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Rosa IM, Henriques AG, Wiltfang J, da Cruz E Silva OAB. Putative Dementia Cases Fluctuate as a Function of Mini-Mental State Examination Cut-Off Points. J Alzheimers Dis 2018; 61:157-167. [PMID: 29125486 DOI: 10.3233/jad-170501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
As the population ages, there is a growing need to quickly and accurately identify putative dementia cases. Many cognitive tests are available; among those commonly used are the Cognitive Dementia Rating (CDR) and the Mini-Mental Status Examination (MMSE). The aim of this work was to compare the validity and reliability of these cognitive tests in a primary care based cohort (pcb-Cohort). The MMSE and the CDR were applied to 568 volunteers in the pcb-Cohort. Distinct cut-off points for the MMSE were considered, namely MMSE 27, MMSE 24, and MMSE PT (adapted for the Portuguese population). The MMSE 27 identified the greatest number of putative dementia cases, and, as determined by the ROC curve, it was the most sensitive and specific of the MMSE cut-offs considered. Putative predictive or risk factors identified included age, literacy, depression, and diabetes mellitus (DM). DM has previously been indicated as a risk factor for dementia and Alzheimer's disease. Comparatively, the MMSE 27 cut-off has the greatest sensibility (94.9%) and specificity (66.3%) when compared to MMSE PT and MMSE 24. Upon comparing MMSE and CDR scores, the latter identified a further 146 putative dementia cases, thus permitting one to propose that in an ideal situation, both tests should be employed. This increases the likelihood of identifying putative dementia cases for subsequent follow up work, thus these cognitive tests represent important tools in patient care. Further, this is a significant study for Portuguese populations, where few of these studies have been carried out.
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Affiliation(s)
- Ilka M Rosa
- Department of Medical Sciences, Neuroscience and Signalling Laboratory, Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
| | - Ana G Henriques
- Department of Medical Sciences, Neuroscience and Signalling Laboratory, Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
| | - Jens Wiltfang
- Department of Medical Sciences, Neuroscience and Signalling Laboratory, Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal.,Department of Psychiatry and Psychotherapy, University Medicine Göttingen, Göttingen, Germany
| | - Odete A B da Cruz E Silva
- Department of Medical Sciences, Neuroscience and Signalling Laboratory, Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
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Ding Y, Niu J, Zhang Y, Liu W, Zhou Y, Wei C, Liu Y. Informant questionnaire on cognitive decline in the elderly (IQCODE) for assessing the severity of dementia in patients with Alzheimer's disease. BMC Geriatr 2018; 18:146. [PMID: 29914396 PMCID: PMC6006922 DOI: 10.1186/s12877-018-0837-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 06/13/2018] [Indexed: 12/25/2022] Open
Abstract
Background The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) is widely used as a complementary screening tool for dementia. However, there are few studies concerning the efficacy of the IQCODE for assessing the severity of cognitive impairments in patients with Alzheimer’s disease (AD). We aimed to evaluate the efficacy of the IQCODE for assessing the severity of dementia in patients with AD. Methods According to the clinical dementia rating (CDR), 394 patients with AD were enrolled and classified into three groups: mild, moderate and severe groups. The IQCODE scores of each group were determined by interviewing the informants with the short version of the 16-item IQCODE. The correlations of the IQCODE score with the Mini-Mental State Examination (MMSE), the Mattis Dementia Rating Scale (DRS) and the Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) were analysed. Statistical analyses were conducted to examine the differences in the IQCODE scores among the three groups. Results The validity coefficients of the IQCODE with the MMSE, DRS and ADAS-Cog were − 0.528, − 0.436, and 0.477, respectively. The sensitivity was 66.1%, and the specificity was 59.8% when using a cut-off score of 65 to discriminate between mild-moderate dementia. When 75 was used as the threshold between moderate-severe dementia, the sensitivity and the specificity were 73.9 and 67.7%, respectively. Conclusions The IQCODE is moderately effective for assessing the severity of cognitive impairment in patients with AD.
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Affiliation(s)
- Yunlong Ding
- Department of Neurology, JingJiang People's Hospital, No. 28, Zhongzhou Road, Jingjiang, CN 214500, Jiangsu, China
| | - Jiali Niu
- Department of Clinical Pharmacy, JingJiang People's Hospital, No. 28, Zhongzhou Road, Jingjiang, CN 214500, Jiangsu, China
| | - Yanrong Zhang
- Department of Neurology, JingJiang People's Hospital, No. 28, Zhongzhou Road, Jingjiang, CN 214500, Jiangsu, China
| | - Wenpeng Liu
- Department of Neurology, JingJiang People's Hospital, No. 28, Zhongzhou Road, Jingjiang, CN 214500, Jiangsu, China
| | - Yan Zhou
- Department of Neurology, Huashan Hospital at Fudan University, No. 12, Urumqi Road, Shanghai, 200040, CN, China
| | - Can Wei
- Department of Neurology, JingJiang People's Hospital, No. 28, Zhongzhou Road, Jingjiang, CN 214500, Jiangsu, China
| | - Yan Liu
- Department of Neurology, JingJiang People's Hospital, No. 28, Zhongzhou Road, Jingjiang, CN 214500, Jiangsu, China.
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Zmudka JA, Sérot JM, Dao S, Sorel C, Macaret AS, Balédent O. Specific Effects of Anti-Hypertensive Treatment in an Older Patient with Dementia. Open Neurol J 2017; 11:15-19. [PMID: 28567135 PMCID: PMC5420187 DOI: 10.2174/1874205x01711010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/15/2017] [Accepted: 02/17/2017] [Indexed: 11/22/2022] Open
Abstract
Dementia is one of the most common health problems in the world. Alzheimer’s disease (AD) is the most common form of dementia. The presence of vascular risk factors such as hypertension (HT) may increase the risk of AD [1,2]. The relation between blood pressure (BP) and dementia has been the subject of numerous epidemiological studies, midlife HT is a risk factor for dementia and AD [3-7] but the association between HT and risk of dementia is lower in the older population [8]. A fair modulation of an antihypertensive treatment, based on the cognitive status of the elderly, can avoid multiple complications. A case of an older for whom cognitive improvement and reduced risk of falls were noticed after mild blood pressure elevation is reported.
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Affiliation(s)
- Jadwiga Attier Zmudka
- Department of Gerontology, General Hospital Saint Quentin, BioFlowImage, University of Picardy Jules Verne, Amiens, France
| | - Jean Marie Sérot
- Department of Gerontology, General Hospital Saint Quentin, BioFlowImage, University of Picardy Jules Verne, Amiens, France
| | - Salif Dao
- Department of Radiology, General Hospital Saint Quentin, Saint Quentin, France
| | - Claire Sorel
- Department of Cardiology, General Hospital Saint Quentin, Saint Quentin, France
| | - Anne-Sophie Macaret
- Department of Neurology, General Hospital Saint Quentin, Saint Quentin, France
| | - Olivier Balédent
- BioFlowImage Image processing unit, University Hospital & University of Picardy Jules Verne, Amiens, France
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Liu S, Jin Y, Shi Z, Huo YR, Guan Y, Liu M, Liu S, Ji Y. The effects of behavioral and psychological symptoms on caregiver burden in frontotemporal dementia, Lewy body dementia, and Alzheimer's disease: clinical experience in China. Aging Ment Health 2017; 21:651-657. [PMID: 26882509 DOI: 10.1080/13607863.2016.1146871] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS Caregivers of individuals with neurodegenerative diseases, including frontotemporal dementia (FTD), Lewy body dementia (DLB), and Alzheimer's disease (AD), experience high levels of psychological and physical stress, likely due to behavioral and psychological symptoms of dementia (BPSD). This study is the first to simultaneously evaluate the effects of BPSD on caregiver burden in these three types of dementia. METHOD A total of 214 dementia patients, including probable FTD (n = 82), DLB (n = 22), and AD (n = 110), as well as their primary caregivers, were assessed using psychological inventories and cognitive evaluation. The FTD group was further divided into the three established clinical variants: behavioral variant frontotemporal dementia (bvFTD, n = 51), non-fluent variant primary progressive aphasia (nfvPPA, n = 15), and semantic variant primary progressive aphasia (svPPA, n = 16). Cognitive impairment and neuropsychiatric symptoms were assessed using the Mini Mental State Examination, Montreal Cognitive Assessment, Clock Drawing Test, and Neuropsychiatric Inventory (NPI), respectively. Caregiver burden was assessed using the Zarit Burden Inventory (ZBI). RESULTS FTD patients had higher NPI and ZBI scores than DLB and AD patients, whose scores were similar. Logistic regression analysis revealed that the factors influencing caregiver burden for each group were: FTD: total NPI scores, agitation, and aberrant motor behavior; bvFTD: total NPI scores; DLB: total NPI scores; and AD: total NPI scores, onset age, apathy, and ADL. Caregivers of bvFTD patients had the highest levels of burden, which were significantly greater than for caregivers of nfvPPA, svPPA, DLB, and AD patients. CONCLUSION BPSD was highly correlated with emotional burden in caregivers of FTD, DLB, and AD patients. The highest burden was observed in bvFTD caregivers.
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Affiliation(s)
- Shuling Liu
- a Department of Neurology , Tianjin Huanhu Hospital , Tianjin , China.,b Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases , Tianjin Huanhu Hospital , Tianjin , China
| | - Yi Jin
- b Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases , Tianjin Huanhu Hospital , Tianjin , China.,c Department of Nursing Management , Tianjin Huanhu Hospital , Tianjin , China
| | - Zhihong Shi
- a Department of Neurology , Tianjin Huanhu Hospital , Tianjin , China.,b Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases , Tianjin Huanhu Hospital , Tianjin , China
| | - Ya Ruth Huo
- d School of Medicine , University of New South Wales , Kensington , NSW , Australia
| | - Yalin Guan
- a Department of Neurology , Tianjin Huanhu Hospital , Tianjin , China.,b Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases , Tianjin Huanhu Hospital , Tianjin , China
| | - Mengyuan Liu
- b Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases , Tianjin Huanhu Hospital , Tianjin , China
| | - Shuai Liu
- a Department of Neurology , Tianjin Huanhu Hospital , Tianjin , China.,b Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases , Tianjin Huanhu Hospital , Tianjin , China
| | - Yong Ji
- a Department of Neurology , Tianjin Huanhu Hospital , Tianjin , China.,b Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases , Tianjin Huanhu Hospital , Tianjin , China
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Does physical exercise improve ADL capacities in people over 65 years with moderate or severe dementia hospitalized in an acute psychiatric setting? A multisite randomized clinical trial. Int Psychogeriatr 2017; 29:323-332. [PMID: 27831462 DOI: 10.1017/s1041610216001460] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Several studies on the effect of physical exercise on activities of daily living (ADL) for people with dementia exist; yet, data concerning the specific context of acute psychiatric hospitals remain scant. This study measured the effect of a physical exercise program on ADL scores in patients with moderate to severe dementia hospitalized in an acute psychiatric ward. METHODS A multicenter clinical trial was conducted in five Swiss and Belgian psychiatric hospitals. Participants were randomly allocated to either an experimental group (EG) or a control group (CG). Members of the EG received 20 physical exercise sessions (strengthening, balance, and walking) over a four-week period while members of the CG participated in social interaction sessions of equivalent duration and frequency, but without physical exercise. The effect of exercise on ADL was measured by comparing scores of the Barthel Index and the Functional Independence Measure in the EG and CG before and after the intervention, and two weeks later. RESULTS Hundred and sixty patients completed the program. Characteristics of participants of both groups were similar at the inception of the study. The mean ADL score of EG decreased slightly over time, whereas that of the CG significantly decreased compared to initial scores. Overall differences between groups were not significant; however, significant differences were found for mobility-related items. CONCLUSIONS ADL scores in elderly with moderate to severe dementia deteriorate during acute psychiatric hospitalization. An exercise program delays the loss of mobility but does not have a significant impact on overall ADL scores.
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Fayed N, Dávila J, Oliveros A, Medrano J, Castillo J. Correlation of findings in advanced MR techniques with global severity scales in patients with some grade of cognitive impairment. Neurol Res 2010; 32:157-65. [PMID: 20158954 DOI: 10.1179/174313209x405164] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Some previous studies in patients with mild cognitive impairment and Alzheimer's disease have probed changes in the results of (1)H magnetic resonance spectroscopy and perfusion- and diffusion-weighted imaging. The purpose of this work was to correlate the results of perfusion- and diffusion-weighted imaging and magnetic resonance spectroscopy with the results of two global severity scales in cognitive impairment: the clinical dementia rating (CDR) and the global deterioration scale (GDS). PATIENTS AND METHODS We evaluated 87 patients with cognitive impairment of diverse grade (35 men and 52 women; mean age, 70.2 +/- 8.5 years old). All patients were evaluated by a neurological team in our hospital. They applied both global severity scales (CDR and GDS) and referred the patients to our diagnostic imaging department to make a cerebral magnetic resonance imaging study and studies of diffusion- and perfusion-weighted imaging and magnetic resonance spectroscopy. We excluded patients with history of Parkinson's disease, frontotemporal dementia, cerebrovascular disease, intracranial tumors, hydrocephaly, epilepsy, alcoholism and psychiatric disorders. Magnetic resonance spectroscopy was carried out in the left occipital cortex and in the posterior cingulate gyrus. The evaluated metabolites were N-acetylaspartate (NAA), choline (Cho), creatine (Cr) and myo-inositol (mI). After diffusion-weighted imaging, we calculated apparent diffusion coefficient values in the region of interest located in hippocampi, white matter of temporal lobes, occipital lobes, parietal lobes, frontal lobes and posterior cingulate gyrus of both hemispheres. In perfusion-weighted imaging, we calculated the relative cerebral blood volume in hippocampi, gray matter of frontal lobes, occipital lobes, temporoparietal regions, posterior cingulate gyri and somatic-sensorial cortex. We used Spearman coefficient to analyse the correlation among the different factors. Statistical analysis was made with SPSS 14 software. RESULTS We found 33 patients with Alzheimer's disease and 54 with mild cognitive impairment. The Spearman coefficient had statistical significance in the correlation of CDR and GDS (R(2)=0.596, p<0.001). Magnetic resonance spectroscopy showed a good correlation between ratios of NAA/Cr and NAA/mI with CDR and GDS in both evaluated regions and a weak correlation between Cho/Cr in the left occipital lobe and GDS. In diffusion-weighted imaging, we found a weak correlation between GDS and apparent diffusion coefficient values in hippocampi, temporal lobes, left frontal lobe and left occipital lobe. Finally, perfusion showed a weak correlation between GDS and relative cerebral blood volume in occipital lobes and posterior cingulate gyrus. CONCLUSION In patients with cognitive impairment, there is a good correlation between CDR and GDS. The tool that showed the closest correlation with the clinical scales (CDR and GDS) was magnetic resonance spectroscopy in the left occipital cortex and posterior cingulate gyrus. Perfusion- and diffusion-weighted imaging are tools with a weak correlation with clinical scales, GDS being unique that gave us significant statistical results; this could be explained by the major number of items considered for cognitive impairment (GDS 2 and 3) compared with CDR (CDR 0.5). Magnetic resonance spectroscopy can be used in the diagnostic, following and evaluation of the response to the treatment in patients with cognitive impairment (mild cognitive impairment and Alzheimer's disease), complementing the information obtained in the clinical evaluation.
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Affiliation(s)
- Nicolás Fayed
- Department of Radiology, Quiron Hospital, Paseo Mariano Renovales s/n, Zaragoza 50006, Spain
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Perneczky R, Wagenpfeil S, Komossa K, Grimmer T, Diehl J, Kurz A. Mapping scores onto stages: mini-mental state examination and clinical dementia rating. Am J Geriatr Psychiatry 2006; 14:139-44. [PMID: 16473978 DOI: 10.1097/01.jgp.0000192478.82189.a8] [Citation(s) in RCA: 454] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although the clinical course of Alzheimer disease (AD) is gradual, it is useful for a number of reasons to distinguish between different levels of severity. The Clinical Dementia Rating (CDR) has demonstrated high validity and reliability for this purpose, but it requires a considerable amount of data to be collected both from the patient and from an informant. In the present study, the authors mapped Mini-Mental State Examination (MMSE) scores onto CDR categories to determine how well the MMSE performs as a surrogate of the CDR as a timesaving method of staging dementia. METHOD Eight hundred sixty-three probands, including 524 patients with probable AD, 92 patients with questionable dementia, and 247 with memory complaints but no objective cognitive impairment, were included. Cutoff scores were identified on one-half of the sample using a receiver operating characteristic analysis. The cutoff values were then applied to the other half of the sample, and the agreement between MMSE score ranges and CDR stages was determined by calculating Cohen's kappa. RESULTS The MMSE discriminated well between CDR stages 0.5, 1, 2, and 3 but performed poorly in the separation between CDR stages zero and 0.5. The MMSE ranges were 30 for no, 26-29 for questionable, 21-25 for mild, 11-20 for moderate, and 0-10 for severe dementia. Substantial agreement between the two instruments was obtained for the categories mild (kappa=0.62, p<0.001, N=115), moderate (kappa=0.69, p<0.001, N=114), and severe dementia (kappa=0.76, p<0.001, N=39), whereas the agreement was moderate for no (kappa=0.44, p<0.001, N=120) and only fair for questionable dementia (kappa=0.28, p<0.001, N=42). CONCLUSION The MMSE can be used as a surrogate measure for the CDR for the staging of dementia in AD.
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Affiliation(s)
- Robert Perneczky
- Department of Psychiatry and Psychotherapy and the Institute of Medical Statistics and Epidemiology, Technische Universität München, Germany.
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