Population-Based Mini-Mental State Examination Norms in Adults of Mexican Heritage in the Cameron County Hispanic Cohort

BACKGROUND

Accurately identifying cognitive changes in Mexican American (MA) adults using the Mini-Mental State Examination (MMSE) requires knowledge of population-based norms for the MMSE, a scale which has widespread use in research settings.

OBJECTIVE

To describe the distribution of MMSE scores in a large cohort of MA adults, assess the impact of MMSE requirements on their clinical trial eligibility, and explore which factors are most strongly associated with their MMSE scores.

METHODS

Visits between 2004-2021 in the Cameron County Hispanic Cohort were analyzed. Eligible participants were ≥18 years old and of Mexican descent. MMSE distributions before and after stratification by age and years of education (YOE) were assessed, as was the proportion of trial-aged (50-85- year-old) participants with MMSE <24, a minimum MMSE cutoff most frequently used in Alzheimer's disease (AD) clinical trials. As a secondary analysis, random forest models were constructed to estimate the relative association of the MMSE with potentially relevant variables.

RESULTS

The mean age of the sample set (n = 3,404) was 44.4 (SD, 16.0) years old and 64.5% female. Median MMSE was 28 (IQR, 28-29). The percentage of trial-aged participants (n = 1,267) with MMSE <24 was 18.6%; 54.3% among the subset with 0-4 YOE (n = 230). The five variables most associated with the MMSE in the study sample were education, age, exercise, C-reactive protein, and anxiety.

CONCLUSION

The minimum MMSE cutoffs in most phase III prodromal-to-mild AD trials would exclude a significant proportion of trial-aged participants in this MA cohort, including over half of those with 0-4 YOE.

Consensus on the diagnosis and treatment of cow's milk protein allergy of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Cow's milk protein allergy (CMPA) is the most frequent cause of food allergy in the first months of life. Despite the fact that there are different guidelines and recommendations on the management of children with CMPA, there continues to be great variability in diagnostic and therapeutic criteria in Latin America. The Food Allergy Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition summoned a group of Latin American experts to reach a consensus and formulate a document to unify diagnostic and therapeutic criteria for CMPA. Three teams were formed, each with a coordinator, and the members of each team developed a series of statements for their corresponding module: a) clinical manifestations and diagnosis; b) diagnostic tools, and c) treatment. A search of the medical literature was carried out to support the information presented in each module and 28 statements were then selected. The statements were discussed, after which they were evaluated by all the experts, utilizing the Delphi method. Their opinions on statement agreement or disagreement were anonymously issued. The final statements selected were those with above 75% agreement and their corresponding recommendations were formulated, resulting in the document presented herein.

Isometry of the posterior cruciate ligament. Effects of functional load and muscle force application

The effects of functional load and muscle force application on isometry of the posterior cruciate ligament were determined. Eight fresh-frozen cadaver knees were mounted in a custom-designed rig. A full range of motion and muscle forces were applied through the quadriceps, hamstring, and gastrocnemius tendons during a simulated static squat maneuver. The low-load isometric posterior cruciate ligament point was located 5.63 mm proximal and 0.18 mm anterior to the anatomic center of the posterior cruciate ligament origin on the femur. The high-load state, with no gastrocnemius and hamstring muscle forces applied, shifted the isometric point 6.32 mm proximal and 6.72 mm anterior (P < 0.05). Loading the hamstring and gastrocnemius muscles also shifted the isometric point (P < 0.05). This study indicated that the most isometric region of the posterior cruciate ligament femoral attachment changed significantly when functional loads and muscle forces were applied to the knee. This finding may have implications for both surgical reconstruction and rehabilitation of the posterior cruciate ligament-injured knee.

The effects of sectioning of the posterior cruciate ligament and the posterolateral complex on the articular contact pressures within the knee

Articular contact pressures in ten cadaveric knees with intact ligaments were measured with the use of film and a model that simulated non-weight-bearing resistive extension of the knee. The measurements were repeated after sequential sectioning of the posterior cruciate ligament and the posterolateral complex (the posterolateral capsule, the popliteus muscle and tendon, and the lateral collateral ligament). Patellofemoral pressures and quadriceps load were most significantly elevated after combined sectioning of the posterior cruciate ligament and the posterolateral complex. Medial compartment pressure was significantly elevated after sectioning of the posterior cruciate ligament. The results coincided with, and may partially explain, the clinical findings associated with these types of ligamentous injuries.

Effect of cold air on aqueous humor dynamics in humans

Several parameters of aqueous humor dynamics were measured in 11 human subjects before and after exposure of one eye to a continuous stream of cold air. In the treated eye, I.O.P. was found to decrease significantly from a mean +/- SD pre-treatment value of 14.1 +/- 2.3 mmHg to a post-treatment value of 12.6 +/- 2.6 mmHg. Episcleral venous pressure was found to decrease significantly from a pre-treatment value of 6.2 +/- 1.3 mm Hg. No significant changes were found in aqueous flow or total outflow facility, indicating that cold air exposure decreased I.O.P. by causing a decrease in episcleral venous pressure.