Discrimination ability of the Short Test of Mental Status (STMS) compared to the Mini Mental State Examination (MMSE) in the spectrum of normal cognition, mild cognitive impairment, and probable Alzheimer's disease dementia: The Turkish standardization study.

BACKGROUND: The aim of the present study was to standardize the Short Test of Mental Status (STMS) in the general Turkish aging population and to find its discriminative ability along the continuum of normal cognition, mild cognitive impairment (MCI), and probable Alzheimer's disease dementia (probable AD). METHOD: The sample was composed of 161 participants older than 50, of which 56 were cognitively normal (CN), 42 had MCI, and 63 had probable AD. STMS, Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), and Geriatric Depression Scale (GDS) were administered. RESULTS: The mean STMS score in healthy participants was 33.44. With a cutoff score of 32, STMS had a sensitivity of 81% and specificity of 74% to detect participants with MCI, whereas the MMSE did not have an optimal cutoff score to detect MCI. With a cutoff score of 24, STMS had a sensitivity of 88% and specificity of 86% to detect participants with dementia. With a cutoff score of 24, MMSE had a good sensitivity (92%) and specificity (84%), as well. STMS significantly and positively correlated with MMSE, and significantly but inversely correlated with CDR. Reliability of the STMS was good (alpha coefficient =.88). CONCLUSION: The results show that STMS is more sensitive than MMSE and can be used by clinicians to differentiate both normal cognition from MCI and MCI from probable AD.

Normal Pressure Hydrocephalus: Clinical Symptoms, Cerebrospinal Fluid Flow Metrics and White Matter Changes.

PURPOSE: The aim of this study was to investigate correlations between clinical symptoms, cerebrospinal fluid flow metrics, hydrocephalus index, small-vessel disease, and white matter (WM) changes in normal pressure hydrocephalus (NPH). METHODS: Aquaductal stroke volumes (ASVs), Z Evans index, Fazekas grading (FG), and diffusion tensor imaging measurements from WM bundles of 37 patients with NPH were retrospectively evaluated. Mann-Whitney U test between clinical symptoms and other variables and Spearman ρ correlations for relationships between variables and Kruskal-Wallis to correlate FG with nonclinical variables were used. RESULTS: Patients with NPH had increased ASV (median 53 µL). No correlation was found between Z Evans index and ASV. Three groups of patients with dementia or ataxia or incontinence had increased ASV values than their counterparts without symptoms (55 vs 48.5 µL, 75 vs 47 µL, 64 vs 49.5 µL, respectively). Patients having 2 common symptoms of dementia and ataxia and patients having all 3 symptoms of dementia, ataxia, and incontinence were compared with ASV values of 63.5 versus 78 µL, respectively. Patients with FG 1 had median ASV values of 45 µL; FG 2, 82.5 µL; and FG 3, 59 µL. Patients with dementia had significantly higher apparent diffusion coefficient (ADC) values of corona radiata (CR) on both sides. There were no significant WM changes in patients with ataxia and incontinence. The Z Evans index was positively correlated with ADC values of CR on both sides and genu of corpus callosum. Fazekas grading was found positively correlated with ADC and negatively correlated with FA values of CR. CONCLUSIONS: Patients with NPH, regardless of stages of the diseases, have increased ASV values and could benefit from shunting. Decreasing ASV values of patients with FG 3 comparing with those with FG 2 support the hypothesis of decreasing compliance of brain with aging and increasing severity of small-vessel disease.