Estimation of cognitive impairment in chronic pain patients and characteristics of estimated mild cognitive impairment

Background

Patients with chronic pain suffer from psychological effects such as anxiety due to the pain itself. Pain can not only impair activities of daily living (ADL) and quality of life (QOL), but also impair cognitive function. Therefore, in this study, we aimed to estimate the cognitive function of chronic pain patients using a deep neural network (DNN) model that has already been implemented in society. We investigated the characteristics of patients presumed to have mild cognitive impairment (MCI) and, at the same time, verified the relationship with the questionnaire commonly used in chronic pain research, which is administered by 43 university affiliated hospitals and medical institutions participating in the chronic pain research group of the Ministry of Health, Labor and Welfare in Japan (assessment batteries).

Method

The study included 114 outpatients from a multidisciplinary pain clinic, and we estimated their Mini-Mental State Examination (MMSE) scores based on age and basic blood test data (23 items). Furthermore, we classified the estimated MMSE scores of chronic pain patients into two groups based on a cutoff score of 27, which indicates MCI, and compared the blood data and assessment batteries. Additionally, we used a control group of 252 healthy adults aged 45 years or older who visited a dementia prevention outpatient clinic for comparison with the MMSE scores of chronic pain patients.

Result

The MMSE scores in chronic pain patients were below the cutoff for MCI. When classified into two groups based on the estimated MMSE score of 27 points, WBC, RBC, Hb, Hct, PLT, UA, BUN, creatinine, Triglyceride, and γ-GT were significantly higher in the blood data. In the MCI group, PDAS values were significantly lower. Furthermore, only in the non-MCI group, a significant correlation was found between the estimated MMSE value and BPI, PDAS, and Locomo. The estimated MMSE scores were significantly lower in chronic pain patients than in healthy adults (p = 0.04).

Conclusion

Patients with chronic pain may exhibit cognitive impairment due to systemic metabolic disturbances. This suggests that chronic pain affects activities of daily living, resulting in systemic metabolic disorders.

Six-item cognitive impairment test (6-CIT)'s accuracy as a cognitive screening tool: best cut-off levels in emergency department setting

Background

Nowadays, elderly patients represent a significant number of accesses to the Emergency Department (ED). Working rhythms do not allow to perform complete cognitive analysis, which would, however, be useful for the health care. This study aims to define the optimal cut-off values of the six-item Cognitive Impairment Test (6-CIT) as a cognitive screening tool in ED.

Methods

This study included 215 subjects, evaluated at the Emergency Department of the University Hospital of Monserrato, Cagliari, Italy, from July to December 2021. The accuracy of 6-CIT as a cognitive screening tool was assessed by comparison with Mini Mental State Examination (MMSE).

Results

The correlation coefficient between the two tests was -0.836 (CI: -0.87 to -0.79; p < 0.0001), and 6-CIT showed AUC = 0.947 (CI: 0.908-0.973; p < 0.0001). The 8/9 6-CIT cut-off score presented 86.76% sensitivity (CI: 76.4-93.8) and 91.84% specificity (CI: 86.2-95.7), and Youden index for this score was 0.786.

Conclusion

Our study demonstrates that 6-CIT is a reliable cognitive screening tool in ED, offering excellent sensitivity and specificity with a 8/9 points cut-off score.

Usefulness of the Cognitive Composition Test as an Early Discriminator of Mild Cognitive Impairment

Mild cognitive impairment (MCI) is the preliminary stage of dementia, which is a serious social problem worldwide. This study aimed to investigate whether the Cognitive Composition Test (CCT) is effective for the early diagnosis of MCI. A total of 104 older adults underwent the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), the Trail Making Test Parts A (TMT-A) and B (TMT-B), and our newly prototyped cognitive composition test (CCT). We created three types of CCT (CCT-A, CCT-B, and CCT-C) with different degrees of difficulty. First, we examined the concurrent validity of CCT-A, CCT-B, and CCT-C with the MoCA, MMSE, TMT-A, and TMT-B. All participants were classified into the healthy control (HC) and MCI groups based on their scores in the Japanese versions of the MoCA and MMSE. The HC and MCI groups were compared using the TMT-A, TMT-B, CCT-A, CCT-B, and CCT-C. Finally, we examined the sensitivity for discrimination of CCT-C. CCT-C had a higher discrimination sensitivity than TMT-A, TMT-B, CCT-A, and CCT-B, with a cut-off value of 65.75 s, a sensitivity level of 0.844, and a specificity of 0.776. It may be a useful screening tool for the early diagnosis of the early-stages of dementia, such as MCI, in asymptomatic older adults.

Corrigendum: A two-year longitudinal study of retinal vascular impairment in patients with amnestic mild cognitive impairment

[This corrects the article DOI: 10.3389/fnagi.2022.993621.].

Relationship between Vitamin C Deficiency and Cognitive Impairment in Older Hospitalised Patients: A Cross-Sectional Study

Vitamin C is a powerful antioxidant and facilitates neurotransmission. This study explored association between vitamin C deficiency and cognitive impairment in older hospitalised patients. This prospective study recruited 160 patients ≥ 75 years admitted under a Geriatric Unit in Australia. Cognitive assessment was performed by use of the Mini-Mental-State-Examination (MMSE) and patients with MMSE scores <24 were classified as cognitively-impaired. Fasting plasma vitamin C levels were determined using high-performance-liquid-chromatography. Patients were classified as vitamin C deficient if their levels were below 11 micromol/L. Logistic regression analysis was used to determine whether vitamin C deficiency was associated with cognitive impairment after adjustment for various covariates. The mean (SD) age was 84.4 (6.4) years and 60% were females. A total of 91 (56.9%) were found to have cognitive impairment, while 42 (26.3%) were found to be vitamin C deficient. The mean (SD) MMSE scores were significantly lower among patients who were vitamin C deficient (24.9 (3.3) vs. 23.6 (3.4), p-value = 0.03). Logistic regression analysis suggested that vitamin C deficiency was 2.9-fold more likely to be associated with cognitive impairment after adjustment for covariates (aOR 2.93, 95% CI 1.05−8.19, p-value = 0.031). Vitamin C deficiency is common and is associated with cognitive impairment in older hospitalised patients.

Cerebrovascular Reserve Capacity as a Predictor of Postoperative Delirium: A Pilot Study

Introduction: Postoperative delirium is a common complication after cardiac surgery with cardiopulmonary bypass (CPB). Compromised regulation of the cerebral circulation may be a predisposing factor for delirium. However, the potential relationship between cerebrovascular reserve capacity and delirium is unknown. The aim of this study was to investigate if impaired cerebrovascular reserve capacity was associated with postoperative delirium. Methods: Forty-two patients scheduled for cardiac surgery with CPB were recruited consecutively. All patients underwent preoperative transcranial Doppler (TCD) ultrasound with calculation of breath-hold index (BHI). BHI < 0.69 indicated impaired cerebrovascular reserve capacity. In addition, patients were examined with preoperative neuropsychological tests such as MMSE (Mini Mental State Examination) and AQT (A Quick Test of cognitive speed). Postoperative delirium was assessed using Nursing Delirium Screening Scale (Nu-DESC) in which a score of ≥2 was considered as delirium. Results: Six patients (14%) scored high for postoperative delirium and all demonstrated impaired preoperative cerebrovascular reserve capacity. Median (25th-75th percentile) BHI in patients with postoperative delirium was significantly lower compared to the non-delirium group [0.26 (-0.08-0.44) vs. 0.83 (0.57-1.08), p = 0.002]. Preoperative MMSE score was lower in patients who developed postoperative delirium (median, 25th-75th percentile; 26.5, 24-28 vs. 28.5, 27-29, p = 0.024). Similarly, patients with postoperative delirium also displayed a slower performance during the preoperative cognitive speed test AQT color and form (mean ± SD; 85.8 s ± 19.3 vs. 69.6 s ± 15.8, p = 0.043). Conclusion: The present findings suggest that an extended preoperative ultrasound protocol with TCD evaluation of cerebrovascular reserve capacity and neuropsychological tests may be valuable in identifying patients with increased risk of developing delirium after cardiac surgery.

Comparison of Postoperative Cognitive Decline Using the Mini-Mental State Examination and Montreal Cognitive Assessment After Minor Elective Surgery in Elderly

Introduction and aim

Postoperative cognitive dysfunction (POCD) is an important complication associated with increased morbidity, mortality, and reduced quality of life. Generally, studies have focused on major surgery so there is little evidence of the incidence of cognitive dysfunction in minor surgery. We aimed to compare the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in terms of detecting cognitive decline in elderly patients after elective inguinal herniorrhaphy procedure with general or spinal anesthesia.

Material and methods

This observational study was conducted from June 2014 to March 2015 at Ankara Numune Education and Research Hospital. The type of anesthesia was determined according to the anesthesiologist’s preference who is blind to the study. Patients were grouped according to anesthesia received: general or spinal anesthesia. The MMSE and MoCA were evaluated presurgery and 24 hours after the operation.

Results

The postoperative (24th hour) MMSE scores of patients (26.23±2.77) were significantly lower than the preoperative scores (27.17±1.93) in only the general anesthesia group (p =0.003). The postoperative (24th hour) MoCA scores (22.87±3.88 for general and 23.13±4.08 for spinal anesthesia) were significantly lower than the preoperative scores (24.32±3.19 for general and 24.35±2.84 for spinal anesthesia) in both the general and spinal anesthesia groups (p =0.000 and 0.019, respectively). The incidence of postoperative cognitive dysfunction was 32.9% using the MoCA and 15.2% using the MMSE (p=0,018).

Conclusion

Early POCD is an important problem after elective minor surgeries, even with spinal anesthesia, in elderly patients. The MoCA is an alternative tool that can be more sensitive than the MMSE to identify cognitive decline in elderly patients undergoing minor surgeries under both general and spinal anesthesia. 

Gene Expressions, Hippocampal Volume Loss, and MMSE Scores in Computation of Progression and Pharmacologic Therapy Effects for Alzheimer's Disease

We build personalized relevance parameterization method (prep-ad) based on artificial intelligence (ai) techniques to compute Alzheimer's disease (ad) progression for patients at the mild cognitive impairment (mci) stage. Expressions of ad related genes, mini mental state examination (mmse) scores, and hippocampal volume measurements of mci patients are obtained from the Alzheimer's Disease Neuroimaging Initiative (adni) database. In evaluation of cognitive changes under pharmacological therapies, patients are grouped based on available clinical measurements and the type of therapy administered, namely donepezil monotherapy and polytherapy of donepezil with memantine. Average leave one out cross validation (loocv) error rates are calculated for prep-ad results as less than 8 percent when mmse scores are used to compute disease progression for a 60 month period, and 3 percent with hippocampal volume measurements for 12 months. Statistical significance is calculated as p = 0.003 for using ad related genes in disease progression and as for the results computed by prep-ad. These relatively small average loocv errors and p-values suggest that our prep-ad methods employing gene expressions, mmse scores and hippocampal volume loss measurements can be useful in supporting pharmacologic therapy decisions during early stages of ad.

Metabolic Syndrome and Cognitive Function: Cross-Sectional Study on Community-Dwelling Non-Demented Older Adults in Japan

AIM

This is a cross-sectional study of relation between metabolic syndrome and cognitive function in community-dwelling non-demented older adults in Japan. We examine the effect of metabolic syndrome and its components on global cognitive function. We also aim to clarify differences of specific cognitive domains between the subjects with and without metabolic syndrome.

METHODS

We studied 2150 subjects aged between 60 and 90 years whose scores on mini mental state examination (MMSE) were over 23 points. We analyzed difference in MMSE scores between the subjects with and without metabolic syndrome. Logistic regression analysis was performed with MMSE score as the dependent variable and metabolic syndrome components as the independent variable adjusted with age. We also examined differences in attention, logical memory, and verbal and category fluency between the subjects with and without metabolic syndrome.

RESULTS

MMSE scores were not significantly different between subjects with and without metabolic syndrome. In logistic regression analysis, the score of MMSE was significantly negatively associated with triglycerides in males and significantly negatively associated with abdominal circumference in females. Subjects with metabolic syndrome showed significantly lower performance of attention tasks compared to subjects without metabolic syndrome.

CONCLUSIONS

Our results suggest that in community-dwelling non-demented Japanese older adults, attention but not global cognitive function may be impaired by metabolic syndrome. Inverted association between some components of metabolic syndrome and global cognitive function indicate necessity of further studies on the relation between undernutrition and cognitive function.

Tiaobu Xinshen Recipe () Improved Mild Cognitive Impairment of Alzheimer's Disease Patients with Xin (Heart) and Shen (Kidney) Deficiency

OBJECTIVE

To observe the intervention effects of Tiaobu Xinshen Recipe (, TXR) on patients with mild cognitive impairment caused by Alzheimer's disease (MCI-AD).

METHODS

Totally 88 MCI-AD patients with syndrome of Xin (Heart) and Shen (Kidney) deficiency were assigned to the experimental group (47 cases, treated with TXR) and the control group (41 cases, treated with donepezil hydrochloride) using a random number table. Final recruited qualified patients were 44 cases in the experimental group and 39 cases in the control group. The therapeutic course was 12 weeks. Neuropsychological scales [mini mental state examination (MMSE) and Montreal cognitive assessment (MoCA)], and Chinese medicine (CM) dementia syndromes scales were performed in all patients, and results were compared between groups or intra-group before and after treatment.

RESULTS

MMSE and MoCA scores of the two groups were increased after treatment compared with those before treatment (P<0.05). But there was no statistical difference in MMSE or MOCA scores after treatment between the two groups (P>0.05). CM dementia syndrome score was significantly decreased after treatment in the experimental group compared with the control group (P<0.01). Visual spatial and executive function scores and delayed recall scores of the two groups were increased compared with those before treatment (P<0.01).

CONCLUSION

TXR could effectively improve cognitive impairment of MCI-AD patients with syndrome of Xin and Shen deficiency.

The Mini Mental State Examination does not accurately screen for objective cognitive impairment in Fabry Disease

Fabry disease (FD) patients may suffer from objective cognitive impairment (OCI). This study assessed the accuracy of the Mini Mental State Examination (MMSE) to screen for OCI in FD patients. Presence or absence of OCI was established using a neuropsychological test battery. For different MMSE cutoffs sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and clinical utility index (CUI) to identify OCI were calculated. Eighty-one patients were included (mean age 44.5 ± 14.3, 35% men, 74% classical phenotype) of which 13 patients (16%) had OCI. The median MMSE score was 29 (range: 25-30). MMSE cutoffs ≤28 and ≤29 had the highest sensitivity and specificity, with higher specificity reached at cutoff ≤28 (sensitivity: .46, specificity: .73) and higher sensitivity at cutoff ≤29 (sensitivity: .92, specificity: .40). PPV was low for both cutoffs (PPV ≤28: .25, PPV ≤29: .23) resulting in a low positive CUI (case finding ability). The results of our study indicate that the MMSE does not accurately screen for OCI in FD, with poor sensitivity-specificity trade-off at all cutoffs. The low PPV shows that the majority of FD patients that score below the cutoffs do not suffer from OCI. Administering the MMSE as a screening test will lead to unnecessary referrals for neuropsychological testing, which is time consuming and burdensome. Screening tools designed to accurately detect mild (executive) impairment might prove more appropriate to screen for OCI in FD.

Detection of severity in Alzheimer's disease (AD) using computational modeling

The prevalent cause of dementia - Alzheimer's disease (AD) is characterized by an early cholinergic deficit that is in part responsible for the cognitive deficits (especially memory and attention defects). Prolonged AD leads to moderate-to-severe AD, which is one of the leading causes of death. Placebo-controlled, randomized clinical trials have shown significant effects of Acetyl cholin esterase inhibitors (ChEIs) on function, cognition, activities of daily living (ADL) and behavioral symptoms in patients. Studies have shown comparable effects for ChEIs in patients with moderate-to-severe or mild AD. Setting a fixed measurement (e.g. a Mini-Mental State Examination score, as a 'when to stop treatment limit) for the disease is not clinically rational. Detection of changed regional cerebral blood flow in mild cognitive impairment and early AD by perfusion-weighted magnetic resonance imaging has been a challenge. The utility of perfusion-weighted magnetic resonance imaging (PW-MRI) for detecting changes in regional cerebral blood flow (rCBF) in patients with mild cognitive impairment (MCI) and early AD was evaluated. We describe a computer aided prediction model to determine the severity of AD using known data in literature. We designed an automated system for the determination of AD severity. It is used to predict the clinical cases and conditions with disagreements from specialist. The model described is useful in clinical practice to validate diagnosis.

Consanguinity Associated with Increased Prevalence and Severity of Bipolar Disorder in Pakistan: A Case Report Highlighting the Genetic Link

This case report highlights the genetic link associated with bipolar disorder and rising prevalence of such cases in Pakistan due to the lack of knowledge and understanding of the disease. It also shows that a family history of bipolar disorder is associated with more aggressive episodes, early onset, and treatment relapse. Further studies are warranted to fully understand the pathophysiology of genetic linkages causing bipolar disorder so we can understand the natural course of illness and provide effective treatment. We report the case of a 25-year-old girl who presented to the hospital with severe mania and had around 20 episodes of acute mania in the last ten years. Her parents (first cousins) and brother all had a diagnosis of bipolar disorder.

How Can We Best Screen for Cognitive Impairment in Malaysia? A Pilot of the IDEA Cognitive Screen and Picture-Based Memory Impairment Scale and Comparison of Criterion Validity with the Mini Mental State Examination

OBJECTIVES

To pilot two new cognitive screening tools for use in an urban Malaysian population and to compare their criterion validity against a gold standard, the well-established Mini-Mental State Examination (MMSE).

METHODS

The IDEA cognitive screen, Picture-based Memory Impairment Scale (PMIS), and MMSE were administered to a convenience sample of elderly (≥ 65 years) from the community and outpatient clinics at an urban teaching hospital. Consensus diagnosis was performed by two geriatricians blinded to PMIS and IDEA cognitive screen scores using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) clinical criteria. The MMSE performance was used as a reference.

RESULTS

The study enrolled 66 participants, with a median age of 78.5 years (interquartile range [IQR], 72.5-83.0) years and 11.0 median years of education (IQR, 9.0-13.0). Forty-three (65.2%) were female, and 32 (48.4%) were Chinese. The area under the receiver operating characteristic (AUROC) curve values were .962 (IDEA cognitive screen), .970 (PMIS), and .935 (MMSE). The optimal cutoff values for sensitivity and specificity were: IDEA cognitive screen: ≤ 11, 90.9% and 89.7%; PMIS: ≤ 6, 97.3% and 69.0%; and MMSE: ≤ 23, 84.6% and 76.0%. Although the sample size was small, multivariable logistic regression modelling suggested that all three screen scores did not appear to be educationally biased.

CONCLUSION

The IDEA and PMIS tools are potentially valid screening tools for dementia in urban Malaysia, and perform at least as well as the MMSE. Further work on larger representative, cohorts is needed to further assess the psychometric properties.

CLINICAL IMPLICATIONS

Study provides alternative screening tools for dementia for both non-specialists and specialists.

Lower cognitive function in patients with age-related macular degeneration: a meta-analysis

Objective

To investigate the cognitive impairment in patients with age-related macular degeneration (AMD).

Methods

Relevant articles were identified through a search of the following electronic databases through October 2015, without language restriction: 1) PubMed; 2) the Cochrane Library; 3) EMBASE; 4) ScienceDirect. Meta-analysis was conducted using STATA 12.0 software. Standardized mean differences with corresponding 95% confidence intervals were calculated. All of the included studies met the following four criteria: 1) the study design was a case–control or randomized controlled trial (RCT) study; 2) the study investigated cognitive function in the patient with AMD; 3) the diagnoses of AMD must be provided; 4) there were sufficient scores data to extract for evaluating cognitive function between cases and controls. The Newcastle–Ottawa Scale criteria were used to assess the methodological quality of the studies.

Results

Of the initial 278 literatures, only six case–control and one RCT studies met all of the inclusion criteria. A total of 794 AMD patients and 1,227 controls were included in this study. Five studies were performed with mini-mental state examination (MMSE), two studies with animal fluency, two studies with trail making test (TMT)-A and -B, one study with Mini-Cog. Results of the meta-analysis revealed lower cognitive function test scores in patients with AMD, especially with MMSE and Mini-Cog test (P≤0.001 for all). The results also showed that differences in the TMT-A (except AMD [total] vs controls) and TMT-B test had no statistical significance (P>0.01). The Newcastle–Ottawa Scale score was ≥5 for all of the included studies. Based on the sensitivity analysis, no single study influenced the overall pooled estimates.

Conclusion

This meta-analysis suggests lower cognitive function test scores in patients with AMD, especially with MMSE and Mini-Cog test. The other cognitive impairment screening tests, such as animal fluency test and TMT, need more studies to assess.

Factors associated with primary care physicians' recognition of cognitive impairment in their older patients

Although there are accurate screens for cognitive impairment, there is as yet no evidence that screening improves outcomes including primary care physicians' (PCP) medical decision making. PCPs' recognition of cognitive impairment being suboptimal, we investigated factors associated with improved recognition. Eligible patients were aged 65 years and above, without documented dementia or previous work-up for dementia, seen consecutively over 2 months by one of 13 PCPs. PCPs indicated whether they, the patient, or the family had concerns about each patient's cognition. We enrolled 130 patients with any cognitive concerns and a matched sample of 133 without cognitive concerns, and administered standardized neuropsychological tests. PCP's judgments of cognitive concern showed 61% sensitivity and 86% specificity against the neuropsychological standard. When combined with a Mini-Mental State Examination score ≤26, PCP recognition improved in sensitivity (82%) with some loss in specificity (74%). True positives increased when PCPs' practices included more cognitively impaired patients and when patients reported poor memory. False positives increased when patients had diabetes, reported poor memory, or no or light alcohol consumption. Medical decision making can be improved by the Mini-Mental State Examination and greater exposure to cognitively impaired patients, but knowledge of certain risk factors for cognitive impairment negatively affected these decisions.

Meta-analysis of randomized controlled trials on cognitive effects of Bacopa monnieri extract

ETHNOPHARMACOLOGICAL RELEVANCE

Bacopa monnieri has a long history in Ayurvedic medicine for neurological and behavioral defects. To assess its efficacy in improving cognitive function.

MATERIALS AND METHODS

MEDLINE, EMBASE, CINAHL, AMED, Cochrane Central of clinical trial, WHO registry, Thai Medical Index, Index Medicus Siriraj library and www.clinicaltrial.gov were searched from the inception date of each database to June 2013 using scientific and common synonyms of Bacopa monnieri, cognitive performance or memory. The reference lists of retrieved articles were also reviewed. Randomized, placebo controlled human intervention trials on chronic ≥ 12 weeks dosing of standardized extracts of Bacopa monnieri without any co-medication were included in this study. The methodological quality of studies was assessed using Cochrane's risk of bias assessment and Jadad's quality scales. The weighted mean difference and 95% confidence interval (95% CI) were performed using the random-effects model of the Dersimonian-Laird method.

RESULTS

Nine studies met the inclusion criteria using 518 subjects. Overall quality of all included trials was low risk of bias and quality of reported information was high. Meta-analysis of 437 eligible subjects showed improved cognition by shortened Trail B test (-17.9 ms; 95% CI -24.6 to -11.2; p<0.001) and decreased choice reaction time (10.6 ms; 95% CI -12.1 to -9.2; p<0.001).

CONCLUSION

This meta-analysis suggests that Bacopa monnieri has the potential to improve cognition, particularly speed of attention but only a large well designed 'head-to-head' trial against an existing medication will provide definitive data on its efficacy on healthy or dementia patients using a standardized preparation.

Comparison of sedation effectiveness of remifentanil-dexmedetomidine and remifentanil-midazolam combinations and their effects on postoperative cognitive functions in cystoscopies: A randomized clinical trial

BACKGROUND

The aim of the study is to compare the effects of remifentanil/dexmedetomidine and remifentanil/midazolam combinations in monitored anesthesia care (MAC) during cystoscopies.

MATERIALS AND METHODS

Forty patients who received remifentanil infusion of 0.05 μg kg(-1) min(-1) for cytoscopy procedure were randomized into two groups: Either dexmedetomidine 1 mg kg(-1) (Group D) or midazolam 0.2 mg kg(-1) h(-1) (Group M) was administered intravenously for the first 10 min. Subsequently, anesthesia was maintained by using the bispectral index as a continuous infusion of dexmedetomidine (0.2-0.7 μg kg(-1) h(-1)) or midazolam (0.05-0.15 μg kg(-1) h(-1)). Heart rate, mean arterial pressure, mini-mental state examination findings, levels of sedation andanalgesia, and the patient's and surgeon's satisfaction were recorded.

RESULTS

Successful sedation and analgesia were achieved in all the patients. We were able to reach the target sedation level faster in Group D (P<0.0001). In Group D, the cognitive functions were less affected than in Group M (P<0.0001). Patient's and surgeon's satisfaction were significantly higher in Group D.

CONCLUSION

The targeted sedation levels were achieved in a shorter period with dexmedetomidine-remifentanil compared to midazolam-remifentanil. The dexmedetomidine-remifentanil combination was observed to affect the cognitive functions less than midazolam-remifentanil did with shorter recovery times. Besides, patient's and surgeon's satisfaction rates were superior with dexmedetomidine-remifentanil. It was concluded that dexmedetomidine-remifentanil may be a combination of choice for monitored anesthesia care applications in outpatient surgical procedures of short duration.

Diabetes mellitus: A risk factor for cognitive impairment amongst urban older adults

BACKGROUND

Studies reported in relation to diabetes mellitus and cognitive impairment are inconclusive. Diabetes mellitus is a wide spread physical illness amongst older adults. The study explores whether, it leads to cognitive impairment amongst older adults in comparison to those without diabetes mellitus.

MATERIALS AND METHODS

Study sample consisted of 900 subjects fulfilling the inclusion/exclusion criteria out of 1067 elderlies aged 55 years and above residing in a randomly selected ward of urban Lucknow. Pathological investigation was done on all elderlies to rule out diabetes mellitus. Out of 900 subjects 145 were found to have Diabetes Mellitus and rests 755 were without diabetes mellitus. These subjects were further divided into two groups: (i) with and (ii) without cognitive impairment based on detailed assessment of Mini Mental State Examination positive subjects by Cambridge Examination for Mental Disorders of the Elderly- Revised (CAMDEX-R). International Classification of Diseases-10(th) revision criteria were used to make diagnosis. Data analysis was done calculating odds ratio, Chi square, and percentages.

RESULTS

Diabetes mellitus was found to be prevalent is 13.7% and 16.9% amongst older adults aged 55-59 years and 60 years and above respectively. Odds ratio 1.3 with CI 95% indicates that subjects with diabetes mellitus is 1.3 times at more risk to develop cognitive impairment amongst urban older adults than non-cognitively impaired subjects. But differences on Chi square test were found to be insignificant.

CONCLUSION

There is a weak association between diabetes mellitus and cognitive impairment amongst urban older adults.

Evaluation of the Effects of Severe Depression on Global Cognitive Function and Memory

INTRODUCTION

Major depressive disorder (MDD) is thought to negatively impact cognitive function; however, the relationship has not been well explored.

OBJECTIVE

This study examined the association between depression severity and global cognitive function and memory in subjects with severe, treatment-resistant MDD.

METHODS

We enrolled 66 subjects with Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosed unipolar MDD in a multicenter trial to assess the efficacy and neurocognitive effects of electroconvulsive therapy (ECT). We measured depression severity with the 24 item Hamilton Rating Scale for Depression (HRSD(24)). Neuropsychologic measures included the Mini Mental State Examination (MMSE), Rey Auditory Verbal Learning Test (RAVLT), and the Complex Figure Test (CFT). Correlational and regression analyses were conducted to explore associations between depression severity and cognitive function.

RESULTS

The mean age of the subjects was 53.6 years (SD=15.8), 65% were female, and mean HRSD(24) was 33.9 (SD=6.7). Mean demographic-corrected T-scores for each neurocognitive measure were in the average to borderline range, and HRSD(24) values were unrelated to performance on the MMSE, RAVLT immediate and delayed recall, and CFT immediate and delayed recall.

CONCLUSION

In this sample of severely depressed subjects referred for ECT, depression severity was unrelated to global cognitive function or memory. Future research should examine the interactions between other depressive characteristics and neurocognitive function.

Short term response is predictive of long term response to acetylcholinesterase inhibitors in Alzheimer's disease: a starting point to explore Bayesian approximation in clinical practice

This study was aimed at identifying, in 203 patients with Alzheimer's disease followed during long-term treatment with Acetylcholinesterase inhibitors (ChEIs), the predictive factors of the clinical response among cognition (MMSE), functioning (BADL and IADL) measures and age and gender at the baseline (T0). The ANCOVA test showed a significant association between MMSE scores at time T0 and T3, and the variation T9 to T0, T15 to T0 and T21 to T0 of the MMSE scores, using also gender, age and drug as covariates. The significance was higher for the patients affected by mild dementia. Regarding functional activities, a significant relationship was detected, by the ANCOVA test, only between the scores at T3 and the variation T15 to T0 for BADL, and the variation T9 to T0, T15 to T0 for IADL, respectively. Our results confirm, in a real world setting, that ChEIs provide long-term cognitive benefit, which is correlated to, and predictable by, the short-term response (within the third month) as well as the cognitive status (evaluated by means of the MMSE) at the beginning of the treatment. These factors should be the basis of any cost/effectiveness algorithm in health economic decision models.