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Wickramasinghe A, Gamage M, Torabi MR, Perera B. Impact of perceived social support and physical fitness on quality of life of institutionalized and non-institutionalized older adults in Sri Lanka. DIALOGUES IN HEALTH 2022; 1:100079. [PMID: 38515873 PMCID: PMC10953875 DOI: 10.1016/j.dialog.2022.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 03/23/2024]
Abstract
Background and aim Quality of life (QoL) in old age contributes to enhance active aging. This study aimed to assess and compare QoL and associated factors of institutionalized and non-institutionalized older adults (aged 60+ years) in Southern Sri Lanka. Methods A total of 160 older adults (80 institutionalized and 80 non-institutionalized) were surveyed. Physical and cognitive skills were measured using Barthel index, and Mini Mental State Examination scales. Nutritional status and perceived social support were measured using Mini Nutritional Assessment and Multidimensional Scale of Perceived Social Support. Descriptive statistics and multiple regression techniques were used in the analysis. Results The mean age of the institutionalized older adults was higher than that of non-institutionalized older adults (74.9 years versus 72.1 years, p < 0.01). About half of the sample consisted of older men (48.8%). Economically under privileged older adults who were unmarried were more likely to become institutionalized. The mean value of the QoL score was higher in non-institutionalized older adults compared to that of institutionalized older adults (63.1 (SD = 21.9) versus 49.1 (SD = 25.6), p < 0.05). Activities of daily living (ẞ=-0.46, p < 0.01) and perceived social support (ẞ=-0.20, p < 0.05) were found to be significant determinants of QoL of institutionalized older adults while activities of daily living (ẞ=-0.28, p < 0.05) and nutritional status (ẞ=-0.27, p < 0.05) were found to be significant determinants of QoL of non-institutionalized older adults. Cognitive impairments was not a significant determinant of QoL in both institutionalized and non-institutionalized older adults. Conclusions Promotion of physically active life style especially among young older adults to maintain their independence as they age and improvements of social support and social connectedness among older adults would be practical and cost-effective strategies to promote active aging in Sri Lankan older adults.
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Affiliation(s)
- Anuradha Wickramasinghe
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Galle, Sri Lanka
| | - Madushika Gamage
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Galle, Sri Lanka
| | - Mohammad R. Torabi
- School of Public Health – Bloomington, Indiana University, IN 47405, USA
| | - Bilesha Perera
- Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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2
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Jayakody S, Arambepola C. Determinants of quality of life among people with dementia: evidence from a South Asian population. BMC Geriatr 2022; 22:745. [PMID: 36096721 PMCID: PMC9469587 DOI: 10.1186/s12877-022-03443-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia has become a public health priority along with population aging worldwide. Owing to its chronic progressive nature in the absence of a cure, maintaining the best possible quality of life (QOL) has become the desired outcome for people with dementia (PWD). AIM The current study aimed to determine the factors associated with 'good QOL' in people with dementia in the Sri Lankan setting. METHODS An unmatched case-control study was conducted to identify the factors associated with 'good QoL. Cases in the study included dementia patients having 'good' QOL, whereas controls were those having 'poor' or 'average' QOL. Both cases and controls were selected from the same patient base at a premier tertiary care state hospital in Colombo District, Sri Lanka. They were identified using the validated DEMQOL (Dementia Specific Quality of Life) tool, adhering to strict eligibility criteria. An interviewer-administered questionnaire was used to assess the associated factors. Bivariate analysis followed by logistic regression modelling determined the associated factors for 'good QOL' adjusted for confounders using odds ratio (OR) and 95% confidence interval (CI). RESULTS The study sample consisted of 64 cases and 208 controls. After adjusting for confounders, education up to GCE O/Level and above (OR = 4.02; 95% CI = 2.97, 12.0), ever employed (OR = 3.21; 95% CI = 1.59, 11.06), good social functioning (OR = 4.14; 95% CI = 3.39, 16.46), mild functional impairment (OR = 1.77; 95% CI = 1.13, 9.67), little or no caregiver burden (OR = 2.96; 95% CI = 1.86, 10.94), absence of apathy (OR = 2.22; 95% CI = 1.27, 12.48) and absence of irritability (OR = 2.17; 95% CI = 1.72, 10.34) were found to be significantly associated with 'good QOL'. 60% of the variance of 'good' QOL among PWD was explained by the factors in the final model. CONCLUSIONS AND RECOMMENDATIONS: The identified determinants of 'good QOL' clearly show how the QOL improvement interventions need to be planned. Accordingly, such programmes should be primarily focused on strategies to improve PWDs' ADL (Activities of Daily living), reduce and manage neuropsychiatric symptoms effectively and to promote activities enhancing social functioning, and plan programmes to address caregiver burden.
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Affiliation(s)
- Surangi Jayakody
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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3
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Feichtenberger PRP, Rocha MRL, Puga MEDS, Martinez JE. Screening for cognitive impairment among individuals aged 60 years or over: scoping review. SAO PAULO MED J 2021; 139:520-534. [PMID: 34287510 PMCID: PMC9632536 DOI: 10.1590/1516-3180.2020.0635.150321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/15/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Growth in aging of the population has led to increasing numbers of elderly people presenting cognitive impairment and evolution to dementia. There is still no consensus within primary care on the best strategy for screening for cognitive impairment among elderly people. Standardization of a simple but reasonably accurate instrument for a brief cognitive test, in primary care environments, would enable healthcare professionals to identify individuals who require a more in-depth assessment of cognition. OBJECTIVES To investigate the instruments used by healthcare professionals in studies conducted worldwide and ascertain the most suitable instruments for screening for cognitive impairment among individuals aged 60 years or over, in the Brazilian population. DESIGN AND SETTING Scoping review developed at Pontifícia Universidade Católica de São Paulo, Brazil. METHOD A systematic search of the literature was conducted for primary studies using instruments to screen for cognitive impairment among individuals aged 60 years or over, in the MEDLINE, EMBASE, Cochrane Central and LILACS databases. RESULTS A total of 983 articles were identified by two independent reviewers, from which 49 were selected for full-text reading, based on the criteria defined for this review. From this, 16 articles adhering to the theme of screening for cognitive impairment among the elderly were selected for in-depth analysis. CONCLUSION The Mini-Mental State Examination was the instrument most cited in these studies. The Pfeffer Functional Activities Questionnaire and the Verbal Fluency Test (semantic category) present characteristics favoring further studies, for testing as screening instruments for cognitive impairment among elderly people in Brazil.
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Affiliation(s)
| | - Maura Regina Laureano Rocha
- MD, PhD. Speech Therapist, Audiology Specialist and Technical director, FONEC - Fonoaudiologia e Neurociência, Itapetininga (SP), Brazil.
| | - Maria Eduarda dos Santos Puga
- MD, PhD. Librarian, Information specialist at Cochrane Center in Brazil, São Paulo (SP), Brazil; and Director, Library Network, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - José Eduardo Martinez
- MD, PhD. Rheumatologist and Full Professor, Department of Internal Medicine, Pontifícia Universidade Católica de São Paulo (PUC-SP), Sorocaba (SP), Brazil.
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Abeygunasekara T, Lekamwasam S, Lenora J, Alwis G. Quality of Life and Functional Independence of Hip Fracture Patients: Data from a Single Center Follow-Up Study in Sri Lanka. Ann Geriatr Med Res 2021; 25:98-104. [PMID: 34120437 PMCID: PMC8273002 DOI: 10.4235/agmr.21.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background Data on the functional outcomes of hip fracture patients in Sri Lanka are limited. As this information is required for the design of long-term care plans, we assessed the physical activities (activities of daily living [ADL]) and quality of life (QoL) of hip fracture survivors in Sri Lanka. Methods A group of 180 consecutive patients with incident hip fractures admitted to a tertiary care center in Southern Sri Lanka were followed up for 12 months. The Sinhala versions of the Barthel Index, 36-Item Short-Form Survey, and Mini-Mental State Examination were used to assess ADL, QoL, and mental status, respectively. Results Of the 180 patients (149 women), 107 underwent surgery. An initial sharp decline and partial recovery of ADL and QoL were observed among patients with hip fractures. Furthermore, patients who underwent surgical treatment showed faster recovery of ADL and QoL than did patients who were managed conservatively. Similarly, patients who did not have complications during the hospital stay showed faster recovery of ADL and QoL than did patients with one or more complications. Conclusions Hip fractures profoundly affected both ADL and QoL, and recovery remained incomplete at 12 months post fracture. Patients who underwent surgery had a faster recovery than did patients who did not undergo surgery; similarly, patients without complications also had a faster recovery than did those with complications.
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Affiliation(s)
- Thilina Abeygunasekara
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Matara, Sri Lanka
| | - Sarath Lekamwasam
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka
| | - Janaka Lenora
- Department of Physiology, Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka
| | - Gayani Alwis
- Department of Anatomy, Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka
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5
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Wickramarachchi BI, Siop SJ, Perera B. Personal Determinants for Physical Activity Behavior of Urban-Dwelling Older Adults in Sri Lanka. Gerontol Geriatr Med 2021; 7:23337214211023684. [PMID: 34179299 PMCID: PMC8202329 DOI: 10.1177/23337214211023684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022] Open
Abstract
Physical inactivity is a vital risk factor for the development and maintenance of chronic ill-health conditions among older adults. This study examined personal factors associated with physical activity (PA) behavior of urban-dwelling older adults in Sri Lanka, a middle-income country in South Asia. A total of 880 older adults (aged ≥60 years) participated in this cross-sectional study. They responded to anthropometrical, health, and socio-demographic data pertaining to their current physical and behavioral status. The mean age of the participants was 70.1 years (SD ±6.0), and the majority (75%) were women. Increasing age, male gender, middle income, having cardiovascular diseases or arthritis, deficiencies in muscle strength and balance, pain, and lower self-rated health were associated with insufficient PA behavior among the participants. Old-age physical activity promotion programs should target older adults in advanced ages and men in particularly, as they are highly vulnerable to sedentary lifestyles. Muscle strength and balance, a neglected area in PA promotion in older adults, seem to play an important role in older adults' participation in physical activities. Incorporation of pain management, and muscle strength and balance techniques into older adults' PA promotion programs would probably increase adherence rates of the participants in such programs.
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Affiliation(s)
- Bimba I Wickramarachchi
- University of Ruhuna, Galle, Sri Lanka.,Department of Nursing, Faculty of Medical and Health Sciences, Universiti Malaysia Sarawak, Malaysia
| | - Sidiah J Siop
- Department of Nursing, Faculty of Medical and Health Sciences, Universiti Malaysia Sarawak, Malaysia
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Dassanayake TL, Hewawasam C, Baminiwatta A, Samarasekara N, Ariyasinghe DI. Sex-, age- and education-adjusted norms for the WHO/UCLA version of the Rey Auditory Verbal Learning Test for Sinhala-speaking Sri Lankan adults. Clin Neuropsychol 2020; 34:127-142. [PMID: 33025851 DOI: 10.1080/13854046.2020.1829069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to create sex-, age- and education-adjusted norms for the WHO/UCLA version of the Rey Auditory Verbal Learning Test (RAVLT) for Sinhala-speaking Sri Lankan adults. METHODS Five-hundred and sixty-one healthy, community-living adults (252 men), aged 19-83 years, and had 0-23 years of education completed the WHO/UCLA RAVLT in Sinhala language. We conducted multiple linear regression analyses with sex, age and years of education to predict RAVLT list A1-A5 individual trial scores; trials A1-A5 total learning; list B score; immediate and delayed recall and recognition trial scores; and retroactive interference. RESULTS We report regression equations to predict RAVLT norms based on sex, age and years of education; and the test variances accounted by those variables. Accordingly, all measures, except retroactive interference had a significant age-related decline. All measures, except the recognition trial hits, significantly improved with more years of education. Women had significantly higher scores in all measures except in trial B and retroactive interference. Proactive interference, learning rate, learning over trials were not associated with sex, age or education. A confirmatory factor analysis loaded the RAVLT outcome measures into two factors: acquisition and retention. CONCLUSIONS We report sex-, age- and education-adjusted WHO/UCLA RAVLT norms for Sinhala-speaking Sri Lankans aged 19-83 years; and supplement the regression formulae with a calculator that produces predicted and standard scores for given test participant. These norms would help clinicians accurately interpret individual test results, accounting for the variability introduced by sex, age and education.
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Affiliation(s)
| | - Chandana Hewawasam
- Faculty of Medicine and Allied Health Sciences, Department of Physiology, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Anuradha Baminiwatta
- Faculty of Medicine, Department of Psychiatry, University of Peradeniya, Peradeniya, Sri Lanka.,Faculty of Medicine, Department of Psychiatry, University of Kelaniya, Ragama, Sri Lanka
| | - Narendra Samarasekara
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Queen Square Institute of Neurology, University College London, London, UK
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El-Hayeck R, Baddoura R, Wehbé A, Bassil N, Koussa S, Abou Khaled K, Richa S, Khoury R, Alameddine A, Sellal F. An Arabic Version of the Mini-Mental State Examination for the Lebanese Population: Reliability, Validity, and Normative Data. J Alzheimers Dis 2020; 71:525-540. [PMID: 31424409 DOI: 10.3233/jad-181232] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Mini-Mental State Examination (MMSE) has not been validated in the Lebanese population and no normative data exist at the national level. OBJECTIVE To evaluate the reliability and validity of an Arabic version of MMSE developed by the "Groupe de Travail sur les Démences de l'Université Saint Joseph" (A-MMSE(GTD-USJ)) and to provide normative data by gender, age, and education in adults over 55. METHODS Study design: national cross-sectional survey. STUDY POPULATION 1,010 literate community-dwelling Lebanese residents aged 55 and above. OUTCOMES reproducibility, internal consistency, sensitivity, specificity, predictive values, and area under the curve of the A-MMSE(GTD-USJ) for the detection of cognitive impairment using the Clinical Dementia Rating (CDR) as the gold standard. Normative data were established from 720 healthy adults. A-MMSE(GTD-USJ) scores corresponding to the 5th, 10th, 15th, and 50th percentiles were identified according to gender, age, and education. RESULTS Intra-rater and inter-rater test-retest score correlations were 0.89 and 0.72, respectively. Cronbach alpha coefficient for internal consistency of the A-MMSE(GTD-USJ) was 0.71. A threshold value of 23 provided a sensitivity of 80% and a specificity of 89.4%. The area under the curve was 0.92. A-MMSE(GTD-USJ) scores increased with education and decreased with age. Women had significantly lower scores than men. Normative data for A-MMSE(GTD-USJ) stratified by gender, age, and education were generated. CONCLUSION In reference to the CDR, the A-MMSE(GTD-USJ) is a valid tool to assess cognitive status among Lebanese subjects aged 55 and above. Normative data will help clinicians in detecting cognitive impairment in this population.
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Affiliation(s)
- Rita El-Hayeck
- Department of Geriatrics, Saint Joseph University School of Medicine, Beirut, Lebanon.,Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l'USJ (GTD-USJ)
| | - Rafic Baddoura
- Department of Epidemiology and Public Health, Saint Joseph University School of Medicine, Beirut, Lebanon.,Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l'USJ (GTD-USJ)
| | - Amine Wehbé
- Department of Geriatrics, Saint Joseph University School of Medicine, Beirut, Lebanon.,Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l'USJ (GTD-USJ)
| | - Nazem Bassil
- Department of Geriatrics, University of Balamand, Saint George Hospital Medical Centre, Lebanon
| | - Salam Koussa
- Department of Neurology, Lebanese University, Lebanese Hospital Geitaoui-UMC, Beirut, Lebanon.,Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l'USJ (GTD-USJ)
| | - Karine Abou Khaled
- Department of Neurology, Saint Joseph University School of Medicine, Beirut, Lebanon.,Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l'USJ (GTD-USJ)
| | - Sami Richa
- Department of Psychiatry, Saint Joseph University School of Medicine, Beirut, Lebanon.,Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l'USJ (GTD-USJ)
| | - Rita Khoury
- Department of Geriatric Psychiatry, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Abbas Alameddine
- Department of Psychiatry, Hôtel-Dieu de France Hospital, Beirut and Department of Psychology, University of Balamand, Lebanon
| | - François Sellal
- Department of Neurology, Hôpitaux Civils de Colmar and INSERM U-1118, School of Medicine, Strasbourg University, France
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8
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Dassanayake TL, Weerasinghe VS, Gawarammana I, Buckley NA. Subacute and chronic neuropsychological sequalae of acute organophosphate pesticide self-poisoning: a prospective cohort study from Sri Lanka. Clin Toxicol (Phila) 2020; 59:118-130. [PMID: 32567959 DOI: 10.1080/15563650.2020.1778719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CONTEXT Some epidemiological evidence implicates acute organophosphate (OP) pesticide poisoning in long-term neurocognitive deficits. However, no study has prospectively followed up poisoned patients long-term from the time of intoxication. We aimed to determine whether clinically significant acute OP self-poisoning leads to subacute and chronic neurocognitive deficits, in a prospective follow up study. METHODS Employing Mini Mental State Examination, Digit Span and Cambridge Neuropsychological Test Automated Battery (CANTAB), we compared multiple cognitive functions in 222 patients hospitalized with acute OP pesticide self-poisoning with a control group of 52 patients hospitalized with paracetamol overdose, at three time points: on discharge following clinical recovery, 6 weeks and 6 months post-ingestion. Intergroup comparisons at each time point were done in multiple regression models, adjusting for sex, age, education and psychiatric comorbidities. OP within-group analysis was done to determine a dose-response relationship. RESULTS After adjusting for covariates, the OP poisoned group had significantly poorer working memory (Digit Span) and episodic memory (CANTAB Paired Associates Learning); impaired spatial planning (CANTAB Stocking of Cambridge); and slower response speed in the sustained attention task (CANTAB Rapid Visual Information Processing), in the post-discharge assessment. Only working memory and episodic memory measures were impaired in the OP group at 6 weeks, whereas no significant intergroup differences were observed at 6 months. The OP subgroup who had complete red cell acetylcholinesterase inhibition on admission had poorer episodic memory when tested post-discharge than those who had partial inhibition, but no significant subgroup differences were observed at 6 weeks or 6 months. DISCUSSION Acute OP pesticide poisoning may cause neuropsychological impairment that outlasts the cholinergic phase on a subacute time scale; but does not cause measurable chronic neuropsychological deficits.
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Affiliation(s)
- Tharaka L Dassanayake
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,School of Psychology, The University of Newcastle, Callaghan, Australia
| | - Vajira S Weerasinghe
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indika Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nicholas A Buckley
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,School of Pharmacology, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Suriyakumara V, Srikanth S, Wijeyekoon R, Gunasekara H, Muthukuda C, Rajapaksha D, Weerasekara R, Gonawala L, Wijekoon N, de Silva KRD. Validation of the Sinhala Version of the Addenbrooke's Cognitive Examination-Revised for the Detection of Dementia in Sri Lanka: Comparison with the Mini-Mental Status Examination and the Montreal Cognitive Assessment. Dement Geriatr Cogn Disord 2020; 47:198-208. [PMID: 31311022 DOI: 10.1159/000497743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sri Lanka is a rapidly aging country, where dementia prevalence will increase significantly in the future. Thus, inexpensive and sensitive cognitive screening tools are crucial. OBJECTIVES To assess the reliability, validity, and diagnostic accuracy of the Sinhalese version of the Addenbrooke's Cognitive Examination-Revised (ACE-R s). METHOD The ACE-R was translated into Sinhala with cultural and linguistic adaptations and administered, together with the Sinhala version of the Montreal Cognitive Assessment (MoCA), to 99 patients with dementia and 93 gender-matched controls. RESULTS The ACE-R s cutoff score for dementia was 80 (sensitivity 91.9%, specificity 76.3%). The areas under the curve for the ACE-R s, Mini-Mental State Examination (MMSE) and MoCA were 0.90, 0.86, and 0.86, respectively. The -ACE-R s had good interrater reliability (intraclass correlation = 0.94), test-retest reliability (intraclass correlation = 0.99), and internal consistency (Cronbach's α = 0.8442). CONCLUSIONS The ACE-R s is sensitive, specific and reliable to detect dementia in persons aged ≥50 years in a Sinhala-speaking population and its diagnostic accuracy is superior to previously validated tools (MMSE and MoCA).
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Affiliation(s)
- Vindika Suriyakumara
- Interdisciplinary Center for Innovation in Biotechnology and Neuroscience, Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Ruwani Wijeyekoon
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Harsha Gunasekara
- Department of Neurology, Sri Jayewardenepura General Hospital, Nugegoda, Sri Lanka
| | | | - Dinalee Rajapaksha
- Interdisciplinary Center for Innovation in Biotechnology and Neuroscience, Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Rasangi Weerasekara
- Department of Neurology and ENT, Sri Jayewardenepura General Hospital, Nugegoda, Sri Lanka
| | - Lakmal Gonawala
- Interdisciplinary Center for Innovation in Biotechnology and Neuroscience, Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Nalaka Wijekoon
- Interdisciplinary Center for Innovation in Biotechnology and Neuroscience, Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - K Ranil D de Silva
- Interdisciplinary Center for Innovation in Biotechnology and Neuroscience, Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka,
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Abstract
BACKGROUND The prevalence of dementia is increasing in Asia than in any other continent. However, the applicability of the existing cognitive assessment tools is limited by differences in educational and cultural factors in this setting. We conducted a systematic review of published studies on cognitive assessments tools in Asia. We aimed to rationalize the results of available studies which evaluated the validity of cognitive tools for the detection of cognitive impairment and to identify the issues surrounding the available cognitive impairment screening tools in Asia. METHODS Five electronic databases (CINAHL, MEDLINE, Embase, Cochrane Library, and Science Direct) were searched using the keywords dementia Or Alzheimer Or cognitive impairment And screen Or measure Or test Or tool Or instrument Or assessment, and 2,381 articles were obtained. RESULTS Thirty-eight articles, evaluating 28 tools in seven Asian languages, were included. Twenty-nine (76%) of the studies had been conducted in East Asia with only four studies conducted in South Asia and no study from northern, western, or central Asia or Indochina. Local language translations of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were assessed in 15 and six studies respectively. Only three tools (the Korean Dementia Screening Questionnaire, the Picture-based Memory Intelligence Scale, and the revised Hasegawa Dementia Screen) were derived de novo from Asian populations. These tools were assessed in five studies. Highly variable cut-offs were reported for the MMSE (17-29/30) and MoCA (21-26/30), with 13/19 (68%) of studies reporting educational bias. CONCLUSIONS Few cognitive assessment tools have been validated in Asia, with no published validation studies for many Asian nations and languages. In addition, many available tools display educational bias. Future research should include concerted efforts to develop culturally appropriate tools with minimal educational bias.
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Creavin ST, Wisniewski S, Noel‐Storr AH, Trevelyan CM, Hampton T, Rayment D, Thom VM, Nash KJE, Elhamoui H, Milligan R, Patel AS, Tsivos DV, Wing T, Phillips E, Kellman SM, Shackleton HL, Singleton GF, Neale BE, Watton ME, Cullum S. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev 2016; 2016:CD011145. [PMID: 26760674 PMCID: PMC8812342 DOI: 10.1002/14651858.cd011145.pub2] [Citation(s) in RCA: 311] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The Mini Mental State Examination (MMSE) is a cognitive test that is commonly used as part of the evaluation for possible dementia. OBJECTIVES To determine the diagnostic accuracy of the Mini-Mental State Examination (MMSE) at various cut points for dementia in people aged 65 years and over in community and primary care settings who had not undergone prior testing for dementia. SEARCH METHODS We searched the specialised register of the Cochrane Dementia and Cognitive Improvement Group, MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), LILACS (BIREME), ALOIS, BIOSIS previews (Thomson Reuters Web of Science), and Web of Science Core Collection, including the Science Citation Index and the Conference Proceedings Citation Index (Thomson Reuters Web of Science). We also searched specialised sources of diagnostic test accuracy studies and reviews: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). We attempted to locate possibly relevant but unpublished data by contacting researchers in this field. We first performed the searches in November 2012 and then fully updated them in May 2014. We did not apply any language or date restrictions to the electronic searches, and we did not use any methodological filters as a method to restrict the search overall. SELECTION CRITERIA We included studies that compared the 11-item (maximum score 30) MMSE test (at any cut point) in people who had not undergone prior testing versus a commonly accepted clinical reference standard for all-cause dementia and subtypes (Alzheimer disease dementia, Lewy body dementia, vascular dementia, frontotemporal dementia). Clinical diagnosis included all-cause (unspecified) dementia, as defined by any version of the Diagnostic and Statistical Manual of Mental Disorders (DSM); International Classification of Diseases (ICD) and the Clinical Dementia Rating. DATA COLLECTION AND ANALYSIS At least three authors screened all citations.Two authors handled data extraction and quality assessment. We performed meta-analysis using the hierarchical summary receiver-operator curves (HSROC) method and the bivariate method. MAIN RESULTS We retrieved 24,310 citations after removal of duplicates. We reviewed the full text of 317 full-text articles and finally included 70 records, referring to 48 studies, in our synthesis. We were able to perform meta-analysis on 28 studies in the community setting (44 articles) and on 6 studies in primary care (8 articles), but we could not extract usable 2 x 2 data for the remaining 14 community studies, which we did not include in the meta-analysis. All of the studies in the community were in asymptomatic people, whereas two of the six studies in primary care were conducted in people who had symptoms of possible dementia. We judged two studies to be at high risk of bias in the patient selection domain, three studies to be at high risk of bias in the index test domain and nine studies to be at high risk of bias regarding flow and timing. We assessed most studies as being applicable to the review question though we had concerns about selection of participants in six studies and target condition in one study.The accuracy of the MMSE for diagnosing dementia was reported at 18 cut points in the community (MMSE score 10, 14-30 inclusive) and 10 cut points in primary care (MMSE score 17-26 inclusive). The total number of participants in studies included in the meta-analyses ranged from 37 to 2727, median 314 (interquartile range (IQR) 160 to 647). In the community, the pooled accuracy at a cut point of 24 (15 studies) was sensitivity 0.85 (95% confidence interval (CI) 0.74 to 0.92), specificity 0.90 (95% CI 0.82 to 0.95); at a cut point of 25 (10 studies), sensitivity 0.87 (95% CI 0.78 to 0.93), specificity 0.82 (95% CI 0.65 to 0.92); and in seven studies that adjusted accuracy estimates for level of education, sensitivity 0.97 (95% CI 0.83 to 1.00), specificity 0.70 (95% CI 0.50 to 0.85). There was insufficient data to evaluate the accuracy of the MMSE for diagnosing dementia subtypes.We could not estimate summary diagnostic accuracy in primary care due to insufficient data. AUTHORS' CONCLUSIONS The MMSE contributes to a diagnosis of dementia in low prevalence settings, but should not be used in isolation to confirm or exclude disease. We recommend that future work evaluates the diagnostic accuracy of tests in the context of the diagnostic pathway experienced by the patient and that investigators report how undergoing the MMSE changes patient-relevant outcomes.
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Affiliation(s)
- Sam T Creavin
- University of BristolSchool of Social and Community MedicineCarynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Susanna Wisniewski
- Cochrane Dementia and Cognitive Improvement Group, Oxford UniversityOxfordUK
| | - Anna H Noel‐Storr
- University of OxfordRadcliffe Department of MedicineRoom 4401c (4th Floor)John Radcliffe Hospital, HeadingtonOxfordUKOX3 9DU
| | - Clare M Trevelyan
- Avon and Wiltshire Mental Health Partnership NHS TrustMedical EducationWoodland View, Brentry LaneBristolUKBS10 6NB
| | - Thomas Hampton
- Frimley Health NHS Foundation TrustENTFrimley Park HospitalPortsmouth RoadFrimley, CamberleySurreyUKGU16 7UJ
| | - Dane Rayment
- Avon and Wiltshire Partnership NHS TrustOlder Adult PsychiatryJenner House, Langley ParkChippenhamWiltshireUKSN15 1GG
| | - Victoria M Thom
- Avon & Wiltshire Mental Health Partnership NHS TrustForensic PsychiatryFromeside, Blackberry Hill HospitalBristolUKBS16 1EG
| | | | - Hosam Elhamoui
- Somerset Partnership NHS TrustPsychiatry91 Comeytrowe LaneTauntonSomersetUKTA1 5QG
| | - Rowena Milligan
- Mansion House SurgeryGeneral PracticeAbbey StreetStoneStaffordshireUKST15 0WA
| | - Anish S Patel
- Avon and Wiltshire Mental Health Partnership NHS TrustNBT Acute Mental Health Liaison TeamDonal Early HouseSouthmead HospitalBristolUKBS10 5NB
| | - Demitra V Tsivos
- North Bristol NHS TrustNeuropsychologySouthmead HospitalBristolUKBS10 5NB
| | - Tracey Wing
- Taunton and Somerset NHS trustCare of Elderly/ITU/A+EBristolUKBS1 3DH
| | - Emma Phillips
- 2gether NHS Foundation TrustCharlton Lane HospitalCheltenhamGloucestershireUKGL53 9DZ
| | - Sophie M Kellman
- Avon and Wiltshire Mental Health Partnership NHS TrustJenner House, Langley ParkChippenhamWiltshireUKSN15 1GG
| | - Hannah L Shackleton
- NHS ScotlandNHS Forth ValleyFalkirk Community Hospital, Majors LoanFalkirkUK
| | | | - Bethany E Neale
- RCGP Severn FacultyGeneral PracticeDeanery HouseBristolUKBA16 1GW
| | | | - Sarah Cullum
- University of BristolSchool of Social and Community MedicineCarynge Hall39 Whatley RoadBristolUKBS8 2PS
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Srinivasan S, Jaleel Q. Norms for a neuropsychological test battery to diagnose dementia in the elderly: A study from Sri Lanka. J Neurosci Rural Pract 2015; 6:177-81. [PMID: 25883476 PMCID: PMC4387807 DOI: 10.4103/0976-3147.153223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims: To pilot a neuropsychological battery for diagnosing dementia and provide normative scores in an elderly Sri Lankan sample. Materials and Methods: Consecutive subjects over the age of 60 yrs were administered tests assessing the individual domains of language, verbal episodic memory, visual perceptuospatial skills and executive functions in the Sinhala language. Results: There were a total of 230 subjects in the final sample. The mean age of the entire sample was 69 years, mean education level was 12 years and the sample comprised 53% female. One-month test-retest reliability ranged from 0.71 to 0.85 for the various tests. Most tests were significantly influenced by age and education level but not gender. The exceptions to this were some language subtests (repetition, grammar comprehension and word picture matching) and two tests of executive functioning (maze completion and alternate target cancellation), which were uninfluenced by age. The subtests where ceiling performance was attained by almost all subjects were repetition, grammar comprehension and word picture matching from the language domain, dot position discrimination from the visuospatial domain and maze completion test from the executive function domain. Scores for various tests after stratifying subjects by age and educational level are given. Conclusions: The tests were well received and could provide a basis for cognitive profiling in similar settings elsewhere.
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Affiliation(s)
| | - Qadir Jaleel
- Department of Neurology, Lanka (Apollo) Hospitals, Colombo, Sri Lanka
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Lobo BDOM, Brunnet AE, Silva TLGD, Santos LMD, Gauer G, Arteche AX, Kristensen CH. Translation and adaptation of the Child Posttraumatic Cognitions Inventory (cPTCI) to Brazilian Portuguese. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2014; 36:107-12. [PMID: 27000710 DOI: 10.1590/2237-6089-2014-1002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Experiencing a traumatic event is a risk factor for the development of mental illness, especially posttraumatic stress disorder. A child's appraisals of a traumatic event may play a prominent role in the development or maintenance of the disorder. Therefore, subjective responses should be evaluated to understand the impact of a traumatic event on a child's life. This study translated and adapted the Child Posttraumatic Cognitions Inventory (cPTCI) for use in linguistic and cultural contexts in Brazil. METHODS The process included translation, back-translation, language expert evaluation and expert committee's evaluation. RESULTS Content validity index scores were good for all dimensions after evaluation by two judges and one reformulation. The back-translation of the final version also showed that the cPTCI items in Brazilian Portuguese maintained the same meanings of the original in English. This version was tested in a sample of the target population, and all the items were above the cut-off point (minimum = 3.6; maximum = 4.0). CONCLUSIONS This study was successful in producing a Brazilian version of the cPTCI. Further studies are underway to examine the reliability and the factorial and concurrent validity of cPTCI subscales.
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Affiliation(s)
| | | | | | | | - Gustavo Gauer
- Department of Developmental and Personality Psychology, Institute of Psychology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Ansari NN, Naghdi S, Hasson S, Valizadeh L, Jalaie S. Validation of a Mini-Mental State Examination (MMSE) for the Persian population: a pilot study. APPLIED NEUROPSYCHOLOGY 2010; 17:190-5. [PMID: 20799110 DOI: 10.1080/09084282.2010.499773] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
- Noureddin Nakhostin Ansari
- Faculty of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave., Pitch-e-shemiran, Tehran, Iran.
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Athanasiov PA, Edussuriya K, Senaratne T, Sennanayake S, Sullivan T, Selva D, Casson RJ. Cataract in central Sri Lanka: prevalence and risk factors from the Kandy Eye Study. Ophthalmic Epidemiol 2010; 17:34-40. [PMID: 20100098 DOI: 10.3109/09286580903324900] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To estimate the prevalence of and risk factors for cataracts in the Kandy District of central Sri Lanka. METHODS A population-based, cross-sectional ophthalmic survey of the inhabitants of rural villages in central Sri Lanka was conducted; 1375 individuals participated (79.9%; age > or = 40 years, average age 57) and 1318 (95.9%) had an examinable lens in at least one eye. Data collection included district, age, occupation, education level, smoking history, height, weight and dilated lens assessment using Lens Opacities Classification System III grading: nuclear (> or =4), cortical (> or =2) and posterior subcapsular (> or =2) cataracts. Aphakic and pseudophakic eyes were included as operated cataracts for statistical analysis. RESULTS The prevalence of any cataract including operated eyes was 33.1% (95% Confidence Interval (CI), 22.4-43.7%): 26.0% cortical; 7.9% posterior sub-capsular and 4.5% nuclear cataracts. No significant association was found between cataract and gender, smoking or outdoor occupation. Low level of education (secondary or higher vs no education: Odds Ratio (OR) 0.6, CI 0.4-0.9, P = 0.04) and shorter stature were associated with a higher likelihood of any cataract (OR 1.7, CI 1.1-2.7, P = 0.02). CONCLUSIONS The overall prevalence of cataract in central Sri Lanka is similar to that in other developing Asian regions except for the unusually low prevalence of nuclear cataract. Illiteracy and height appear to be significant predictors for cataract in this population and further investigation is required to explore their influence.
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Affiliation(s)
- Paul A Athanasiov
- Department of Ophthalmology & Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, South Australia.
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Keskinoglu P, Ucku R, Yener G, Yaka E, Kurt P, Tunca Z. Reliability and validity of revised Turkish version of Mini Mental State Examination (rMMSE-T) in community-dwelling educated and uneducated elderly. Int J Geriatr Psychiatry 2009; 24:1242-50. [PMID: 19337986 DOI: 10.1002/gps.2252] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the reliability and validity of the revised Turkish version of Mini Mental State Examination (rMMSE-T) in educated and uneducated community-dwelling elderly, to re-organize the present Turkish version of MMSE and to determine cut-off point of the revised test. METHODS This cross-sectional and analytical study involved totally 490 elderly subjects selected by cluster sampling method. Receiver operating characteristic (ROC) analysis, kappa analysis and Cronbach's alpha coefficients were used for statistical analysis. RESULTS Areas under ROC curve in educated and uneducated elderly were found as 0.953 and 0.907. Cut-off point of 22/23 of rMMSE-T in educated elderly had the highest sensitivity (90.9), specificity (97.0) and positive likelihood ratio (30.3), whereas cut-off point of 18/19 of the test in uneducated elderly had the highest sensitivity (82.7), specificity (92.3) and positive likelihood ratio (10.7). The Cronbach's alpha values of the rMMSE-T for educated and uneducated elderly were higher than 0.7 (sign of good internal consistency of the test). A significant correlations between intrarater and interrater test-retest in educated elderly subjects were observed (0.966 (p = 0.000); 0.855 (p = 0.000), respectively), and also in uneducated elderly (0.988 (p = 0.000); 0.934 (p = 0.000), respectively). Kappa value of the test in educated and uneducated elderly showed a perfect agreement interraters (1.000) and a substantial agreement in intraraters (1.000, 0.784; 0.826, 0.656, respectively). CONCLUSION rMMSE-T had a high reliability and validity. It will be more appropriate to use the revised test and the new cut-off point for the diagnosis and screening of dementia among community-dwelling Turkish elderly population.
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De Silva R, Disanayaka S, De Zoysa N, Sanjeewanie N, Somaratne S, Foster J, Srikanth S, Kathriarachchi ST, Martins RM. Norms for the Mini-Mental State Examination from a sample of Sri Lankan older people. Int J Geriatr Psychiatry 2009; 24:666-70. [PMID: 19132690 DOI: 10.1002/gps.2168] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To derive norms for the Mini Mental State Examination (MMSE) based on age, gender and level of formal education among the elderly in Sri Lanka. METHOD A validated Sinhalese version of the MMSE was administered to people aged 55 years and above residing in 14 randomly selected elders' homes. Effects of age, gender and level of formal education on MMSE scores were compared using multiple linear regression analysis. RESULTS A total of 446 subjects [male/female = 136/320] formed the final sample. Level of education and gender exerted a significant influence on MMSE scores, but not age. The median and 10th percentile scores on the Sinhalese MMSE for the education groups were as follows: education <5 years = 19 and 12; education >5 years = 24 and 16, respectively. CONCLUSION The findings confirm the influence of level of education on MMSE scores among the elderly living in care homes in Sri Lanka, and suggest that education stratified cut-off scores should be used while screening for cognitive impairment in this population.
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Affiliation(s)
- Ranil De Silva
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Department of Anatomy, Nugegoda, Sri Lanka.
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Steis MR, Schrauf RW. A Review of Translations and Adaptations of the Mini-Mental State Examination in Languages Other than English and Spanish. Res Gerontol Nurs 2009; 2:214-24. [DOI: 10.3928/19404921-20090421-06] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 02/19/2009] [Indexed: 11/20/2022]
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Abstract
BACKGROUND The Mini-mental State Examination (MMSE) is widely used in Japan and the U.S.A. for cognitive screening in the clinical setting and in epidemiological studies. A previous Japanese community study reported distributions of the MMSE total score very similar to that of the U.S.A. METHODS Data were obtained from the Monongahela Valley Independent Elder's Study (MoVIES), a representative sample of community-dwelling elderly people aged 65 and older living near Pittsburgh, U.S.A., and from the Tajiri Project, with similar aims in Tajiri, Japan. We examined item-by-item distributions of the MMSE between two cohorts, comparing (1) percentage of correct answers for each item within each cohort, and (2) relative difficulty of each item measured by Item Characteristic Curve analysis (ICC), which estimates log odds of obtaining a correct answer adjusted for the remaining MMSE items, demographic variables (age, gender, education) and interactions of demographic variables and cohort. RESULTS Median MMSE scores were very similar between the two samples within the same education groups. However, the relative difficulty of each item differed substantially between the two cohorts. Specifically, recall and auditory comprehension were easier for the Tajiri group, but reading comprehension and sentence construction were easier for the MoVIES group. CONCLUSIONS Our results reaffirm the importance of validation and examination of thresholds in each cohort to be studied when a common instrument is used as a dementia screening tool or for defining cognitive impairment.
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Rajakumaraswamy N, Rajapakse IH, Fernando DJS. The frequency of cognitive dysfunction in elderly Sri Lankans with type 2 diabetes mellitus. Int J Geriatr Psychiatry 2008; 23:1205-6. [PMID: 18395887 DOI: 10.1002/gps.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Garre-Olmo J, Lax-Pericall C, Turro-Garriga O, Soler-Cors O, Monserrat-Vila S, Vilalta-Franch J, Taylor JL, López-Pousa S. Adaptación y validez convergente de una versión telefónica del Mini-Mental State Examination. Med Clin (Barc) 2008; 131:89-95. [DOI: 10.1157/13124011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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de Silva HA, Gunatilake SB, Johnston C, Warden D, Smith AD. Medial Temporal Lobe Atrophy, Apolipoprotein Genotype, and Plasma Homocysteine in Sri Lankan Patients with Alzheimer's Disease. Exp Aging Res 2007; 31:345-54. [PMID: 16036726 DOI: 10.1080/03610730590948221] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The authors studied the association of Alzheimer's disease (AD) with total plasma homocysteine (tHcy) and apolipoprotein E (apoE) genotype, and the usefulness of measuring medial temporal lobe thickness (MTL) thickness for the diagnosis of AD in Sri Lankan patients. Using criteria of the NINCDS-ADRDA, 23 AD patients and 21 controls were recruited. All underwent MTL-oriented computed tomographic (CT) scans, measurement of plasma tHcy, and apoE genotyping. Mean plasma tHcy was significantly higher in AD patients than controls (p=.001). This association was independent of age, sex, body mass index (BMI), serum folate and vitamin B12, and serum creatinine. The frequency of apoE4 allele was significantly higher (p=.003) in AD patients, and the adjusted odds ratio of AD for the presence of one or more apoE4 alleles compared with none was 10.39 (95% CI 1.77-61.10; p=.010). The mean minimum MTL thickness was significantly higher in control subjects compared to that of AD patients (p<.001). This first report of apoE4, plasma tHcy, MTL thickness, and AD from Sri Lanka shows that high plasma tHcy, the presence of apoE4 allele, and MTL atrophy are associated with AD.
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Affiliation(s)
- H Asita de Silva
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Sri Lanka.
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Kathriarachchi ST, Sivayogan S, Jayaratna SD, Dharmasena SR. Comparison of three instruments used in the assessment of dementia in Sri Lanka. Indian J Psychiatry 2005; 47:109-12. [PMID: 20711293 PMCID: PMC2918294 DOI: 10.4103/0019-5545.55957] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Dementia is poorly recognized even by physicians. This study compares three instruments used to assess dementia in a community setting in Sri Lanka. METHOD Translated and culturally adapted versions of the Mini Mental State Examination (MMSE), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and Clinical Dementia Rating (CDR) were administered to 363 individuals selected by stratified random sampling in a periurban community in Sri Lanka. The results on the three instruments were compared with the independent psychiatric evaluation done on a concentrated sample of 37 individuals from the study population. RESULTS Culturally adapted MMSE, IQCODE and CDR can be used to screen dementia in Sri Lanka. IQCODE is the best among the three instruments with a sensitivity of 71.4% and a specificity of 82.6% when 3.5 is the cut-off. In addition, IQCODE is culturally acceptable, easy to administer and can be used in those with a low level of literacy as well as in those with hearing or visual impairment. CONCLUSION IQCODE was found to be more effective and culturally acceptable as a screening tool for dementia in Sri Lanka, compared with MMSE and CDR.
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Affiliation(s)
- S T Kathriarachchi
- Associate Professor, Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura
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Papadopoulos FC, Petridou E, Argyropoulou S, Kontaxakis V, Dessypris N, Anastasiou A, Katsiardani KP, Trichopoulos D, Lyketsos C. Prevalence and correlates of depression in late life: a population based study from a rural Greek town. Int J Geriatr Psychiatry 2005; 20:350-7. [PMID: 15799076 DOI: 10.1002/gps.1288] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Depression in late life is common and has serious consequences on function, medical co-morbidity, quality of life, and use of medical services. OBJECTIVE To estimate the age- and gender-specific prevalence of depression among people over 60 years of age, and to examine correlates of depression, in particular the relationship between depression and cognitive impairment. METHOD From a total of 965 inhabitants, aged over 60 years, in Velestino, a rural town in central Greece, 608 were accessible and constituted the target population. During a five-month period in 2000, a trained health visitor interviewed all study participants. The interview covered socio-demographic characteristics, medical history, and administration of the 15-question Geriatric Depression Scale (GDS-15) and the Mini Mental Scale Examination instrument (MMSE). RESULTS The prevalence of mild or more severe depression (GDS> or =7) was 27%, while the prevalence of moderate to severe depression (GDS> or =11) was 12%. Increasing age, female gender, lower education, and being currently unmarried were associated with higher risk of depression in univariate regression models, but these associations disappeared after controlling for cognitive function, except for the association with marital status. Cognitive impairment was strongly associated with increased risk for depression. The co-morbid presence of digestive, neurological and heart conditions was also associated with increased risk for depression, while cancer was not. CONCLUSION In a rural Greek area, the prevalence of depression in late life is high. Depression was more common among unmarried individuals, those with significant cognitive impairment, and in association with specific medical conditions.
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Affiliation(s)
- F C Papadopoulos
- Department of Hygiene and Epidemiology, Athens University Medical School, Athens, Greece
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Mathuranath PS, Hodges JR, Mathew R, Cherian PJ, George A, Bak TH. Adaptation of the ACE for a Malayalam speaking population in southern India. Int J Geriatr Psychiatry 2004; 19:1188-94. [PMID: 15526301 DOI: 10.1002/gps.1239] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To adapt the Addenbrooke's Cognitive Examination (ACE) as a dementia-screening tool in a community in south India. To establish that items in the adapted version are equivalent to that in the original. METHODS The ACE was adapted into the local language, Malayalam (m-ACE), following cultural/linguistic modifications. To establish equivalence, qualitative comparisons were made (on the distribution of scores, percentage scoring at ceiling, and relative difficulty across items) between a UK sample receiving the ACE (n = 50; mean age = 67.9 +/- 7.4; education >/= 9, mean = 10.9 +/- 2.5) and a community-based educationally-stratified Indian sample receiving the m-ACE: 'India >/= 9' (n = 50; mean age = 67.8 +/- 5.2; education >/= 9, mean = 13.9 +/- 2.7) and 'India </= 8' (n = 50; mean age = 67.1 +/- 5.3; education </= 8, mean = 3.1 +/- 2.0). RESULTS Most ACE items were retained. The score distribution (mean +/- 1SD), percentage at ceiling, and relative difficulties across items is comparable between the UK and the educationally equivalent India >/= 9 groups. Language, Naming, Attention and Orientation are relatively easy (>/= 80% at ceiling) and Recall and Verbal fluency are relatively difficult (</= 22% at ceiling). Although the percentage at ceiling were lower for the India </= 8 group, the order of relative difficulty was similar and the percentage scoring at floor was </= 10% on all except visuospatial item. CONCLUSIONS The m-ACE provides a culture-fair Malayalam adaptation of the ACE with component items of equivalent difficulty.
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Affiliation(s)
- P S Mathuranath
- Cognition and Behavioural Neurology Center (CBNC), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India.
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de Silva HA, Gunatilake SB, Smith AD. Prevalence of dementia in a semi-urban population in Sri Lanka: report from a regional survey. Int J Geriatr Psychiatry 2003; 18:711-5. [PMID: 12891639 DOI: 10.1002/gps.909] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The prevalence of dementia in Sri Lanka, which has a rapidly ageing population, is unknown. OBJECTIVE This study aimed to determine the prevalence of Alzheimer's disease (AD) and other dementias in a semi-urban elderly Sinhala-speaking population in Ragama, Sri Lanka. METHODS The study was conducted in two phases. Phase I: After informed consent 703 subjects aged > or =65 years from the study area (population 15 828) were screened for cognitive impairment using the Sinhalese Mini Mental State Examination. Subjects scoring < or =17 were regarded as suspected dementia cases. Phase II: All subjects who screened positive in phase I were included in phase II for detailed evaluation for dementia according DSM IV and NINCDS-ADRDA criteria which included structured neuropsychiatric assessment, laboratory investigations, an axial CT scan of the brain and an informant interview. RESULTS In the study sample, 61% were female and 86% were between 65-75 years. 42 subjects screened positive in phase I. Of these, 28 subjects were diagnosed as having dementia, giving an overall prevalence rate of 3.98% (95% Confidence Intervals (CI) =2.6-5.7%). Of these, 20 (71.4%) had probable AD, four had vascular dementia (14.3%), two had mixed (vascular and AD) dementia (7.1%), one had Lewy body dementia, and one had dementia due to syphilis. Greater age, illiteracy and female gender were associated with higher prevalence of dementia. CONCLUSION Comparison with other community studies performed in North India suggests that dementia prevalence is higher in Sri Lanka. This may be due to regional differences in disease incidence.
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Affiliation(s)
- H A de Silva
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
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Xu G, Meyer JS, Huang Y, Du F, Chowdhury M, Quach M. Adapting mini-mental state examination for dementia screening among illiterate or minimally educated elderly Chinese. Int J Geriatr Psychiatry 2003; 18:609-16. [PMID: 12833305 DOI: 10.1002/gps.890] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Illiteracy is prevalent among current elderly Chinese. There are few brief cognitive tests in Chinese designed to screen those possibly demented for more detailed evaluation in a clinical setting. OBJECTIVES The present study adapted the Mini-Mental State Examination (MMSE) for screening dementia among illiterate or less educated elderly Chinese. METHODS Literacy-dependent items of the MMSE were modified or substituted by equivalent items that are not literacy-dependment. Some items were modified to provide socio-cultural compatibility. After developing it, the Chinese adapted MMSE (CAMSE) was administered to 370 elderly outpatients from Xijing hospitals located in Xi'an, China, 93 of whom were found to be demented and 277 non-demented. Sensitivities and specificities for detecting dementia were evaluated by adjusting for different CAMSE cut-off points. The optimal cut-off points of 22 for literates and 20 for illiterates yielded a sensitivity of 83.87% and a specificity of 84.48%. Corresponding positive predictive value (PPV) was 0.65, and negative predictive value (NPV) was 0.94. The impact of literacy on CAMSE and individual test items was also evaluated. Illiterate subjects got a higher CAMSE total score than literate subjects (p < 0.05). Only one out of 12 test items, serial sevens, was negatively influenced by illiteracy (p < 0.01). After an interval of 4-6 weeks, 32 randomly selected subjects were retested with CAMSE. The test-retest reliability for total scores was 0.75 (p < 0.01). CONCLUSIONS Results suggest that in the socio-cultural context for Chinese, irrespective of their literacy skills, CAMSE proved feasible for use in clinical settings for dementia screening.
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Affiliation(s)
- Gelin Xu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, PR, China
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Current awareness in geriatric psychiatry. Int J Geriatr Psychiatry 2002; 17:494-501. [PMID: 11994944 DOI: 10.1002/gps.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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