Validating mini-mental status, cognitive capacity screening and Hamilton depression scales utilizing subjects with vascular headaches

Unmet needs for rehabilitation service of middle-aged and older adult residents in Chengdu, Sichuan, China: A cross-sectional study

To investigate the unmet needs for rehabilitation services among middle-aged and older adults in Chengdu, Sichuan, China, and identify the associated factors. This cross-sectional study was conducted on middle-aged and older adults in Chengdu, Sichuan, China, between 2015 and 2016. The questionnaire included demographic data and questions about rehabilitation needs. Multivariable logistic regression analysis was used to identify the associated factors of unmet needs for rehabilitation services. Among 663 participants, 91.70% needed medical rehabilitation (608/663), 26.55% of who need auxiliary equipment (176/663), 77.07% of who need daily care and social participation (511/663), and 79.34% of who need recreational therapy activities (526/663), while < 30% required auxiliary equipment. Multivariate logistic regression analysis showed that residents who were married, had annual income < CNY 80,000, had no medical insurance, had three or more health problems, were aged ≥ 60, and the disability status were independently associated with unmet needs for rehabilitation services (all P < 0.05). Marital status, annual income, medical insurance, health problems, and disability might be factors independently associated with the unmet needs for rehabilitation services. Attention should be paid to the financial burden of the population on rehabilitation services, and in addition to the disabled, the slow patients should also be given priority.

Development of an inter-professional screening instrument for cancer patients' education process

AIM

The aim of this paper is to describe the development of an inter-professional screening instrument for cancer patients' cognitive resources, knowledge expectations and inter-professional collaboration within patient education.

DESIGN AND METHODS

Four empirical datasets during 2012-2014 were analyzed in order to identify main categories, subcategories and items for inter-professional screening instrument.

FINDINGS

Our inter-professional screening instrument integrates the critical moments of cancer patient education and the knowledge expectation types obtained from patient datasets to assessment of patients' cognitive resources, knowledge expectations and comprehension; and intra; and inter-professional.

Understanding the Outcomes Measures used in Huntington Disease Pharmacological Trials: A Systematic Review

BACKGROUND

The identification of the gene mutation causing Huntington disease has raised hopes for new treatments to ease symptoms and slow functional decline. As such, there has been a push towards designing efficient pharmacological trials (i.e., drug trials), especially with regard to selecting outcomes measures that are both brief and sensitive to changes across the course of the disease, from subtle prodromal changes, to more severe end-stage changes.

OBJECTIVES

Recently, to aid in efficient development of new HD research studies, the National Institute of Neurological Disorders and Stroke (NINDS) published recommendations for measurement selection in HD. While these recommendations are helpful, many of the recommended measures have little published data in HD. As such, we conducted a systematic review of the literature to identify the most common outcomes measures used in HD clinical trials.

METHODS

Major medical databases, including PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials, were used to identify peer-reviewed journal articles in English from 2001 through April 2013; 151 pharmacological trials were identified.

RESULTS

The majority of HD clinical trials employed clinician-reported outcomes measures (93%); patient reported outcome measures (11%) and observer reported outcome measures (3%) were used with much less frequency.

CONCLUSIONS

We provide a review of the most commonly used measures across these trials, compare these measures to the clinical recommendations made by the NINDS working groups, and provide recommendations for selecting measures for future clinical trials that meet the Food and Drug Administration standards.

Effects of sociodemographic and health variables on Mini-Mental State Exam scores in older Australians

OBJECTIVE

This article examines the influence of sociodemographic, biological, and health variables on Mini-Mental State Exam (MMSE) performance, and assesses how the diversity of the population should be reflected in the MMSE cutoff scores used for screening.

METHODS

The sociodemographic profiles and MMSE scores of adults aged 65-years and over who participated in the Australian National Mental Health and Well-being Survey were assessed (N = 1,792).

RESULTS

The regression models showed that older age, education levels, language spoken at home and in country of birth, socioeconomic status (SES), occupation, sex, and presence of a mood disorder made significant and unique contributions to performance on the MMSE. The individual (univariate) influence of each factor ranged from -2.61 to 0.09 points, with non-English speaking background (NESB) making the biggest impact. Based on a MMSE score of < or =23 points, 7.7% of the Australian elderly population screened positive for cognitive impairment that may be indicative of dementia. In those scoring < or =23 points, the multivariate model accounted for 24.61% of the variance.

CONCLUSION

Many sociodemographic variables and the presence of a mood disorder influence MMSE performance. Using conventional cutoff scores for screening will lead to a high rate of false positives in older adults (75+ years), those with NESB, and those with low SES, and is insensitive for those with high education. The authors suggest simple rules for the correction of the impact of these variables.

Cognitive processing in cluster headache

Little is known about specific changes of cognitive processing in cluster headache. Studies on event-related potentials (ERP) suggest that stimulus evaluation is impaired in chronic cluster headache and in episodic cluster headache during the cluster period, but not in the interval between two periods. Patients with chronic paroxysmal hemicrania do not show this impairment. Unlike patients with migraine, patients with cluster headache do not present with a loss of cognitive habituation as measured by ERP. In neuropsychologic evaluations, a reversible decline of memory processing was detected during the cluster attack, but not between two attacks. Long-term observation revealed no progressive cognitive decline in cluster headache patients over the years. With regard to personality changes, a liability susceptibility to anxiety disorders and to hypochondriasis, but not to mood changes, has been described inconsistently. All changes in alterations of cognitive processing in cluster headache are demonstrated to be mild and do not relevantly contribute to the clinical picture of this disease.

P300 (Latency) Event-Related Potential: An Accurate Predictor of Memory Impairment

To determine if P300 latency changes precede and correlate with memory and mental status, patients (N=1506 aged 20–100 years) who received medical and psychiatric diagnoses (from 1997 to 2002), were assessed for P300 (N=1496), WMS-III (N=694), and MMSE (N=456). Patient and control groups included, a) normal WMS-III on all 4 subscales (N=36), b) normal WMS-III and MMSE (N=189) with subjective memory/mental status complaints, and c) medical patients with normal WMS-III and no memory complaints (N=205), and d) P300 control group without medical, psychiatric or memory problems for ROC.

Patients with impaired/borderline memory had a prolonged P300 latency (P<0.02) compared to age matched non-impaired controls; in patients with normal WMS-III/MMSE, with subjective mild memory/mental status impairment, P300 latency was prolonged compared to controls (P=0.0004). The P300 latency increased by 0.72ms per year (P=7.9×10−65) and voltage decreased by 0.03dV per year (P=6.7×10−10), and both parameters were linearly correlated with the age of the subjects.

Male subjects had an average voltage of 6.1dV and female 6.8dV(P=0.00009). Statistically, prolonged latency began at age range 41–50 (P=0.0002); reduced P300 voltage began at age range 51–60 (P=0.003). WMS-III memory decline for all measures began in females at age range 61–70 (P value at least=0.02) and for males at age range 61–80 (P=0.02). Prolonged P300 latency (P≤0.0001) and memory impairment (at least <0.02) were greater for females than males. MMSE memory decline, male and female, began at age range 81–90 (P value of at least 0.00007).

In our logistic regression model P300 latency was more predictive of WMS-III impairment than MMSE >24. In patients whose WMS-III score is impaired ≤69, or borderline ≤79 (P at least =0.004), a P300 latency more prolonged than the norm (≥300 + 30 + Age) identifies these patients, whereas a MMSE >24 failed. With the ROC curve, we confirmed that P300 latency could accurately identify borderline/impaired memory.

Screening for mild cognitive impairment (MCI) utilizing combined mini-mental-cognitive capacity examinations for identifying dementia prodromes

OBJECTIVE

To test correctness of results when combining Mini-Mental State Examination (MMSE) and Cognitive Capacity Screening Examination (CCSE) for identifying mild cognitive impairment (MCI) among non-demented elderly subjects at risk for developing dementia.

METHODS

A retrospective study was conducted among consecutively referred volunteers with memory complaints to a research out-patient clinic. Two cognitive screening tests (MMSE and CCSE) were performed according to established protocol. Resulting combined screening test (termed by acronym as CMC) combined the non-overlapping test items derived from both MMSE and CCSE. Conversion to dementia at follow-up served as the 'gold-standard' for evaluating correctness of CMC for identifying MCI.

RESULTS

Of 351 subjects completing cognitive assessments and meeting requirements for study protocol, 84 (23.9%) developed dementia of different types within 3-6 years (3.89 +/- 2.17) of follow-up. Among these, 47 met criteria for probable Alzheimer disease (AD), 22 for probable vascular dementia (VaD), 12 for mixed AD/VaD and three for probable frontotemporal dementia. When final diagnosis of AD was used as the 'gold standard' for testing correctness of MCI identified by cognitive screening tests, sensitivities of MMSE, CCSE and CMC for identifying MCI were relatively 61.0%, 74.3% and 83.1% with minimum specificity set at 80%. When diagnosis of all types of dementia was used as the standard for testing predictive correctness of MCI, CCSE emerged as an optimal MCI screening test.

CONCLUSION

Combining the CCSE and MMSE screening tests resulted in higher sensitivity than was achieved by MMSE alone and maintained specificity at comparable levels for identifying MCI. The results confirmed that CMC has optimal correctness and utility as a brief cognitive test for screening MCI as a prodrome for dementia among non-demented elderly populations.

Is mild cognitive impairment prodromal for vascular dementia like Alzheimer's disease?

BACKGROUND AND PURPOSE

Individuals with mild cognitive impairment (MCI) are at increased risk of Alzheimer's disease (AD) and probably other forms of dementia. Some subtypes of vascular dementia (VaD) may possess minor neuropathological changes of AD that may contribute to cognitive impairments. It was posited that MCI, identified by criteria described here, might present as a prodrome for VaD and AD.

METHODS

Serial Mini-Mental State Examination was administered at 3- to 6-month intervals, and neuroimaging was performed annually. Subtle cognitive dysfunctions were weighted and measured according to MCI criteria defined here. Subjects identified with MCI were then followed up for an additional 3.88+/-3.01 years. Diagnoses of VaD and AD were made according to established criteria.

RESULTS

During 3.72+/-2.94 years of follow-up of the original normative subjects, 73 of 291 (25.1%) developed MCI. Of the 27 subjects who developed VaD, 15 (55.6%) had prodromal MCI. Of these, two thirds were subclassified as having small-vessel dementia. The remaining 12 patients with VaD (44.4%) were diagnosed directly from a cognitively normal status without preceding MCI. These were predominantly multi-infarct or strategic-infarct dementia (66.7%). An additional 35 MCI subjects (47.9%) developed AD. Both VaD and AD diagnosed after MCI prodromes manifested similar spectral domains of cognitive impairments, which included memory, during their MCI stages.

CONCLUSIONS

In some VaD subtypes, particularly those caused by subcortical microvascular disease, dementia may be preceded by MCI, which has similar domains of cognitive impairment and a similar progressive course that may mimic AD.