Adaptation of the Montreal Cognitive Assessment for elderly Filipino patients

OBJECTIVE

The Montreal Cognitive Assessment (MoCA) is an instrument that aids clinicians in detecting mild cognitive impairment and early Alzheimer's disease. The study aimed to adapt the MoCA for use in the Philippines, and determine its psychometric validity when used in the Filipino setting.

METHODS

The MoCA was adapted by a multidisciplinary team working at the Memory Center of St. Luke's Medical Center, Manila, the Philippines. Contextual adaptation, rather than direct translation, was done. Pilot testing of the Filipino version of the MoCA (MoCA-P) was done on 12 grade 6 pupils and subsequently on 14 cognitively intact elderly people. Reliability testing of the MoCA-P was done on 25 elderly people by trained psychologists. Internal consistency, inter-rater and intra-rater reliability, as well as convergent and divergent validity of the MoCA-P were determined.

RESULTS

The MoCA-P yielded a high level of internal consistency (Cronbach's alpha; = 0.938). Inter-rater and intra-rater reliability were 0.887 (p ≤ 0.05) and 0.969 (p ≤ 0.05), respectively. The MoCA-P correlated negatively with the Epworth Sleepiness Scale (r = -0.233) and had a positive but low correlation with the Mini-Mental State Examination (r = 0.555).

CONCLUSION

Contextual translation and pilot testing yielded several modifications of the MoCA. The MoCA-P is a reliable instrument for use in elderly Filipino patients. Further diagnostic validation of the MoCA-P to establish cutoff scores that would discriminate elderly individuals with normal cognition from those with dementia is needed to establish the clinical utility of the test.

Renal bicarbonate reabsorption and hydrogen ion excretion in normal infants

After acute administration of ammonium chloride, infants 1 to 16 months of age were similar to older children in their capacity to acidify their urine. The infants had a higher rate of excretion of titratable acid and a lower rate of excretion of ammonium but were similar in their rate of excretion of total hydrogen ion.Bicarbonate titrations performed in infants during the first year of life demonstrated a threshold ranging from 21.5 to 22.5 mmoles per L, maximal rate of reabsorption from 2.6 to 2.9 mmoles per 100 ml glomerular filtrate, and marked titration splay. A nephronic frequency distribution curve of the ratio of glomerular filtration rate to tubular reabsorptive capacity demonstrated both heterogeneity and skewing to the right, suggesting the presence of significant numbers of nephrons with low tubular transport capacity relative to filtration rate.It is suggested that the "physiologic acidosis" of the infant is due neither to a limited renal capacity to excrete hydrogen ion nor to a reduced capacity for reabsorption of bicarbonate, but rather to a low renal plasma bicarbonate threshold. Although the level of the threshold may relate to the kinetics of bicarbonate reabsorption during this period, it appears to be due at least in part to functional and morphologic heterogeneity of nephrons.

Novel ATP6V1B1 and ATP6V0A4 mutations in autosomal recessive distal renal tubular acidosis with new evidence for hearing loss

Autosomal recessive distal renal tubular acidosis (rdRTA) is characterised by severe hyperchloraemic metabolic acidosis in childhood, hypokalaemia, decreased urinary calcium solubility, and impaired bone physiology and growth. Two types of rdRTA have been differentiated by the presence or absence of sensorineural hearing loss, but appear otherwise clinically similar. Recently, we identified mutations in genes encoding two different subunits of the renal alpha-intercalated cell's apical H(+)-ATPase that cause rdRTA. Defects in the B1 subunit gene ATP6V1B1, and the a4 subunit gene ATP6V0A4, cause rdRTA with deafness and with preserved hearing, respectively. We have investigated 26 new rdRTA kindreds, of which 23 are consanguineous. Linkage analysis of seven novel SNPs and five polymorphic markers in, and tightly linked to, ATP6V1B1 and ATP6V0A4 suggested that four families do not link to either locus, providing strong evidence for additional genetic heterogeneity. In ATP6V1B1, one novel and five previously reported mutations were found in 10 kindreds. In 12 ATP6V0A4 kindreds, seven of 10 mutations were novel. A further nine novel ATP6V0A4 mutations were found in "sporadic" cases. The previously reported association between ATP6V1B1 defects and severe hearing loss in childhood was maintained. However, several patients with ATP6V0A4 mutations have developed hearing loss, usually in young adulthood. We show here that ATP6V0A4 is expressed within the human inner ear. These findings provide further evidence for genetic heterogeneity in rdRTA, extend the spectrum of disease causing mutations in ATP6V1B1 and ATP6V0A4, and show ATP6V0A4 expression within the cochlea for the first time.

Three new European cases of urofacial (Ochoa) syndrome

We report on three European cases of urofacial (Ochoa) syndrome. This entity was originally described in Colombian patients and very few cases have been reported from other countries. It is likely that they may be missed because of variability of the urinary problems and failure to recognize the characteristic facial grimacing. Establishing an early diagnosis has important consequences for the management and prognosis of urinary problems in these patients.

Right ventricular infarction mimicking anterior infarction: a case report

Right ventricular infarction usually occurs in association with inferior infarction, with no remarkable electrocardiographic signs in conventional leads. This report describes a patient with a previous inferior acute myocardial infarction who developed right ventricular infarction with significant anterior lead ST segment elevation (V1-V4) caused by the loss of two large right ventricular branches during a coronary angioplasty of the right coronary artery. The case is discussed and the literature is reviewed.

[Ketotic hiperglycinemia: one case of possible propionic acidemia (author's transl)]

Authors present the first case to be observed in Spain of neonatal propionic acidemia. The subject is a newborn with symtoms free interval, family consanquinity and siblings who have died prematurely with a similar picture of hyperventilation "sine materiae", progressive metabolic acidosis without anionic discrepancy and terminal coma. The possibility that it might be a question of other metabolopathies is under discussion, but bio-chemical examination, with discovery of large quantities of propionic acid in urine (51 mcg./ml.) and concentrations of aminoacids in plasma, strongly suggest the diagnosis of a new case of neonatal propionic acidemia.

[Urinary tract infections presenting with jaundice (author's transl)]

Ten two to ten weeks old children are presented with urinary tract infection and jaundice. In six cases "E. coli" was the causative organism. Laboratory data seemed to indicate that hemolisis was an important factor in the pathogenesis of jaundice. Treatment with appropriate antibiotics was favorable in all cases. Urinary tract infection with bacteriemia and jaundice is probably the most frequent cause of jaundice among children of two to ten weeks of age.

[Alterations of renal function in pyelonephritis (author's transl)]

Renal function was investigated in a group of ten patients aged two months to eleven years, with chronic or recurrent urinary tract infection caused by different malformations of the urinary tract. The following tests were performed: endogenous creatinine clearance, maximal urinary concentrating ability, urinary acidification, maximal urinary diluting ability, free water clearance, index of fractional distal sodium delivery and index of distal tubular reabsorption of sodium. It is concluded that the follow-up of glomerular function by means of creatinine clearance and of tubular function by means of maximal concentrating ability consitute the most sensible way to detect renal functional impairment in children with chronic or recurrent pyelonephritis.