The relevance of Mini Mental State Examination (MMSE) use on demential interdiction exams in judicial proceedings / A importância do Miniexame do Estado Mental (MEEM) nos exames de interdição demencial em processos judiciais

ABSTRACT Objective To highlight the important role of Mini Mental State Examination (MMSE) use on judicial interdiction assessments. Methods On this paper, we present a case in which we have used the Mini mental state examination (MMSE) for screening an initial dementia diagnosis, suggested by clinical and mental state examination. Results The relevance of using a screening test for demencial states on judicial interdictions assessments, as MMSE, in order to provide more objective findings to the court, has been demonstrated. Also, we review the current evidence for using MMSE on this setting and the importance of its use on demential interdiction exams in judicial proceedings. Conclusions Judicial evidence is a critical element in decision making. Judicial interdiction assessment is usually performed by expert psychiatrists. As psychiatric diagnosis relies on clinical history and mental state examination, it is composed of subjective elements, varying also according to the examiner's personal technical orientation and impressions. Neuroimaging exams are helpful on a minority of cases, in which specific findings are present. In such cases, clinical screening questionnaires play an important role - providing objective elements of neuropsychic functioning of an individual, thus limiting the subjective realm of the expert forensic report.

RESUMO Objetivo Destacar a importância do uso do Miniexame do Estado Mental (MEEM) nas perícias de interdição judicial por demência. Métodos Neste artigo, apresentamos um caso no qual aplicamos o MEEM para rastreamento de demência inicial, cujo diagnóstico foi sugerido por meio de história clínica e exame do estado mental. Resultados Foi demonstrada a importância de usar um teste de rastreamento para demência, no caso o MEEM, nas perícias de interdição por esse diagnóstico, a fim de fornecer elementos mais objetivos ao juízo. Ainda, fornecemos uma revisão das evidências atuais para a aplicação do MEEM nesse contexto, bem como a importância do uso dele nas perícias de interdição por demência. Conclusões A prova pericial é um elemento crítico para a tomada de decisão judicial. A perícia de interdição judicial por demência é usualmente realizada por especialistas em psiquiatria. Como o diagnóstico psiquiátrico baseia-se na história clínica e no exame do estado mental, é composto de elementos subjetivos, variando de acordo com a técnica e impressão individual do examinador. Exames de neuroimagem são úteis em uma minoria de casos, nos quais achados específicos estão presentes. Assim, questionários clínicos para rastreamento de doenças mostram-se importantes, pois fornecem elementos objetivos do funcionamento neuropsíquico do indivíduo, diminuindo o papel da subjetividade no laudo pericial.

Psychometric properties of Cognitive Instruments in Vascular Dementia and Alzheimer's disease: a neuropsychological study

OBJECTIVES: To describe elderly performance in the Bender Gestalt Test (BGT) and to discriminate its score by using types of errors as comparison among healthy controls, Alzheimer's disease (AD) patients, and vascular dementia (VD) patients. METHODS: We performed a cross-sectional analysis of 285 elderly individuals of both sexes, all over 60 years old and with more than 1 year of schooling. All participants were assessed through a detailed clinical history, laboratorial tests, neuroimaging, and neuropsychological tests including the BGT, the Cambridge Cognitive Examination (CAMCOG), the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Pfeffer Functional Activities Questionnaire (PFAQ). The BGT scores were not used to establish diagnosis. RESULTS: Mean BGT scores were 3.2 for healthy controls, 7.21 for AD, and 8.04 for VD with statistically significant differences observed between groups (p<0.0001). Logistic regression analysis was used to identify the main risk factors for the diagnostic groups. BGT's scores significantly differentiated the healthy elderly from those with AD (p<0.0001) and VD (p<0.0001), with a higher area under the curve, respectively 0.958 and 0.982. BGT's scores also showed that the AD group presented 12 types of errors. Types of errors evidenced in the execution of this test may be fundamental in clinical practice because it can offer differential diagnoses between senescence and senility. CONCLUSION: A cut-off point of 4 in the BGT indicated cognitive impairment. BGT thus provides satisfactory and useful psychometric data to investigate elderly individuals.

Prevalence of Risk Factors for Dementia in Elderly Population in a Tribal Area of Central India – A Community-Based Cross-Sectional Study

Background: Approximately 50 million people worldwide are suffering from dementia, it is the 7th leading cause of death among the elderly. In India, more than 4 million people have some form of dementia 3. According to the World Health Organization, India’s population of those aged over 65, which was 40 million in 1997, is set to increase to 108 million by 2025 and 240 million by 2050.Aim and Objective: The aim of the study was to study the prevalence of risk factors of dementia among the elderly population residing in a tribal area of Central India.Materials and Methods: A door to door cross-sectional study was conducted in the rural/tribal area with a pre-designed case record form that investigated the prevalence of risk factors along with measurement of anthropometry and mini-mental state examination was used to categorize subjects according to their mental status.Results: This study reports high prevalence of risk factors such as hypertension (31.8%), tobacco chewing (25.43%), high waist-hip ratio (24.57%), smoking habit (15.03%), head injury (11%), overweight (9.54%), alcohol intake (9.25%), 71–80 age (9.25%), diabetics (9%), stroke (4.62%), family history of dementia (2.6%), obesity (2.31%), coronary artery disease (CAD) (1.73%), and depression (1.45%).Conclusions: This study highlights a significant burden of undiagnosed cases of hypertension, diabetes, depression, and CAD all of which are important risk factors for dementia in the community, most of them are poorly controlled. There is a need to identify the large pool of undiagnosed cases of the mentioned morbidities by screening and offer early treatment to avoid complications.

Efectividad Del Foto-Test Frente Al Mmse, Para El Cribado Del Deterioro Cognitivo En Población Peruana / Effectiveness Of The Photo-Test Front Of The Mmse, For The Screening Of Cognitive Deterioration In Peruvian Population

Resumen El progresivo incremento de la enfermedad de Alzheimer ha generado el interés en su detección temprana, siendo los test de cribado cognitivo una herramienta útil, sin embargo, se necesita que los mismos estén culturalmente adaptados, sean objetivos y confiables. En el Perú, esta necesidad es mayor ya que el nivel educativo de la población de la tercera edad es mayoritariamente bajo. La presente investigación tiene como objetivo conocer la sensibilidad y especificidad del FOTOTEST frente al MMSE para el cribado/detección de deterioro cognitivo, analizando la relación de estos test cognitivos frente a uno de actividad funcional. Se evaluaron a 107 adultos mayores, con un rango de edad entre 60 y 89 años. Se utilizó la escala de Yesavage para la depresión geriátrica, el cuestionario de actividades funcionales de Pfeffer, MMSE y FOTOTEST. El análisis efectuado a través de la prueba de Pearson, evidencia una correlación significativa positiva entre el MMSE/FOTOTEST (Pearson 0.386, p<0.003), mientras que solo el MMSE mostró una correlación significativa negativa con el PFAQ (Pearson -0.320, p<0.013). Sin embargo, el FOTOTEST no mostró una correlación significativa con el PFAQ (Pearson -0.067, p<0.613). Adicionalmente, se calcula el porcentaje de efectividad y especificidad estimada para el FOTOTEST siendo de 100.00% y 92.68% respectivamente, superior al del MMSE, cuyo porcentaje estimado de efectividad fue de 83.33%, y especificidad 34.14%. Se concluye que el FOTOTEST sería una prueba más útil para la detección del deterioro cognitivo.

Abstract The progressive increase of Alzheimer's disease has generated interest in its early detection with cognitive screening tests being a useful tool, however, they need to be culturally adapted, objective and reliable. In Peru, this need is greater since the educational level of the elderly population is mostly low. The aim of the present study is to know the estimate sensitivity and specificity of FOTOTEST against MMSE for the screening/detection of cognitive impairment, analyzing the relationship of these cognitive tests with one of functional activity. 107 elderly people, aged 60-89 years, were evaluated. The Yesavage scale for geriatric depression was used, the functional activities questionnaire of Pfeffer, MMSE, and FOTOTEST. Pearson's analysis showed a significant positive correlation between MMSE/FOTOTEST (Pearson 0.386, p <0.003), whereas only MMSE showed a significant negative correlation with PFAQ (Pearson -0.320, p <0.013). However, FOTOTEST did not show a significant correlation with PFAQ (Pearson -0.067, p <0.613). In addition, the percentage of effectiveness and specificity estimated for FOTOTEST was 100.00% and 92.68%, respectively, higher than the MMSE, with an estimated percentage of effectiveness being 83.33%, and specificity of 34.14%. We conclude that FOTOTEST would be a more useful test for the detection of cognitive impairment than MMSE

Comparative evaluation of levetiracetam and valproic acid as monotherapy on cognitive impairment in patients of epilepsy

Background: Cognitive decline with AEDs (Anti-epileptic drugs) is associated with learning and memory deficits especially in the younger age group. The data regarding the impact of levetiracetam and valproic acid as monotherapy on cognition in epileptic patients is scarce. The present study was done for evaluation of cognitive decline associated with the use of AEDs.Methods: Present study was a prospective study on 60 patients on AEDs for a period of 12 weeks. Patients were enrolled from the Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India and divided into group A (levetiracetam) and group B (valproic acid) with 30 patients in each group. Permission from the institutional ethics committee and written informed consent was taken from all the patients. They were analyzed for cognitive impairment using MMSE and MoCA scales at baseline and 12 weeks.Results: The mean duration of disease was 2.13�1 years and 2.08�1 years and mean age of the patients was 14.67�9 years in group A and 16.20�6 years in group B. GTCS was present in 31 patients (52%) followed by partial seizures in 29 patients (48%). The mean change in the MMSE scores from baseline to 12 weeks was significant in group A 1.30�1 (p value <0.05) and change group B was -0.20�4 not statistically significant. The mean change was observed in MoCA scores from baseline to 12 weeks was significant in both groups A and B by 1.17�1 and -0.70�1 respectively (P value <0.05).Conclusions: Patients on levetiracetam showed cognitive improvement, whereas patients on valproic acid showed a decline in the MMSE and MoCA scores.

An MRI-Based Quantification for Correlation of Imaging Biomarker and Clinical Performance in Chronic Phase of Carbon Monoxide Poisoning

PURPOSE: The purpose of this study was to determine the relation between quantitative magnetic resonance imaging biomarkers, and clinical performances in chronic phase of carbon monoxide intoxication. MATERIALS AND METHODS: Eighteen magnetic resonance scans and cognitive evaluations were performed, on patients with carbon monoxide intoxication in chronic phase. Apparent diffusion coefficient (ADC) ratios of affected versus unaffected centrum semiovale, and corpus callosum were obtained. Signal intensity (SI) ratios between affected centrum semiovale, and normal pons in T2-FLAIR (fluid-attenuated inversion recovery) images were obtained. The Mini-Mental State Exam, and clinical outcome scores were assessed. Correlation coefficients were calculated, between MRI and clinical markers. Patients were further classified into poor-outcome and good-outcome groups based on clinical performance, and imaging parameters were compared. T2-SI ratio of centrum semiovale was compared, with that of 18 sex-matched and age-matched controls. RESULTS: T2-SI ratio of centrum semiovale was significantly higher in the poor-outcome group, than that in the good-outcome group and was strongly inversely correlated, with results from the Mini-Mental State Exam. ADC ratios of centrum semiovale were significantly lower in the poor outcome group than in the good outcome group, and were moderately correlated with the Mini-Mental State Exam score. CONCLUSION: A higher T2-SI and a lower ratio of ADC values in the centrum semiovale, may indicate presence of more severe white matter injury and clinical impairment. T2-SI ratio and ADC values in the centrum semiovale, are useful quantitative imaging biomarkers for correlation with clinical performance in individuals with carbon monoxide intoxication.

acupuncture method for mild cognitive impairment: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical efficacy of acupuncture method for mild cognitive impairment in the elderly.@*METHODS@#A total of 96 patients were randomly divided into an observation group, a control group and a waiting group, 32 cases in each group. The patients in the observation group were treated with acupuncture at Baihui (GV 20), Shenting (GV 24), Yintang (GV 29) and Sishencong (EX-HN 1), etc, while the patients in the control group were treated with nonpenetrating sham acupuncture at the same acupoints as the observation group. The treatment was given once every other day, three times a week for 8 weeks. The patients in the waiting group only received health guidance for 8 weeks. Montreal cognitive assessment scale (MoCA) and mini-mental state examination (MMSE) were used before and after 8-week treatment in all three groups. The observation group and the control group were followed up for 2 months and evaluated with MoCA and MMSE.@*RESULTS@#The MoCA scores in the observation group after treatment and during follow-up were higher than before treatment (0.05). The MoCA scores in the control group after treatment and during follow-up were higher than before treatment (0.05). The difference before and after treatment in the observation group was higher than the control group and waiting group (0.05). The MMSE scores after treatment and during follow-up were higher than before treatment in the control group (0.05). The difference before and after treatment the observation group and control group was not significant (>0.05), and those in the two groups were higher than the waiting group (<0.01). The difference between follow-up and before treatment in the observation group was higher than the control group (<0.01), and the difference between follow-up and after treatment was lower than the control group (<0.01).@*CONCLUSION@# acupuncture method could improve cognitive impairment in elderly patients with mild cognitive impairment.

Practicability of Six Weeks of Korean-Style Mediterranean Diet for Elderly Koreans with High Risk for Dementia

The purpose of this study was to verify whether Mediterranean diet, which proved to have a significant effect on preventing dementia for people aged 65 or older, could be well modified to be a Korean-style Mediterranean diet. This study was performed as a randomized-controlled trial for 6 weeks. Functional physical changes, cognitive scores, depression scores and dietary changes were all assessed. The walking speed (P<0.001) and the cognitive scores were statistically improved in only the experimental group (P<0.001), and the depression scores were also significantly improved in only the experimental group (P<0.01). The dietary intake showed a 30% improvement for consuming more than 7 cups per day of vegetables and fruits. When the participants were contacted four months after the end of the study, 90% of them said that the Korean-style Mediterranean diet was feasible and 100% said the nutrition interventions helped them maintain the diet during their daily lives. The results suggest that although the Mediterranean diet can be difficult to apply, any limitations of this healthy diet can be overcome.

Rendimiento Diagnóstico De Minimental Frente Al Dsm-5 En Trastorno Cognitivo: Experiencia De Una Cohorte En Colombia / Diagnostic Performance Of Minimental Against Dsm-5 In Cognitive Disorder. Experience Of A Cohort In Colombia

Resumen Antecedentes: Las herramientas de cribado cognitivo son útiles en el escenario clínico e investigación. MiniMental (MMSE) es uno de los instrumentos más utilizados en Colombia. El objetivo de este trabajo es determinar el rendimiento operativo del MMSE, frente a los nuevos criterios del DSM-5 para el diagnóstico de trastorno cognitivo. Materiales y métodos: Estudio de prueba diagnóstica ensamblado en una cohorte colombiana, se evaluó una muestra consecutiva de 200 participantes mayores de 50 años (66.5,+/-8.86) que representaron todo el espectro de la condición de interés, la prueba índice (MMSE) fue comparada con el estándar clínico de referencia (consenso diagnóstico y clasificación por criterios DSM-5). Resultados: Para trastorno cognitivo leve (TCL), el rendimiento diagnóstico de MMSE fue: Sensibilidad 45.3%(IC95% 33.7 a 57.4), especificidad 96.9% (IC95% 91.4 a 99.0) y exactitud del 76.9% (IC 95% 69.5 a 82.4) a un punto de corte de 26 y para trastorno cognitivo mayor (TCM) fue: Sensibilidad 76.32% (IC 95% 60.8-87.0) y especificidad 97.53% (IC 95% 93.8-99.0) en el punto de corte de 24. Conclusiones: MMSE continúa siendo una alternativa válida para diagnóstico de TCM, sin embargo, tiene limitada validez para la detección de TCL, por lo que nuevas herramientas con objetivo de cribado de TCL deben ser consideradas.

Abstract Background: Cognitive screening tools are useful in the clinical and research setting. MiniMental (MMSE) is one of the most used instruments in Colombia, the objective of this work is to determine its performance against the new criteria for the diagnosis of cognitive disorder (DSM-5). Materials and methods: Diagnostic test study, assembled in a Colombian cohort, we evaluated a consecutive sample of 200 participants older than 50 years (66.5,+/-8.86) that represented the whole spectrum of the condition of interest, the index test (MMSE) was compared with the clinical reference standard (consensus diagnosis and classification by criteria DSM-5). Results: For mild cognitive impairment (MCI), the diagnostic performance of MMSE was: Sensitivity 45.3% (95% CI 33.7 to 57.4), specificity 96.9% (95% CI 91.4 to 99.0) and 76.9% accuracy (95% CI 69.5 to 82.4) at a cut-off point of 26 and, for major cognitive disorder (MCD) was: Sensitivity 76.32% (95% CI 60.8-87.0) and specificity 97.53% (95% CI 93.8-99.0) at the cut-off point of 24. Conclusions: MMSE is a valid alternative for the diagnosis of MCD, however it has limited validity for the detection of MCI, so new tools for the purpose of screening of MCI should be considered.

Multicenter study on the treatment of cerebralcare granule for patients with mild and moderate vascular cognitive impairment / 中华行为医学与脑科学杂志

Objective To explore the improvement of cognitive impairment in patients with mild and moderate vascular cognitive impairment( VCI) treated with cerebralcare granule ( CG) and basic treat-ment.Methods From October in 2014 to December in 2016 year,143 cases of VCI patients were admitted from six hospitals in some areas of Hebei Province as the research objects,and divided into CG treatment group (experimental group,n=98) and conventional treatment group (control group,n=66).Three months and six months after treatment,the score of mental state examination ( MMSE) ,the Montreal cognitive assess-ment scale ( MoCA) and the daily living capacity scale( ADL) of the two groups were compared after 3 and 6 moths of treatment.Results ①The total score of MMSE in the experimental group was higher than that of the control group for six months after treatment, and the difference was statistically significant ( ( 23. 76 ± 4.02) vs (21.52±5.13),P<0.05).②Six months after treatment,the total score of MoCA ((21.06±4.66) vs (18.32±5.20)) and visual spatial/executive function((3.05±1.37) vs (2.42±1.66)),calculation force ((2.24±0.84) vs (1.83±1.05)) and orientation ability((5.20±1.12) vs (4.06±1.35)) scores in the ex-perimental group were significantly higher than those in the control group (P<0.05) .③Six months after treat-ment,the ADL score in the experimental group was lower than that before treatment,and the difference was statistically significant((24.96±8.74) vs (29.20±11.55),P<0.05);while there was no significant difference in the ADL score between the experimental group and the control group after 6 months (P>0.05).Conclusion CG can improve cognitive function in mild to moderate VCI patients,mainly in visual space/execution func-tion,calculation ability and orientation ability,and with the extension of treatment time,the curative effect is more obvious.

A case-control study of cognitive impairment and related factors among elderly patients / 中国心理卫生杂志

Objective: To explore risk factors for cognitive impairment among elderly patients. Methods: There were 257 qualified subjects recruited, a case-control study was performed by collecting data of Mini Mental State Examination, carotid artery color Doppler flow imaging, biochemical tests, personal information on ages, medical histories, smoking as well as physical exercise among the recruited elderly in-patients/out-patients. A logistic regression was conducted to screen main effects of variables on occurrences of cognitive impairment. Results: Using logistic regression, the carotid intima-media thickness was found to be a significant risk factor (P<0.001) with larger regression coefficients (15.105 - 22.065) for the occurrence of cognitive impairment among elderly; about 71％ -78％ and 4％ decrease in risks of dementia occurrence for every 1 pg/mL serum free triiodothyronine and lkg body weight increase. Conclusion: The increase in carotid intima-media thickness is a significant risk factor for the occurrence of cognitive impairment among elderly patients. The decrease in serum free triiodothyronine and body weight are the related factors to increase risk for dementia.

Characteristics of cognitive dysfunction in essential tremor patients / 西安交通大学学报(医学版)

Objective To explore the characteristics and influencing factors of cognitive dysfunction in patients with essential tremor (ET).Methods We recruited ET patients diagnosed by the Department of Neurology of the First Affiliated Hospital of Xi`an Jiaotong University and healthy volunteers who matched the ET patients in age, gender and education level for the study.We recorded all the patients` demographic information, tremor degree, and family history based on the family tree.All the participants were tested by MMSE, MoCA, ADL, HAMD and HAMA.Results There were 88 ET patients and 63 normal subjects included in the study.According to MMSE, 31.82％ of the patients had cognitive dysfunctions, with orientation, short-term memory, calculation ability, language skills, retelling, reading comprehension, three-level command and drawing being significantly lower than those of the healthy volunteers (P<0.01);orientation was the most serious damage in cognitive function domain (K=0.624, S=0.726);three-level command was the least serious damage (K=0.274, S=0.319).According to MoCA, 86.36％ of the ET patients had cognitive dysfunction higher than normal people (P<0.05);visual space and execution, clock drawing task, naming, attention, 100-7, language skills, abstract thinking and orientation were significantly lower than normal people (P<0.01);the most serious damage in cognitive function domain was visual space and execution (K=0.651, S=0.786); the least serious damage cognitive function domain was “100-7” (K=0.406, S=0.484). Education level and age affected cognitive dysfunction (P<0.05). ADL scores showed negative correlation with cognitive function (correlation =－0.375 and －0.383, respectively; P<0.001). After the effects of anxiety and depression were excluded, onset age and tremor grading were correlated with cognitive dysfunction (P<0.05). When the above factors were put into binary Logistic regression model, education level was found to be contributed to the model (P<0.05).Conclusion Patients with ET widely suffer from cognitive impairment. Age, education level, daily life disability, age of onset, and tremor degree classification can affect cognitive dysfunction.

Clinical Observation of Acupuncture plus Medication for Vascular Dementia Due to Blood Stasis Blocking Collaterals / 上海针灸杂志

Objective To observe the clinical efficacy of acupuncture plus Nao Xue Shu oral liquid in treating vascular dementia (VD) due to blood stasis blocking collaterals. Method A total of 135 patients with VD due to blood stasis blocking collaterals were randomized into a basic group, a medication group, and an acupuncture-medication group, 45 cases in each group. The basic group was intervened by conventional treatment, while the control group was additionally given Nao Xue Shu oral liquid, and the acupuncture-medication group was additionally intervened by acupuncture plus Nao Xue Shu oral liquid, 60 d as a treatment course. The Mini-mental State Examination (MMSE), Brief Screening Scale for Dementia (BSSD) and the syndrome of blood stasis blocking collaterals subscale in the syndrome differentiation scale of vascular dementia (SDSVDA) were scored before and after the treatment, and the changes of calcitonin gene-related peptide (CGRP), lipid peroxidation (LPO) and serum uric acid (SUA) were also observed. Result One case dropped out in the basic group. After 60-day treatment, the total effective rate was 91.1%(41/45) in the acupuncture-medication group, significantly higher than 65.9% (29/44) in the basic group (P<0.01) and 75.6% (34/45) in the medication group (P<0.05). The improvements of MMSE, BSSD and SDSVDA scores in the acupuncture-medication group were more significant than those in the basic group and medication group (P<0.05). The improvements of CGRP, LPO and SUA levels in the acupuncture-medication group were superior to those in the basic group and medication group (P<0.05). Conclusion Traditional acupuncture method plus Nao Xue Shu oral liquid can produce a significant efficacy in treating VD due to blood stasis blocking collaterals.

Comparison on effects of piracetam and oxiracetam on elderly cognitive dysfunction after cerebral hemorrhage / 药物评价研究

Objective To compare the effects of piracetam and oxiracetam on elderly cognitive dysfunction after cerebral hemorrhage.Methods Elderly patients (82 cases) with cerebral hemorrhage treated in Tongchuan People's Hospital from January 2012 to December 2015 were selected and divided into two groups according to the different treatment drugs.Two groups were treated by oxiracetam and piracetam respectively.The Montreal cognitive assessment scale (MoCA),simple mental state examination (MMSE),and daily life ability scale (ADL) score of the two groups before and after treatment were compared.The neuron-specific enolase levels and cognitive function after treatment of 1,3,and 6 months were also compared.Results After treatment,MoCA,MMSE,and ADL scores of two groups were significantly improved (P ＜ 0.05),and oxiracetam group were significantly better than piracetam group (P ＜0.05).After treatment 6 months,MoCA,MMSE,ADL effective and total effective rate of the two groups were significantly higher (P ＜0.05),and oxiracetam group were significantly better than those ofpiracetam group (P ＜ 0.05).After treatment for 1,3,and 6 months,the neuron-specific enolase levels were significantly lower than those before treatment (P ＜ 0.05),and in the treatment of 3 and 6 months,oxiracetam group were significantly lower than piracetam group (P ＜ 0.05).The incidence of adverse reactions had no significant difference.Conclusion Oxiracetam can improve the elderly cognitive dysfunction after cerebral hemorrhage,the curative effect was increased with the prolonging of the time,and can reduce the neuron-specific enolase levels,which has high clinical value.

Application of MoCA and MMSE in screening for cognitive impairment in acute ischemic stroke / 中华行为医学与脑科学杂志

Objective To compare the applicability of the Beijing Version of the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE) in screening for cognitive impairment in patients with acute ischemic stroke for 2-3 weeks.Methods MoCA and MMSE were conducted in 201 patients with acute ischemic stroke within 2 to 3 weeks after the onset of stroke.With MoCA＜23 and MMSE ＜26 as the cut off value,we assessed the clinic effect of the MoCA and MMSE and explored the correlation between two instruments.Results The average scores of MoCA and MMSE scale were (20.5±4.3) and (25.4±3.5) points.The prevalence of cognitive impairment evaluated with MoCA and MMSE were 57.2％and 43.3％,respectively.MoCA showed significant correlation with MMSE score (Pearson's correlation coefficient=0.833,P＜0.001),and an agreement with Kappa values of 0.532 (P＜0.01) in screening for cognitive impairment.Conclusions The prevalence of cognitive impairment assessed with MoCA is higher than that of with MMSE when using MoCA＜23 and MMSE＜26 as the cut off values.Both instruments show a good agreement for screening cognitive impairment in acute ischemic stroke within 2 to 3 weeks following the disease onset.

Clinical observation of Sweet Dream Oral Liquid curing deficiency of spleen and kidney style MCI / 中草药

Objective To observe the clinical effect of Sweet Dream Oral Liquid on the mild cognitive impairment (MCI) patients of spleen and kidney deficiency. Methods A total of 102 patients with MCI were randomly divided into two groups, the treatment group with 53 patients and the control group with 49 patients. Both groups were given Citicoline Sodium Tablets for 8 weeks. The treatment group was given Sweet Dream Oral Liquid extra. Mini-mental state examination (MMSE), Transcranial Doppler (TCD) and Traditional Chinese Medicine Syndrome Score (TCMSS) were performed before and after the treatment. Compliance and adverse reactions for both groups were observed during the treatment. Results MMSE improved after the treatment for both groups; Especially, MMSE of the treatment group improved more obviously (P < 0.01); The difference between the two groups was significant (P < 0.05); For treatment group, the average blood flow velocity (Vm) of the cerebral arteries was increased significantly after the treatment(P < 0.01); Compared with the control group, the difference was obvious (P < 0.05); The total effective rate of the treatment group on spleen and kidney deficiency syndrome was 96.23%. It was 18.37% for the control group. Difference between the two groups was significant (P < 0.01). After the treatment, TCMSS of the treatment group was significantly reduced (P < 0.01); It was a significant difference comparing with the control group (P < 0.01). During the treatment, both groups had a good compliance, no adverse reactions and no shedding patients. Conclusion Sweet Dream Oral Liquid can improve the cognitive function and living quality of the patients with deficiency of spleen and kidney style MCI by reducing TCMSS, improving cerebral hemodynamics and rising MMSE score.

The Correlation between Cognitive Function and Glaucoma

PURPOSE: To compare mini-mental state examination (MMSE) score between glaucoma group and normal control group and to evaluate the correlation between MMSE score and spectral domain-optical coherence tomography (SD-OCT) values in both groups. METHODS: This prospective study includes thirty glaucoma patients (eleven primary open angle glaucoma and nineteen normal tension glaucoma) and thirty normal controls. Retinal nerve fiber layer (RNFL) and Ganglion cell-inner plexiform layer (GC-IPL) thickness were measured with SD-OCT, and the average values of both eyes were used. The cognitive function was evaluated with MMSE by a single examiner. RESULTS: The mean MMSE scores of glaucoma group and normal group were 26.07 ± 2.95, and 27.00 ± 1.68 respectively (p = 0.137). MMSE score of less than 24 only showed in glaucoma group. MMSE score and RNFL thickness showed statistically no signifance in correlation (R² = 0.236; p = 0.070), however, MMSE score and GC-IPL showed statistically significant correlation (R² = 0.256; p = 0.048). CONCLUSIONS: Glaucoma patients tend to show low cognitive function even though the correlation between glaucoma patient and low cognitive function was not statistically significant. Therefore, the aspect of cognitive depression should be concerned, when facing glaucoma patients.

Evaluation of relationship between cognitive function and occlusal status in elderly individuals using the T-scan III® system / 대한구강보건학회지

OBJECTIVES: The aim of this study was to investigate the relationship between cognitive function and occlusal status in elderly individuals. METHODS: A total of 162 individuals aged 65 years and older, who attended the senior citizen center in Daegu city, were included after consent for participation in the study was obtained. The Korean version of the Mini-Mental State Examination (MMSE-K) was used to evaluate the level of cognitive function. Occlusal status was determined using the T-scan III® system. All collected data were analyzed by χ² test, t-test, one way ANOVA, and linear regression analysis using SPSS version 23.0 for Windows. RESULTS: There was a significant relationship between the cognitive function and the use of dentures. Individuals with posterior occlusal status had higher MMSE-K scores than those with anterior occlusal status. There was a positive correlation between the cognitive function and posterior occlusal force. CONCLUSIONS: These results suggest that occlusal status was associated with cognitive function in the elderly individuals. Active national policies to improve occlusal condition in the elderly population are needed.

Contabilidad, validez de criterio y discriminante del Montreal Cognitive Assessment (MoCA) test, en un grupo de adultos de Bogotá / Reliability, criterion and discriminant validity of the Montreal Cognitive Assessment Test (MoCA) in a group of adults from Bogotá

Resumen Introducción: el MoCA-test es un instrumento breve de tamizaje, sensible y específico, utilizado para la detección del deterioro cognitivo leve (DCL) y la demencia, con puntos de corte que varían según la población estudiada. Objetivo: evaluar la confiabilidad y validez discriminante del MoCA-test, en un grupo de adultos de Bogotá, con diferentes escolaridades. Material y Métodos: se aplicó el MoCA-test y el MMSE, a 1174 adultos mayores de 50 años de diferentes localidades de Bogotá. Los sujetos con MoCA-test < 26 y MMSE <24, fueron citados a una segunda evaluación aplicándoseles un protocolo amplio y fueron analizados por consenso, para determinar normalidad o deterioro cognitivo. Se determinó la consistencia interna (con coeficiente alpha de Cronbach), confiabilidad test-retest (con coeficiente de Lin), la validez de criterio (con coeficiente de Spearman) y validez discriminante (por medio de curvas ROC) del MoCA-Test. Resultados: la consistencia interna (alfa-Cronbach=0.851) y la confiabilidad test-retest (Lin=0.62) fueron aceptables. La validez de criterio respecto al MMSE, fue moderada (r=0.65). El MoCA mostró capacidad para discriminar entre diferentes grupos diagnósticos y sociodemográficos. El área bajo la curva fue 0.76 para DCL y 0,81 para demencia; el punto de corte para discriminar entre normalidad y DCL en el grupo en general fue 20/21 y entre DCL y demencia 17/18. Estos puntos variaron con el grado de escolaridad. Conclusión: el MoCA-test puede ser el instrumento de tamización en atención primaria, para detectar deterioro cognitivo en nuestra población adulta, considerando los puntos de corte propuestos según la escolaridad. (Acta Med Colomb 2016; 40: 221-228).

Abstract Introduction: the MoCA-Test is a brief, sensitive and specific screening tool used to detect mild cognitive impairment (MCI) and dementia, with cut-off points that vary according to the population studied. Objective: to evaluate the reliability and discriminant validity of the MoCA-test, in a group of adults from Bogotá, with different levels of schooling. Material and Methods: the MoCA-test and the MMSE were applied to 1174 adults over 50 years old from different locations in Bogotá. Subjects with MoCA-test <26 and MMSE <24, were referred to a second evaluation by applying a broad protocol and were analyzed by consensus, to determine normality or cognitive impairment. Internal consistency (with Cronbach's alpha coefficient), test-retest reliability (with Lin coefficient), criterion validity (with Spearman's coefficient) and discriminant validity (using ROC curves) of the MoCA-Test were determined. Results: internal consistency (alpha-Cronbach = 0.851) and test-retest reliability (Lin = 0.62) were acceptable. The criterion validity with respect to MMSE was moderate (r = 0.65). The MoCA-test showed the capacity to discriminate between different diagnostic and sociodemographic groups. The area under the curve was 0.76 for MCI and 0.81 for dementia; the cutoff point for discriminating between normality and MCI in the group in general was 20/21 and between MCI and dementia 17/18. These points varied with the level of schooling. Conclusion: the MoCA-test can be the screening tool in primary care in order to detect cognitive impairment in our adult population, considering the proposed cutoff points according to schooling. (Acta Med Colomb 2016; 40: 221-228).

The effect of sugammadex on postoperative cognitive function and recovery / O efeito de sugamadex sobre a função cognitiva e recuperação no pós-operatório

Abstract Background and objective: Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. Methods: Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S) or the Neostigmine group (Group N). The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). After baseline assessment 12-24 h before the operation. After the operation, when the Modified Aldrete Recovery Score was ≥9 the MMSE and 1 h later the MoCA tests were repeated. Results: Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p > 0.05). The time to reach TOF 0.9 was 2.19 min in Group S and 6.47 min in Group N (p < 0.0001). Recovery time was 8.26 min in Group S and 16.93 min in Group N (p < 0.0001). Conclusion: We showed that the surgical procedure and/or accompanying anesthetic procedure may cause a temporary or permanent regression in cognitive function in the early postoperative period. However, better cognitive performance could not be proved in the Sugammadex compared to the Neostigmine.

Resumo Justificativa e objetivo: Sugamadex é o primeiro agente de ligação relaxante seletivo. Após a administração de sugamadex, os tempos de despertar e de recuperação dos pacientes são menores, em comparação com neostigmina. Neste estudo, a hipótese foi que um despertar mais rápido e claro dos pacientes submetidos à anestesia geral tem efeitos positivos sobre as funções cognitivas no pós-operatório imediato. Métodos: Após a aprovação do Comitê de Ética local, 128 pacientes foram incluídos neste estudo prospectivo, randômico, controlado e duplo-cego. Os pacientes foram designados para o grupo sugamadex (Grupo S) ou grupo neostigmina (Grupo N). O desfecho primário do estudo foi a recuperação cognitiva no pós-operatório imediato, de acordo com a mensuração da Avaliação de Montreal da Função Cognitiva (MoCA) e com o Mini Exame do Estado Mental (MMSE), após a avaliação inicial 12-24 h antes da operação. Após a operação, quando o escore de recuperação de Aldrete modificado era ≥ 9, o teste MMSE e, uma hora depois, o teste MoCA foram repetidos. Resultados: Embora tenha havido uma redução nos escores de MoCA e MMSE tanto no Grupo S quanto no Grupo N, entre os escores pré- e pós-operatório não houve diferença estatisticamente significativa nas reduções (p > 0,05). O tempo para atingir TOF 0,9 foi de 2,19 min no Grupo S e de 6,47 min no Grupo N (p < 0,0001). O tempo de recuperação foi de 8,26 min no Grupo S e de 16,93 min no Grupo N (p < 0,0001) Conclusão: Mostramos que o procedimento cirúrgico e/ou procedimento anestésico de acompanhamento pode causar uma regressão temporária ou permanente da função cognitiva no pós-operatório imediato. No entanto, um desempenho cognitivo melhor não pode ser provado no grupo sugamadex em comparação com o grupo neostigmina.