Does gender influence P300 latency and mini mental state examination score in type 2 diabetes mellitus patients?

Background: P300 event-related potentials (ERPs) is an electrophysiologic marker of cognitive ability which closely reflects cognitive functions. Type 2 Diabetes mellitus (T2DM) causes many complications. Diabetes mellitus-induced damage to the central nervous system is a key focus of research. Latest magnetic resonance imaging evidence suggested that the changes in anatomy of brain is more rapidly seen in males than in females. This study was carried out to study the gender variations in P300 latency and Mini Mental State Examination (MMSE). Aim and Objective: To study the influence of gender on MMSE score as well as P300 ERP. Materials and Methods: 30 diagnosed Type 2 Diabetics aged above 40 years, with more than 2 years duration of diabetes were included in this study. MMSE questionnaire was administered to each diabetic and P300 was recorded using RMS EMG EP MARK 2 machine in all the diabetics. Results: The P300 ERP of male diabetics was prolonged significantly with mean ± standard deviation (SD) of (347.01 ± 31.55) whereas female diabetics had a mean ± SD of (318.26 ± 28.22; P = 0.014) and no significant difference was found between the mean MMSE scores of male diabetics (26.06 ± 1.38) and female diabetics (26.13 ± 1.30). Conclusion: The change in P300 ERP is swifter in males when compared with females in the middle to old age. Compared to MMSE, P300 Latency is a sensitive electrophysiological tool for diagnosing early cognitive deterioration in T2DM.

Effects of repetitive transcranial magnetic stimulation combined with oral paroxetine on cognitive status and activities of daily living in older adult patients with severe depression / 中国基层医药

Objective:To investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with oral paroxetine in the treatment of older adult patients with severe depression and its effects on the scores of the Hamilton Rating Scale for Depression (HAMD), the Mini-Mental State Examination (MMSE), and Activities of Daily Living (ADL).Methods:A total of 192 older adult patients with severe depression who received treatment in Shaoxing 7 th People's Hospital from January 2018 to December 2019 were included in this study. They were randomly assigned to receive either oral paroxetine (control group, n = 96) or rTMS + oral paroxetine (observation group, n = 96). All patients received 1 month of treatment. Clinical efficacy was compared between the two groups. HAMD, MMSE, and ADL scores pre- and post-treatment and the incidence of adverse events during the treatment were compared between the two groups. Results:Total response rate was significantly higher in the observation group than in the control group [96.88% (93/96) vs. 89.58% (86/96), χ2 = 4.04, P < 0.05]. HAMD scores post-treatment were significantly lower in the observation group than in the control group [(6.43 ± 2.33) points vs. (11.32 ± 2.02) points, t = 15.53, P < 0.05]. MMSE and ADL scores post-treatment in the observation group were (29.13 ± 3.01) points and (71.52 ± 5.32) points, respectively, which were significantly higher than those in the control group [(24.65 ± 2.79) points, (69.65 ± 5.17) points, t = 10.69, 2.47, P < 0.05]. There was no significant difference in the incidence of adverse events between the two groups ( P > 0.05). Conclusion:The combined therapy of rTMS and oral paroxetine is highly effective on severe depression in older adult patients. It can improve cognitive function and the activities of life living.

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.

Association between serum non-high-density lipoprotein cholesterol and cognitive dysfunction after acute ischemic stroke: a cross-sectional study

This study aimed to explore the association between serum non-high-density lipoprotein cholesterol (non-HDL-C) and cognitive dysfunction risk in patients with acute ischemic stroke (AIS). This cross-sectional study enrolled 583 AIS patients. Biochemical markers and lipid profile were collected after admission. AIS patients were classified into high group (non-HDL-C ≥3.4 mM) and normal group (non-HDL-C <3.4 mM). Mini-Mental State Examination scale (MMSE), Montreal Cognitive Assessment scale (MoCA), Activities of Daily Living (ADL) scale, Neuropsychiatric Inventory (NPI), and Hamilton Depression scale 21 version (HAMD-21) were applied on the third day after admission. Compared with the control group, patients of the high group had higher body mass index and higher frequency of intracranial artery stenosis, and exhibited higher levels of non-HDL-C, total cholesterol, triglycerides, low-density lipoprotein cholesterol, homocysteine, fasting blood glucose, and glycosylated hemoglobin (HbA1c), and lower levels of high-density lipoprotein cholesterol (all P<0.05). Compared with the control group, patients of the high group had significantly lower MMSE and MoCA scores (MMSE: 26.01±4.17 vs 23.12±4.73, P<0.001; MoCA: 22.28±5.28 vs 20.25±5.87, P<0.001) and higher scores on the NPI and HAMD-21 (both P<0.001). MMSE (r=-0.306, P<0.001) and MoCA scores (r=-0.251, P<0.001) were negatively associated with non-HDL-C level. Multivariate regression analysis revealed that non-HDL-C level (OR=1.361, 95%CI: 1.059-1.729, P=0.016) was independently associated with the presence of cognitive dysfunction after adjusting for confounding factors. High serum non-HDL-C level might significantly increase the risk of cognitive dysfunction after AIS.

Correlation among Three Cognitive Tools in Memory Assessment / 中国康复理论与实践

Objective:To explore the correlation and characteristics of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Rivermead Behavioural Memory Test-III (RBMT-III) in evaluating memory ability of patients with brain injuries. Methods:From March, 2016 to February, 2018, 62 patients with brain injuries were evaluated with the Chinese version of MMSE, MoCA and RBMT-III. The correlation among them was analyzed. Results:There was positive correlation among the total scores of MMSE, MoCA and RBMT-III (r = 0.682 to 0.786, P < 0.001), as well as the retrospective memory (r = 0.525 to 0.610, P < 0.001) and long-term memory (r = 0.553 to 0.692, P < 0.001). There was positive correlation between RBMT-III and MMSE in short-term memory (r = 0.337, P = 0.007). The prospective memory of RBMT-III positively correlated with retrospective memory of MMSE and MoCA (r = 0.639, r = 0.585, P < 0.001), and the short-term memory of RBMT-III with long-term memory of MMSE and MoCA (r = 0.454, r = 0.534, P < 0.001). Conclusion:MMSE, MoCA and RBMT-III are consistent in evaluating retrospective memory and long-term memory for patients with brain injuries. RBMT-III and MMSE are consistent in evaluating short-term memory for patients with brain injuries. The memory scores of MMSE and MoCA are helpful to judge the event-based prospective memory in patients with brain injuries, while the scores of long-term memory are helpful to judge short-term memory.

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.

Comparison between the Mini-Mental State Examination and Montreal Cognitive Assessment as a Cognitive Screening Tool in Patients with Human Immunodeficiency Virus-Associated Neurocognitive Disorders

Abstract INTRODUCTION: The number of human immunodeficiency virus-associated neurocognitive disorders has increased, reaching more than 50% of the cases. However, there are currently no substantial data on the screening methods for this disease. This study aimed to evaluate and compare the Mini-Mental State Examination to the Montreal Cognitive Assessment in human immunodeficiency virus-infected patients. METHODS: This was an observational study comprising 82 human immunodeficiency virus-positive individuals with and without cognitive complaints. RESULTS: Positive correlation (p<0.001) between the Mini-Mental State Examination and the Montreal Cognitive Assessment test scores was observed, but the mean scores revealed that the Mini-Mental State Examination showed worse performance for trails (p<0.001), cube copying (p<0.001), and clock drawing (p<0.001) than the Montreal Cognitive Assessment. CONCLUSIONS: The Mini-Mental State Examination and the Montreal Cognitive Assessment tests should be used concomitantly for the assessment of human immunodeficiency virus-associated neurocognitive disorders, but visuoexecutive and visuospatial dysfunctions are better evaluated using the Montreal Cognitive Assessment test than the Mini-Mental State Examination.

Characterization of quantitative EEG in patients with postoperative cognitive dysfunction / 医学研究生学报

Objective Very few studies have been reported on the application of quantitative electroencephalogram (qEEG) in patients with postoperative cognitive dysfunction (POCD). This study was to investigate the qEEG features of POCD and provide some help for the early detection and diagnosis of the condition. Methods We enrolled 31 postoperative patients treated in our Department of Critical Care Medicine from January 2018 to October 2018. Based on the pre- and post-operative scores on the Mini-Mental State Examination (MMSE), we divided the patients into a POCD (MMSE score >2, n = 11) and a non-POCD control group (MMSE score ≤2, n = 20). Using the brain function instrument, the electrode set according to the standard international 10-20 system and with bipolar longitudinal F3-P3 and F4-P4 four channels, we conducted bedside monitoring for all the patients and calculated the average value of the consecutive clips of 10-min qEEG. Then, we analyzed the amplitude-integrated EEG (aEEG), relative frequency band energy, relative α variability and spectrum entropy, and the correlation of relative frequency band energy and relative α variability with the MMSE scores. Results Compared with the non-POCD controls, the POCD patients showed significant decreases in the total MMSE scores (28.35 ± 1.27 vs 18.91 ± 2.34, P < 0.05), orientation score (9.75 ± 0.44 vs 6.82 ± 1.47, P < 0.05) and memory score (2.90 ± 0.31 vs 2.09 ± 1.04, P < 0.05) as well as in the concentration, calculation, recalling and language scores (all P < 0.05); and the POCD patients also exhibited marked reduction in the left α variability ([22.59 ± 10.98]% vs [14.39 ± 8.25]%, P < 0.05), right α variability ([24.07 ± 9.73]% vs [15.70 ± 9.59]%, P < 0.05), left α frequency band energy ([7.17 ± 4.73] vs [3.83 ± 2.62] μV2, P < 0.05) and right α frequency band energy ([6.94 ± 4.53] vs [3.82 ± 2.51] μV2, P < 0.05). The MMSE scores were found to be negatively correlated with left α variability (r = -0.793, P = 0.004), right α variability (r = -0.835, P = 0.001), left α frequency band energy (r = -0.633, P = 0.037) and right α frequency band energy (r = -0.682, P = 0.021). Conclusion Quantitative EEG of POCD patients is characterized by significantly decreased α variability and α frequency band energy, which may contribute to the early detection and diagnosis of POCD.

Effects of Low-carbohydrate and High-fat Diet Supplemented with Ketogenic Drink on Cognitive Function and Physical Performance in the Elderly at High Risk for Dementia / 대한지역사회영양학회지

OBJECTIVES: Reduced glucose utilization in the main parts of the brain involved in memory is a major cause of Alzheimer's disease, in which ketone bodies are used as the only and effective alternative energy source of glucose. This study examined the effects of a low-carbohydrate and high-fat (LCHF) diet supplemented with a ketogenic nutrition drink on cognitive function and physical activity in the elderly at high risk for dementia.METHODS: The participants of this study were 28 healthy elderly aged 60-91 years showing a high risk factor of dementia or whose Korean Mini-Mental State Examination (K-MMSE) score was less than 24 points. Over 3 weeks, the case group was given an LCHF diet with nutrition drinks consisting of a ketone/non-ketone ratio of 1.73:1, whereas the control group consumed well-balanced nutrition drinks while maintaining a normal diet. After 3 weeks, K-MMSE, body composition, urine ketone bodies, and physical ability were all evaluated.RESULTS: Urine ketone bodies of all case group subjects were positive, and K-MMSE score was significantly elevated in the case group only (p=0.021). Weight and BMI were elevated in the control group only (p<0.05). Grip strength was elevated in all subjects (p<0.01), and measurements of gait speed and one leg balance were improved only in the case group (p<0.05).CONCLUSIONS: We suggest that adherence to the LCHF diet supplemented with a ketogenic drink could possibly influence cognitive and physical function in the elderly with a high risk factor for dementia. Further, we confirmed the applicability of this dietary intervention in the elderly based on its lack of any side effects or changes in nutritional status.

Development and Validation of the Full Version of Story Memory in the Korean-Mini Mental State Examination, 2nd Edition: Expanded Version (K-MMSE-2: EV)

BACKGROUND AND PURPOSE: The Korean version of Story Memory (SM) in the Korean-Mini Mental State Examination, 2nd Edition: Expanded Version (K-MMSE-2: EV) was developed. Based on the SM, we additionally developed a full version of SM including delayed recall (DR) and recognition adding to immediate recall (IR). This study aimed to examine the reliabilities and validities of the newly developed SM in the K-MMSE-2: EV and its full version. METHODS: Ninety-five healthy elderly individuals (HE), 90 patients with amnestic mild cognitive impairment (aMCI), and 53 patients with dementia of the Alzheimer's type (DAT) participated in the study. They were administered the full version of SM with the Seoul Verbal Learning Test-Elderly's version (SVLT-E) and Rey Complex Figure Test (RCFT). In addition, the SM was re-administered to 51 participants after a 5-week interval. Two clinical neuropsychologists independently rated the performance of 50 participants. RESULTS: The test-retest reliabilities of the IR, DR, and recognition of the SM were statistically significant. The inter-rater reliabilities (Cohen's kappa) were high (0.87–1.00) for all the measures. The IR, DR, and recognition of SM had significant positive correlations with those of the SVLT-E and RCFT. Significant group differences in IR and DR of SM were found among the HE, aMCI, and DAT groups. The recognition scores were significantly different between the aMCI and DAT groups, but not between the HE and aMCI groups. CONCLUSIONS: The newly developed full version of SM in the K-MMSE-2: EV was proven to be a reliable and valid memory measure for clinical use.

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.

Development of a Screening Algorithm for Alzheimer's Disease Using Categorical Fluency and Confrontational Naming Abilities

OBJECTIVE: Declines in naming ability and semantic memory are well-known features of early Alzheimer's disease (AD). We developed a new screening algorithm for AD using two brief language tests : the Categorical Fluency Test (CFT) and 15-item Boston Naming Test (BNT15). METHODS: We administered the CFT, BNT15, and Mini-Mental State Examination (MMSE) to 150 AD patients with a Clinical Dementia Rating of 0.5 or 1 and to their age- and gender-matched cognitively normal controls. We developed a composite score for screening AD (LANGuage Composite score, LANG-C) that comprised demographic characteristics, BNT15 subindices, and CFT subindices. We compared the diagnostic accuracies of the LANG-C and MMSE using receiver operating curve analysis. RESULTS: The LANG-C was calculated using the logit of test scores weighted by their coefficients from forward stepwise logistic regression models : logit (case)=12.608−0.107×age+1.111×gender+0.089×education−0.314×HS(1st)−0.362×HS(2nd)+0.455×perseveration+1.329×HFCR(2nd)−0.489×MFCR(1st)−0.565×LFCR(3rd). The area under the curve of the LANG-C for diagnosing AD was good (0.894, 95% confidence interval=0.853–0.926 ; sensitivity=0.787, specificity=0.840), although it was smaller than that of the MMSE. CONCLUSION: The LANG-C, which is easy to automate using PC or smart devices and to deliver widely via internet, can be a good alternative for screening AD to MMSE.

Behavioral Memory Assessment for Traumatic Brain Injury Patients with Normal Result in Mini-Mental State Examination / 中国康复理论与实践

Objective:To observe the performance of the traumatic brain injury (TBI) patients with normal results in Mini-Mental State Examination (MMSE) in the Montreal Cognitive Assessment (MoCA) and Rivermead Behavioral Memory Test-3 (RBMT-3). Methods:From March, 2015 to June, 2018，40 TBI patients with cognitive complaints but normally in MMSE and other 30 healthy persons (controls) were assessed with MoCA and RBMT-3. Results:There were 14 patients sounded normally in MoCA. The scores of MoCA, as well as both the raw score and scale score of RBMT-3, were less in the patients than in the controls (t > 2.822, P < 0.01), especially in the verbal and delayed recall subtests of MoCA (t > 2.790, P < 0.01), and delayed story recall, skill learning instant recall, delayed skills recall (both raw and scale scores) (t > 2.507, P < 0.05), and remember name delay recall and story instant recall (raw score only) (t > 2.018, P < 0.05) of RBMT-3. Conclusion:For TBI patients with cognitive complaints, it is necessary to assesse with both MMSE and MoCA. If there is any memory impairment, RBMT-3 is needed.

Clinical Study of Eight Nape Needle Therapy for Mild Cognitive Impairment After Cerebral Stroke / 上海针灸杂志

Objective To observe the therapeutic efficacy of eight nape needle therapy in treating mild cognitive impairment (MCI) after cerebral stroke. Method By following a randomized controlled trial design, 200 eligible patients were randomized into an eight nape needle group and a medication group by the random number table, with 100 cases in each group. The patients all received basic medications, while the eight nape needle group was additionally intervened by acupuncture at the eight nape acupoints including Fengchi (GB20), Fengfu (GV16), Dazhui (GV14) and Xiangsihua points (Extra), and the medication group additionally received oral administration of nimodipine. The intervention lasted eight weeks, followed by a three-month follow-up. Before and after treatment, the two groups of patients were evaluated by Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Barthel Index (BI). Result Respectively at four-week and eight-week treatment and the follow-up, the scores of MMSE, MoCA and BI showed improvements compared with the corresponding baseline (P<0.01, P<0.05);compared with the medication group, the eight nape needle group was superior to the medication group comparing the MMSE score at each time point after treatment (P<0.01, P<0.05); there were no significant differences in the MoCA and BI scores between the two groups at four-week treatment (P>0.05), but the differences were significant at eight-week treatment and the follow-up (P<0.01). Conclusion Eight nape needle therapy can effectively improve the cognitive function in patients with MCI after cerebral stroke.

Desempenho cognitivo através do mini-exame do estado mental na distrofia muscular de Duchenne / Cognitive performance by mini mental state examination in Duchenne muscular dystrophy

OBJETIVO: A distrofia muscular de Duchenne (DMD) é frequentemente associada à deficiência intelectual (DI) e ao prejuízo de funções superiores como leitura, raciocínio, lógica, e memória. O objetivo do estudo foi avaliar o desempenho cognitivo de pacientes com DMD através do Mini-Exame do Estado Mental (MEEM), um teste simples e rápido, usado como primeiro rastreio intelectual, principalmente quando baterias psicométricas complexas, dependentes de psicólogos especializados, não estão disponíveis. MÉTODO: Foi realizado um estudo observacional de trinta e quatro meninos com DMD, com idades entre 8 e 22 anos, separados em dois grupos de acordo com a presença de DI moderada-grave, conforme a definição clínica do funcionamento adaptativo do Manual Estatístico e Diagnóstico de Desordens Mentais 5º edição (DSM-5). Foram avaliados a pontuação no MEEM, marcos do desenvolvimento, independência nas atividades de vida cotidiana e capacidade de alfabetização. RESULTADOS: Os marcos motores e de linguagem estavam atrasados (16 meses), e a média no MEEM foi 21, ponto de corte mais baixo do que verificado em pares da mesma idade. O grupo com DI moderada-grave apresentou uma média de 12 no MEEM, e os subtestes de orientação, atenção e cálculo e linguagem foram os que demonstraram piores desempenhos. O ponto de corte de maior acurácia para distinguir DI moderada-grave nos pacientes com DMD foi 21. CONCLUSÃO: O MEEM apresentou adequada sensibilidade (100%) e especificidade (90%) para o ponto de corte de 21, revelando-se um bom método de triagem cognitiva para DI moderada-grave na DMD.

BACKGROUND: Duchenne muscular dystrophy (DMD) is often associated with intellectual disability (ID) and with impairment of higher mental functions as reading, learning, logical thinking and memory. The goal of this study was evaluate the cognitive performance of DMD patients by Mini-Mental State Examination (MMSE), first bedside screening test, widely used in pediatrics, when neuropsychologic batteries, dependent on specialized psychologists, are not easily available in public health system. METHODS: An observational study of thirty-four boys with DMD, aged 8-22 years, was performed, spliting this group into two sub-groups, according to the presence of moderate-severe, defined by Diagnostic and Statistical Manual of Mental Disorders (DSM-5) adaptative functioning clinical criteria. The MMSE scores, developmental milestones, independence in daily life activities and literacy skills were evaluated. RESULTS: Motor and language milestones were reached with 16 months, later than usual and mean on MMSE was 21, lower than in healthy pairs. In assessment by groups, patients with moderate-severe intellectual disability presented a performance in total MMSE (12) and orientation, attention/calculation and language MMSE subtests lower than patients without ID. The most accurate cutoff value on MMSE to distinguish moderate-severe intellectual disability in DMD patients was 21. CONCLUSION: This study has shown adequate sensitivity and specificity of the MMSE for detection of moderate-severe intellectual disability, with almost 100% sensitivity and 90% specificity for cutoff values of 21 points in DMD.

A cross-sectional study on behavioural and psychological symptoms of dementia in elderly and its impact on quality of life in a tertiary care hospital

Background: Historically, the word dementia was derived from Latin word ‘dementatus’, which means ‘out of one’s mind’. There were 24.3 million people with dementia in the world and 4.6 million are being added every year. Present study was done to evaluate the behavioral and psychological symptoms of dementia in elderly patients and its impact on their quality of life.Methods: It was a hospital based descriptive, cross-sectional study. 100 cognitively impaired patients in the age group of 60 years and above were enrolled. The socio-demographic profile, severity of dementia on MMSE; behavioral disturbances on BPSD; psychiatric illness on NPI; agitation on CMAI and their impact on quality of life, and disability were assessed on WHOQOL-Bref and WHO DAS 2.0 scales, respectively.Results: Out of 110 patients that were screened, 100 participated in the study (response rate 91%). Majority of subjects (53%) were illiterate and belongs to rural background (57%). Mean dementia severity score was 17.01±4.439 SD which was of mild to moderate level. Overall mean age was 68.16±8.16 SD and negatively related (r= -0.652; F=27.044, p<0.001) but weakly associated to severity of dementia. There was a statistically significant increase in the NPI scores with increase in dementia severity (Item score F=91.754, p<0.001 and distress score F=81.647, p<0.001). There was significant increase in agitation/aggression (CMAI) with an increase in severity of dementia. BPSD on NPI item score was weakly related (r=0.757) and caused increase in disability but decrease in quality of life. Dementia severity as per MMSE score was negatively related to WHO DAS disability (r= -0.863), BPSD on NPI item (r= -0.797) and agitation/aggression on CMAI (r= -0.587). WHOQOL-Bref decreases with increase in severity of dementia and disability.Conclusions: Dementia severity was of mild to moderate level and it increased with age. Most common psychiatric symptom was agitation/aggression (76%) and least common was hallucinations (12%). BPSD causes significant decrease in quality of life and an increase in severity of disability.

A comparative study for evaluation of cognitive function in type-II diabetes mellitus patients and non-diabetics

Background: To evaluate the impact of type-II diabetes mellitus on cognitive function and to assess the factors associated with impaired function.Methods: This prospective study compared 100 type-II diabetic people attending the diabetic clinic of Tirunelveli Medical College Hospital with another 100 membered control group. The study group was selected randomly between the age group of 45-65 years. A neuro-cognitive assessment was done using Standardized Mini Mental State Examination (SMMSE), which is a simple and reliable screening test. This scale has 12 questions with time limits to assess orientation, memory, calculation, language, attention and construction. Magnitude and severity of cognitive decrement were analysed along with the possible factors affecting it.Results: Mean age of the study population was 54.6�24 years. Cognitive impairment was noted among 62 of cases and 48 of the control group, which means a 14% higher prevalence of cognitive impairment among the type 2 diabetics. The association of development of cognitive impairment and duration of diabetes mellitus was significant statistically (p value = 0.025443; p<0.05). Other demographic variables like gender, education and domicile were also seen to affect the results.Conclusions: Mild to moderate cognitive impairment was found significantly higher among the type-II diabetics than the non-diabetics. The cognitive impairment was found to be associated with the duration of diabetes. Hence the routine screening of cognition by SMMSE should be done in all type-II diabetic patients.

Validation of MoCA-MMSE Conversion Scales in Korean Patients with Cognitive Impairments

BACKGROUND AND PURPOSE: Two conversion scales between the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) have been validated for Korean patients with Parkinson's disease. The aim of the present study was to validate these conversion scales for all patients with cognitive impairments regardless of dementia subtype. METHODS: Medical records of 323 subjects who completed both MMSE and MoCA on the same day were retrospectively reviewed. Mean, median, and root mean squared error (RMSE) of the difference between true and equivalent MMSE scores were calculated. Intraclass correlation coefficients (ICCs) between true and equivalent MMSE scores were also calculated. The validity of MoCA-MMSE conversion scales was evaluated according to educational level (low educated: ≤6 years; high educated: ≥7 years) and subtypes of cognitive impairment. RESULTS: The difference between true and equivalent MMSE scores had a median value of 0, a mean value of 0.19 according to the van Steenoven scale, a mean value of 0.57 according to the Lawton scale, RMSE value of 2.2 according to the van Steenoven scale, and RMSE value of 0.42 according to the Lawton scale. Additionally, ICCs between true and equivalent MMSE scores were 0.92 and 0.90 on van Steenovan and Lawton conversion scales, respectively. These results were maintained in subgroup analyses. CONCLUSIONS: Findings of the present study suggest that both van Steenovan and Lawton MoCA-MMSE conversion scales are applicable to transforming MoCA scores into MMSE scores in patients with cognitive impairments regardless of dementia subtype or educational level.

Usefulness of the Clock Drawing Test as a Cognitive Screening Instrument for Mild Cognitive Impairment and Mild Dementia: an Evaluation Using Three Scoring Systems

BACKGROUND AND PURPOSE: Although the clock drawing test (CDT) is a widely used cognitive screening instrument, there have been inconsistent findings regarding its utility with various scoring systems in patients with mild cognitive impairment (MCI) or dementia. The present study aimed to identify whether patients with MCI or dementia exhibited impairment on the CDT using three different scoring systems, and to determine which scoring system is more useful for detecting MCI and mild dementia. METHODS: Patients with amnestic mild cognitive impairment (aMCI), vascular mild cognitive impairment (VaMCI), mild Alzheimer's disease (AD), mild vascular dementia (VaD), and cognitively normal older adults (CN) were included. All participants were administered the CDT, the Korean-Mini Mental State Examination (K-MMSE), and the Clinical Dementia Rating scale. The CDT was scored using the 3-, 5-, and 15-point scoring systems. RESULTS: On all three scoring systems, all patient groups demonstrated significantly lower scores than the CN. However, while there were no significant differences among patients with aMCI, VaMCI, and AD, those with VaD exhibited the lowest scores. Area under the Receiver Operating Characteristic curves revealed that the three CDT scoring systems were comparable with the K-MMSE in differentiating aMCI, VaMCI, and VaD from CN. In differentiating AD from CN, however, the CDT using the 15-point scoring system demonstrated the most comparable discriminability with K-MMSE. CONCLUSIONS: The results demonstrated that the CDT is a useful cognitive screening tool that is comparable with the Mini-Mental State Examination, and that simple CDT scoring systems are sufficient for differentiating patients with MCI and mild dementia from CN.

Observation of the Effect of Acupuncture-moxibustion on Mild Cognitive Impairment Based on Constitution Differentiation of Traditional Chinese Medicine / 上海针灸杂志

Objective To observe the clinical efficacy of acupuncture-moxibustion in treating mild cognitive impairment based on constitution differentiation of traditional Chinese medicine (TCM). Method Eighty patients with mild cognitive impairment were randomized into a treatment group and a control group, 40 cases each. The treatment group was intervened by acupuncture-moxibustion according to their constitution, while the control group received oral administration of Nimodipine tablets. After successive 3-month treatment, changes in the scores of Classification and Diagnosis of Constitution of Traditional Chinese Medicine and Mini-Mental State Examination (MMSE) were observed. The clinical efficacies of the two groups were also compared. Result After the treatment, the constitution and MMSE scores of the treatment group were significantly different from those of the control group (P<0.05). The total effective rate was 87.2％ in the treatment group versus 65.8％ in the control group, and the between-group difference was statistically significant (P<0.05). Conclusion Based on the constitution differentiation of TCM, acupuncture- moxibustion can precisely improve mild cognitive impairment in patients with different constitutions, and correct their cognitive bias.