Delirium in acute stroke: a predictor of subsequent cognitive impairment? A two-year follow-up study.

OBJECTIVE: Delirium is an independent risk factor for cognitive impairment and development of dementia in medical patients. It has never been thoroughly studied whether this association is also present in the stroke population. Our aim was to evaluate the effects of delirium in the acute phase after stroke on cognitive functioning two years later. METHODS: Two years after stroke, 50 patients (22 with and 28 without delirium in the acute phase) were assessed on two screening instruments for dementia and a neuropsychological test battery. RESULTS: Delirium was an independent predictor for development of dementia as assessed by the Clinical Dementia Rating Scale (odds ratio (OR) 4.7; 95% confidence interval (CI) 1.08 to 20.42) and by the Rotterdam-CAMCOG (OR 7.2, 95% CI 1.88 to 27.89). Cognitive domains most affected in patients with previous delirium were memory, language, visual construction and executive functioning. CONCLUSIONS: Delirium in the acute phase after stroke is an independent predictor for severe cognitive impairment two years after stroke. These findings emphasize the importance of both rapid detection and treatment of delirium after stroke. Furthermore, periodic monitoring and evaluation of cognitive functioning in these vulnerable patients in the years after stroke is strongly recommended.

The death knoll for the MMSE: has it outlived its purpose?

The Mini-Mental State Examination (MMSE) is arguably the best-known cognitive screen in the world. Originally designed to assess cognitive impairment in elderly populations, it has become one of the first steps toward a dementia diagnosis. Routinely used in the clinic and in research internationally, the MMSE, despite its flaws, has managed to retain its popularity for more than 30 years. This review explores when and how the test is used, lists its advantages and disadvantages, and ultimately questions its value. The specific issue that is addressed here is whether the test has outlived its original purpose. The conclusion is that although the MMSE may be a useful tool in many circumstances where a cognitive screen is required, practitioners should be wary of using MMSE total scores as a shortcut toward a dementia diagnosis.

Diagnosing Alzheimer's dementia in Down syndrome: problems and possible solutions.

It is widely accepted that people with Down syndrome are more likely than the general population to develop Alzheimer's dementia as they age. However, the diagnosis can be problematic in this population for a number of reasons. These include: the large intra-individual variability in cognitive functioning, the different diagnostic and methodological procedures used in the field and the difficulty in obtaining baseline levels of cognitive functioning in this population with which to assess cognitive and behavioral change. Recent researchers have begun to suggest ways around these difficulties. This review explores these recent developments and provides recommendations which may aid clinicians in their attempts to diagnose Alzheimer's dementia in the early stages in the Down syndrome population.

Free recall and learning of emotional word lists in very elderly people with and without dementia.

An emotional memory advantage has been found across the life span where recall is better for emotional (as opposed to neutral) stimuli. Our goal was to design emotionally valent word lists for easy use by practitioners and to test whether demented and healthy elderly participants showed an emotional memory advantage with these lists. Three new word lists (a positive, a negative, and a neutral list) were constructed. Thirty-eight controls, 37 with mild cognitive impairment and 20 Alzheimer's dementia participants' free recall was tested. Unsurprisingly, controls had better recall overall. Emotionally valent words were recalled better in comparison to neutral words in all 3 groups. No recall advantage for positive versus negative words emerged. Learning differed among the groups with the Alzheimer's dementia participants showing flatter learning curves. The results tentatively suggest that emotional memory may stay intact longer but that learning of such lists becomes more difficult as dementia progresses.