The factorial structure of the Mini-Mental State Examination (MMSE) in Japanese dementia patients

Biomarkers of Airway Disease, Barrett's and Underdiagnosed Reflux Noninvasively (BAD-BURN): a Case-Control Observational Study Protocol

BACKGROUND

Particulate matter exposure (PM) is a cause of aerodigestive disease globally. The destruction of the World Trade Center (WTC) exposed fifirst responders and inhabitants of New York City to WTC-PM and caused obstructive airways disease (OAD), gastroesophageal Refux disease (GERD) and Barrett's Esophagus (BE). GERD not only diminishes health-related quality of life but also gives rise to complications that extend beyond the scope of BE. GERD can incite or exacerbate allergies, sinusitis, bronchitis, and asthma. Disease features of the aerodigestive axis can overlap, often necessitating more invasive diagnostic testing and treatment modalities. This presents a need to develop novel non-invasive biomarkers of GERD, BE, airway hyperreactivity (AHR), treatment efficacy, and severity of symptoms.

METHODS

Our observational case-cohort study will leverage the longitudinally phenotyped Fire Department of New York (FDNY)-WTC exposed cohort to identify Biomarkers of Airway Disease, Barrett's and Underdiagnosed Refux Noninvasively (BAD-BURN). Our study population consists of n = 4,192 individuals from which we have randomly selected a sub-cohort control group (n = 837). We will then recruit subgroups of i. AHR only ii. GERD only iii. BE iv. GERD/BE and AHR overlap or v. No GERD or AHR, from the sub-cohort control group. We will then phenotype and examine non-invasive biomarkers of these subgroups to identify under-diagnosis and/or treatment efficacy. The findings may further contribute to the development of future biologically plausible therapies, ultimately enhance patient care and quality of life.

DISCUSSION

Although many studies have suggested interdependence between airway and digestive diseases, the causative factors and specific mechanisms remain unclear. The detection of the disease is further complicated by the invasiveness of conventional GERD diagnosis procedures and the limited availability of disease-specific biomarkers. The management of Refux is important, as it directly increases risk of cancer and negatively impacts quality of life. Therefore, it is vital to develop novel noninvasive disease markers that can effectively phenotype, facilitate early diagnosis of premalignant disease and identify potential therapeutic targets to improve patient care.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05216133; January 18, 2022.

Sex Disparity in the Association of Metabolic Syndrome with Cognitive Impairment

Background/Objectives: Metabolic syndrome (MS) is a constellation of several cardiometabolic risk factors. We investigated sex disparity in the associations between MS and cognitive impairment using cross-sectional data from Taiwan Biobank. Methods: We determined the associations of MS and its five components with cognitive impairment (mini-mental state examination, MMSE < 24) and the five domains of MMSE using logistic regression analyses. Results: A total of 7399 men and 11,546 women were included, and MS was significantly associated with cognitive impairment only in women (adjusted OR 1.48, 95% CI 1.29-1.71, p = 0.001) (p for interaction 0.005). In women, the association with MS was significant in orientation (adjusted OR 1.21, 95% CI 1.07-1.37, p = 0.003), memory (adjusted OR 1.12, 95% CI 1.01-1.25, p = 0.034) and design copying (adjusted OR 1.41, 95% CI 1.23-1.62, p = 0.001) (p value for interaction 0.039, 0.023, and 0.093, respectively). Among the components of MS, a large waist circumference (adjusted OR 1.25, 95% CI 1.08-1.46, p = 0.003), high fasting glucose (adjusted OR 1.16, 95% CI 1.00-1.34, p = 0.046), and low HDL cholesterol (adjusted OR 1.16, 95% CI 1.00-1.34, p = 0.049) were significantly associated with cognitive impairment in women. Conclusions: Our findings suggest that sex has a significant influence on the association between MS and cognitive dysfunction, especially in orientation and memory.

Oscillatory characteristics of resting-state magnetoencephalography reflect pathological and symptomatic conditions of cognitive impairment

Background

Dementia and mild cognitive impairment are characterised by symptoms of cognitive decline, which are typically assessed using neuropsychological assessments (NPAs), such as the Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB). Magnetoencephalography (MEG) is a novel clinical assessment technique that measures brain activities (summarised as oscillatory parameters), which are associated with symptoms of cognitive impairment. However, the relevance of MEG and regional cerebral blood flow (rCBF) data obtained using single-photon emission computed tomography (SPECT) has not been examined using clinical datasets. Therefore, this study aimed to investigate the relationships among MEG oscillatory parameters, clinically validated biomarkers computed from rCBF, and NPAs using outpatient data retrieved from hospital records.

Methods

Clinical data from 64 individuals with mixed pathological backgrounds were retrieved and analysed. MEG oscillatory parameters, including relative power (RP) from delta to high gamma bands, mean frequency, individual alpha frequency, and Shannon's spectral entropy, were computed for each cortical region. For SPECT data, three pathological parameters-'severity', 'extent', and 'ratio'-were computed using an easy z-score imaging system (eZIS). As for NPAs, the MMSE and FAB scores were retrieved.

Results

MEG oscillatory parameters were correlated with eZIS parameters. The eZIS parameters associated with Alzheimer's disease pathology were reflected in theta power augmentation and slower shift of the alpha peak. Moreover, MEG oscillatory parameters were found to reflect NPAs. Global slowing and loss of diversity in neural oscillatory components correlated with MMSE and FAB scores, whereas the associations between eZIS parameters and NPAs were sparse.

Conclusion

MEG oscillatory parameters correlated with both SPECT (i.e. eZIS) parameters and NPAs, supporting the clinical validity of MEG oscillatory parameters as pathological and symptomatic indicators. The findings indicate that various components of MEG oscillatory characteristics can provide valuable pathological and symptomatic information, making MEG data a rich resource for clinical examinations of patients with cognitive impairments. SPECT (i.e. eZIS) parameters showed no correlations with NPAs. The results contributed to a better understanding of the characteristics of electrophysiological and pathological examinations for patients with cognitive impairments, which will help to facilitate their co-use in clinical application, thereby improving patient care.

Decreased beta-band activity in left supramarginal gyrus reflects cognitive decline: Evidence from a large clinical dataset in patients with dementia

Cognitive impairment is a major concern in clinical medicine. It is usually evaluated with neuropsychological assessments, which have inherent limitations. To compensate for them, magnetoencephalography has already come into clinical use to evaluate the level of cognitive impairment. It evaluates global changes in the frequency of resting-state brain activity, which are associated with cognitive status. However, it remains unclear what neural mechanism causes the frequency changes. To understand this, it is important to identify cortical regions that mainly contribute to these changes. We retrospectively analysed the clinical records from 310 individuals with cognitive impairment who visited the outpatient department at our hospital. The analysis included resting-state magnetoencephalography, neuropsychological assessment, and clinical diagnosis data. Regional oscillatory intensities were estimated from the magnetoencephalography data, which were statistically analysed, along with neuropsychological assessment scores, and the severity of cognitive impairment associated with clinical diagnosis. The regional oscillatory intensity covering a wide range of regions and frequencies was significantly associated with neuropsychological assessment scores and differed between healthy individuals and patients with cognitive impairment. However, these associations and differences in all conditions were overlapped by a single change in beta frequency in the left supramarginal gyrus. High frequency oscillatory intensity in the left supramarginal gyrus is associated with cognitive impairment levels among patients who were concerned about dementia. It provides new insights into cognitive status measurements using magnetoencephalography, which is expected to develop as an objective index to be used alongside traditional neuropsychological assessments.

Mortality Risks after Two Years in Frail and Pre-Frail Older Adults Admitted to Hospital

BACKGROUND

Frailty is characterized by a progressive decline in the physiological functions of multiple body systems that lead to a more vulnerable condition, which is prone to the development of various adverse events, such as falls, hospitalization, and mortality. This study aims to determine whether frailty increases mortality compared to pre-frailty and to identify variables associated with a higher risk of mortality.

MATERIALS

Two cohorts, frail and pre-frail subjects, are evaluated according to the Fried phenotype. A complete examination of frailty, cognitive status, comorbidities and pharmacology was carried out at hospital admission and was extracted through electronic health record (EHR). Mortality was evaluated from the EHR.

METHODS

Kaplan-Meier estimates of survival probability functions were calculated at two years censoring time for frail and pre-frail cohorts. The log-rank test assessed significant differences between survival probability functions. Significant variables for frailty (p < 0-05) were extracted by independent sample t-test. Further selection was based on variable significance found in multivariate logistic regression discrimination between frail and pre-frail subjects. Cox regression over univariate t-test-selected variables was calculated to identify variables associated with higher proportional hazard risks (HR) at two years.

RESULTS

Frailty is associated with greater mortality at two years censoring time than pre-frailty (log-rank test, p < 0.0001). Variables with significant (p < 0.05) association with mortality identified in both cohorts (HR 95% (CI in the frail cohort) are male sex (0.44 (0.29-0.66)), age (1.05 (1.01-1.09)), weight (0.98 (0.96-1.00)), and use of proton-pump inhibitors (PPIs) (0.60 (0.41-0.87)). Specific high-risk factors in the frail cohort are readmission at 30 days (0.50 (0.33-0.74)), SPPB sit and stand (0.62 (0.45-0.85)), heart failure (0.67 (0.46-0.98)), use of antiplatelets (1.80 (1.19-2.71)), and quetiapine (0.31 (0.12-0.81)). Specific high-risk factors in the pre-frail cohort are Barthel's score (120 (7.7-1700)), Pfeiffer test (8.4; (2.3-31)), Mini Nutritional Assessment (MNA) (1200 (18-88,000)), constipation (0.025 (0.0027-0.24)), falls (18,000 (150-2,200,000)), deep venous thrombosis (8400 (19-3,700,000)), cerebrovascular disease (0.01 (0.00064-0.16)), diabetes (360 (3.4-39,000)), thyroid disease (0.00099 (0.000012-0.085)), and the use of PPIs (0.062 (0.0072-0.54)), Zolpidem (0.000014 (0.0000000021-0.092)), antidiabetics (0.00015 (0.00000042-0.051)), diuretics (0.0003 (0.000004-0.022)), and opiates (0.000069 (0.00000035-0.013)).

CONCLUSIONS

Frailty is associated with higher mortality at two years than pre-frailty. Frailty is recognized as a systemic syndrome with many links to older-age comorbidities, which are also found in our study. Polypharmacy is strongly associated with frailty, and several commonly prescribed drugs are strongly associated with increased mortality. It must be considered that frail patients need coordinated attention where the diverse specialist taking care of them jointly examines the interactions between the diversity of treatments prescribed.

Relationship between adaptability during turning and the complexity of walking before turning in older adults

In this study, the relationship between behavioral complexity (sample entropy, SEn) during steady walking and the quickness of subsequent turning performance in older adults. Herein, healthy older and younger adults (n = 12 each) were instructed to walk straight and then turn into an intersection surrounded by four pylons. This walking task was performed under two turning conditions: reactive and pre-planned turning, where the direction of turning was unknown until immediately before turning or was informed beforehand, respectively. For older adults, behavioral complexity was comparable under both conditions, but was higher under reactive than pre-planned turning condition for younger adults. This suggests that older adults cannot adapt their walking patterns in response to turning conditions. Correlation analysis showed that older adults with lower SEn had more difficulty in turning rapidly under reactive turning condition, indicating a relationship between the two variables. Thus, deterioration of the reactive turning performance in older adults is related to stereotyped movements during steady walking.

Effect of gait training using rhythmic auditory stimulation on gait speed in older adults admitted to convalescent rehabilitation wards: A study protocol for a pilot randomized controlled clinical trial

Background

Decreased walking speed in older patients admitted to convalescent rehabilitation wards (CRWs) is one of the factors that inhibit home discharge. Therefore, interventions to improve gait speed in older patients admitted to CRWs are important, and rhythmic auditory stimulation (RAS) may be an effective intervention strategy. However, the effect of RAS on gait speed in older patients admitted to CRWs is not well known. Therefore, this study protocol aims to determine the feasibility of the RAS-based gait practice for older patients admitted to the CRW.

Methods

The study is designed as a single-center, open-label, pilot, randomized, parallel-group study. Participants will be 30 patients aged ≥65 years admitted to the CRW and randomly assigned to the experimental group (RAS-based gait practice; n = 15) or the control group (normal gait practice; n = 15). In both groups, interventions will be conducted for 30 min per session, 5 times per week for 3 weeks. The primary outcome is the change in the 10-m walk test 3 weeks after the baseline assessment. Secondary outcome is the change in the score of the Medical Outcome Study 8-Item Short-Form Health Survey and the Japanese version of the modified Gait Efficacy Scale from baseline assessment to 3 weeks later.

Discussion

This exploratory RCT was developed using strict scientific standards and is based on defined protocols. Thus, this study will be used to assess the viability of a larger investigation into RAS-based gait practice. If our theory is accurate, this study could serve as a foundation for establishing RAS-based gait practice in CRWs as a common rehabilitation strategy.

Trial registration

This study was registered in the University Hospital Medical Information Network (UMIN) clinical trials registry in Japan (UMIN000049089).

Recovery of Patients With Upper Limb Paralysis Due to Stroke Who Underwent Intervention Using Low-Frequency Repetitive Transcranial Magnetic Stimulation Combined With Occupational Therapy: A Retrospective Cohort Study

OBJECTIVES

The combination of repetitive transcranial magnetic stimulation (rTMS) and motor practice is based on the theory of neuromodulation and use-dependent plasticity. Predictive planning of occupational therapy (OT) is important for patients with rTMS conditioning. Recovery characteristics based on the severity of pretreatment upper extremity paralysis can guide the patient's practice plan for using the paretic hand. Therefore, we evaluated the recovery of patients with upper limb paralysis due to stroke who underwent a novel intervention of rTMS combined with OT (NEURO) according to the severity of upper limb paralysis based on the scores of the Fugl-Meyer assessment for upper extremity (FMA-UE) with recovery in proximal upper extremity, wrist, hand, and coordination.

MATERIALS AND METHODS

In this multicenter retrospective cohort study, the recovery of 1397 patients with upper limb paralysis was analyzed by severity at six hospitals that were accredited by the Japanese Stimulation Therapy Society for treatment. The delta values of the FMA-UE scores before and after NEURO were compared among the groups with severe, moderate, and mild paralysis using the generalized linear model.

RESULTS

NEURO significantly improved the FMA-UE total score according to the severity of paralysis (severe = 5.3, moderate = 6.0, and mild = 2.9). However, when the FMA-UE subscores were analyzed separately, the results indicated specific improvements in shoulder/elbow, wrist, fingers, and coordination movements, depending on the severity.

CONCLUSIONS

This study had enough patients who were divided according to severity and stratified by lesion location and handedness parameters. Our results suggest that independently of these factors, the extent of recovery of upper limb motor parts after NEURO varies according to the severity of paralysis.

A modified mental state assessment tool for impact analysis of virtual reality-based therapeutic interventions in patients with cognitive impairment

Objectives

This work has developed a modified mental state assessment tool for impact analysis of therapeutic interventions for patients with cognitive impairment. This work includes a pilot study to validate the proposed tool and assess the impact of virtual reality-based interventions on patient well-being, which includes assessment of cognitive ability and mood.

Methods

The suggested tool's robustness and reliability are assessed in care home facilities with elderly residents over the age of 55. Because of the repetitive nature of the pilot study, test-retest strategy for Cronbach's alpha coefficient is employed to validate the internal consistency of the proposed tool over time. Qualitative and quantitative analyses are performed on the collected data to draw inferences on the impact of virtual reality-based interventions on patients with cognitive impairments.

Results

The Cronbach's alpha coefficient value shows that the proposed tool's resilience is comparable to that of its pre-intervention counterparts. The Cronbach's alpha coefficient values are determined for Pre-virtual reality and Post-virtual reality interventions, which include 116 virtual reality sessions for 52-participant, and three cohorts of virtual reality sessions for 21 participants. These values for a majority of the interventions remained within the acceptable range of 0.6-0.8.

Conclusions

The proposed modified mental state assessment tool is observed to be a reliable tool for investigating the impact of virtual reality-based interventions on patients with cognitive impairments. One of the notable significance of the proposed tool is that this allows for resource allocation for such interventions to be tailored to the needs of the patient, leading to greater therapeutic efficacy and resource efficiency.

Relationship between Empowerment and Functioning and Disability in Older Japanese Patients: A Covariance Structure Analysis

In the present study, 151 Japanese older adults aged over 65 years and admitted to recovery-phase rehabilitation facilities were enrolled to investigate the relationship between empowerment and contextual factors, functioning and disability, with structural equation modeling (SEM). The analysis included 151 patients aged 81.75 ± 7.15 years, including 54 males (35.76%) and 97 females (64.24%). The results of the SEM analysis showed that role presence (β = 0.45, p < 0.01) and family structure (β = 0.18, p = 0.02) significantly impacted empowerment. In addition, the results showed that patient empowerment positively impacted physical activity (β = 0.25, p < 0.01) and psychosomatic functions and abilities (β = 0.36, p < 0.01). Furthermore, the goodness-of-fit of the model hypothesized in this study was shown to have explanatory power. This study showed that empowerment contributed to the prevention of physical inactivity and confinement among Japanese older patients. In other words, the study provided evidence for the importance of empowerment-based program planning in the practice of person-centered care aimed at promoting the health and discharge of older patients in Japan.

Early detection and determinants of dementia in the working area of Mojolangu Public Health Center, Malang (Indonesia)

Lack of public awareness about the symptoms of dementia and the absence of dementia screening can lead to delays in diagnosis. This study was aimed to determine the prevalence and determinants of dementia in the working area of Mojolangu Public Health Center Malang. This crosssectional study was conducted in January- March 2020. A total of 84 respondents aged ≥45 years old who registered at the Integrated Health Service Post for the Elderly were selected using the proportionate stratified random sampling method. Dementia was assessed by using The Mini- Mental State Examination (MMSE). Multiple logistic regression analysis was used to determine the determinants of dementia. The prevalence of dementia from mild to severe was found to be 69%. Sex, smoking behavior, and education level had a significant relationship with dementia. Therefore, it is necessary to carry out early detection of dementia to the public. People can be encouraged to stop smoking and optimize various activities that can hone cognitive functions, such as reading, discussing, doing hobbies to prevent early dementia.

Latest Trends in Outcome Measures in Dementia and Mild Cognitive Impairment Trials

Disease modification trials in dementia and mild cognitive impairment (MCI) have not met with success. One potential criticism of these trials is the lack of sensitive outcome measures. A large number of outcome measures have been employed in dementia and MCI trials. This review aims to describe and analyze the utility of cognitive/clinical outcome measures in Alzheimer’s disease (AD) and MCI trials. Methods: A PubMed search was conducted using relevant MeSH terms and exploded keywords. The search was confined to English language publications of human studies from the last five years which describe the latest trends in the use of outcome measures. Results: Despite broad use, the outcome measures employed are heterogeneous, with little data on correlations between scales. Another problem is that most studies are over-reliant on clinician/researcher assessment and cognitive outcomes, and there is a definite lack of stakeholder input. Finetuning of the paradigm is also required for people with early-stage disease, mild to moderate disease, and advanced dementia, as the outcome measures in these subgroups have varying relevance. Disease modification/prevention is an appropriate goal in early disease, whereas palliation and freedom from discomfort are paramount in later stages. The outcome measures selected must be suitable for and sensitive to these particular care goals. Although there is a shift to enrich MCI cohorts using a biomarker-based approach, the clinical relevance of such outcome measures remains uncertain. Conclusions: Outcome measures in dementia/MCI trials remain inhomogeneous and diverse, despite extensive use. Outcome measures fall within several paradigms, including cognitive, functional, quality-of-life, biomarker-based, and patient-reported outcome measures. The success of future disease-modifying trials is reliant to a large extent on the selection of outcome measures which combine all outcomes of clinical relevance as well as clinical meaning. Outcome measures should be tied to the type and stage of dementia and to the specific interventions employed.

Italian telephone-based Mini-Mental State Examination (Itel-MMSE): item-level psychometric properties

Background

The Italian telephone-based Mini-Mental State Examination (Itel-MMSE), despite being psychometrically sound, has shown relevant ceiling effects, which may negatively impact the interpretation of its scores. In address to overcome such an issue, this study aimed at providing item-level insights on the Itel-MMSE through Item Response Theory (IRT) analyses.

Methods

Five-hundred and sixty-seven healthy Italian adults (227 males, 340 females; mean age: 51 ± 17 years, range 18–96; mean education: 13.31 ± 4.3 years). A two-parameter logistic IRT model was implemented to assess item discrimination and difficulty of the Itel-MMSE. Construct unidimensionality, statistical independence of items, and model and item fit were tested. Informativity levels were also assessed graphically.

Results

With respect to the Itel-MMSE total score, ceiling effects were found in 92.7% of participants. Unidimensionality was violated; both model and item fit were poor; a few items showed statistical dependence. Both the whole test and its items proved to be scarcely informative, especially for medium-to-high levels of ability, except for attention and spatial orientation subtests, which consistently yielded the highest discriminative capability.

Discussion

The Itel-MMSE appears to be most informative in low-performing healthy individuals. However, the present findings should not lead practitioners to aprioristically equate ceiling effects/low informativity to clinical uselessness. Items assessing attention and, to a lesser extent, spatial orientation appear to be the most informative.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-02041-4.

Distinctive effects of executive dysfunction and loss of learning/memory abilities on resting-state brain activity

Dementia is a syndrome characterised by cognitive impairments, with a loss of learning/memory abilities at the earlier stages and executive dysfunction at the later stages. However, recent studies have suggested that impairments in both learning/memory abilities and executive functioning might co-exist. Cognitive impairments have been primarily evaluated using neuropsychological assessments, such as the Mini-Mental State Examination (MMSE). Recently, neuroimaging techniques such as magnetoencephalography (MEG), which assess changes in resting-state brain activity, have also been used as biomarkers for cognitive impairment. However, it is unclear whether these changes reflect dysfunction in executive function as well as learning and memory. In this study, parameters from the MEG for brain activity, MMSE for learning/memory, and Frontal Assessment Battery (FAB) for executive function were compared within 207 individuals. Three MEG parameters were used as representatives of resting-state brain activity: median frequency, individual alpha frequency, and Shannon’s spectral entropy. Regression analysis showed that median frequency was predicted by both the MMSE and FAB scores, while individual alpha frequency and Shannon’s spectral entropy were predicted by MMSE and FAB scores, respectively. Our results indicate that MEG spectral parameters reflect both learning/memory and executive functions, supporting the utility of MEG as a biomarker of cognitive impairment.

Research trends in computerized cognitive training contents with text network

Computerized Cognitive Training (CCT) contents used to improve patients’ cognitive ability with Mild Cognitive Impairment (MCI) can provide customized training through individual data collection and analysis. However, studies on transfer effect of improving other untrained cognitive domains while performing the contents are insufficient. The present paper intended to collect literature published by PubMed, EMBASE, Cochrane Library, and Web of Science until December 2019 and analyze the trends of CCT and the transfer effect in each training area. Studies on CCT (82/891) have been increasing each year, and universities (60/82) in the United States (17/82) have published the most. In the literature that reported clinical effect (18/82), the cognitive domain mostly studied was memory (14/18), and the N-Back (3/14) method accounted for most of the training contents. Moreover, the contents that showed the highest degree, closeness, and betweenness centrality (BC) indices were the memory area, and video accounted for the highest among the intervention methods. In particular, the closeness centrality (CC) index of the memory and attention contents showed similar results. It can be interpreted that the possibility of the transfer effect occurring from memory and attention areas is the highest since the semantic distance (i.e. the similarity of the training process) between the attention contents and memory contents was the closest. The effectiveness of the actual transfer effect between the memory and attention should be verified.

Right entorhinal cortical thickness is associated with Mini-Mental State Examination scores from multi-country datasets using MRI

PURPOSE

To discover common biomarkers correlating with the Mini-Mental State Examination (MMSE) scores from multi-country MRI datasets.

METHODS

The first dataset comprised 112 subjects (49 men, 63 women; range, 46-94 years) at the National Hospital Organization Kyushu Medical Center. A second dataset comprised 300 subjects from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database (177 men, 123 women; range, 57-91 years). Three-dimensional T1-weighted MR images were collected from both datasets. In total, 14 deep gray matter volumes and 70 cortical thicknesses were obtained from MR images using FreeSurfer software. Total hippocampal volume and the ratio of hippocampus to cerebral volume were also calculated. Correlations between each variable and MMSE scores were assessed using Pearson's correlation coefficient. Parameters with moderate correlation coefficients (r > 0.3) from each dataset were determined as independent variables and evaluated using general linear model (GLM) analyses.

RESULTS

In Pearson's correlation coefficient, total and bilateral hippocampal volumes, right amygdala volume, and right entorhinal cortex (ERC) thickness showed moderate correlation coefficients (r > 0.3) with MMSE scores from the first dataset. The ADNI dataset showed moderate correlations with MMSE scores in more variables, including bilateral ERC thickness and hippocampal volume. GLM analysis revealed that right ERC thickness correlated significantly with MMSE score in both datasets. Cortical thicknesses of the left parahippocampal gyrus, left inferior parietal lobe, and right fusiform gyrus also significantly correlated with MMSE score in the ADNI dataset (p < 0.05).

CONCLUSION

A positive correlation between right ERC thickness and MMSE score was identified from multi-country datasets.

The Role of Brief Global Cognitive Tests and Neuropsychological Expertise in the Detection and Differential Diagnosis of Dementia

Dementia is a global public health problem and its impact is bound to increase in the next decades, with a rapidly aging world population. Dementia is by no means an obligatory outcome of aging, although its incidence increases exponentially in old age, and its onset may be insidious. In the absence of unequivocal biomarkers, the accuracy of cognitive profiling plays a fundamental role in the diagnosis of this condition. In this Perspective article, we highlight the utility of brief global cognitive tests in the diagnostic process, from the initial detection stage for which they are designed, through the differential diagnosis of dementia. We also argue that neuropsychological training and expertise are critical in order for the information gathered from these omnibus cognitive tests to be used in an efficient and effective way, and thus, ultimately, for them to fulfill their potential.

Decline in Emotional Face Recognition Among Elderly People May Reflect Mild Cognitive Impairment

Background

As with cognitive function, the ability to recognize emotions changes with age. In the literature regarding the relationship between recognition of emotion and cognitive function during aging, the effects of predictors such as aging, emotional state, and cognitive domains on emotion recognition are unclear. This study was performed to clarify the cognitive functions underlying recognition of emotional facial expressions, and to evaluate the effects of depressive mood on recognition of emotion in elderly subjects, as well as to reproduce the effects of aging on the recognition of emotional facial expressions.

Materials and Methods

A total of 26 young (mean age = 20.9 years) and 30 elderly subjects (71.6 years) participated in the study. All subjects participated in face perception, face matching, emotion matching, and emotion selection tasks. In addition, elderly subjects were administered a multicomponent cognitive test: the Neurobehavioral Cognitive Status Examination (Cognistat) and the Geriatric Depression Scale-Short Version. We analyzed these factors using multiple linear regression.

Results

There were no significant differences between the two groups in the face perception task, but in the face matching, emotion matching, and emotion selection tasks, elderly subjects showed significantly poorer performance. Among elderly subjects, multiple regression analyses showed that performance on the emotion matching task was predicted by age, emotional status, and cognitive function, but paradoxical relationships were observed between recognition of emotional faces and some verbal functions. In addition, 47% of elderly participants showed cognitive decline in one or more domains, although all of them had total Cognistat scores above the cutoff.

Conclusion

It might be crucial to consider preclinical pathological changes such as mild cognitive impairment when testing for age effects in elderly populations.

Identification of predictors for mini-mental state examination and revised Hasegawa's Dementia Scale scores using MR-based brain morphometry

Purpose

The early detection of cognitive function decline is crucial to help manage or slow the progression of symptoms. The Mini-Mental State Examination (MMSE) and revised Hasegawa's Dementia Scale (HDS-R) are widely used in screening for cognitive impairment. The purpose of this study was to explore common predictors of the two different cognitive testing systems using MR-based brain morphometry.

Materials and Methods

This retrospective study included 200 subjects with clinical suspicion of cognitive impairment who underwent 3D T1-weighted MRI at our institution between February 2019 and August 2020. Variables related to the volume of deep gray matter and 70 cortical thicknesses were obtained from the MR images using voxel-based specific regional analysis system for Alzheimer's disease (VSRAD) and FreeSurfer software. The correlation between each variable including age and MMSE/HDS-R scores was evaluated using uni- and multi-variate logistic regression analyses.

Results

In univariate analysis, parameters include hippocampal volume and bilateral entorhinal cortex (ERC) thickness showed moderate correlation coefficients with both MMSE and HDS-R scores. Multivariate analysis demonstrated the right ERC thickness was the common parameter which significantly correlates with both MMSE and HDS-R scores (p < 0.05).

Conclusion

Right ERC thickness appears to offer a useful predictive biomarker for both MMSE and HDS-R scores.

Association between Regional Cerebral Blood Flow and Mini-Mental State Examination Score in Patients with Alzheimer's Disease

BACKGROUND

In patients with Alzheimer's disease (AD), cerebral blood flow (CBF) is decreased from the early stages. CBF in AD is currently estimated from Z-scores using statistical analysis. However, the Z-score is not considered the impaired area ratio.

METHODS

In the present study, a novel indicator, ΣzS, associated with brain surface area and Zscores, is defined and the association with regional CBF has been estimated using Mini-Mental State Examination (MMSE) scores, which indicate the severity of cognitive impairment in patients with AD.

RESULTS

A negative correlation was detected between ΣzS in the posterior cingulate gyrus and the subset numbers 1, 2, and 5 of the total MMSE scores. Furthermore, a negative correlation was detected between the total MMSE score and ΣzS in Brodmann area 30, which is a subdivided area of the brain.

CONCLUSION

These results suggest that ΣzS may be a useful indicator of CBF metabolism, and thus may improve the current understanding of cognitive function in patients with AD.

Usefulness of CogEvo, a computerized cognitive assessment and training tool, for distinguishing patients with mild Alzheimer's disease and mild cognitive impairment from cognitively normal older people

Aim

This study aimed to assess whether CogEvo, a computerized cognitive assessment and training tool, could distinguish patients with mild Alzheimer's disease and mild cognitive impairment from cognitively normal older people.

Methods

This cross‐sectional study enrolled 166 participants with Alzheimer's disease, mild cognitive impairment and cognitively normal older people. In CogEvo, five types of cognitive tasks were carried out, and the z‐scores were used as a composite score. Logistic regression and receiver operating characteristics analyses were then carried out to evaluate the usefulness of CogEvo in distinguishing between the three groups.

Results

CogEvo and Mini‐Mental State Examination scores showed excellent correlation, and could significantly differentiate between the Alzheimer's disease, mild cognitive impairment and cognitively normal older people groups (Mini‐Mental State Examination 20.4 ± 3.5, 25.5 ± 1.6 and 27.6 ± 2.0, respectively; CogEvo: −1.9 ± 0.9, −0.8 ± 0.8 and 0.0 ± 1.0, respectively; both P < 0.001 by analysis of variance). Logistic regression analysis adjusted for age, sex and years of education significantly differentiated the mild cognitive dysfunction group (mild cognitive impairment plus mild Alzheimer's disease; n = 78) from the cognitively normal group (n = 88) (P < 0.001), whereas receiver operating characteristics analysis showed moderate accuracy (area under the receiver operating characteristic curve 0.830).

Conclusions

These results suggest that CogEvo, a computerized cognitive assessment tool, is useful for evaluating early‐stage cognitive impairment. Further studies are required to assess its effectiveness as a combination assessment and training tool. Geriatr Gerontol Int 2021; 21: 192–196.

A Cross-sectional Study of Attention Bias for Facial Expression Stimulation in Patients with Stroke at the Convalescence Stage

BACKGROUND

Post-stroke depression increases the likelihood of adverse physical symptoms. Attentional bias (AB) for negative stimuli is important in depression onset, maintenance, and remission. Stroke is more likely in older adults, who can have reduced cognitive function. Individuals with mild cognitive impairment (MCI) can have delayed reaction times (RTs). We hypothesized that RT to select neutral facial expression is affected by depressive symptoms and cognitive function in patients with stroke.

METHODS

This study analyzed 61 patients with stroke. Beck Depression Inventory-Second Edition (BDI-II) and Profile of Mood States (short version) scores were determined. Task stimuli comprised eight pairs of facial expressions containing affective (angry) and neutral faces. AB was measured as the RT to select the neutral face in two simultaneously presented images using attention bias modification (ABM) software. Patients were grouped according to depressive symptoms using BDI-II scores. Between-subject factors of depressive symptoms and cognitive function were determined by ANCOVA.

RESULTS

No significant interaction was found between depressive symptoms and cognitive function on RT. There was a main effect of cognitive function, but not depressive symptoms. In patients with hemiparesis and depressive symptoms, RT was significantly shorter in patients without MCI compared with patients with MCI.

CONCLUSIONS

People with stroke and elevated depression symptoms with hemiparesis but without MCI quickly selected neutral facial expressions from neutral and aversive expressions, and thus do not need ABM to escape aversive stimuli. ABM in response to aversive stimuli may be useful in evaluating negative emotions in individuals with post-stroke depression without MCI.

Cognitive Impairment and Dementia in Primary Care: Current Knowledge and Future Directions Based on Findings From a Large Cross-Sectional Study in Crete, Greece

Introduction: Dementia severely affects the quality of life of patients and their caregivers; however, it is often not adequately addressed in the context of a primary care consultation, especially in patients with multi-morbidity. Study Population and Methods: A cross-sectional study was conducted between March-2013 and December-2014 among 3,140 consecutive patients aged >60 years visiting 14 primary health care practices in Crete, Greece. The Mini-Mental-State-Examination [MMSE] was used to measure cognitive status using the conventional 24-point cut-off. Participants who scored low on MMSE were matched with a group of elders scoring >24 points, according to age and education; both groups underwent comprehensive neuropsychiatric and neuropsychological assessment. For the diagnosis of dementia and Mild-Cognitive-Impairment (MCI), the Diagnostic and Statistical Manual-of-Mental-Disorders (DSM-IV) criteria and the International-Working-Group (IWG) criteria were used. Chronic conditions were categorized according to ICD-10 categories. Logistic regression was used to provide associations between chronic illnesses and cognitive impairment according to MMSE scores. Generalized Linear Model Lasso Regularization was used for feature selection in MMSE items. A two-layer artificial neural network model was used to classify participants as impaired (dementia/MCI) vs. non-impaired. Results: In the total sample of 3,140 participants (42.1% men; mean age 73.7 SD = 7.8 years), low MMSE scores were identified in 645 (20.5%) participants. Among participants with low MMSE scores 344 (54.1%) underwent comprehensive neuropsychiatric evaluation and 185 (53.8%) were diagnosed with Mild-Cognitive-Impairment (MCI) and 118 (34.3%) with dementia. Mental and behavioral disorders (F00-F99) and diseases of the nervous system (G00-G99) increased the odds of low MMSE scores in both genders. Generalized linear model lasso regularization indicated that 7/30 MMSE questions contributed the most to the classification of patients as impaired (dementia/MCI) vs. non-impaired with a combined accuracy of 82.0%. These MMSE items were questions 5, 13, 19, 20, 22, 23, and 26 of the Greek version of MMSE assessing orientation in time, repetition, calculation, registration, and visuo-constructive ability. Conclusions: Our study identified certain chronic illness-complexes that were associated with low MMSE scores within the context of primary care consultation. Also, our analysis indicated that seven MMSE items provide strong evidence for the presence of dementia or MCI.

Network analysis of the structure and change in the mini-mental state examination: a nationally representative sample

PURPOSE

The structure of the mini-mental state examination (MMSE) is inconsistent across factor analytic studies, and yet to be examined based on network analysis. The current study aims to identify the (I) cross-sectional network structure and (II) longitudinal network changes of the MMSE.

METHODS

The MMSE was administered to a nationally representative sample of older adults (age 50 and over) in Ireland twice over 4 years (2012-2013: N = 7207; 2016: N = 5715). Psychometric network analysis was computed at each time point to identify structure, strength and magnitude of the network associations. Item clustering was examined, and modularity scores were computed to measure the overall strength of clustering. Centrality indices were used to identify the main aspects of the MMSE. Longitudinal differences between the networks were examined.

RESULTS

Cross-sectionally, the MMSE network structure clustered into a single community (modularity score = 0) with orientation items identified as most central. Longitudinally, the MMSE was time invariant regarding structure, centrality and magnitude of the positive associations between the items. The average magnitude of the negative associations increased over time[(t(65.15) = 3.78, p < 0.001; time 1: M = - 0.59, SD = 0.58 time 2: M = - 1.65, SD = 1.97] as did their percentage.

CONCLUSION

Network analysis of the MMSE showed that the measure consisted of a single entity of cognitive functioning irrespective of time. Orientation items were repeatedly identified as most central. Longitudinal changes of the network were evident in increased negative associations between selected cognitive components after 4 years of follow-up. These changes may be explained by neuro-cognitive compensation processes.

An iPad application-based intervention for improving post-stroke depression symptoms in a convalescent rehabilitation ward: A pilot randomized controlled clinical trial protocol

BACKGROUND

Post-stroke depression (PSD) is a neuropsychiatric sequela that causes serious adverse effects on the prognosis of stroke patients. Our developed iPad application is a very innovative approach designed to improve participants' depressive symptoms by presenting positive words stimuli in a video. Although this application has fewer side effects than existing pharmacological and non-pharmacological interventions and is likely less burdensome for patients and caregivers, its efficacy for PSD has not been investigated. Here we present a pilot randomized controlled trial (RCT) protocol to investigate the therapeutic potential of this application intervention for PSD patients.

METHODS

This study is designed as a 5-week, single-center, open-label, parallel-group, pilot RCT. Thirty-two patients with PSD will be randomly assigned to a combination of the iPad application and usual rehabilitation or usual rehabilitation alone (1:1 allocation ratio). The iPad application intervention lasts 3 min a day, and the usual rehabilitation lasts 3 h a day. The primary outcome is the change from baseline in The Center for Epidemiologic Studies Depression Scale score at the end of the 5-week intervention.

DISCUSSION

This pilot RCT is the first study to investigate the potential of iPad application interventions to reduce depressive symptoms in PSD patients. This pilot RCT determines whether this is a viable and effective intervention and informs the design for a full-scale trial. If our hypothesis is correct, this trial can provide evidence to augment the standard practice of iPad application interventions to improve depressive symptoms in patients with PSD.

Relationship between Performance on the Mini-Mental State Examination Sub-Items and Activities of Daily Living in Patients with Alzheimer's Disease

Mini-mental state examination (MMSE) subitems provide useful information about the cognitive status of patients with Alzheimer's disease (AD). If the relationship between MMSE subitems and activities of daily living (ADL) can be shown, the performance of sub-items can predict ADL status and may provide useful information for early ADL intervention. Therefore, the purpose of this study was to investigate the relationship between MMSE subitem scores and ADL. The study sample consisted of 718 patients with AD. Logistic regression analysis using the Physical Self-maintenance Scale (PSMS) and Lawton's Instrumental ADL (L-IADL) was performed with each of the subitems as the dependent variables and the MMSE subitem as the independent variable. As a result, the subitems of MMSE, which are strongly related to each item in PSMS differed (e.g., toilet: registration odds ratio 3.00, grooming: naming 3.66). In the case of L-IADL, most items were strongly associated with "writing" (e.g., shopping: odds ratio 4.29, laundry 3.83). In clinical practice, we often focus only on the total MMSE score in patients with AD. However, the relationship between each MMSE subitem and ADL suggested in this study may be useful information that can be linked to ADL care from the performance of the MMSE subitem.

Is Barthel Index Suitable for Assessing Activities of Daily Living in Patients With Dementia?

OBJECTIVES

To evaluate application of the Barthel Index (BI) in assessing basic activities of daily living (ADL) of patients with dementia using Rasch analysis.

DESIGN

A multi-country cross-sectional study.

SETTING AND PARTICIPANTS

Nineteen long-term care facilities located in China, Japan, South Korea, and Thailand. A total of 644 patients with dementia were included.

METHODS

Unidimensionality, global and item fit, local dependence, person-item targeting, threshold disordering, and differential item functioning (DIF) were examined. Negative correlations between scores for DIF items and Neuropsychiatric Inventory Nursing Home version (NPI-NH) were evaluated.

RESULTS

Item reliability (1.0) and person reliability (.88) were acceptable. The Rasch dimension explained 72.9% of the variance (Eigenvalue = 27), while the first contrast explained 6.6% (Eigenvalue = 2.4). The "mobility" was misfitting to the Rasch model (infit mean square = 1.86). The overall difficulty of the BI exceeded patients' ability (person location = -2.27 logits). The "stairs climbing" and "mobility" showed narrow category thresholds (< 1.4 logits). The location of "controlling bladder" and "toilet use" overlapped. Removing "stairs climbing", collapsing categories with narrow threshold widths in "mobility", and combining "controlling bowel" and "controlling bladder" into one item, improved unidimensionality, and item fit of the scale. Only three items ("grooming", "dressing", and "toilet use") were free from DIF across countries. The scores for "feeding" were negatively related to scores for "disinhibition" (r = -0.46, P < 0.01), and scores for "controlling bowel" were negatively related to scores for "disinhibition" (r = -0.44, P < 0.01), "agitation" (r = -0.32, P < 0.05), and "aggression" (r = -0.27, P < 0.01) in Japanese samples.

CONCLUSIONS AND IMPLICATIONS

The performance of the BI for assessing patients with dementia might be compromised by misfit items, person-item mistargeting, measurement gaps, redundant items, narrow threshold width, and item bias. Mobility ability might not be helpful for determining capability of basic ADL in the patients. Comparisons of BI scores between countries should be undertaken with caution due to item bias. Neuropsychiatric symptoms might interact with basic ADL abilities of the patients. We will not suggest using the instrument in patients with dementia, without future refining to improve its performance.

Three-year prospective study on olfaction of patients with Parkinson's disease

OBJECTIVE

We conducted a 3-year prospective study on olfaction of patients with Parkinson's disease (PD) in order to examine the severity and frequency of smell disorder in PD using odor identification test, Open Essence (OE) and to verify the validity of olfactory tests as a predictor of cognitive symptom onset of PD.

PATIENTS AND METHODS

We conducted a prospective study by performing an annual examination over a 3-year period. For 56 cases diagnosed with PD by the Department of Neurology at our hospital, OE and Jet Stream Olfactometry (JSO) were performed to assess the olfactory function, and Mini-Mental-State Examination (MMSE) was conducted to measure cognitive impairment.

RESULTS

At the beginning, 56 cases were examined, of which 42 remained to be followed up for 3 years. Based on the results of baseline, we found a correlation between OE and the average cognitive thresholds of JSO, but did not find any correlation between OE and MMSE. OE (median 4.0→4.0) and the average cognitive thresholds of JSO (median 2.2→1.6)　decreased after 3 years, and MMSE (median 29→29) also declined, but not significantly. At the 3rd year, 6 cases with MMSE score of 23 or less were identified as suspected dementia and 36 cases with more than 24 points were defined as an invariant group. In order to distinguish these two groups, OE scores of baselines were evaluated with a combination of 12 odors. Sensitivity 1.0 and specificity 0.722 were obtained and the sensitivity+specificity value (1.722) was the highest when the number of correct answers was 4 or less using an odor combination of lumber, menthol, Japanese orange, gas for household use, Hinoki cypress and condensed milk.

CONCLUSION

When the number of correct answers of 6 odors (lumber, menthol, Japanese orange, gas for household use, Hinoki cypress and condensed milk) is 4 or less in patients with PD, there is a possibility that MMSE declines in 3 years.

Type D personality is a predictor of prolonged acute brain dysfunction (delirium/coma) after cardiovascular surgery

BACKGROUND

Previous studies have shown a relationship between delirium and depressive symptoms after cardiac surgery with distress personalities linking to negative surgical outcomes. The aim of the present study is to further investigate the association between patients with Type D (distressed) personality with regards to delirium after cardiac surgery.

METHODS

We conducted a consecutive-sample observational cohort pilot study with an estimated 142 patients needed. Enrollment criteria included patients aged ≥18 years who were undergoing planned cardiovascular, thoracic and abdominal artery surgery between October 2015 to August 2016 at the University of Tsukuba Hospital, Japan. All patients were screened by Type-D Personality Scale-14 (DS14) as well as the Hospital Anxiety and Depression Scale (HADS) the day before surgery. Following surgery, daily data was collected during recovery and included severity of organ dysfunction, sedative/analgesic exposure and other relevant information. We then evaluated the association between Type D personality and delirium/coma days (DCDs) during the 7-day study period. We applied regression and mediation modeling for this study.

RESULTS

A total of 142 patients were enrolled in the present study and the total prevalence of delirium was found to be 34% and 26% of the patients were Type D. Non-Type D personality patients experienced an average of 1.3 DCDs during the week after surgery while Type D patients experienced 2.1 days over the week after surgery. Multivariate analysis showed that Type D personality was significantly associated with increased DCDs (OR:2.8, 95%CI:1.3-6.1) after adjustment for depressive symptoms and clinical variables. Additionally, there was a significant Type D x depression interaction effect (OR:1.7, 95% CI:1.2-2.2), and depressive symptoms were associated with DCDs in Type D patients, but not in non-Type D patients. Mediation modeling showed that depressive symptoms partially mediated the association of Type D personality with DCDs (Aroian test =0.04).

CONCLUSIONS

Type D personality is a prognostic predictor for prolonged acute brain dysfunction (delirium/coma) in cardiovascular patients independent from depressive symptoms and Type D personality-associated depressive symptoms increase the magnitude of acute brain dysfunction.

Detailed analysis of the Japanese version of the Rapid Dementia Screening Test using Arabic-hiragana conversion

AIM

The number-transcoding task on the Japanese version of the Rapid Dementia Screening Test (RDST-J) requires conversion between Arabic and Chinese numerals (209 to , 4054 to , to 681, to 2027). In this task, questions and answers are written for Chinese-Arabic conversion. We reported that the RDST-J could distinguish subjects with Alzheimer's disease with a Clinical Dementia Rating Scale score of 0.5 from controls. In this study, we investigated the impact of changing the task to a hiragana-Arabic conversion.

METHODS

Participants consisted of 45 patients with a Clinical Dementia Rating Scale score of 0.5 and 52 normal controls.

RESULTS

The sensitivity and specificity of total scores ≥9 on the two RDST-J versions for discriminating subjects with a Clinical Dementia Rating Scale score of 0.5 from controls were 73.1% and 75.5%, respectively, on the original version, and 71.8% and 73.0%, respectively, on the revised version.

CONCLUSIONS

The sensitivity and specificity of the revised version of the RDST-J was equivalent to those of the original version.

Detailed analysis of the Japanese version of the Rapid Dementia Screening Test, revised version

AIM

The number-transcoding task on the Japanese version of the Rapid Dementia Screening Test (RDST-J) requires mutual conversion between Arabic and Chinese numerals (209 to , 4054 to , to 681, to 2027). In this task, question and answer styles of Chinese numerals are written horizontally. We investigated the impact of changing the task so that Chinese numerals are written vertically.

METHODS

Subjects were 211 patients with very mild to severe Alzheimer's disease and 42 normal controls. Mini-Mental State Examination scores ranged from 26 to 12, and Clinical Dementia Rating scores ranged from 0.5 to 3.

RESULTS

Scores of all four subtasks of the transcoding task significantly improved in the revised version compared with the original version. The sensitivity and specificity of total scores ≥9 on the RDST-J original and revised versions for discriminating between controls and subjects with Clinical Dementia Rating scores of 0.5 were 63.8% and 76.6% on the original and 60.1% and 85.8% on revised version.

CONCLUSIONS

The revised RDST-J total score had low sensitivity and high specificity compared with the original RDST-J for discriminating subjects with Clinical Dementia Rating scores of 0.5 from controls.

Cognitive impairment and hypertension in older adults living in extreme poverty: a cross-sectional study in Peru

BACKGROUND

Previous studies have shown that hypertension is a risk factor for cognitive impairment, but whether this association is also present in extremely poor populations in Low Middle Income Countries settings remains to be studied. Understanding other drivers of cognitive impairment in this unique population also merits attention.

METHODS

We performed a secondary analysis using data from the "Encuesta de Salud y Bienestar del Adulto Mayor", a regional survey conducted in an extremely poor population of people older than 65 years old from 12 Peruvian cities in 2012. The outcome variable was cognitive impairment, determined by a score of ≤7 in the modified Mini-Mental State Examination. The exposure was self-reported hypertension status. Variables such as age, gender, controlled hypertension, education level, occupation, depression and area of living (rural/urban) were included in the adjusted analysis. We used Poisson regression with robust variance to calculate prevalence ratios (PR) and 95% confidence interval (95% CI) adjusting for confounders.

RESULTS

Data from 3842 participants was analyzed, 51.8% were older than 70 years, and 45.6% were females. The prevalence of cognitive impairment was 1.7% (95% CI 1.3%-2.1%). There was no significant difference on the prevalence of cognitive impairment between the group of individuals with hypertension in comparison with those without hypertension (PR = 0.64, 95% CI 0.33-1.23).

CONCLUSIONS

The association described between hypertension and cognitive impairment was not found in a sample of extremely poor Peruvian older adults.

Detailed analysis of error patterns in the number-transcoding task on the Japanese version of the Rapid Dementia Screening Test

AIM

The number-transcoding task on the Japanese version of the Rapid Dementia Screening Test requires mutual conversion between Arabic and Chinese numerals (e.g. 209 → , 4054 → ,  → 681,  → 2027). During this task, some characteristic errors have been seen among patients with Alzheimer's disease (AD). The objective of this study was to clarify whether the frequency of appearance of error patterns differs between patients with mild and severe AD according to Clinical Dementia Rating (CDR) scores.

METHODS

A total of 250 patients with AD were recruited and subsequently categorized into two groups based on CDR scores (mild AD: CDR of 0.5 or 1; severe AD: CDR of 2 or 3). We analyzed 19 qualitative error patterns, including 15 that had been reported to date and 4 previously unreported errors, in each subtest.

RESULTS

The frequency of appearance of two previously reported and four previously unreported errors in the mild and severe AD groups, respectively, were statistically significant.

CONCLUSIONS

Characteristic error pattern distributions in number transcoding can be observed in patients with mild and severe AD according to CDR scores and offers useful information for interpreting cognitive screening data.

Detailed analysis of the supermarket task included on the Japanese version of the Rapid Dementia Screening Test

AIM

The supermarket task, which is included in the Japanese version of the Rapid Dementia Screening Test, requires the quick (1 min) generation of words for things that can be bought in a supermarket. Cluster size and switches are investigated during this task. We investigated how the severity of dementia related to cluster size and switches on the supermarket task in patients with Alzheimer's disease.

METHODS

We administered the Japanese version of the Rapid Dementia Screening Test to 250 patients with very mild to severe Alzheimer's disease and to 49 healthy volunteers. Patients had Mini-Mental State Examination scores from 12 to 26 and Clinical Dementia Rating scale scores from 0.5 to 3. Patients were divided into four groups based on their Clinical Dementia Rating score (0.5, 1, 2, 3). We performed statistical analyses between the four groups and control subjects based on cluster size and switch scores on the supermarket task.

RESULTS

The score for cluster size and switches deteriorated according to the severity of dementia. Moreover, for subjects with a Clinical Dementia Rating score of 0.5, cluster size was impaired, but switches were intact.

CONCLUSIONS

Our findings indicate that the scores for cluster size and switches on the supermarket task may be useful for detecting the severity of symptoms of dementia in patients with Alzheimer's disease.

The Validity and Reliability of the Mini-Mental State Examination-2 for Detecting Mild Cognitive Impairment and Alzheimer's Disease in a Korean Population

Objective

To examine the validity and reliability of the MMSE-2 for assessing patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) in a Korean population. Specifically, the usefulness of the MMSE-2 as a screening measure for detecting early cognitive change, which has not been detectable through the MMSE, was examined.

Methods

Two-hundred and twenty-six patients with MCI, 97 patients with AD, and 91 healthy older adults were recruited. All participants consented to examination with the MMSE-2, the MMSE, and other detailed neuropsychological assessments.

Results

The MMSE-2 performed well in discriminating participants across Clinical Dementia Rating (CDR) stages and CDR-Sum of Boxes (CDR-SOB), and it showed excellent internal consistency, high test-retest reliability, high interrater reliability, and good concurrent validity with the MMSE and other detailed neuropsychological assessments. The MMSE-2 was divided into two factors (tests that are sensitive to decline in cognitive functions vs. tests that are not sensitive to decline in cognitive functions) in normal cognitive aging. Moreover, the MMSE-2 was divided into two factors (tests related overall cognitive functioning other than memory vs. tests related to episodic memory) in patients with AD. Finally, the MMSE-2 was divided into three factors (tests related to working memory and frontal lobe functioning vs. tests related to verbal memory vs. tests related to orientation and immediate recall) in patients with MCI. The sensitivity and specificity of the three versions of the MMSE-2 were relatively high in discriminating participants with normal cognitive aging from patients with MCI and AD.

Conclusion

The MMSE-2 is a valid and reliable cognitive screening instrument for assessing cognitive impairment in a Korean population, but its ability to distinguish patients with MCI from those with normal cognitive aging may not be as highly sensitive as expected.

The Japanese version of the Rapid Dementia Screening Test is effective compared to the clock-drawing test for detecting patients with mild Alzheimer's disease

BACKGROUND

The Japanese version of the Rapid Dementia Screening Test (RDST-J) and the clock-drawing test (CDT) are both brief psychometric screening tools used to detect the severity of Alzheimer's disease. It remains unclear, however, which is more effective when screening for mild Alzheimer's disease.

METHODS

We administered the RDST-J and CDT to 250 patients with very mild to severe Alzheimer's disease and to 49 healthy volunteers. Patients with a Mini-Mental State Examination score of 12-26 had Clinical Dementia Rating (CDR) scores from 0.5 to 3. Patients were divided into four groups according to CDR score. We performed one-way factorial anova between the four groups and control subjects based on the CDT and RDST-J scores.

RESULTS

Data analysis revealed that RDST-J could distinguish patients with CDR 0.5 from the controls, but CDT could not. Furthermore, the sensitivity of a RDST-J score ≥8 was 57.1%, with a specificity of 81.0%, and the sensitivity of a RDST-J score ≥9 was 79.6%, with a specificity of 55.1% for discriminating CDR 0.5 from controls.

CONCLUSIONS

RDST-J is a more effective tool than CDT for distinguishing CDR 0.5 from controls.

Effect of Long-Term Body-Mass-Based Resistance Exercise on Cognitive Function in Elderly People

The study examined the effect of a body-mass-based home exercise program on cognitive functioning among 170 male and female elderly people (52-81 years). This program comprised five kinds of resistance exercises that elderly people can perform at home without supervision or specialized equipment using only their body mass for resistance. Various cognitive tasks were used to assess cognitive functioning, including a simple reaction task, Go/No-Go reaction task, Stroop task, serial subtraction task, and coincident timing task. These tasks were performed before and after a 3-month body-mass-based home exercise program. Although there were no significant improvements in the simple reaction and coincident timing tasks, significant improvement was shown in the Go/No-Go reaction task and serial subtraction task. This study shows that even simple resistance exercise, using only body mass for resistance, may be an effective method for preventing age-related cognitive decline of inhibitory control and working memory among elderly people.

Serum uric acid and impaired cognitive function in a cohort of healthy young elderly: data from the Brisighella Study

Contrasting evidence shows a possible association between serum uric acid (SUA) and cognitive function in elderly subjects. We aimed at evaluating the impact of circulating SUA levels on cognitive function in a cohort of pharmacologically untreated young elderly subjects. For this study, we selected 288 healthy young elderly participants from the historical cohort of the Brisighella Heart Study (M: 108, F: 180; mean age: 69 ± 6 years old). Exclusion criteria were limitation of activities of daily living, depression, chronic pharmacological treatment, patients in secondary prevention for cardiovascular disease, known neurodegenerative disorders, confirmed diabetes or gout, and ultrasonic evaluated carotid atherosclerosis. Cognitive functions were assessed by scholarship-adjusted mini-mental state examination (MMSE). A stepwise multiple regression analysis was carried out including a large set of clinical and laboratory parameters, carotid intima-media thickness, and the Beck Depression scale score. The analysis was then repeated by gender. In the multiple regression analysis, the only factors associated with the MMSE score were: age (B = -0.058, 95% CI -0.108, -0.009, p = 0.022), LDL-C (B = -0.639, 95% CI -0.912, -0.411, p = 0.034) and SUA (B = -0.527, 95% CI -0.709, -0.344, p = 0.022). Repeating the analysis by low or high SUA level (based on the gender specific SUA distribution 50th percentile), it appears that in subjects with a low SUA, cognitive decline is only associated with age, while in those with high SUA it is associated with LDL-C (OR 1.18, 95% CI 1.07-1.33, p = 0.019) and SBP (OR 1.02, 95% CI 1.001-1.048, p = 0.039). Our data demonstrate a positive association between circulating levels of uric acid and cognitive dysfunction in a sample of pharmacologically untreated young elderly subjects.

Arterial Stiffness Predicts Cognitive Decline in Japanese Community-dwelling Elderly Subjects: A One-year Follow-up Study

AIM

The purpose of this study was to determine whether arterial stiffness can be used to predict one-year changes in the cognitive function in Japanese community-dwelling elderly subjects.

METHODS

A total of 103 Japanese community-dwelling elderly patients joined this study. Information regarding the age, height, weight, gender and past medical history of each participant was obtained. Additionally, arterial stiffness was determined according to the cardio-ankle vascular index (CAVI), and the cognitive function was assessed with the Mini-Mental State Examination (MMSE). One year later, we performed the MMSE in the same subjects. After dividing the cohort according to the 80th percentile of the CAVI (normal and arterial stiffness [AS] groups), we examined whether the degree of cognitive decline, as determined using the pre- and post-MMSE, was significantly different based on the severity of arterial stiffness, adjusted for age, BMI, gender and the pre-MMSE scores.

RESULTS

Of the 103 subjects who participated in the pre-data collection, 74 (38 men and 36 women, 73.4±4.0 years) joined the post-data collection. We found a significant difference in the change in the post-MMSE scores between the normal and AS groups (pre-MMSE: normal group [27.4±2.1] and AS group [26.9±2.4] and post-MMSE: normal group [27.2±2.1] and AS group [25.5±2.3], F=5.95, p=0.02). For each domain of the MMSE, the changes in MMSE-attention-and-calculation (F=5.11, p=0.03) and MMSE-language (F=4.32, p=0.04) were significantly different according to an ANCOVA.

CONCLUSIONS

We found that arterial stiffness predicts cognitive decline in Japanese community-dwelling elderly subjects regardless of the initial level of the global cognitive function. This finding indicates the potential use of the degree of arterial stiffness as an indicator for preventing or delaying the onset of dementia in the elderly.

Construct validity of the mini mental state examination across time in a sample with low-education levels: 10-year follow-up of the Bambuí Cohort Study of Ageing

OBJECTIVE

The study aims to investigate whether longitudinal data on the structure of the mini mental state examination (MMSE) collected in an older Brazilian cohort support factorial invariance over time.

DESIGN

Analysis of 10-year data from a community-based cohort study was performed.

SETTING

The study took place in Bambuí, Brazil.

PARTICIPANTS

The study sample comprised 1558 (89.4%) of all eligible 1742 elderly residents.

MEASUREMENTS

A standard Brazilian version of the MMSE was used.

RESULTS

A five-factor solution (developed on the baseline of the cohort) either with no constraints or with loadings constrained to equality across time provided a reasonable fit for the MMSE. A comparison between both models suggested that the model with no constraints was superior. However, the five absolute goodness-of-fit indices suggest that the fully constrained model was also adequate and did not differ substantively from the model without any restriction.

CONCLUSION

The structure of the MMSE remained relatively unchanged across the 10 measurement times, thus providing evidence for the good construct validity of the scale across time.

Time orientation and visual construction subdomains of the MMSE as independent risk factors for hip fractures

Hip fractures may result in severe morbidity and mortality among elderly patients. Many risk factors for hip fracture have been identified, including cognitive impairment. The authors used the Mini-Mental State Examination (MMSE), a screen test for cognitive impairment, as the study material for their hip fracture survey. The authors hypothesized that certain subdomains would have a strong association with hip fractures. A total of 217 individuals with hip fracture and 215 individuals without hip fractures matched by age and sex were recruited for the study. A standardized questionnaire was used to register their MMSE performance and demographic data. Scores for these subdomains were analyzed using conditional logistic regression with adjustment of 5 clinically important risk factors for hip fractures, including educational level, difficulty with activities of daily living, physical activities, body mass index, and bone mineral density. In univariate analyses, those subdomains with lower scores had significantly higher hip fracture risks. In multivariate analyses, only the subdomains time orientation and visual construction remained significant. Further receiver operating characteristic curve analysis revealed that these 2 subdomains could differentiate hip fractures from nonfractures better than total MMSE. Time orientation and visual construction subdomains are strong predictors for hip fractures and can be used effectively in the hospital to screen patients at high risk of hip fractures. Prospective cohort studies are warranted to further validate this finding.

Differences in dual-task performance and prefrontal cortex activation between younger and older adults

BACKGROUND

The purpose of this study was to examine task-related changes in prefrontal cortex (PFC) activity during a dual-task in both healthy young and older adults and compare patterns of activation between the age groups. We also sought to determine whether brain activation during a dual-task relates to executive/attentional function and how measured factors associated with both of these functions vary between older and younger adults.

RESULTS

Thirty-five healthy volunteers (20 young and 15 elderly) participated in this study. Near-infrared spectroscopy (NIRS) was employed to measure PFC activation during a single-task (performing calculations or stepping) and dual-task (performing both single-tasks at once). Cognitive function was assessed in the older patients with the Trail-making test part B (TMT-B). Major outcomes were task performance, brain activation during task (oxygenated haemoglobin: Oxy-Hb) measured by NIRS, and TMT-B score. Mixed ANOVAs were used to compare task factors and age groups in task performance. Mixed ANOVAs also compared task factors, age group and time factors in task-induced changes in measured Oxy-Hb. Among the older participants, correlations between the TMT-B score and Oxy-Hb values measured in each single-task and in the dual-task were examined using a Pearson correlation coefficient.Oxy-Hb values were significantly increased in both the calculation task and the dual-task within patients in both age groups. However, the Oxy-Hb values associated with there were higher in the older group during the post-task period for the dual-task. Also, there were significant negative correlations between both task-performance accuracy and Oxy-Hb values during the dual-task and participant TMT-B scores.

CONCLUSIONS

Older adults demonstrated age-specific PFC activation in response to dual-task challenge. There was also a significant negative correlation between PFC activation during dual-task and executive/attentional function. These findings suggest that the high cognitive load induced by dual-task activity generates increased PFC activity in older adults. However, this relationship appeared to be strongest in participants with better baseline attention and executive functions.

A retrospective analysis of the sentence writing component of the Mini Mental State Examination: cognitive and affective aspects

BACKGROUND

One of the components of the Mini Mental State Examination (MMSE) is the request to write a sentence. We investigated the relationship between the characteristics of the written sentence of the MMSE and the cognitive and affective status of elderly patients.

METHODS

The characteristics of the sentence were compared to the total MMSE score, sociodemographic characteristics, tests evaluating cognition and affective status, and diagnoses.

RESULTS

The number of words was significantly associated with the degree of cognitive impairment, whereas the emotional polarity of sentences and concerns about health were associated with depression.

CONCLUSIONS

Characteristics of the MMSE sentence may provide important additional information regarding both cognition and affect when assessing older people.

Using the Folstein Mini Mental State Exam (MMSE) to explore methodological issues in cognitive aging research

Cognitive scales are used frequently in geriatric research and practice. These instruments are constructed with underlying assumptions that are a part of their validation process. A common measurement scale used in older adults is the Folstein Mini Mental State Exam (MMSE). The MMSE was designed to screen for cognitive impairment and is used often in geriatric research. This paper has three aims. Aim one was to explore four potential threats to validity in the use of the MMSE: (1) administering the exam without meeting the underlying assumptions, (2) not reporting that the underlying assumptions were assessed prior to test administration, (3) use of variable and inconsistent cut-off scores for the determination of presence of cognitive impairment, and (4) failure to adjust the scores based on the demographic characteristics of the tested subject. Aim two was to conduct a literature search to determine if the assumptions of (1) education level assessment, (2) sensory assessment, and (3) language fluency were being met and clearly reported in published research using the MMSE. Aim three was to provide recommendations to minimalize threats to validity in research studies that use cognitive scales, such as the MMSE. We found inconsistencies in published work in reporting whether or not subjects meet the assumptions that underlie a reliable and valid MMSE score. These inconsistencies can pose threats to the reliability of exam results. Fourteen of the 50 studies reviewed reported inclusion of all three of these assumptions. Inconsistencies in reporting the inclusion of the underlying assumptions for a reliable score could mean that subjects were not appropriate to be tested by use of the MMSE or that an appropriate test administration of the MMSE was not clearly reported. Thus, the research literature could have threats to both validity and reliability based on misuse of or improper reported use of the MMSE. Six recommendations are provided to minimalize these threats in future research.

Using the Folstein Mini Mental State Exam (MMSE) to explore methodological issues in cognitive aging research

Cognitive scales are used frequently in geriatric research and practice. These instruments are constructed with underlying assumptions that are a part of their validation process. A common measurement scale used in older adults is the Folstein Mini Mental State Exam (MMSE). The MMSE was designed to screen for cognitive impairment and is used often in geriatric research. This paper has three aims. Aim one was to explore four potential threats to validity in the use of the MMSE: (1) administering the exam without meeting the underlying assumptions, (2) not reporting that the underlying assumptions were assessed prior to test administration, (3) use of variable and inconsistent cut-off scores for the determination of presence of cognitive impairment, and (4) failure to adjust the scores based on the demographic characteristics of the tested subject. Aim two was to conduct a literature search to determine if the assumptions of (1) education level assessment, (2) sensory assessment, and (3) language fluency were being met and clearly reported in published research using the MMSE. Aim three was to provide recommendations to minimalize threats to validity in research studies that use cognitive scales, such as the MMSE. We found inconsistencies in published work in reporting whether or not subjects meet the assumptions that underlie a reliable and valid MMSE score. These inconsistencies can pose threats to the reliability of exam results. Fourteen of the 50 studies reviewed reported inclusion of all three of these assumptions. Inconsistencies in reporting the inclusion of the underlying assumptions for a reliable score could mean that subjects were not appropriate to be tested by use of the MMSE or that an appropriate test administration of the MMSE was not clearly reported. Thus, the research literature could have threats to both validity and reliability based on misuse of or improper reported use of the MMSE. Six recommendations are provided to minimalize these threats in future research.

Temporal resolution deficits in patients with refractory complex partial seizures and mesial temporal sclerosis (MTS)

We studied the temporal resolution ability in patients with refractory complex partial seizures and mesial temporal sclerosis (MTS) using Gaps-In-Noise (GIN) test in a prospective cross-sectional study. Thirteen patients with right MTS (age: 31±7.67 years; M:F=8:5) and 13 patients with left MTS (age: 25.76±8.26 years; M:F=9:4) having normal hearing and mini-mental state examination (MMSE) score of >23/30 were recruited. Fifty healthy volunteers (26.3±5.17 years; M:F=28:22) formed the control group. Gaps-In-Noise test demonstrated impaired temporal resolution: 69.2% of patients with right MTS (RMTS) and 76.9% of patients with left MTS (LMTS) had abnormal scores in the right ear for gap detection threshold (GDT) measure. Similarly, 53.8% of patients in the RMTS group and 76.9% of patients in the LMTS group had abnormal scores in the left ear. In percentage of correct identification (PCI), 46.1% of patients with RMTS and 69.2% of patients with LMTS had poorer scores in the right ear, whereas 46.1% of patients with RMTS and 61.5% of patients with LMTS had poorer scores in the left ear. Both patient groups, viz., RMTS and LMTS, demonstrated bilateral temporal resolution deficits.