A cross-sectional study to determine the cognitive impairment and depression among elderly in a rural area of West Bengal

Background: The increase in worldwide life expectancy among the elderly is contributing to an increase in cognitive impairment (CI). A more complicated etiology makes CI an essential clinical concern for elderly patients with depression. Ageing populations as a result of demographic change have accelerated the development of certain geriatric conditions, including CI and depression. Aims and Objectives: The objective was to identify the prevalence and contributing factors of CI and depression in the elderly rural community. Materials and Methods: A descriptive, cross-sectional, and community-based study was conducted in rural field practice area of Medical College, Kolkata, among 133 geriatric people during time period of March–June, 2022. The prevalence of CI was measured using the Mini-Mental State Examination (MMSE) scale and depression was assessed using the geriatric depression scale. Data were analyzed in SPSS software version 16. Results: Mean age of the participants was 65.68 (±6.03) years. The prevalence of CI was 86.5%, with a mean MMSE score of 19.27 ± 4.34, and the depression was 77.5% and 7.07 ± 3.39. Conclusion: Almost two-third of the geriatric population is suffering from depression and CI. To handle the issue of CI, depression, and its resulting effects, new and modified geriatric health policies are very much needed.

A Study of Cognitive Impairment in Patients with Type 2 Diabetes Mellitus – A Prospective Observational Study

Introduction: Type 2 diabetes mellitus (DM) is the most lifestyle risk factor for cognition. Regular treatment and managementof Type 2 DM could prevent the onset and progression of cognitive impairment. Cognitive decline associated with DM mayinfluence one’s ability to perform self-care and affect glycemic control.Aim: Our prospective observational study aimed to analyze the cognitive impairment using a mini-mental status examination(MMSE) in patients with Type 2 DM.Materials and Methods: This prospective observational study was conducted to analyze the cognitive impairment using MMSEin patients with Type 2 DM. A total of 50 patients diagnosed with Type 2 diabetes were included in the study. All the demographicand laboratory investigation data so obtained was tabulated and was analyzed statistically, and results were discussed.Results: Of 50 patients, 26 patients were male and 24 patients were female. Based on the age group, 11 patients were in theage group below 40 years, 21 patients between 40 and 50 years, 16 patients between 51 and 60 years, and 2 patients >60years. Based on the duration of Type 2 diabetes, 16 patients had <5 years and MMSE score of 24.28 and 34 patients had >5years and MMSE score of 22.14. Based on cognitive impairment, 44 patients had mild cognitive impairment and 6 patientshad moderate cognitive impairment.Conclusion: From this study, we concluded that the duration of Type 2 DM and level of HbA1c affect the cognitive status ofthe individuals. A greater understanding of the mechanisms linking Type 2 DM and cognitive impairment may facilitate thedevelopment of new ways for the treatment of cognitive impairment.

Accuracy of Korean-Mini-Mental Status Examination Based on Seoul Neuro-Psychological Screening Battery II Results / 가정의학회지

BACKGROUND: The Korean-Mini-Mental Status Examination (K-MMSE) is a dementia-screening test that can be easily applied in both community and clinical settings. However, in 20% to 30% of cases, the K-MMSE produces a false negative response. This suggests that it is necessary to evaluate the accuracy of K-MMSE as a screening test for dementia, which can be achieved through comparison of K-MMSE and Seoul Neuropsychological Screening Battery (SNSB)-II results. METHODS: The study included 713 subjects (male 534, female 179; mean age, 69.3±6.9 years). All subjects were assessed using K-MMSE and SNSB-II tests, the results of which were divided into normal and abnormal in 15 percentile standards. RESULTS: The sensitivity of the K-MMSE was 48.7%, with a specificity of 89.9%. The incidence of false positive and negative results totaled 10.1% and 51.2%, respectively. In addition, the positive predictive value of the K-MMSE was 87.1%, while the negative predictive value was 55.6%. The false-negative group showed cognitive impairments in regions of memory and executive function. Subsequently, in the false-positive group, subjects demonstrated reduced performance in memory recall, time orientation, attention, and calculation of K-MMSE items. CONCLUSION: The results obtained in the study suggest that cognitive function might still be impaired even if an individual obtained a normal score on the K-MMSE. If the K-MMSE is combined with tests of memory or executive function, the accuracy of dementia diagnosis could be greatly improved.

Serial Mini-Mental Status Examination to Evaluate Cognitive Outcome in Patients with Traumatic Brain Injury / 대한신경손상학회지

OBJECTIVE: This study was aimed at finding out the changes in cognitive dysfunction in patients with traumatic brain injury (TBI) and investigating the factors limiting their cognitive improvement. METHODS: Between January 2010 and March 2014, 33 patients with TBI participated in serial mini-mental status examination (MMSE). Their cognitive functions were statistically analyzed to clarify their relationship with different TBI status. Patients who developed hydrocephalus were separately analyzed in regards to their cognitive function depending on the placement of ventriculoperitoneal shunt (VPS). RESULTS: Bi-frontal lobe injury (beta=-10.441, p<0.001), contre-coup injury (beta=-6.592, p=0.007), severe parenchymal injury (beta=-7.210, p=0.012), temporal lobe injury (beta=-5.524, p=0.027), and dominant hemisphere injury (beta=-5.388, p=0.037) significantly lowered the final MMSE scores. The risk of down-grade in the prognosis was higher in severe parenchymal injury [odds ratio (OR)=13.41, 95% confidence interval (CI)=1.31-136.78], temporal lobe injury (OR=12.3, 95% CI=2.07-73.08), dominant hemisphere injury (OR=8.19, 95% CI=1.43-46.78), and bi-frontal lobe injury (OR=7.52, 95% CI=1.31-43.11). In the 11 post-traumatic hydrocephalus patients who underwent VPS, the final MMSE scores (17.7+/-6.8) substantially increased from the initial MMSE scores (11.2+/-8.6). CONCLUSION: Presence of bi-frontal lobe injury, temporal lobe injury, dominant hemisphere injury, and contre-coup injury and severe parenchymal injury adversely influenced the final MMSE scores. They can be concluded to be poor prognostic factors in terms of cognitive function in TBI patients. Development of hydrocephalus aggravates cognitive impairment with unpredictable time of onset. Thus, close observation and routine image follow-up are mandatory for early detection and surgical intervention for hydrocephalus.

Korean Version of Mini Mental Status Examination for Dementia Screening and Its' Short Form

OBJECTIVE: We developed a Korean version of Mini-Mental Status Examination (MMSE) optimized for screening dementia (MMSE-DS) and its' short form (SMMSE-DS). METHODS: We constructed the MMSE-DS using the items of the two current Korean versions of MMSE and then construct the SMMSE-DS consisted of 13 items from the MMSE-DS based on the diagnostic accuracy of individual items for dementia. We investigated reliability and validity of MMSE-DS and SMMSE-DS on 1,555 subjects (1,222 nondemented controls, 333 dementia patients). We compared the diagnostic accuracy of the SMMSE-DS with that of the three full Korean versions of MMSE, and examined its' age- and education-specific optimal cutoff scores for dementia. RESULTS: The internal consistency obtained by Cronbach's coefficient alpha was 0.826. The inter-rater reliability and test-retest reliability were 0.968 (p<0.001) and 0.825 (p<0.001), respectively. It showed significant correlation with the Clinical Dementia Rating (CDR) (r=-0.698, p<0.05) and the three full Korean versions of MMSE (r=0.839-0.938, p<0.001). The area under the receiver operator curve for dementia of the SMMSE-DS was larger than those of the three full Korean versions of MMSE (p<0.001). Age, education and gender explained 19.4% of the total variance of SMMSE-DS scores. The optimal cutoff scores for dementia of the SMMSE-DS were estimated differently by age and educational attainment of the subjects. CONCLUSION: The SMMSE-DS was found to be accurate, brief and portable instrument for screening dementia in Korean elders, and may be particularly useful for screening dementia in elderly populations with wide variation in educational levels.

Reliability and Validity of the Korean Version of Severe Mini-Mental Status Examination (SMMSE-K) / 신경정신의학

OBJECTIVES: We developed the Korean version of Severe Mini-Mental Status Examination (SMMSE-K) which is a brief cognitive test for the severely demented patients. METHODS: The translation was carried out keeping the basic structure of the English version Severe Mini-Mental Status Examination (SMMSE). The SMMSE-K, Korean version of Mini Mental State Examination (MMSE-KC), and Clinical Dementia Rating (CDR) were administered to 84 Alzheimer's disease (AD) patients and 36 cognitively normal elderly subjects. For evaluating the reliability of the SMMSE-K, Cronbach alpha coefficient, inter-rater reliability, and test-retest reliability were examined. For confirming the validity of the SMMSE-K, the correlations of the SMMSE-K with MMSE-KC and CDR were examined, and factor analysis was performed using principal component analysis with Varimax rotation. RESULTS: SMMSE-K was found to have a high internal consistency (Cronbach alpha coefficient=0.906, p<0.01), inter-rater reliability (Pearson correlation coefficient=0.980, p<0.01) and test-retest reliability (Pearson correlation coefficient=0.940, p<0.01). Performances on the SMMSE-K and MMSE-KC were found to correlate significantly in the subjects with CDR of 2 (Pearson correlation coefficient=0.827, p<0.001) and 3 (Pearson correlation coefficient=0.929, p<0.001). In the subjects with CDR of 3, the MMSE-KC showed a floor effect (2.93+/-3.21), whereas the SMMSE-K did not (11.00+/-8.48). Exploratory factor analysis yielded two factors (automatic informational processing, controlled informational processing) accounting for 76.1% of the total variance. CONCLUSION: The SMMSE-K was found to be a reliable and valid test for assessing the cognition of severely demented patients.

Clinical significance of clock-drawing test and MMSE in Alzheimer's disease / 中国康复理论与实践

@#ObjectiveTo observe the clinical sense of clock-drawing test(CDT) and Mini Mental Status Examination(MMSE) in Alzheimer's disease(AD). MethodsMMSE and CDT were used to assess the intellectual ability in AD group and control group. ResultsThe orientation force, immediate memory, ability of calculation, short-term memory and speech ability in AD group were significantly decreased than that of the control group(P<0.05). The score of CDT in AD group was markedly suppression than that of control group(P<0.01). ConclusionThe CDT and MMSE are the ideal cognitive screening test to determine the degree in Alzheimer's disease.

Cognition assessment in subjects with brain injury:comparison of LOTCA and MMSE / 中华物理医学与康复杂志

Objective To assess the cognitive function of subjects with brain injury with Loewenstein occupational therapy cognitive assessment (LOTCA) and mini-mental status examination (MMSE). Methods Two groups of subjects participated in this study. One group consisted of 36 subjects with brain injury (patient group). They were 28 males and 8 females,aged 61.0?16.7 years old. The other group was made of 44 healthy subjects (control group),with 25 males and 19 females,aged 55.4?23.7 years old. All subjects were assessed using LOTCA and MMSE and the results of them were analyzed. Results There was high correlation between the total scores of LOTCA and those of MMSE ( r =0.892,P

Evaluating Driving Ability of Brain Damaged Subjects with MMSE and MVPT

OBJECTIVE: The purpose of this study was to determine the ability of Mini Mental Status Examination (MMSE) and Motor Free Visual Perception Test (MVPT) to predict driving outcome in subject with brain damage. METHOD: Fifteen brain damaged subjects were administered for this study. Fourteen subjects had brain damage due to stroke and only one subject had traumatic brain injury. All subjects were evaluated with MMSE and MVPT. We used total score for each tests. Subjects were also evaluated in driving simulator that measured their operational responses to filmed driving situation. Correlation between neuropsy chological tests score and driving simulator score were analyzed. RESULTS: 1) By average score, MMSE score was 26.6 and MVPT score was 23.7. Driving simulator score was average 30.1. 2) There was good correlation between MVPT score and driving simulator score (r=0.675, p<0.01). 3) There were no correlation between MMSE and driving simulator score nor between MMSE and MVPT score. CONCLUSION: MVPT can be used as screening test for identifying person who are not ready to drive after getting brain damage

Influence of Aphasia on the Cognitive Screening Test in Stroke Patients with Unilateral Cerebral Hemispheric Lesion

OBJECTIVE: To evaluate the influence of aphasia on the cognitive screening test in stroke patients with unilateral cerebral hemispheric lesions. METHOD: We evaluated 51 hemiplegic patients with unilateral cerebral hemispheric lesions using CT or MRI. We divided the subjects into three groups according to the presence of aphasia and motor weakness: right hemiplegic patients with aphasia, right hemiplegic patients without aphasia, and left hemiplegic patients. Functional Independence Measure (FIM), Mini-Mental Status Examination (MMSE) and Neurobehavioral Cognitive Screening (NCSE) Tests were applied in all patients. RESULTS: No differences were observed in motor FIM scores between three groups. Total FIM and cognitive FIM scores of the right hemiplegic patients with aphasia were lower than those of the other two groups. MMSE and several sub-items of NCSE (orientation, attention, comprehension, repetition, naming and calculation) showed the same results. But the mean scores of memory, similarity, and judgement items in NCSE were higher in the left hemiplegic patients than the right hemiplegic patients. No differences were observed in the construction score. CONCLUSION: All three cognitive screening tests used in this study were remarkably influenced by the ability of the language function of the patients. Lack of adequate items to detect right cerebral hemispheric lesions were also noticed.

The Development of PC-based Mini-Mental Status Examination

OBJECTIVE: The aim of this study is to develop the PC-based Mini-mental Status Examination (PC-MMSE) including its protocol to improve the reliability of MMSE, to have convenience for administration, and to evaluate the test-retest reliability. METHOD: The factors of decreasing the reliability on MMSE are analyzed such as following. 1) The way of question, pronunciation, and loudness of speech can be different between the test-retest or tester-tester, 2) the learning effect can occur when the test is repeatedly administrated, and 3) the test protocol is not determined in detail. The PC-MMSE and its protocol are designed to solve this problem. PC-MMSE has been developed to have functions such as following. 1) It was made constant verbal stimulation, 2) the question contents of the same level of difficulty in changeable items were developed and some of those can be randomly selected, and 3) it was made the adminstration of test and the management on the test results, conveniently. Protocol on PC-MMSE was also developed for standardization in the administration of test. These two tests of PC-MMSE on 26 stroke patients are administrated for the evaluation of test-retest reliability. RESULTS: The test-retest Spearman's correlation coefficient of PC-MMSE is 0.967 (p<0.01). The Spearman's correlation coefficient of PC-MMSE which is related with sex, education, lesion site, and hemiplegic side is more than 0.89. CONCLUSION: The PC-MMSE and its protocol are thought to be useful for the repeated evaluation of cognitive function.

A Study on the Relationship between the Risk Factors of Stroke and Cognitive-Perceptual Function

OBJECTIVE: To investigate the correlation of main risk factors and cognitive-perceptual functions of stroke patients assessed with Mini-mental status examination (MMSE) and Motor-free visual perception test (MVPT) scores. METHOD: Subjects were 41 stroke patients from 35 to 70 years of age. Data collection was done through chart review on risk factors of stroke including hypertension, diabetes mellitus, heart disease, hypercholesterolemia, and cigarette smoking. Three months after the onset of stroke, MMSE and MVPT were performed. RESULTS: The subjects with diabetes had significantly lower scores in MMSE (p<0.05) and MVPT (p<0.05) compared to those with nondiabetics. The subjects with left hemispheric lesion scored higher in MMSE than those with right hemispheric lesion (p<0.05). CONCLUSION: Among the several risk factors, diabetes mellitus has significant relationship to cognitive and visual perceptual function in the stroke patients.

Comparison of Sensitivity of Neurobehavioral Cognitive Status Examination and Mini-mental State Examination

The neurobehavioral cognitive status examination(NCSE), a screening examination tool that assesses cognitive funtion in a brief but quantitative fashion, is used as an independent test of five major areas: language, constructions, memory, calculation and reasoning. The examination also separately assesses levels of consciousness, orientation, and attention. This instrument quickly identifies the intact areas of functioning, yet provides more detailed assessment in the areas of dysfunction. To determine whether the neuro behavioral cognitive status examination is a more sensitive instrument for the detection of cognitive impairment than the minimental state examination(MMSE), we performed these test simultaneously in 26 patients with stroke. The sensitivities were 88.5% for NCSE and 53.8% for MMSE respectively. The sensitivity of NCSE was derived from two features of its design: the use of independent tests to assess skills within five major areas of cognitive functioning, and the use of graded tasks within each of these cognitive domains.