the longitudinal relationship between MMSE score and explanatory variables. Results Individuals with dementia between age 97 and 100 had lower mean MMSE scores than those without dementia. Those who died during the 3-year follow-up had lower MMSE scores than those who survived. MMSE scores at baseline did not differ between those without dementia and those who developed dementia during the 3-year follow-up. Participants with more education had higher MMSE scores, but there was no association between education and linear change. Conclusion MMSE score is associated with dementia and subsequent mortality even in very old individuals, although the preclinical phase of dementia may be short in older age. Level of education is positively associated with MMSE score but not rate of decline in individuals approaching age 100.

Purpose: The activity of the glymphatic system is impaired in animal models of Alzheimer’s disease (AD). We evaluated the activity of the human glymphatic system in cases of AD with a diffusion-based technique called diffusion tensor image analysis along the perivascular space (DTI-ALPS). Materials and methods: Diffusion tensor images were acquired to calculate diffusivities in the x, y, and z axes of the plane of the lateral ventricle body in 31 patients. We evaluated the diffusivity along the perivascular spaces as well as projection fibers and association fibers separately, to acquire an index for diffusivity along the perivascular space (ALPS-index) and correlated them with the mini mental state examinations (MMSE) score. Results: We found a significant negative correlation between diffusivity along the projection fibers and association fibers. We also observed a significant positive correlation between diffusivity along perivascular spaces shown as ALPS-index and the MMSE score, indicating lower water diffusivity along the perivascular space in relation to AD severity. Conclusion: Activity of the glymphatic system may be evaluated with diffusion images. Lower diffusivity along the perivascular space on DTI-APLS seems to reflect impairment of the glymphatic system. This method may be useful for evaluating the activity of the glymphatic system.

The aim was to examine the effect of handball training on cognitive ability in elderly with mild cognitive impairment. A total of 60 elderly were randomly divided into training group (n=30) and control group (n=30). The mini-mental state examination (MMSE) score and abilities of daily living scale (ADL) score before, after 3-month, and after 6-month intervention period was measured. The results showed that MMSE score was increased and ADL score was decreased in training group after 3-month and 6-month intervention (P

To determine a quantifiable measure to identify patients with dementia who can choose an illustration of meaningful activity using an iPad application, Aid for Decision-making in Occupation Choice (ADOC).We recruited 116 patients from 5 institutions in Japan. Occupational therapists interviewed patients with dementia to determine meaningful activities using ADOC. The most meaningful activity was confirmed by their primary caregivers. The cut-off was estimated from Mini-Mental State Examination (MMSE).Receiver operating characteristic analysis indicated that an MMSE score of 8 was the cut-off for choosing meaningful activities using ADOC. Sensitivity and specificity was 91.0% and 74.1%, respectively, and the area under the curve value was 0.89.ADOC can provide individualized information regarding meaningful activities for patients with moderate dementia. Implications for Rehabilitation As dementia progresses, difficulty in expressing needs or desires regarding meaningful activity may increase. The iPad application (Aid for Decision-making in Occupation Choice; ADOC) can be useful to promote shared decision-making through a systematic goal-setting process involving a choice of 95 illustrations describing daily activities. Mini-Mental State Examination (MMSE) score greater than 8 points is required to use the ADOC to choose most meaningful activities. ADOC provides individual information regarding meaningful activities for patients with moderate dementia.

Introduction: The diagnostic paradigm of Alzheimer's disease (AD) is changing; there is a trend toward diagnosing the disease in its early stages, even before the complete syndrome of dementia is apparent. The clinical stage at which AD is usually diagnosed in our area is unknown. Therefore, the purpose of this study is to describe the clinical stages of AD patients at time of diagnosis. Methods: Multicentre, observational and cross-sectional study. Patients with probable AD according to NINCDS-ARDRA criteria, attended in specialist clinics in Spain, were included in the study. We recorded the symptom onset to evaluation and symptom onset to diagnosis intervals and clinical status of AD (based on MMSE, NPI questionnaire, and CDR scale). Results: Participants in this study included 437 specialists representing all of Spain's autonomous communities and a total of 1707 patients, of whom 1694 were included in the analysis. Mean MMSE score was 17.6 ± 4.8 (95% CI: 17.4–17.9). Moderate cognitive impairment (MMSE between 10 and 20) was detected in 64% of the patients, and severe cognitive impairment (MMSE

Parkinson’s disease (PD) is a progressive neurological disorder and appears to have gender-specific symptoms. Studies have observed a higher frequency for development of PD in male than in female. In the current study, we evaluated the gender-based changes in cortical thickness and structural connectivity in PD patients. With informed consent, 64 PD (43 males and 21 females) patients, and 46 (12 males and 34 females) age-matched controls underwent clinical assessment including Mini-Mental State Examination (MMSE) and magnetic resonance imaging on a 1.5 Tesla clinical MR scanner. Whole brain high-resolution T1-weighted images were acquired from all subjects and used to measure cortical thickness and structural network connectivity. No significant difference in MMSE score was observed between male and female both in control and PD subjects. Male PD patients showed significantly reduced cortical thickness in multiple brain regions including frontal, parietal, temporal, and occipital lobes as compared with those in female PD patients. The graph theory-based network analysis depicted lower connection strengths, lower clustering coefficients, and altered network hubs in PD male than in PD female. Male-specific cortical thickness changes and altered connectivity in PD patients may derive from behavioral, physiological, environmental, and genetical differences between male and female, and may have significant implications in diagnosing and treating PD among genders.

In this study, the relationships between high water arsenic exposure and cognitive impairment were investigated. A total of 483 residents aged 40 or older were randomly recruited and were divided into four groups according to the concentrations of arsenic in their water. Consumption levels (x¯ ± sd) of drinking water arsenic for normal, mild, moderate, and high exposure groups were 4 ± 2 μg/L, 25 ± 11 μg/L, 73 ± 15 μg/L, and 183 ± 88 μg/L, respectively. The average scores (x¯ ± sd) of the Chinese version Mini-Mental State Examination (MMSE) for females in each group were 21.49 ± 3.14, 19.04 ± 5.87, 16.18 ± 8.14, and 15.82 ± 7.78, and the average scores (x¯ ± sd) for males were 24.50 ± 3.97, 23.16 ± 4.45, 21.00 ± 6.57, and 18.92 ± 7.99, respectively. Significant differences among the average scores of MMSE for males or females in the four groups were found (p

Higher variety in fruit and vegetable intake has been associated with a lower risk of several chronic diseases. It remains unclear whether such associations exist relating to cognition. The authors examined associations between total quantity and variety in fruit and vegetable intake and cognitive function in a cross-sectional sample of 1412 Puerto Rican adults, aged 45–75 years from the Boston Puerto Rican Health Study, 2004–9. Fruit and vegetable intake was assessed with a FFQ. Cognitive function was measured with a battery of seven tests; the Mini Mental State Examination (MMSE) was administrated to assess global cognitive function. Greater variety, but not total quantity, of fruit and vegetable intake was associated with a higher MMSE score after multivariate adjustment (P for trend = 0·012). This association remained significant after further adjusting for total quantity of fruit and vegetable intake (P for trend = 0·018). High variety of fruit and vegetable intake was also associated with individual cognitive domains, including executive function, memory and attention (all P for trend

In recent years, the Mini-Mental State Examination (MMSE) has been widely used and has been proposed for cognitive decline screening in the framework of a systematic geriatric evaluation in health centers. The aim of the present longitudinal study was to identify the potential determinants of MMSE score and its evolution over a 4-year period in a population aged over sixty years with good general health without dementia and consulting for a health check-up.Longitudinal study.The preventive medical center (CMP) in Nancy.687 subjects over 60 years of age (mean age 65.6 ± 5.07 years) were included from the Senior health examination study.All subjects underwent 2 visits over a period of 4 years. MMSE measurement and a self-administered questionnaire of emotional and psychological state were evaluated at baseline and at the follow-up visit.The major components of total variance of baseline MMSE were represented by education level, practice of regular physical activity, nervousness and despair. Multivariate analysis identified 3 variables at baseline visit that independently predicted annual changes in MMSE: MMSE score, education level and "Difficulty in social relations" (r= -0.222, 0.154 and -0.255 respectively).Education level and several psychological factors may influence MMSE score and its evolution over time in community-dwelling subjects aged over 60 years without dementia. In these subjects, a low MMSE score does not predict cognitive decline over a period of 4 years. Therefore, the reliability of MMSE in this type of population is questionable.

Objectives: To evaluate the predictive ability of four clinical frailty indexes as regards one-year rapid cognitive decline (RCD — defined as the loss of at least 3 points on the MMSE score), and one-year institutional admission (IA) and mortality respectively; and to measure their agreement for identifying groups at risk of these severe outcomes. Design: One-year follow-up and multicentre study of old patients participating in the SAFEs cohort study. Setting: Nine university hospitals in France. Participants: 1,306 patients aged 75 or older (mean age 85±6 years; 65% female) hospitalized in medical divisions through an Emergency department. Measurements: Four frailty indexes (Winograd; Rockwood; Donini; and Schoevaerdts) reflecting the multidimensionality of the frailty concept, using an ordinal scoring system able to discriminate different grades of frailty, and constructed based on the accumulation of identified deficits after comprehensive geriatric assessment conducted during the first week of hospital stay, were used to categorize participants into three different grades of frailty: Gl — not frail; G2 — moderately frail; and G3 — severely frail. Comparisons between groups were performed using Fisher's exact test. Agreement between indexes was evaluated using Cohen's Kappa coefficient. Results: All patients were classified as frail by at least one of the four indexes. The Winograd and Rockwood indexes mainly classified subjects as G2 (85% and 96%), and the Donini and Schoevaerdts indexes mainly as G3 (71% and 67%). Among the SAFEs cohort population, 250, 1047 and 1,306 subjects were eligible for analyses of predictability for RCD, 1-year IA and 1-year mortality respectively. At 1 year, 84 subjects (34%) experienced RCD, 377 (36%) were admitted into an institutional setting, and 445 (34%) had died With the Rockwood index, all subjects who expenenced RCD were classified in G2; and in G2 and G3 when the Donini and Schoevaerdts indexes were used No significant difference was found between frailty grade and RCD, whereas frailty grade was significantly associated with an increased risk of IA and death, whatever the frailty index considered. Agreement between the different indexes of frailty was poor with Kappa coefficients ranging from −0.02 to 0.15. Conclusion: These findings confirm the poor clinimetric properties of these current indexes to measure frailty, underlining the fact that further work is needed to develop a better and more widely-accepted definition of frailty and therefore a better understanding of its pathophysiology

About one fourth of Lewy body disease (LBD) patients show cortical β-amyloid load, basically a hallmark of Alzheimer disease (AD). Using [11C]PIB-PET, we tested whether LBD patients with β-amyloid burden differ from those without with respect to demographic, clinical, biochemical and genetic parameters. Thirty-five LBD subjects (9 patients with Lewy body dementia, DLB; 12 demented Parkinson patients, PDD; 14 non-demented PD, PDND) underwent [11C]PIB-PET, and were classified as either PIB(+) or PIB(−) according to cortical PIB uptake. PIB(+) and PIB(−) patients were then compared according to demographic, clinical, biochemical and genetic parameters. None of the PDND, but four PDD and four DLB subjects were PIB(+). In PIB(+) subjects, ApoE4 prevalence was higher, CSF Abeta42 levels were lower and, among demented patients, PIB-binding was associated with a lower MMSE score. Motor symptoms were not associated with PIB binding. Thus, LBD patients with cortical β-amyloid show characteristics usually observed in AD.

Adequate dietary intake might prevent cognitive decline among ageing subjects; hence, the relationships between dietary intake and cognitive function in a sample of non-institutionalized active elderly were assessed.Total 187 subjects aged over 65. Dietary intake was assessed using a three-day record and cognitive function using the mini-mental state examination (MMSE). After 8.5+/-3.5 months of follow-up, cognitive function was re-assessed in 110 subjects.A considerable portion of the subjects presented a low intake of several key nutrients. At baseline, no differences were found between subjects with normal or low MMSE score regarding all dietary parameters. At follow-up, 63 subjects (57%) showed a mild improvement of their MMSE score; their consumption of calcium and of n-3 fatty acids was higher (p0.01 and p0.03, respectively) than subjects without improvement. Similarly, multivariate logistic regression showed subjects whose consumption of calcium was above the dietary reference intake had a significantly higher odds ratio (OR) of improving their MMSE (OR=5.41; 95% CI: 1.44-20.29), whereas no effect was found for n-3 fatty acids (OR=2.48; 95% CI: 0.46-13.36).Increased calcium consumption is related to improved cognitive function; the exact effect of n-3 fatty acids intake remains to be assessed.

BackgroundPostoperative delirium is one of the most common postoperative complications in geriatric patients. Mini-mental state examination (MMSE) assesses cognitive function in patients and is associated with postoperative delirium. However, whether there is an age-dependent relationship between preoperative MMSE score and postoperative delirium remains unknown.MethodsWe therefore set out to investigate the association between preoperative MMSE score and postoperative delirium in young-old (≤80 year-old, 75.46±4.69 years, 27.0% male, n = 63) and old-old (>80 year-old, 84.51±3.46 years, 20.9% male, n = 67) participants, who had repairs of hip fractures under general anesthesia. The Confusion Assessment Method and Memorial Delirium Assessment Scale were administrated before surgery, and on the first, second and fourth days after surgery, to assess the incidence and severity of the delirium, respectively. A receiver operating characteristic curve analysis was used to calculate the optimal cutoff score of MMSE in predicting postoperative delirium.ResultsThirty-four (26.2%) of 130 patients (80.12±6.12 years, 23.8% male) developed postoperative delirium. Preoperative MMSE scores were negatively associated with higher incidences and greater severity of postoperative delirium. The optimal cutoff scores of MMSE associated with postoperative delirium for young-old and old-old participants were 18.4 and 21.4, with a sensitivity of 60% and 83.8%, and a specificity of 92.5% and 62.8%, respectively.ConclusionThe data demonstrated the optimal cutoff score of MMSE associated with postoperative delirium in young-old adults might be lower than that in old-old adults. Pending further investigation, these findings suggest that the association between preoperative MMSE score and postoperative delirium is age-dependent.

The aim of the present study was to provide a statistically sound way of reciprocally converting scores of the mini-mental state examination (MMSE) and the Milan overall dementia assessment (MODA). A consecutive series of 182 patients with "probable" Alzheimer's disease patients was examined with both tests. MODA and MMSE scores proved to be highly correlated. A formula for converting MODA and MMSE scores was generated.

Yutaka Takata,1 Toshihiro Ansai,2 Inho Soh,2 Shuji Awano,2 Ikuo Nakamichi,1 Sumio Akifusa,3 Kenichi Goto,1 Akihiro Yoshida,2 Hiroki Fujii,1 Ritsuko Fujisawa,1 Kazuo Sonoki31Division of General Internal Medicine, Kyushu Dental University, 2Division of Community Oral Health Development, Kyushu Dental University, 3Department of Oral Health and Environment, School of Oral Health Science, Kyushu Dental University, Kitakyushu, JapanAbstract: The relationship between mortality and impaired cognitive function has not been thoroughly investigated in a very elderly community-dwelling population, and little is known about the association of disease-specific mortality with Mini-Mental State Examination (MMSE) subscale scores. Here we evaluated these data in Japanese community-dwelling elderly. In 2003, 85 year-olds (n=207) were enrolled; 205 completed the MMSE for cognitive function and were followed-up for 10 years, during which time 120 participants died, 70 survived, and 17 were lost to follow-up. Thirty-eight deaths were due to cardiovascular disease, 22 to senility, 21 to respiratory disease, and 16 to cancer. All-cause mortality decreased by 4.3% with a 1-point increase in the global MMSE score without adjustment, and it decreased by 6.3% with adjustment for both sex and length of education. Cardiovascular mortality decreased by 7.6% and senility mortality decreased by 9.2% with a 1-point increase in the global MMSE score with adjustment for sex and education. No association was found between respiratory diseases or cancer mortality and global MMSE score. All-cause mortality also decreased with increases in MMSE subscale scores for time orientation, place orientation, delayed recall, naming objects, and listening and obeying. Cardiovascular mortality was also associated with the MMSE subscale of naming objects, and senility mortality was associated with the subscales of time orientation and place orientation. Thus, we found that impaired cognitive function determined by global MMSE score and some MMSE subscale scores were independent predictors of all-cause mortality or mortality due to cardiovascular disease or senility in 85 year-olds.Keywords: cognition, elderly, mortality, community-dwelling, MMSE

Early detection of behavioral changes in Alzheimer's disease (AD) would help the design and implementation of specific interventions.The target of our investigation was to establish a correlation between diagnosis and unconstrained motion behavior in subjects without major clinical behavior impairments.We studied everyday motion behavior in 23 dyads with one partner suffering from AD dementia and one cognitively healthy partner in the subjects' home, employing ankle-mounted three-axes accelerometric sensors. We determined frequency features obtained from the signal envelopes computed by an envelope detector for the carrier band 0.5 Hz to 5 Hz. Based on these features, we employed quadratic discriminant analysis for building models discriminating between AD patients and healthy controls.After leave-one-out cross-validation, the classification accuracy of motion features reached 91% and was superior to the classification accuracy based on the Cohen-Mansfield Agitation Inventory (CMAI). Motion features were significantly correlated with MMSE and CMAI scores.Our findings suggest that changes of everyday behavior are detectable in accelerometric behavior protocols even in the absence of major clinical behavioral impairments in AD.

Delirium is a common condition frequently seen in consultation-liaison psychiatry. It is especially common among medically compromised patients and is an indicator of the severity of the medical illness. In addition, it is associated with a higher morbidity, mortality or longer hospitalization. Traditionally, haloperidol has been used to treat delirium-associated agitation. However, atypical antipsychotics are being increasingly used to treat delirium.Two case studies of delirium that were treated with 30 mg and 15 mg aripiprazole were described. The improvement of delirium was monitored using the Mini-Mental Status Exam (MMSE) and Delirium Rating Scale (DRS).In both cases, the patients' confusion, disorientation, and agitation improved within 7 days of treatment. In the first case, the patient's MMSE score improved from 5 to 28, while his DRS score decreased from 28 to 6. In the second case, her MMSE score improved from 7 to 27, while her DRS score went down from 18 to 6.To the best of our knowledge, this is the first report on the utilization of aripiprazole in the successful treatment of delirium. Although these cases showed positive results, future studies should be performed in order to further substantiate its use in delirium treatment.

The purpose of this study was to evaluate whether atrial fibrillation affects the short-term functional outcome of elderly patients with ischemic stroke, undergoing post-acute in-hospital rehabilitation. We studied 919 consecutive patients admitted for ischemic stroke rehabilitation, out of whom 19.6% were diagnosed with atrial fibrillation. The Functional outcome of atrial fibrillation (AF) and non-atrial fibrillation (Non-AF) patients were assessed by the Functional Independence Measurement scale (FIM) at admission and discharge. Data were analyzed by t-test, Chi-square test and by multiple linear regression analysis. Compared with Non-AF, patients with AF were slightly older (p

We evaluated the sensitivity and specificity of our French version of Addenbrooke’s cognitive examination (ACE) to detect dementia in our patient population. One hundred and fifty-eight cases were included in the study. In our patient series, the sensitivity for diagnosing dementia with a Mini-Mental State Examination (MMSE) score of ≤24/30 was 48.5%, the sensitivity of an MMSE score of ≤27/30 was 82.5% with a specificity of 72.1%, the sensitivity of an ACE score of ≤83/100 was 86.6% with a specificity of 70.5% and the sensitivity of an ACE score of ≤88/100 was 97.9% with a specificity of 59%. We conclude that the French version of the ACE is a very accurate test for the detection of dementia, and should be widely used in clinical practice.

The aim of this cohort study was to evaluate the concordance of the Sickness Impact Profile for Nursing Homes (SIP- NH) and Sickness Impact Profile (SIP) in classifying change. Subjects consisted of 194 consecutive long- stay nursing home residents at one academic department of the V.A. and in 8 community proprietary nursing homes in San Antonio, Texas. They were to have more than 3 months residency; to be ⩾61 years; and to be dependent in at least 2 ADLs with an MMSE score of ⩾15. Subjects were administered a 128- item SIP and a reduced 66- item SIP- NH at baseline and 4, 8, and 12- month follow- up. At each follow- up, subjects were classified into 3 mutually exclusive change categories using a change score of ⩾5 points. Concordance of the classification of subjects by the SIP- NH and SIP was evaluated. The misclassification rate as well as its direction was also assessed. Both instruments classified a little over one- quarter of the subjects as better, over a third as being unchanged, and another third as being worse at the four- month follow- up. More subjects were classified as worse by both instruments at 8 and 12 months. All kappas ranged from 0.52 to 0.78, indicating good to excellent agreement. Overall, the SIP- NH characterized persons as changed more often than the SIP with no systematic directional bias. In conclusion, the SIP- NH was concordant with the SIP in classifying change in subjects. However, we cannot say which of the two is better for detecting change. Future research must focus on defining a change score which has clinical meaning, and evaluate responsiveness to change. (Aging Clin. Exp. Res. 7: 228–233, 1995)

AIM In this study we aimed to evaluate the frequency of cerumen impaction in Japanese elderly and clarify the associations between cerumen, cognitive function, and hearing impairment. METHODS The subjects enrolleded in this study were participants in the National Institute for Longevity Sciences, Longitudinal Study of Aging (NILS-LSA). The data of 792 community-dwelling participants aged 60 to 88 years old were collected. All had taken the Mini-Mental State Examination (MMSE) and had undergone pure tone audiometry (PTA) assessment and video recording of an otoscopic examination. We then analyzed associations between the incidence of the cerumen impaction of better-hearing ear, hearing level and MMSE scores using a general linear model. RESULTS Cerumen impaction of the better-hearing ear was observed in 10.7% of all participants. In participants with an MMSE score of less than 24, the frequency of cerumen impaction was 23.3%. Cerumen was significant associated with poorer hearing after adjustment for sex and age (p=0.0001). Cerumen impaction also showed a significant association with a low MMSE score after adjustment for sex, age, hearing level and education (p=0.02). CONCLUSIONS The frequency of cerumen impaction in Japanese elderly was estimated to be approximately 10%. The existence of cerumen impaction was associated with poorer hearing level and lower MMSE score.

The objective of the study was to develop and validate a translated and culturally adapted Mini-Mental State Examination (MMSE) for the Persian-speaking population. The MMSE was translated into Persian. Two groups of neurologically intact subjects (n = 100) and subjects with Alzheimer's disease (n = 13) were studied. The difference between groups on the mean total scores of the Persian MMSE was statistically significant (control = 28.62 +/- 2.09; subjects with Alzheimer's disease = 11.77 +/- 5.66; p.001). The cutoff score of 23 was the best cutoff score for our subjects with a sensitivity and specificity of 98% and 100%, respectively. There was a significant correlation between the Persian MMSE score and the level of education (r = .46) and with age (r = -.77). There was no significant correlation between the Persian MMSE and gender. The Persian MMSE was found to be valid for discrimination of cognitive impairment in the Persian-speaking community.

Pathophysiological aspects of dementia and its rate of cognitive deterioration could be dependent on disease subtype, Alzheimer's dementia (AD), vascular dementia (VaD), and Parkinson's disease with dementia (PDD). 150 patients diagnosed at the Chungnam National University Hospital (87 women and 63 men) memory clinic. The participants consisted of 68 patients with AD, 23 patients with VaD, and 59 patients with PDD, who were diagnosed by the individual criteria, respectively. Cognitive screening was evaluated using the Korean version of the mini-mental state examination (MMSE). Repeated evaluations were conducted at 6-month, 1 year, and 2 years after initial baseline assessment. Rates of cognitive decline were calculated by dividing MMSE score differences by the number of months lapsed. No difference was found between the three dementia subtypes with respect to baseline MMSE scores. Cognitive decline was not obvious up to 6-month of the follow-up, but by 12-month of follow-ups was significant regardless of the dementia subtype. Furthermore, the rate of cognitive decline in the AD group was significantly faster than in the PDD or VaD groups. This study suggests that rate of cognitive deterioration in dementia is not linear over time and that dementia subtypes have different rates of cognitive deterioration.

DHEA and its sulfate derivative (DHEAS) decline with age. The decline in DHEAS levels has been associated with many physiological impairments in older persons including cognitive dysfunction. However, data regarding the possible relationship between DHEAS and cognition are scant. We investigated whether DHEAS levels are associated with presence and development of lower cognitive function measured by the Mini Mental State Examination (MMSE) in older men and women. One thousand and thirty-four residents agedor =65 yr of the InCHIANTI Study with data available on DHEAS and MMSE were randomly selected. MMSE was administered at baseline and 3 yr later. Among these, 841 completed a 3-yr follow-up. Parsimonious models obtained by backward selection from initial fully-adjusted models were used to identify independent factors associated with MMSE and DHEAS. The final analysis was performed in 755 participants (410 men and 345 women) with MMSE scoreor =21. A significant age-related decline of both DHEAS levels (p0.001) and MMSE score (p0.001) was found over the 3-yr follow-up. At enrolment, DHEAS was significantly and positively associated with MMSE score, independently of age and other potential confounders (beta+/-SE 0.003+/-0.001, p0.005). Low baseline DHEAS levels were predictive of larger decline of MMSE and this relationship was significant after adjusting for covariates (beta+/-SE -0.004+/-0.002, p0.03). Our data show a significant and positive association between DHEAS and cognitive function, assessed by MMSE test. Low DHEAS levels predict accelerated decline in MMSE score during the 3-yr follow-up period.

Objective. To investigate the possibility that a patient with a diagnosis oF probable Alzheimer's disease (AD) can still obtain a score oF 30/30 on the Mini-Mental State Exam (MMSE). Design. Chart review. Setting. The McGill University/Jewish General Hospital Memory Clinic. Participants. Participants were selected From the Memory Clinic's patient database. All underwent comprehensive evaluations, including relevant blood work and a computed tomographic scan or a magnetic resonance imaging scan oF the brain to rule out other causes oF dementia. Measurements. All patients had one or more neuropsychological evaluation. Data oF all psychometric testing, including the MMSE, were gathered From these visits. Results. Eight patients were Found to meet the criteria oF AD although achieving a score oF 30/30 on the MMSE. Four oF 8 patients achieved this score although they were taking cholinesterase inhibitors. Conclusion. Although rare, it is possible to achieve a score oF 30/30 on the MMSE even iF a subject is suFFering From a dementing illness.

Background It is reported that blood pressure (BP) variability increases with aging, and cognitive dysfunction may be related to BP variability; however, there are no data showing that exaggerated BP variability is associated with cognitive dysfunction or quality of life (QOL) in the older elderly. We investigated the relationships and the differences between ambulatory BP variability and cognitive function or QOL in younger elderly and very elderly. Methods We recruited both 101 very elderly (aged ≥80 years) and 101 younger elderly (aged 61 to 79 years). Twenty-four-hour ambulatory blood pressure monitoring, mini-mental state examinations (MMSE), and Medical Outcome Study Short-Form 36 Items Health Survey (SF-36) were performed for all subjects. Results The mean standard deviation (SD) of daytime systolic BP in young elderly was 17.2 ± 4.6 mm Hg (mean SD ± SD of mean SD), and that in very elderly was 21.2 ± 4.3 mm Hg. The MMSE score significantly decreased with the tertile of SD of daytime systolic BP in very elderly (P = .004) and young elderly (P = .03). In very elderly, there was no significant association between the SD of daytime systolic BP and each of eight SF-36 categories. On the other hand, in younger elderly, two of eight SF-36 categories decreased with the tertile of SD of daytime systolic BP (P = .001 for Vitality and P = .003 for Role emotion). Conclusions Very elderly had larger BP variability than younger elderly. Exaggerated ambulatory BP variability was related to cognitive dysfunction in the elderly, especially in the very elderly, and was related to lower QOL in the younger elderly.

We compared plasma levels of beta-amyloid 1–42 (pg/ml) found for 146 sporadic Alzheimer (AD) patients, 89 subjects with mild cognitive impairment (MCI) and 89 age-matched controls (CT). AD patients had significantly lower levels (38, 54, 52; p < 0.01), unrelated to severity of the disease as assessed by MMSE score, age, sex or APOE4 status. Twenty cases investigated at two time points 18 months apart did not demonstrate further decreases. Thus, the reduction in beta-amyloid 1–42 may be a marker for AD status, specifically, a transition from normal status or MCI to AD, rather than a marker for neurodegenerative processes occurring in the disease.

A prospective study of patients with moderate ( n = 20) and severe ( n = 19) dementia of the Alzheimer type was performed to compare the ability of patients to recognize themselves. A Mini-Mental State Examination cut-off score was used to separate those patients with severe dementia (MMSE score

Age and education are known to be independently associated with MMSE score. This study addressed the relationship of principal lifetime occupations, which are related to both age and education, with MMSE scores in 524 community-dwelling elders aged 70 and older. The data suggest that principal lifetime occupations are correlated with MMSE scores independently of the effect of age and education. As an example, formers have an average MMSE score 2.33 points lower than white-collar workers in a multiple linear regression analysis (95% C.I. 0.46-4.21), even after adjustment for age, education, and financial dissatisfaction.

We examined the relation between selected psychiatric symptoms and the average rate of decline in different areas of cognition in patients with Alzheimer's disease. Measures of decline were computed by determining patients' average rates of decline on the underlying factors of the Mini-Mental State Examination (MMSE). Patients with agitation or wandering declined more rapidly on the total MMSE score than did patients without either symptom. The Following Commands factor accounted for almost all of this decline. The findings suggest a relation between the presence of certain behavioral problems in Alzheimer's disease and decline in particular cognitive areas.

In the water maze test, oral administration with 1,2-dilynoleoyl-sn-glycero-3-phosphocholine (DLPhtCho)(5 mg/kg) alone or DLPhtCho (5 mg/kg) plus 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (POPhtCho)(5 mg/kg) significantly shortened the prolonged acquisition latency for rats intraperitoneally injected with scopolamine, with more efficient effect than (POPhtCho)(5 mg/kg) alone, arachidonic acid (AA)(5 mg/kg) alone, docosahexaenoic acid (DHA)(5 mg/kg) alone, or 1-palmitoyl-2-linoleil-sn-glycero-3-phosphoserine (PLPhtSer)(5 mg/kg) alone. POPhtCho (5 mg/kg) alone or DLPhtCho (5 mg/kg) plus POPhtCho (5 mg/kg) also significantly shortened the prolonged retention latency for rats intraperitoneally injected with scopolamine, but otherwise no significant effect was obtained with DLPhtCho (5 mg/kg) alone, AA (5 mg/kg) alone, DHA (5 mg/kg) alone, or PLPhtSer (5 mg/kg) alone. Oral co-administration with DLPhtCho (5 mg/kg) and POPhtCho (5 mg/kg) significantly shortened the acquisition latency for rats untreated with scopolamine as compared with the latency for administration with polyethylene glycol (PEG), DLPhtCho alone at doses of 5 and 10 mg/kg, or POPhtCho alone at doses of 5 and 10 mg/kg, while no efficient effect on the retention latency was obtained. To assess the effect of DLPhtCho and POPhtCho on cognitive functions for humans, Mini Mental State Examination (MMSE) test was performed in subjects with cognitive disorders (the average MMSE score, 15). Oral co-intake with DLPhtCho (50 mg) and POPhtCho (45 mg) once after breakfast everyday raised the score to over 20, corresponding to normal cognitive functions, throughout 5 months after intake, and the increase in the score was significantly greater than that for oral intake with DLPhtCho (100 mg/day) alone or POPhtCho (90 mg/kg) alone. Taken together, the results of the present study show that co-intake with DLPhtCho and POPhtCho could enhance learning and memory ability and improve cognitive disorders for both the animals and humans with a promising efficacy.