scholarly journals Has the referral of older adults with dementia changed since the availability of acetylcholinesterase inhibitors and the NICE guidelines?

2006 ◽  
Vol 30 (4) ◽  
pp. 131-134 ◽  
Author(s):  
Christopher O'Loughlin ◽  
Jon Darley
Keyword(s):  
Mini Mental State Examination ◽  
Mmse Score ◽  
Acetylcholinesterase Inhibitors ◽  
Clinical Excellence ◽  
Clinical Implications ◽  
Nice Guidelines ◽  
Specialist Services ◽  
Old Age Psychiatry ◽  
The Mean ◽  
State Examination

Aims and MethodTo investigate whether patients with dementia are referred to specialist services earlier in the disease since the launch of acetylcholinesterase inhibitors and the publication of the National Institute for Clinical Excellence (NICE) guidelines for the use of these drugs. All referrals to old age psychiatry services in two 6-month periods in 1996 and 2003 were surveyed retrospectively for diagnosis, Mini-Mental State Examination (MMSE) score and use of acetylcholinesterase inhibitors.ResultsThe mean MMSE score at referral increased from 18.8 to 21.5 (P=0.0005) between 1996 and 2003. Acetylcholinesterase inhibitors were prescribed for 35% of all patients and 58% of patients that would be suitable according to NICE guidelines in the 2003 group.Clinical ImplicationsThe earlier referral of patients with dementia to mental health services is encouraging.

Apolipoprotein E, Cognitive Function, and Dementia in a General Population Aged 85 Years and Over

2000 ◽  
Vol 12 (3) ◽  
pp. 379-387 ◽  
Author(s):  
Kati Juva ◽  
Auli Verkkoniemi ◽  
Petteri Viramo ◽  
Tuomo Polvikoski ◽  
Katariina Kainulainen ◽  
...  
Keyword(s):  
Mini Mental State Examination ◽  
Mmse Score ◽  
Reference Population ◽  
Apo E ◽  
Diagnosis Of Dementia ◽  
Ε4 Allele ◽  
Very Old Age ◽  
The Mean ◽  
Apo E Genotype ◽  
State Examination

We examined 510 subjects representing 83.2% of all citizens of a Finnish city aged 85 years or over. Mini-Mental State Examination (MMSE) scores, diagnosis of dementia by DSM-III-R criteria, and Apo-E genotype were determined. The prevalence of dementia was 38.6%. The odds ratio (OR) of the Apo-E ε4 carriers (with the reference population of people with the genotype ε3/ε3) for dementia was 2.36 (95% CI 1.58–3.58). There was a significant sex difference: The OR in women was 3.23 (95% CI 2.02–5.17) whereas among men it was insignificant. The mean MMSE score (± SD) among the Apo-E ε4 carriers (15.0 ± 10.0) and noncarriers (18.7 ± 8.6) (p < .001) differed among the whole population, but not within the demented or nondemented subjects analyzed separately. This study does not support the hypothesis that the Apo-E ε4 allele impairs cognitive functions of nondemented elderly, at least in those surviving to very old age.

scholarly journals Cognitive function and risk factors in the older population: differences between the sexes

2021 ◽  
Author(s):  
Vinícius Lúcio de Barros ◽  
Larissa Gomes Peres Bomfim ◽  
Melyssa Alves Souza ◽  
Danielle Ginsicke ◽  
Mileny Esbravatti Stephano Colovati ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Mini Mental State Examination ◽  
Mmse Score ◽  
The Elderly ◽  
Sao Paulo ◽  
São Paulo ◽  
Brain Health ◽  
The Mean ◽  
State Examination ◽  
Study Inclusion

Background: Studies have shown a sex difference in the cognitive dysfunction in the elderly where women are more susceptible to Alzheimer’s disease than men. Physical activity (PA) is an important strategy for brain health, but the exact mechanism is unclear. Santos has the largest proportion of the elderly population in São Paulo State (22%), but no studies have whether there are differences between the sexes in cognitive function. Objective: To evaluate the differences between the sexes in the cognitive function of the elderly and which factors are associated with this difference. Methods: Ninety-seven women and sixty-nine men were eligible for the study. Inclusion criteria were >65 years old, no severe cognitive impairment, preserved activities of daily living. Cognitive function and PA were assessed by the mini-mental state examination (MMSE) and Baecke questionnaire. Results: The mean age was 75±7 and 73±7, for women and men, respectively. Both sexes showed a similar MMSE score (26, varying between 14 and 30) that was inversely associated with age. The influence of the schooling status on MMSE was greater in women (r=0.49, p=0.0001) compared to men (r= 0.30, p9. Conclusions: The MMSE score is affected by the aging process similarly between the sexes. The years of schooling have an influence on cognitive function in women that is attenuated by higher PA. Ethical Committee: CAAE 20938619.4.0000.5509. Financial Support: São Paulo Research Foundation.

scholarly journals A study of clozapine and long-term hospitalisation rates

2004 ◽  
Vol 28 (8) ◽  
pp. 285-288 ◽  
Author(s):  
Alan A. Woodall ◽  
David B. Menkes ◽  
Thomas R. Trevelyan ◽  
Colin P. Lanceley
Keyword(s):  
Side Effects ◽  
Older Patients ◽  
Clinical Excellence ◽  
Clinical Implications ◽  
Treatment Resistant ◽  
Nice Guidelines ◽  
Resistant Disease ◽  
Factors Influencing ◽  
The Mean

Aims and MethodThe aim of the study was to investigate the use of clozapine in treatment-resistant schizophrenia and its impact on hospitalisation rates when prescribed in accordance with National Institute for Clinical Excellence (NICE) guidelines. Case records were examined of patients admitted to the psychiatric unit of Glan Clwyd Hospital between 1996 and 2001.ResultsOf 59 patients identified as having treatment-resistant schizophrenia, 83% had been considered for clozapine, 48% were taking clozapine, 20% had refused the drug and 15% had stopped taking it because of side-effects. The mean annual hospitalisation rate for patients receiving clozapine for a minimum of 3 years was 13.5 days, markedly lower than those not receiving this drug (34.0 days, P=0.03). Older patients were less likely to have been offered clozapine (P=0.006).Clinical ImplicationsThis study supports the NICE guidelines recommending clozapine for patients with treatment-resistant disease. Clozapine is offered less often to older patients; factors influencing this require investigation.

Three-year follow-up of Mini-Mental State Examination score in community residents aged 85 and over

1995 ◽  
Vol 25 (4) ◽  
pp. 841-848 ◽  
Author(s):  
G. J. Izaks ◽  
J. Gussekloo ◽  
K. M. T. Dermout ◽  
T. J. Heeren ◽  
G. J. Ligthart
Keyword(s):  
Cognitive Function ◽  
Mental State ◽  
Mini Mental State Examination ◽  
Mmse Score ◽  
Regression Line ◽  
Regression To The Mean ◽  
Floor Effect ◽  
The Mean ◽  
State Examination

SYNOPSISThe objective of this study was to describe over time the course of cognitive function of elderly without cognitive impairment and of elderly with different stages of impairment, and to assess if the change in cognitive function was dependent on the initial level of function. The Mini-Mental State Examination (MMSE) was used at two time points. The first assessment (MMSE-1) was part of a community-based study and was obtained from 871 subjects. For the second assessment (MMSE-2) a sample of 166 subjects was drawn from the subjects alive at follow-up who had an MMSE-1 score. This sample was stratified by MMSE-1 score to avoid oversampling of subjects with high MMSE-1 scores. A second MMSE score was obtained from 134 elderly, whereas 18 subjects refused participation and 14 subjects were not traceable. The median age at first assessment was 89 years (25th percentile 87, 75th percentile 92), the mean follow-up period (S.D.) was 3·3 (0·5) years. The median change in MMSE score was minus 4 points (95% confidence interval (CI) − 7 to − 2) and the slope of the regression line of MMSE-2 on MMSE-1 was 1·1 (95% CI 0·9–1·3). It is likely that the slope was underestimated due to a floor effect, regression to the mean and missing observations. However, the probability of decline decreased if MMSE-1 was higher. Nevertheless, the probability ranged from 27 to 59% for subjects with the highest MMSE-1 scores aged 85 and 95 years respectively. The latter is an argument in favour of a periodical examination of all subjects aged 85 and over to reveal causes of cognitive decline that can be treated or are amenable to prevention.

scholarly journals Study of cognitive functions in major idiopathic interstitial pneumonias

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Mohamed W. Zakaria ◽  
Reem I. El-Korashy ◽  
Mostafa O. Shaheen ◽  
Samah Selim ◽  
Kwashi J. Amum
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cognitive Dysfunction ◽  
Mini Mental State Examination ◽  
Mmse Score ◽  
Control Group ◽  
Healthy Individuals ◽  
Co Morbidity ◽  
Impaired Lung Function ◽  
State Examination

Abstract Background Cognitive dysfunction in idiopathic interstitial pneumonia (IIP) is an important clinical co-morbidity that is associated with impaired lung function. The aim of the work is to assess cognitive function in major IIP and to find out the relation between cognitive dysfunction and the oxygenation parameters. Results Fifty individuals were involved in the study; 30 patients with major IIP and 20 healthy individuals. Patients with IIP had significantly lower mini mental state examination (MMSE) score compared to the control group (P < 0.001). Wechsler Deterioration Index (WDI) revealed that 33.3% (n = 10) of the patients with IIP had sure cognitive impairment and 26.6% (n = 8) had ongoing cognitive deterioration. Patients with idiopathic pulmonary fibrosis (IPF) had lower cognitive function than other IIP. Conclusion There is an impairment of cognitive function in patients with major IIP, particularly in IPF, as measured by WDI and MMSE. Further large studies are needed to assess the possible predictors of cognitive impairment and their effects on the patients’ outcome.

Disruptive Vocalization and Depression in Older Nursing Home Residents

2000 ◽  
Vol 12 (4) ◽  
pp. 463-471 ◽  
Author(s):  
Michael Dwyer ◽  
Gerard J. A. Byrne
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Mini Mental State Examination ◽  
Mmse Score ◽  
Nursing Home Residents ◽  
Confounding Variables ◽  
The Relationship ◽  
State Examination ◽  
Age And Sex

Screaming and other types of disruptive vocalization are commonly observed among nursing home residents. Depressive symptoms are also frequently seen in this group, although the relationship between disruptive vocalization and depressive symptoms is unclear. Accordingly, we sought to examine this relationship in older nursing home residents. We undertook a controlled comparison of 41 vocally disruptive nursing home residents and 43 non-vocally-disruptive nursing home residents. All participants were selected to have Mini-Mental State Examination (MMSE) scores of at least 10. Participants had a mean age of 81.0 years (range 63-97 years) and had a mean MMSE score of 17.8 (range 10-29). Nurse ratings of disruptive vocalization according to a semioperationalized definition were validated against the noisy behavior subscale of the Cohen-Mansfield Agitation Inventory. Subjects were independently rated for depressive symptoms by a psychiatrist using the Dementia Mood Assessment Scale, the Cornell Scale for Depression in Dementia, and the Depressive Signs Scale. Vocally disruptive nursing home residents scored significantly higher than controls on each of these three depresion-in-dementia scales. These differences remained significant when the effects of possible confounding variables of cognitive impairment, age, and sex were removed. We conclude that depressive symptoms are associated with disruptive vocalization and may have an etiological role in the generation of disruptive vocalization behaviors in elderly nursing home residents.

Serum Level of Alkaline Phosphatase Correlates Negatively with Mini-Mental State Examination Score in the Very Elderly of Ashikaga City: Part of the Results of the Ashikaga Longevity Study

2021 ◽  
Author(s):  
Minoru Yamakado
Keyword(s):  
Oxidative Stress ◽  
Alkaline Phosphatase ◽  
Cognitive Function ◽  
Life Expectancy ◽  
Mental State ◽  
Mini Mental State Examination ◽  
Mmse Score ◽  
Healthy Life Expectancy ◽  
Healthy Life ◽  
State Examination

Objective: An important medical issue in both Japan and Ashikaga City is how to extend healthy life expectancy. To determine factors associated with healthy life expectancy, we established a joint study between Ashikaga City and the Ashikaga University Faculty of Nursing called the Ashikaga Longevity Study, using new biomarkers such as Diacron reactive oxygen metabolites (d-ROMs) and biological antioxidant potential (BAP) tests as indicators of oxidative stress. In this study, factors related to cognitive function were clarified. Methods: Participants comprised 95 individuals (36 men; mean age, 91.0±5.1 years and 59 women; mean age, 92.2±5.9 years). Cognitive impairment was assessed using the Mini-Mental State Examination (MMSE). Results: MMSE score was ≤23 in 28 subjects (29.5%) and ≥24 in 67 subjects (70.5%). MMSE score showed significant negative correlations with age (p<0.0096), plasma alkaline phosphatase (p=0.0007), and peripheral leukocyte-to-lymphocyte ratio (p=0.0119), and positive correlations with plasma albumin (p=0.0096) and BAP-to-d-ROMs ratio (p=0.0427). Conclusions: These results suggest that cognitive decline may involve brain cell dysfunction due to inflammation based on a reduced ability to control oxidative stress. Not only anti-oxidative aerobic exercise but also anti-oxidative foods, may be necessary to maintain cognitive function.

scholarly journals Medium-Chain Triglycerides (8:0 and 10:0) Increase Mini-Mental State Examination (MMSE) Score in Frail Elderly Adults in a Randomized Controlled Trial

2020 ◽  
Vol 150 (9) ◽  
pp. 2383-2390 ◽  
Author(s):  
Sakiko Abe ◽  
Osamu Ezaki ◽  
Motohisa Suzuki
Keyword(s):  
Mental State ◽  
Frail Elderly ◽  
Mini Mental State Examination ◽  
Mmse Score ◽  
Medium Chain Triglycerides ◽  
Elderly Individuals ◽  
Intention To Treat ◽  
Randomized Controlled ◽  
State Examination

ABSTRACT Background Supplementation with medium-chain triglycerides (MCTs) was previously shown to increase muscle function in frail elderly individuals. Objective We aimed to assess effects of MCTs on cognition in such individuals. Methods We enrolled 64 elderly nursing home residents (85.5 ± 6.8 y; 13 men, 51 women; BMI 18.6 ± 2.5 kg/m2) in a 3-mo randomized, controlled, single-blinded, intervention trial. Participants were randomly allocated to 3 groups: the first group received supplemental L-leucine (1.2 g) and cholecalciferol (20 μg) enriched with 6 g/d of MCTs (LD + MCT group) as a positive control, the second group received 6 g/d of MCTs (MCT group) as the test nutrient, and the third group received 6 g/d of long-chain triglycerides (LCT group) as a negative control. Cognition (secondary outcome) was monitored 4 times: baseline, 1.5 and 3 mo after initiation of the intervention (intervention), and 1.5 mo after termination of the intervention (postintervention follow-up). Cognition scores were assessed by a linear mixed model (intention-to-treat analysis). Results MCT supplementation increased the Mini-Mental State Examination (MMSE) score by 3.5 points at the 3-mo intervention from baseline (P &lt; 0.001) [intention-to-treat adjusted means: baseline 17.5 points (95% CI: 14.9, 20.2), 3-mo intervention 21.0 points (18.3, 23.7)], whereas LCT supplementation decreased the MMSE score by −0.7 points [baseline 17.0 points (95% CI: 14.4, 19.6), 3-mo intervention 16.3 points (13.6, 18.9)]. At the 3-mo intervention, the difference in MMSE score between the MCT (21.0 points) and LCT (16.3 points) groups became significant (P &lt; 0.05). The increase in MMSE score in response to MCTs was 2.1-fold greater at 3 mo than at 1.5 mo and had returned to baseline value at the 4.5-mo postintervention follow-up visit. Conclusion Supplementation with 6 g MCTs/d may improve the cognition of frail elderly individuals. This trial was registered at umin.ac.jp as UMIN000023302.

scholarly journals Kihito, a Traditional Japanese Kampo Medicine, Improves Cognitive Function in Alzheimer’s Disease Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Hidetoshi Watari ◽  
Yutaka Shimada ◽  
Mie Matsui ◽  
Chihiro Tohda
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Clinical Trial ◽  
Cognitive Function ◽  
Mental State ◽  
Mini Mental State Examination ◽  
Mmse Score ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
State Examination

Background and Aims. We previously reported that the administration of traditional Japanese medicines, kihito (Gui-Pi-Tang in Chinese) and kamikihito (Jia-Wei-Gui-Pi-Tang in Chinese), to Alzheimer’s disease (AD) model mice improved memory impairment. There are a few reports that show kihito and kamikihito have a beneficial effect on the cognitive function of AD patients in clinical studies. However, these studies are not comparative and are retrospective studies; thus, more evidence is needed. Therefore, we conducted an open-label, crossover designed clinical trial to investigate the effect of kihito on cognitive function of AD patients. Methods. The inclusion criteria for eligible patients were as follows: (1) imaging diagnosis (magnetic resonance imaging and single-photon emission computed tomography) of AD, (2) a treatment regimen including acetylcholinesterase inhibitors (ChEIs), and (3) a Mini-Mental State Examination (MMSE) score ≥15. The exclusion criteria were as follows: (1) change in ChEI dosage, (2) memantine usage, and (3) MMSE score < 15. To prevent bias in age and baseline cognitive function, patients were divided into two groups: the first group received 2.5 g of kihito extract 3 times/day during the first half of the study (weeks 0-16) and the second group received the same dose of kihito during the second half of the study (weeks 17-32). ChEI dosage did not change during the study period. Patients underwent a cognitive function test during weeks 0, 16, and 32. Cognitive function was evaluated by Japanese versions of the Mini-Mental State Examination (MMSE-J) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS-J) test. Results. Ten patients completed the clinical trial (4 males, 6 females, average age 71.7 years). MMSE-J scores significantly increased during the kihito intake period. RBANS-J test scores had a slight improvement during the kihito intake period compared with the ChEI alone treatment period, but no significant changes were observed. Conclusion. Kihito improves cognitive function in AD patients.

scholarly journals Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients after general anaesthesia: A meta-analysis

2016 ◽  
Vol 44 (6) ◽  
pp. 1182-1190 ◽  
Author(s):  
Chengmao Zhou ◽  
Yu Zhu ◽  
Zhen Liu ◽  
Lin Ruan
Keyword(s):  
General Anaesthesia ◽  
Cognitive Dysfunction ◽  
Mini Mental State Examination ◽  
Mmse Score ◽  
Meta Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
Cochrane Library ◽  
Methodologic Quality ◽  
The Cochrane Library ◽  
State Examination

Objective We undertook a meta-analysis to investigate the effect of dexmedetomidine on postoperative cognitive dysfunction (POCD). Methods We searched PubMed, EMBASE, the Cochrane Library, CNKI and Google Scholar to find randomized controlled trials (RCTs) of the influence of dexmedetomidine on POCD in elderly adults who had undergone general anaesthesia. Two researchers independently screened the literature, extracted data, and evaluated methodologic quality against inclusion and exclusion criteria. We used RevMan 5.2 to undertake our meta-analysis. Results Thirteen RCTs were included. Compared with controls, dexmedetomidine: 1) significantly reduced the incidence of POCD (relative risk = 0.59, 95% confidence interval [CI] 0.45–2.95) and improved Mini-Mental State Examination (MMSE) score (mean difference, MD = 1.74, 95% CI 0.43–3.05) on the first postoperative day; and 2) reduced the incidence of POCD after the first postoperative day (MD = 2.73, 95% CI 1.33–4.12). Conclusion Dexmedetomidine reduces the incidence of POCD and improves postoperative MMSE score.

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