Mini-Mental State Examination (MMSE) performance of partially remitted community-dwelling patients with schizophrenia

Quality of Life, Family Support, and Comorbidities in Institutionalized Elders With and Without Symptoms of Depression

The institutionalization of elders can decrease the health status and quality of life in this population. The aim of this study was to analyze the socio-demographic, quality of life, family support, and comorbidities variables in institutionalized elders with and without symptoms of depression. This was a cross-sectional study in institutions for long permanence for the elderly in the State of Rio Grande do Norte, Brazil. Two institutionalized elderly groups were compared (138 elders: 69 with and 69 without depressive symptoms). The instruments used were: mini-mental state examination, geriatric depression scale in the reduced version, socio-demographic questionnaire, quality of life (World Health Organization Quality of Life abbreviated-WHOQOL-bref), and inventory of perception of family support. Elders with depressive symptoms had inferior quality of life than those without depressive symptoms. Other factors that negatively influenced the quality of life in this population include: low economic conditions, occurrence of comorbidities, and deficient family assistance. These results have important implications in the decision making process with regard to strategies for improving the health status of institutionalized elders.

Correlation between age and MMSE in schizophrenia

BACKGROUND

The Mini-Mental State Examination (MMSE) is widely used in schizophrenia, although normative data are lacking in this population. This review and meta-regression analysis studies the effect of aging on MMSE scores in schizophrenic patients.

METHODS

We entered the search terms schizophrenia and MMSE in PubMed and PsychInfo. Bibliographies of pertinent articles were also examined. We included every study presenting the MMSE scores in schizophrenic patients along with a corresponding mean age. We conducted our analyses using simple linear regression weighted for the inverse of within-trial variance of the age variable, thus conferring more importance to studies with narrower age groups.

RESULTS

We identified 56 articles (n = 5,588) published between 1990 and 2012. The MMSE scores of schizophrenic patients decline by approximately 1 point for every four years (y = 34.939-0.247x, 95% Confidence Interval (CI) [-0.304, -0.189], R 2 = 0,545), which is five times the rate in the general population. Institutionalized patients account for a large proportion of this decline (y = 37.603-0.308x, 95% CI [-0.349, -0.267], R 2 = 0.622) whereas community-dwelling patients are relatively stable throughout aging (y = 27.591-0.026x, 95% CI [-0.074, 0.023], R 2 = 0.037).

CONCLUSIONS

Subgroup analyses show different trajectories between institutionalized and outpatients with schizophrenia. The deterioration observed in institutionalized patients may have to do with greater illness severity, heavier medication load, vascular risk factors, and lack of stimulation in institutional settings. Studies documenting the role of these variables would be useful. Cognitive screening tools that assess executive functions would be interesting to study in schizophrenics, as they may reveal more subtle age-related cognitive changes not measured by the MMSE.

Application of the Audio Recorded Cognitive Screen and its relation to functioning in schizophrenia

OBJECTIVE

This study investigated the ability of the Audio Recorded Cognitive Screen (ARCS) to detect cognitive deficit in individuals with schizophrenia, relative to the Mini Mental State Examination (MMSE) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and explored the associations between the ARCS and functional outcomes. We hypothesised that the ARCS would be able to better discriminate between individuals with schizophrenia and healthy controls than the MMSE, and that ARCS performance would be correlated with measures of social and vocational functioning.

METHODS

The participants were 19 community-dwelling individuals with schizophrenia or schizoaffective disorder and 19 healthy controls recruited from the Australian Schizophrenia Research Bank (ASRB). Participants completed the ARCS, MMSE, and self-report measures of social and vocational functioning. Clinical and diagnostic data stored by the ASRB were also utilised.

RESULTS

The schizophrenia group performed worse than the control group on the ARCS, with memory, t(36)=2.49, p=0.02, 95% CI [-1.84, -18.79] and fluency, t(36)=2.40, p=0.02, 95% CI [-1.87, -22.24] domains being the main discriminating measures. The RBANS also discriminated between the two groups, and ARCS and RBANS total scores were moderately to strongly correlated. There was no difference between the two groups on the MMSE after controlling for demographic variables. ARCS performance was associated with employment status [χ2(1)=7.16, p=0.007].

CONCLUSION

The ARCS may be sensitive to the cognitive deficits in outpatients with schizophrenia and an indicator of functional outcomes in this population.

Investigation of the Montreal Cognitive Assessment (MoCA) as a cognitive screener in severe mental illness

This study examined the Montreal Cognitive Assessment (MoCA) as a neurocognitive screener and its relationship with functional outcomes in a sample of outpatients diagnosed with severe mental illness (SMI). The MoCA, Brief Assessment of Cognition in Schizophrenia (BACS), UCSD Performance-Based Skills Assessment Test-2 (UPSA-2), and Global Assessment of Functioning (GAF) were administered to 28 SMI patients and 18 non-psychiatric controls. Patients obtained significantly lower scores on the MoCA, BACS, UPSA-2, and GAF compared to non-patients. The cutoff score <26 of the MoCA resulted in favorable sensitivity (89%) but lower specificity (61%) in classification of SMI patients. The MoCA was significantly correlated with UPSA scores but not GAF scores, whereas the BACS was not significantly correlated with UPSA or GAF scores. When entered into hierarchical regression analyses, the MoCA accounted for significant variance in UPSA scores above variance accounted for by the BACS. Both the MoCA and the BACS contributed unique variance in GAF scores. Overall, the MoCA demonstrated high sensitivity as a cognitive screener in SMI. Moreover, MoCA scores were related to performance-based measures of functional capacity.

A pilot study to measure cognitive impairment in patients with severe schizophrenia with the Montreal Cognitive Assessment (MoCA)

Cognitive impairment has been suggested to be a core feature of a schizophrenia diagnosis. Many comprehensive neuropsychological batteries and experimental procedures have been used to assess cognitive impairment in schizophrenia. A few brief performance-based cognitive assessments have been developed to fulfill the need of a more feasible cognitive assessment for schizophrenia in clinical settings. However, their usability is in question. The Montreal Cognitive Assessment (MoCA), a brief cognitive assessment tool, has been used widely in different clinical settings because of its high sensitivity and specificity for detecting cognitive impairments. This study assessed cognitive function in patients with schizophrenia by using the MoCA tool. The results showed that the MoCA was sensitive enough to detect cognitive impairment in patients with schizophrenia. It also provided normative data for the MoCA in schizophrenia patients. Furthermore, the results revealed that cognitive impairment measured by the MoCA was correlated with their education level, severity of illness, and negative symptoms. Lastly, the MoCA total score could be a significant predictor of patients' length of stay in the facility.

Hippocampi, thalami, and accumbens microstructural damage in schizophrenia: a volumetry, diffusivity, and neuropsychological study

Volumetric abnormalities in the subcortical structures have been described in schizophrenia. However, it still has to be clarified if subtle microstructural damage is also present. Thus, we aimed to detect subcortical volume and mean diffusivity (MD) alterations in 45 patients with diagnosis of schizophrenia compared with 45 age-, gender-, and educational attainment-matched healthy comparison (HC) participants, by using a combined volumetry and diffusion tensor imaging (DTI) method. A secondary aim was to identify the neuropsychological correlates of subcortical abnormalities in the schizophrenic group. We found thalami and hippocampi bilaterally and left accumbens to show MD increase in the schizophrenic group. No volumetric decrease was found. Moreover, significant correlations between the MD values in subcortical structures (right thalamus and hippocampus and left accumbens) and working memory performance were found. Thus, subcortical microstructural alterations are present in schizophrenia even in absence of volumetric abnormalities. Furthermore, microstructural damage in subcortical areas is linked to working memory, suggesting the presence of a subtle microstructural subcortical dysfunction in the pathoetiological mechanism underlying high cognitive load performances in schizophrenia. Finally, our findings indicate that MD is a more sensitive marker of brain tissue deficits than signal intensity variations measured in T1-weighted imaging data, consistently with previous reports. Thus, DTI appears to be an invaluable tool to investigate subcortical pathology in schizophrenia, greatly enhancing the ability to detect subtle brain changes in this complex disorder.

Diminished humour perception in schizophrenia: relationship to social and cognitive functioning

This study attempted to confirm that humour recognition deficits previously found in schizophrenia are specific to the condition and not attributable to other parameters such as depression or anxiety. Secondarily, we explored any possible cognitive or social functioning correlates to humour recognition deficits. A total of 60 participants (20 outpatients with schizophrenia, 20 psychiatric control participants and 20 control participants) underwent a 64-question humour task in addition to a battery of standard cognitive tests and Social Functioning Scales. In order to compare the three groups of participants, we conducted an analysis of variance (ANOVA) and post-hoc t-tests on neuropsychological measures, social functioning measures, and the primary outcome, humour recognition. The schizophrenia group showed significant and substantial deficits in humour recognition compared to the healthy control group, t(38)=5.1, P<0.001, ES=-1.55 and the psychiatric control group, t(38)=3.6, P=0.001. In the schizophrenia group, humour recognition correlated positively with general intellectual functioning (NART) r=.45, P=0.04, social reasoning (WAIS-III Comprehension) r=.54, P=0.01, executive functioning (WCST-CC) r=.69, P=0.001 and social adjustment ratings (SASS scores), r=.54, P=0.02. These findings support the assertion that humour recognition deficits in schizophrenia are specific to the condition and not attributable to other factors such as depression or anxiety. Furthermore, humour recognition deficits in schizophrenia may perhaps be preferentially associated with deficiencies in set shifting and semantic cognition.

Screening for cognitive functioning in psychiatric outpatients with schizophrenia, alcohol dependence, and dual diagnosis

Cognitive impairment is common to both schizophrenia and alcoholism. Despite increasing recognition that people with both disorders represent a problematic client group, little is known about the possible additive effect of a dual diagnosis upon impaired cognitive function. This study investigates impairment of cognitive functioning in patients with schizophrenia, alcohol dependence, or a dual diagnosis of schizophrenia and alcohol use disorder. It was hypothesised that patients with dual diagnosis would show greater cognitive impairment than those with a single diagnosis. The Mini-Mental State Examination (MMSE) and standardised measures of psychiatric health and substance use were administered to 120 community psychiatric patients with a diagnosis of schizophrenia, alcohol dependence and both conditions (dual diagnosis). Higher rates of cognitive impairment were found among dual diagnosis patients compared to the schizophrenia or alcohol patients. This was shown in age-adjusted measures of global functioning, and on the tests of language, reading and writing, and visuospatial construction. Despite its common usage, global MMSE scores were insensitive to the cognitive impairments typically found in these clinical groups. Where the MMSE is used as a screening tool, it is recommended that scores are adjusted for the effects of age.

Perception of facial emotions in chronic schizophrenia does not correlate with negative symptoms but correlates with cognitive and motor dysfunction

BACKGROUND

Appropriate expression of emotions and correct perception of emotional expression in others are important social skills which may be impaired in schizophrenia and contribute to poor social adjustment. We examined the relationship between expression of emotions as measured by affective flattening and other negative symptoms and their perception. We compared performance on tests of perception of facial emotions with that in other cognitive areas.

METHODS

36 chronic schizophrenic patients on stable doses of atypical antipsychotics were assessed using tests of identification (FID) and discrimination (FDIS) of facial emotional expressions, visual retention (BVRT) and general cognitive function (Mini Mental State Examination, MMSE). Clinical symptoms were assessed with scales for the assessment of negative symptoms (SANS) and positive symptoms (SAPS). Motor symptoms were assessed with side effects (SA) and AIMS scales and Finger Tapping Test.

RESULTS

Negative symptoms showed no relation to FID or FDIS. FID showed significant correlation with Visual Retention and Finger Tapping but not MMSE.

CONCLUSION

The ability to identify facial emotional expressions is not related to negative symptoms in chronic schizophrenia and shares common mechanisms with visual reproduction and ability to make rapid motor movements. This suggests common defects in perceptual, timed processes consistent with postulated dysfunction of cortico-subcortical circuits.

Anticholinergic differences among patients receiving standard clinical doses of olanzapine or clozapine

This study evaluated anticholinergic effects among patients with schizophrenia, schizoaffective disorder, or bipolar I disorder who were receiving either olanzapine (N = 12) or clozapine (N = 12) at standard clinical doses in a naturalistic setting. Serum anticholinergic levels were determined in adult male and female subjects using a radioreceptor binding assay. The Udvalg for Kliniske Undersogelser Scale was used to evaluate anticholinergic side effects clinically, and the Mini-Mental State Examination provided a global cognitive measure. Patients had achieved target doses that were stable at the time at which blood samples were obtained, and no other concomitant medicine with known anticholinergic potential was allowed. Patients receiving olanzapine (average dose, 15 mg/day) had serum anticholinergic levels of 0.96 (+/-0.55) pmol/ atropine equivalents compared with levels of 5.47 (+/-3.33) pmol/atropine equivalents for those receiving clozapine (average dose, 444 mg/day) (p < 0.001). Rates of increased and decreased salivation were significantly more common among the clozapine- and olanzapine-treated patients, respectively, whereas constipation, urinary disturbances, and tachycardia/palpitations were significantly more common among clozapine-treated patients. Neither group showed any global cognitive deficits. Olanzapine-treated patients had serum anticholinergic levels that were less than one fifth those of the clozapine-treated patients. Furthermore, clinical evaluations confirmed that clozapine-treated patients experienced more frequent and severe anticholinergic side effects (except dry mouth). However, none of the patients in either group expressed any desire to discontinue these medications as a result of the anticholinergic side effects.