Revisión de las pruebas cognitivas breves para pacientes con sospecha de demencia / Review of brief cognitive tests for patients with suspected dementia

RESUMEN NTRODUCCIÓN: Para ser útiles, las pruebas cognitivas breves (PCB) deben ser rápidas, sensibles, fáciles de realizar y no necesitar de un gran entrenamiento para hacerlo. Las pruebas cognitivas breves comúnmente utilizadas incluyen el Mini Examen del Estado Mental (MMSE) y la Evaluación Cognitiva de Montreal (MoCA). OBJETIVO: Brindar una descripción de las PCB disponibles y sus propiedades psicométricas para la detección de la demencia. MÉTODOS: Revisión narrativa RESULTADOS: El MMSE le otorga un gran peso a la orientación, la memoria, la visuo-espacialidad y el lenguaje, y, en consecuencia, puede ser sensible a los déficits cognitivos encontrados en la demencia tipo Alzheimer. MoCA es una prueba breve más compleja que evalúa una gama más amplia de dominios cognitivos, especialmente funciones ejecutivas, proporcionando una mayor sensibilidad para detectar el deterioro cognitivo leve y otros tipos de demencia, no solo la demencia tipo Alzheimer. CONCLUSIONES: Las PCB son parte del arsenal necesario para ayudar a confirmar la sospecha de la demencia. La escolaridad tiene un impacto importante en el desempeño de las PCB y puede sesgar la interpretación de los resultados obtenidos.

ABSTRACT INTRODUCTION: To be useful, Brief Cognitive Tests (BCTs) must be fast, sensitive, easy to perform, and not require extensive training to do so. Commonly used brief cognitive tests include the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). OBJECTIVE: To provide a description of the available BCTs and their psychometric properties for the detection of dementia. METHODS: Narrative review RESULTS: The MMSE places great weight on orientation, memory, visuospatiality, and language, and, consequently, may be sensitive to the cognitive deficits found in Alzheimer's dementia. MoCA is a more complex brief test that assesses a broader range of cognitive domains, especially executive functions, providing greater sensitivity for detecting mild cognitive impairment and other types of dementia, not just Alzheimer's dementia. CONCLUSIONS: BCTs are part of the arsenal needed to help confirm suspected dementia. Schooling has an important impact on the performance of BCTs and can bias the interpretation of the results obtained.

Quality of Life of Elderly People Living in Different Types of Long-term Care Facilities

Abstract Population aging is a worldwide occurrence that has become urgent in developing countries. Quality of life can be measured to identify functional capacity and determine the degree of impact on quality of life exerted on an individual. This study aimed to measure the quality of life of elderly people who have been living in different long-term care facilities for the elderly. Therefore, this research was developed with a qualitative and descriptive approach. Data were obtained from medical records and interviews, and were analyzed in R language interpreter software on the Ubuntu Linux operating system. Seventy-nine elderly people participated in the study. Eleven lived in Home Marista, and 68 lived in Home Jesus Maria José. A socioeconomic questionnaire was used to collect data on the socioeconomic characteristics of the participants. The Mini-Mental State Exam was used to measure degree of cognition. The Short Form-36 Questionnaire was used to measure quality of life. The present study suggests that the results found can clarify the individual vulnerability of the elderly in the age group studied regardless of the type of residence. Despite the discrepancy found regarding the care provided at the long-term care facilities, the scores, obtained with the quality of life assessment, did not show significant differences.

Study of the prevalence of isolated vitamin B12 deficiency related dementia in patients presenting to a tertiary care hospital

Background: Objective of the study was to determine the prevalence of Isolated B12deficient dementia in patients presenting to a tertiary care hospital. The MMSE was much lower in B12 deficiency compared to irreversible causes Thus, shorter duration, severe dementia, focal neurological signs, and a vegetarian diet were significantly associated with the development of B12 deficiency.Methods: Based on exclusion and inclusion criteria 100 patients were included in this study, a detailed history of the patient were taken with respect to duration of dementia and its symptoms, type and treatment. Study in terms of the correlation of the clinical features with investigations and diet. Estimation of the prevalence of dementia with reference to B12 deficiency. Mean MMSE analysis, assessment of the improvement in MMSE after treatment with B12 injections after a6-8 wks period.Results: In this study most of our patients were in the 60-69 age groups across all causes of dementia, 22out of 26, B12 deficient patients were vegetarians. This value was in keeping with the known fact that a vegetarian diet predisposes a person to develop B12 deficiency. The association between B12 deficiency, high MCV and megaloblastic blood picture in peripheral blood smear was significant. The MMSE scores were significantly lower 13.42 in patients with B12 deficiency as compared to those with Alzheimer's 14.3 means and those with multi-infarct state 17.3 means.Conclusions: The duration of the presentation in B12 deficiency was10-12months averagely. There was a significant improvement in MMSE after treatment in pureB12 deficient patients (by 9 points) if they presented within one year of symptoms. Except for myelopathy, there was an improvement in other neurological symptoms and signs. Early diagnosis and proper treatment can make improvements in a patient's memory and quality of life.

Mini-mental state exam for children (MMC) in children with hemiplegic cerebral palsy / Mini-exame do estado mental para crianças (mmc) na paralisia cerebral

ABSTRACT Cognitive impairment is frequent in cerebral palsy (CP) and there is a lack of multiprofessional screening instruments. OBJECTIVE: The aim of this study was to investigate the utility of the Mini-Mental State Examination for Children (MMC), an adapted version of the Mini-Mental State Examination, in screening for cognitive impairments in children with CP. METHODS: We assessed 397 Brazilian children, 310 with typical development and 87 with CP (hemiplegic and quadriplegic forms), aged 5-16 years. Association between the MMC and general intelligence was assessed by the Colored Progressive Matrices instrument. RESULTS: Psychometric indexes for the MMC were adequate. ROC analyses revealed effective diagnostic accuracy in all ages assessed. Cut-off values are reported. Major difficulties on the MMC were observed in children with CP, particularly individuals with the quadriplegic form. Moreover, the MMC showed moderate correlation with the intelligence test, and was reliable in discriminating, among clinical cases, those with poorer cognitive abilities. CONCLUSION: The MMC could be useful as a multiprofessional screening instrument for cognitive impairment in children with hemiplegic CP. Results of the MMC in quadriplegic CP children should be interpreted with caution. Diagnosis should be confirmed by further psychological testing.

RESUMO Comprometimentos cognitivos são frequentes na Paralisia Cerebral (PC) e existe uma falta de instrumentos multiprofissionais para uma triagem. OBJETIVO: Investigar a viabilidade do uso do mini-exame do estado mental para crianças (MMC), uma adaptação do mini-exame do estado mental, como uma triagem para comprometimento cognitivo em crianças com PC. MÉTODOS: Nós avaliamos 397 crianças brasileiras, 310 com desenvolvimento típico e 87 com PC (hemiplégica e quadriplégica), com idades entre cinco e 16 anos. A associação entre MMC e a inteligência geral foi avaliada através das Matrizes Coloridas Progressivas de Raven. RESULTADOS: Os índices psicométricos para o MMC foram adequados. As análises ROC revelaram eficácia diagnóstica para todas as idades avaliadas. Os valores de corte são relatados. Dificuldades importantes na MMC foram observadas em crianças com PC, principalmente em crianças tetraplégicas. Além disso, MMC mostrou correlação moderada com o teste de inteligência e boa precisão na identificação das crianças com PC que possuem habilidades cognitivas prejudicadas. CONCLUSÃO: O MMC poderia ser útil como um instrumento de triagem multiprofissional para comprometimento cognitivo em crianças hemiplégicas. Os resultados de MMC em crianças tetraplégicas devem ser interpretados cuidadosamente. O diagnóstico deve ser confirmado por mais testes psicológicos.

Incidence and risk factors for cognitive impairment in rural elderly populations in Costa Rica / Incidencia y factores de riesgo para la discapacidad cognitiva en poblaciones rurales de tercera edad en Costa Rica

Risk factors for the onset of cognitive impairment in Costa Rica are not well understood, despite a substantial elderly population stemming from a higher than average life expectancy for the western hemisphere. To investigate the risk factors that predict the onset of cognitive impairment in the rural elderly of Costa Rica, a modified version of the Mini Mental State Exam-designed for illiterate populations-was administered to 90 elderly inhabitants of San Carlos, Alajuela, Costa Rica between April and May of 2011. Subsequently, each participant took a structured interview assessing viability of risk factors and behaviors potentially contributing to a diagnosis of cognitive impairment. Results showed strong dependencies between age (p=0.0001), education level (p=0.0095), the ability to read (p=0.0001) and write (p=0.0153), frequency of reading (p=0.0011), use of puzzles and mind games (p<0.0001), vocation (p=0.0225), area of residence (p<0.0001), comorbid mental diseases (p=0.0005), history of stroke or brain trauma (p=0.0104), urinary or renal problems (p=0.0443), consistent cooking practices (p=0.0262) and number of living companions (p=0.0299) in susceptibility for developing cognitive impairment. The study concluded that high intellectual use, or lack thereof, during the lifetime of a person was a predictor for cognitive status later in life. In addition, comorbid mental disorders, including neurological trauma due to stroke, impeded normal cognitive function. Future research should examine incidence and risk factors of cognitive impairment in urban, more educated populations. Rev. Biol. Trop. 62 (3): 869-876. Epub 2014 September 01.

Los factores de riesgo asociados con el inicio de la discapacidad cognitiva en Costa Rica son poco comprendidos, a pesar de la existencia de una considerable población de la tercera edad que ha resultado de una expectativa de vida mayor que el promedio en el hemisferio occidental. Para investigar los factores de riesgo que indican el inicio de la discapacidad cognitiva en adultos mayores de zonas rurales en Costa Rica, se les administró una versión modificada del Mini Examen del Estado Mental diseñado para poblaciones analfabetas a 90 adultos mayores residentes en San Carlos de Alajuela, Costa Rica, entre abril y mayo 2011. Posteriormente cada participante recibió una entrevista estructurada para evaluar la viabilidad de los factores de riesgo y comportamientos que podrían contribuir a un diagnóstico de discapacidad cognitiva. Los resultados mostraron una fuerte relación de dependencia entre la edad (p=0.0001), el nivel educativo (p=0.0095), la capacidad de leer (p=0.0001) y escribir (p=0.0153), la frecuencia de lectura (p=0.0011), la utilización de rompecabezas y juegos de estímulo intelectual (p<0.0001), la vocación (p=0.0225), el lugar de residencia (p<0.0001), las enfermedades mentales comórbidas (p=0.0005), un historial de derrame o de trauma cerebral (p=0.0104), los trastornos urinarios o renales (p=0.0443), la preparación de alimentos en forma consistente (p=0.0262), el número de personas con quienes convive (p=0.0299) y la susceptibilidad de desarrollar la discapacidad cognitiva. El estudio concluyó que un alto nivel de uso del intelecto, o la falta del mismo, durante la vida es un indicador del estatus cognitivo en etapas más avanzadas de la vida. Además, se encontró que las enfermedades mentales comórbidas, como el trauma neurológico provocado por un derrame cerebral, impiden la función cognitiva normal. Se recomienda que futuras investigaciones examinen la incidencia y los factores de riesgo asociados con la discapacidad cognitiva en poblaciones urbanas de mayores niveles educativos.

Severe Cognitive Dysfunction and Occupational Extremely Low Frequency Magnetic Field Exposure among Elderly Mexican Americans.

Aims: This report is the first study of the possible relationship between extremely low frequency (50-60 Hz, ELF) magnetic field (MF) exposure and severe cognitive dysfunction. Earlier studies investigated the relationships between MF occupational exposure and Alzheimer’s disease (AD) or dementia. These studies had mixed results, depending upon whether the diagnosis of AD or dementia was performed by experts and upon the methodology used to classify MF exposure. Study Design: Population-based case-control. Place and Duration of Study: Neurology and Preventive Medicine, Keck School of Medicine, University of Southern California, 2 years. Methodology: The study population consisted of 3050 Mexican Americans, aged 65+, enrolled in Phase 1 of the Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE) study. Mini-Mental State Exam (MMSE) results, primary occupational history, and other data were collected. Severe cognitive dysfunction was defined as an MMSE score below 10. The MF exposure methodology developed and used in earlier studies was used. Results: Univariate odds ratios (OR) were 3.4 (P< .03; 95% CI: 1.3-8.9) for high and 1.7 (P=.27; 95% CI: 0.7-4.1) for medium or high (M/H) MF occupations. In multivariate main effects models, the results were similar. When interaction terms were allowed in the models, the interactions between M/H or high occupational MF exposure and smoking history or age group were statistically significant, depending upon whether two (65-74, 75+) or three (65-74, 75-84, 85+) age groups were considered, respectively. When the analyses were limited to subjects aged 75+, the interactions between M/H or high MF occupations and a positive smoking history were statistically significant. Conclusion: The results of this study indicate that working in an occupation with high or M/H MF exposure may increase the risk of severe cognitive dysfunction. Smoking and older age may increase the deleterious effect of MF exposure.

Investigations on prevalence and risk factors of visual hallucination in patients with Parkinson' s disease / 上海第二医科大学学报

Objective To investigate the prevalence and characteristics of visual hallucination among patients with Parkinson's disease (PD), and analyse the potential risk factors. Methods One hundred and twenty-eight patients with PD were administered self-prepared visual hallucination questionnaires, and prevalence of visual hallucination was surveyed. The differences in sex, age, disease duration, Mini Mental State Exam (MMSE) scores, Hoehn & Yahr stage, types of medicine used and levodopa equivalent doses (LDE) were compared between the patients with visual hallucination and those without visual hallucination. The prevalence of rapid eye movement sleep behavior disorder (RBD) was investigated in patients with visual hallucination. Results Eighteen patients (14.06%) experienced visual hallucination, among whom 10 (55.56%) experienced visual hallucination no less than one time per day, 11 (61.11%) "saw" the shadow of human figure and 15(83.33%)were complicated with RBD. There were significant differences in MMSE scores, Hoehn & Yahr stage, female proportion and usage of dopamine agonists between patients with visual hallucination and those without visual hallucination(P<0.05). Conclusion Visual hallucination is a common non-motor symptom among patients with PD, and cognitive function, disease severity and usage of dopamine agonista may be related to visual hallucination.

Subclinical encephalopathy in chronic obstructive pulmonary disease

BACKGROUND: Clinical and experimental evidence suggests that chronic obstructive pulmonary disease (COPD) is associated with a variety of mental symptoms that range from cognitive slowing to mental confusion and dementia. PURPOSE: To test the hypothesis that COPD leads to cognitive impairment in the absence of acute confusion or dementia. METHOD: The global cognitive status of 30 patients with COPD without dementia or acute confusion and 34 controls was assessed with a Brazilian version of the Mini-Mental State Exam (MMSE). RESULTS: The MMSE scores were significantly lower in the patient group and inversely related to the severity of COPD. This finding could not be attributed to age, education, gender, daytime sleepiness, hypoxemia, chronic tobacco use, or associated diseases such as diabetes, depression, high blood pressure or alcoholism. CONCLUSION: These results suggest the existence of a subclinical encephalopathy of COPD characterized by a subtle impairment of global cognitive ability.

CONTEXTO: Evidências clínicas e experimentais sugerem que a doença pulmonar obstrutiva crônica (DPOC) se associa a sintomas neurocomportamentais que variam da lentidão cognitiva à confusão mental e à demência. PROPÓSITO: Testar a hipótese de que a DPOC pode comprometer a cognição na ausência de estado confusional agudo ou de demência. MÉTODO: O estado cognitivo global de 30 pacientes com DPOC sem demência e sem confusão mental aguda e o de 34 controles foi examinado com a versão brasileira do Mini-Exame do Estado Mental (MEEM). RESULTADOS: As pontuações no meem mostraram-se significativamente mais baixas nos pacientes, e inversamente relacionadas à gravidade da DPOC. Este achado não pôde ser atribuído a diferenças de idade, escolaridade, sonolência diurna, hypoxemia, tabagismo crônico, ou a doenças associadas como diabetes, depressão, hipertensão arterial ou alcoolismo. CONCLUSÃO: Estes resultados sugerem a existência de uma encefalopatia subclínica da DPOC caracterizada por comprometimento sutil da capacidade cognitiva global.