scholarly journals Screening of cognitive impairment by general internists using two simple instruments

2012 ◽  
Vol 6 (1) ◽  
pp. 42-47 ◽  
Author(s):  
Alessandro Ferrari Jacinto ◽  
Sonia Maria Dozzi Brucki ◽  
Claudia Sellitto Porto ◽  
Milton de Arruda Martins ◽  
Ricardo Nitrini
Keyword(s):  
Cognitive Impairment ◽  
High Sensitivity ◽  
The Elderly ◽  
University Hospital ◽  
Cognitively Impaired ◽  
Screening Instruments ◽  
Outpatient Services ◽  
Functional Activities ◽  
General Internists ◽  
Combined Use

ABSTRACT General internists (GIs) tend to overlook cognitive impairment in the elderly. Lack of time to diagnose and/or poor knowledge on how to use screening instruments may be the reasons for this shortcoming. Objectives: To verify the efficacy of simple instruments in the screening of cognitive impairment in elders. Methods: In a previous study, 248 patients aged ≥65 that had been assisted by GIs within outpatient services of a public university hospital in São Paulo, Brazil, were evaluated. The Mini-Mental State Examination and/or the Informant Questionnaire on Cognitive Decline in the Elderly (short-IQCODE) were employed to classify patients into probable cognitively impaired cases or otherwise. Other tests and questionnaires were also applied, but were not used to perform this classification. After full assessment and consensus meetings, cases were classified into dementia, cognitively impaired not demented, and without cognitive impairment. In this study, the sensitivity and specificity of the combined use of the category fluency test (CFT) and the Functional Activities Questionnaire (FAQ) was evaluated as if used as screening instruments for the whole sample. Results: The combined use of the CFT and/or FAQ showed sensitivity of 88.3% and specificity of 76.5% in the screening of cognitive impairment for the whole sample. Conclusions: Two simple and easy-to-apply instruments showed high sensitivity and reasonable specificity, and are probably useful for the screening of cognitive impairment in the elderly in outpatient services.

scholarly journals Clinical diagnosis of 80 cases of dementia in a university hospital

2013 ◽  
Vol 62 (2) ◽  
pp. 139-143 ◽  
Author(s):  
Renata Teles Vieira ◽  
Norami de Moura Barros ◽  
Leonardo Caixeta ◽  
Sergio Machado ◽  
Adriana Cardoso Silva ◽  
...  
Keyword(s):  
Demographic Data ◽  
Lewy Body Dementia ◽  
The Elderly ◽  
Healthcare Services ◽  
Epidemiological Studies ◽  
University Hospital ◽  
Functional Activities ◽  
Considerable Impact ◽  
The City ◽  
State Examination

OBJECTIVE: This study aims to estimate the prevalence of dementia subtypes and to assess the socio-demographic data of patients attending the outpatient clinic of dementia at Hospital das Clínicas from January 2008 to December 2009, in the city of Goiânia-GO, Brazil. METHODS: Procedures provided for diagnosis included physical and neurological examination, laboratory tests, neuroimaging and DSM-IV. The functional capacity and level of cognitive deficit were assessed by Pfeffer Functional Activities Questionnaire (Pfeffer-FAQ) and Mini-Mental State Examination (MMSE), respectively. RESULTS: Eighty patients met the criteria for dementia. The mean age was 63.48 (± 16.85) years old, the schooling was 3.30 (± 3.59) years old, the MMSE was 13.89 (± 7.79) and Pfeffer 17.73 (± 9.76). The Vascular Dementia (VD; 17.5%) was the most frequent cause of dementia, followed by Lewy body dementia (LBD) and Alzheimer's disease (AD) (12.25%). CONCLUSION: Considering entire sample and only the elderly over 60 years, VD, AD and LBD are the most common subtypes observed at both groups. Further epidemiological studies are necessary to confirm such rates, which may have a considerable impact on the organization and planning of healthcare services in our country.

scholarly journals Vitamin B12 supplementation and cognitive scores in geriatric patients having Mild Cognitive Impairment

2016 ◽  
Vol 6 (9) ◽  
pp. 578 ◽  
Author(s):  
Komal Chauhan ◽  
Aditika Agarwal
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Vitamin B12 ◽  
Neurological Disorders ◽  
Geriatric Patients ◽  
Serum Vitamin ◽  
The Elderly ◽  
Cognitively Impaired ◽  
Vitamin B12 Supplementation ◽  
Young Old

Background: The Neurodegenerative diseases are increasingly affecting the elderly with a severe impact on their brain health. There is a wide gap in supplementation based studies for increasing the cognition levels of the geriatric population especially in the developing countries like India, which are at extreme risk of developing neurological disorders. Vitamin B12 herein has caught much attention lately for improving the cognitive status. Literature has linked the possibility of alleviating neurological disorders in the elderly with effective vitamin B12 management. Abundant animal and human models have proved that supplementation of vitamin B12 is beneficial for the restoration of cognitive functions. Objective: To supplement vitamin B12 deficient mild cognitively impaired geriatric patients with injectable doses of vitamin B12 followed by impact evaluation. Methods: Screening of the mild cognitively impaired patients was carried out using the Mini-Mental State Examination and Yamaguchi Fox Pigeon Imitation test. Baseline information was elicited from the patients residing in urban Vadodara (a district in the state of Gujarat), India. This included socio-demographic, medical and drug history, anthropometric and physical activity pattern as well as biochemical parameters comprising of serum vitamin B12 and glycated haemoglobin profile. A sub-sample of 60 patients with mild cognitive impairment (MCI) demonstrating severe vitamin B12 deficiency were conveniently enrolled for injectable doses of Vitamin B12 in the dosage of 1,000 μg every day for one week, followed by 1,000 μg every week for 4 weeks & finishing with 1,000 μg for the remaining 4 months. Post six months intervention all the parameters were elicited. Results: Vitamin B12 supplementation resulted in a significant (p<0.001) improvement in the MMSE scores of the patients with a rise of 9.63% in the total patients. Gender-wise division also highlighted a significant increase (p<0.001) in the scores by 6.79% and 12.46% in overall males and females and a 10.20% and 8.24% rise for young-old (60-69 yrs) and old- old (70-85 yrs) categories, respectively. As a result, 27 patients progressed towards the category from the MCI state being assessed by MMSE scores. In the same manner, YGFPIT too demonstrated a 38% increase in normal with 35% males, 42% females, 41% young–old and 31% old-old moving to normal status. Thus, a total number of 28 patients progressed to the normal condition as per YGFPIT.Conclusion: Hence, vitamin B12 supplementation was found significantly effective in placing the serum vitamin B12 of MCI patients from the deficiency state to sufficient levels and in turn increased their performance in MMSE and YFPIT scores. Keywords: Mild Cognitive Impairment, vitamin B12, geriatrics, cognition

scholarly journals Cognitive screening instruments for dementia: comparing metrics of test limitation

2021 ◽  
Vol 15 (4) ◽  
pp. 458-463
Author(s):  
Andrew J. Larner
Keyword(s):  
Cognitive Impairment ◽  
High Sensitivity ◽  
Misclassification Rate ◽  
Test Accuracy ◽  
Screening Instruments ◽  
Cognitive Screening ◽  
Net Benefit ◽  
Likelihood Ratios ◽  
Sensitivity Specificity ◽  
State Examination

ABSTRACT Cognitive screening instruments (CSIs) for dementia and mild cognitive impairment are usually characterized in terms of measures of discrimination such as sensitivity, specificity, and likelihood ratios, but these CSIs also have limitations. Objective: The aim of this study was to calculate various measures of test limitation for commonly used CSIs, namely, misclassification rate (MR), net harm/net benefit ratio (H/B), and the likelihood to be diagnosed or misdiagnosed (LDM). Methods: Data from several previously reported pragmatic test accuracy studies of CSIs (Mini-Mental State Examination, the Montreal Cognitive Assessment, Mini-Addenbrooke’s Cognitive Examination, Six-item Cognitive Impairment Test, informant Ascertain Dementia 8, Test Your Memory test, and Free-Cog) undertaken in a single clinic were reanalyzed to calculate and compare MR, H/B, and the LDM for each test. Results: Some CSIs with very high sensitivity but low specificity for dementia fared poorly on measures of limitation, with high MRs, low H/B, and low LDM; some had likelihoods favoring misdiagnosis over diagnosis. Tests with a better balance of sensitivity and specificity fared better on measures of limitation. Conclusions: When deciding which CSI to administer, measures of test limitation as well as measures of test discrimination should be considered. Identification of CSIs with high MR, low H/B, and low LDM, may have implications for their use in clinical practice.

Serum Immunoglobulins and Cognitive Status in the Elderly: 1. A Population Study

1980 ◽  
Vol 136 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Donna Cohen ◽  
Carl Eisdorfer
Keyword(s):  
Cognitive Impairment ◽  
Population Study ◽  
Elevated Serum ◽  
Cognitive Disorders ◽  
The Elderly ◽  
Cognitive Status ◽  
Cognitively Impaired ◽  
Immunological Factors ◽  
A Current ◽  
Age And Sex

SummaryFifty-seven cognitively impaired elderly had significantly elevated serum IgG (P $0.005) and IgA (P $0.01) levels and similar IgM levels, compared to a population of 65 elderly matched for age and sex, who did not manifest cognitive impairment. These findings are compatible with a current hypothesis that immunological factors may be important in the cognitive disorders observed with increasing frequency among the aged.

scholarly journals Longitudinal Trajectories of Informant-Reported Daily Functioning in Empirically Defined Subtypes of Mild Cognitive Impairment

2017 ◽  
Vol 23 (6) ◽  
pp. 521-527 ◽  
Author(s):  
Kelsey R. Thomas ◽  
Emily C. Edmonds ◽  
Lisa Delano-Wood ◽  
Mark W. Bondi
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Functional Decline ◽  
Executive Dysfunction ◽  
Functional Change ◽  
Cognitively Impaired ◽  
Cognitive Domains ◽  
Functional Activities ◽  
Rate Of Decline

AbstractObjectives: Within the Alzheimer’s Disease Neuroimaging Initiative (ADNI)’s mild cognitive impairment (MCI) cohort, we previously identified MCI subtypes as well as participants initially diagnosed with MCI but found to have normal neuropsychological, biomarker, and neuroimaging profiles. We investigated the functional change over time in these empirically derived MCI subgroups. Methods: ADNI MCI participants (n=654) were classified using cluster analysis as Amnestic MCI (single-domain memory impairment), Dysnomic MCI (memory+language impairments), Dysexecutive/Mixed MCI (memory+language+attention/executive impairments), or Cluster-Derived Normal (CDN). Robust normal control participants (NCs; n=284) were also examined. The Functional Activities Questionnaire (FAQ) was administered at baseline through 48-month follow-up. Multilevel modeling examined FAQ trajectories by cognitive subgroup. Results: The Dysexecutive/Mixed group demonstrated the fastest rate of decline across all groups. Amnestic and Dysnomic groups showed steeper rates of decline than CDNs. While CDNs had more functional difficulty than NCs across visits, both groups’ mean FAQ scores remained below its suggested cutoff at all visits. Conclusions: Results (a) show the importance of executive dysfunction in the context of other impaired cognitive domains when predicting functional decline in at-risk elders, and (b) support our previous work demonstrating that ADNI’s MCI criteria may have resulted in false-positive MCI diagnoses, given the CDN’s better FAQ trajectory than those of the cognitively impaired MCI groups. (JINS, 2017, 23, 521–527)

scholarly journals Association between Physical Activity and Cognitive Function among the Elderly in the Health and Social Centers in Kenitra, Rabat, and Sidi Kacem City (Morocco)

2021 ◽  
Vol 14 ◽  
pp. 117863882110267
Author(s):  
Abdeljalil Talhaoui ◽  
Youssef Aboussaleh ◽  
Ahmed Ahami ◽  
Rachid Sbaibi ◽  
Naima Agoutim ◽  
...  
Keyword(s):  
Physical Activity ◽  
Logistic Regression ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Protective Factor ◽  
Binary Logistic Regression ◽  
The Elderly ◽  
Cognitively Impaired ◽  
Gender Education ◽  
Global Physical Activity Questionnaire

Objective: The aim of this study was to determine the link between the physical activity (PA) and cognitive function among the elderly in the health and social centers in Kenitra, Rabat, and Sidi Kacem city (Morocco). Materials and methods: This study was conducted among 172 elderly (56.4% men) aged above 60 years (67.53 ± 7.53) in the health and social centers in Kenitra, Rabat, and Sidi Kacem city (Morocco). Cognitive functions were assessed by the Mini-Mental State Examination (MMSE) (Normal: MMSE’s score >24 and cognitive impairment (CI): MMSE’s score ⩽ 24). The physical activity (PA) was evaluated using the GPAQ (Global Physical Activity Questionnaire), ranking the elderly by high, moderate, and limited level of PA. The binary logistic regression was performed by the cognitive function (dependent variable), and PA level (independent variable). Results: The elderly people with cognitive impairment (MMSE score <24 tend to practice less walking and cycling activities ( P  =  .005). However no difference was found between normal and cognitively impaired subjects for all other subtypes of PA ( P > .05). The binary logistic regression adjusted for gender, education, profession, pension, depression, and nutritional status reveled that only the moderate level of PA was a protective factor against cognitive impairment compared to limited level (ORa = 0.136, 95% CI: 0.04-0.41) (ORa: Adjusted Odd Ratio; 95% CI: 95% of Confidence Interval). Conclusion: Our finding demonstrates that moderate PA specially walking or cycling is associated with lower risk of cognitive impairment. This indicates that a regular practice of walking or cycling as PA can play an important role for cognitive impairment prevention. And the necessity for further researches to more understands this association.

scholarly journals Codex (Cognitive Disorders Examination) Decision Tree Modified for the Detection of Dementia and MCI

Diagnostics ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. 58 ◽  
Author(s):  
Besa Ziso ◽  
Andrew J. Larner
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Decision Tree ◽  
Cognitive Disorders ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Word Recall ◽  
Screening Instruments ◽  
Cognitive Screening ◽  
Dementia Diagnosis

Many cognitive screening instruments are available to assess patients with cognitive symptoms in whom a diagnosis of dementia or mild cognitive impairment is being considered. Most are quantitative scales with specified cut-off values. In contrast, the cognitive disorders examination or Codex is a two-step decision tree which incorporates components from the Mini-Mental State Examination (MMSE) (three word recall, spatial orientation) along with a simplified clock drawing test to produce categorical outcomes defining the probability of dementia diagnosis and, by implication, directing clinician response (reassurance, monitoring, further investigation, immediate treatment). Codex has been shown to have high sensitivity and specificity for dementia diagnosis but is less sensitive for the diagnosis of mild cognitive impairment (MCI). We examined minor modifications to the Codex decision tree to try to improve its sensitivity for the diagnosis of MCI, based on data extracted from studies of two other cognitive screening instruments, the Montreal Cognitive Assessment and Free-Cog, which are more stringent than MMSE in their tests of delayed recall. Neither modification proved of diagnostic value for mild cognitive impairment. Possible explanations for this failure are considered.

scholarly journals Bewildered and alone: supporting people with cognitive impairment on COVID isolation wards

2021 ◽  
pp. 1-2
Author(s):  
Martha Finnegan ◽  
Elaine Greene
Keyword(s):  
Cognitive Impairment ◽  
The Elderly ◽  
Cognitively Impaired ◽  
Pharmacological Interventions ◽  
Specific Group ◽  
Liaison Psychiatry ◽  
Professional Boundaries ◽  
Off Label ◽  
New Challenges

SUMMARY Managing isolation protocols for distressed, cognitively impaired COVID-19-positive patients presented a range of new challenges to our liaison psychiatry for the elderly service. In this article we present some of the scenarios we have experienced, our own reflections on the needs of this specific group and how this has challenged us in terms of tolerating risk, prescribing off-label, collaborating with distressed colleagues, professional boundaries and being creative in non-pharmacological interventions.

scholarly journals Evaluation Of Motor Performance In Cognitively Impaired Elderly Patients With Berg Test: A pilot study

2020 ◽  
Author(s):  
Annamaija Sutela ◽  
Timo Kauppila
Keyword(s):  
Cognitive Impairment ◽  
Motor Performance ◽  
Motor Program ◽  
The Elderly ◽  
Cognitively Impaired ◽  
Care Hospital ◽  
Verbal Instructions ◽  
Primary Care Hospital ◽  
Quasi Experimental ◽  
Normal Cognition

Abstract Objectives We studied whether we can determine a degree of cognitive impairment in which the testing for need of physiotherapy cannot be evaluated without continuous non-verbal instructions in the elderly patients.Present study was a retrospective observational quasi-experimental cohort study performed with patients of geriatric primary care hospital. Fifty-seven aged (>65 years) patients who are aiming to be rehabilitated to home-like facilities participated this study. We compared groups of different levels of cognitive performance (normal cognition, mild, moderate, and severe cognitive impairment) as determined with MiniMental(MMSE)-test by using their motor performance in Berg test.ResultsSeverely cognitively impaired patients (MMSE≤11) were equally able to perform the Berg test as their less cognitively compromised controls if they were continuously advised non-verbally. However, standing without support, sitting without support, reaching forward, watching backwards by turning as well as turning around 360° were too difficult tasks for these patients to be performed without continuous extra assistance given by the physiotherapists. Even the most cognitively impaired patients may be able to perform a motor program in physiotherapy. However, with these patients autonomous exercise is likely to fail and excessive work by physiotherapists is thereby required for their training.

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