[Polynesian adaptation of the Mini-Mental State Examination]

An Arabic Version of the Mini-Mental State Examination for the Lebanese Population: Reliability, Validity, and Normative Data

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.

Effects of different analgesia regimens on early post-operative cognitive dysfunction in elderly patients undergoing radical resection of cervical carcinoma

This study was designed to compare the effects of epidural and intravenous analgesia on early post-operative cognitive dysfunction (POCD) in elderly patients undergoing radical resection of cervical cancer. For this purpose, 74 patients aged 60-78 years [body mass index (BMI), 18-25 kg/m²; American Society of Anesthesiologists (ASA) classification score of I-III) undergoing radical resection of cervical cancer were divided into the epidural group (group E) and parenteral group (group P) groups (37 patients in each group). All patients underwent their surgical procedures under epidural anesthesia and intravenously-delivered general anesthesia. Patient-controlled analgesia (PCA) was supplied for 72 h after the surgery. Epidural analgesia was provided for the patients in group E and intravenous analgesia was provide for those in group P. General patient information was recorded and peripheral blood neutrophil counts, C-reactive protein (CRP) levels and interleukin (IL)-6 concentrations were measured immediately prior to the surgery (T₀), and at 24, 48 and 72 h after the procedure (T₁, T₂ and T₃, respectively). Visual analog scale (VAS) scores were also recorded at T₁, T₂ and T₃, and the mini-mental state evaluation (MMSE) scores at T₀, T₁, T₂, and T₃ were calculated. Patients were diagnosed as having POCD according to their MMSE score differences between the peri-operative and post-operative values. The results revealed that the levels of CRP and IL-6 significantly increased in both groups after the surgery (T_1-3). However, the CRP and IL-6 levels in group E were significantly lower than those in group P at all time points examined (P<0.05). The VAS scores in group E at T₁, T₂ and T₃ were significantly lower than those in group P (P<0.05). Finally, the incidence of POCD in group E was significantly lower than that in group P (P<0.05). On the whole, the post-operative epidural analgesia reduced the systemic inflammatory response, the perceived pain, and the incidence of POCD in patients undergoing radical resection of cervical cancer, when compared with the effects of intravenous analgesia.

Alzheimer's disease patient groups derived from a multivariate analysis of cognitive test outcomes in the Coalition Against Major Diseases dataset

Aim:

The mini-mental state examination, commonly used to measure cognitive impairment of Alzheimer’s disease (AD) patients, consists of five test categories. The final score is calculated as their total sum, implying a loss of information.

Materials & methods:

In this study, we propose a new multivariate approach to address this issue.

Results:

We analyzed the current largest AD-related coalition against major diseases dataset comprising 3717 patients of interest. Our clustering approach revealed five groups of patients associated with distinct characteristics and prognosis. Interestingly, only three cognitive test categories significantly contribute to their determination: registration, attention and recall.

Conclusion:

The insight that only these categories are critical for AD group determination may help to resolve the patients’ educational background issue often discussed in relation to the mini-mental state examination assessment.

The mini-mental state examination is commonly used to measure cognitive impairment of Alzheimer’s disease (AD)-diagnosed patients. Traditionally, the resulting score of this test is assessed as the total number of correct answers to five types of questions. In this study, we employed a more sophisticated multivariate approach to determine the most common groups of AD patients defined by their cognitive performance in each single category separately. Interestingly, our results revealed that out of the currently employed five question categories only three are crucial for the patient group determination. This insight may impact on the cognitive test design in AD.