Association between baseline Mini-Mental State Examination score and dementia incidence in a cohort of oldest old

ABSTRACT Background: The Brazilian population has aged rapidly. The oldest old, defined as persons aged 80 years or older, is the fastest growing segment of the Brazilian population. Several instruments have been used to assess the cognitive performance of the older people and predict dementia. One of the most commonly used is the Mini-Mental State Examination (MMSE). Objective: The aim of this study was to investigate the relationship between baseline MMSE score and the incidence of dementia in a Brazilian cohort of independent oldest old. Methods: Sociodemographic data and serial cognitive assessment of 248 older adults were analyzed. Results: Mean follow-up time of subjects was 4.0(±1.9) years, 71.4% were women, and mean MMSE score at entry was 25(±3.5). Mean MMSE scores at baseline were significantly higher (p=0.001) in the cognitively intact group than in those who developed dementia. The logistic regression showed that for a one point increase in MMSE score at baseline there was a 10% reduction in the probability of dementia. Conclusions: In the Brazilian scenario of a rapidly growing population of oldest old, the extensive use of the MMSE gives rise to the need not only to determine its effectiveness for screening dementia, but also to interpret its score in terms of future conversion to dementia.

Memory Complaint Is a Surrogate for Memory Decline in the Middle-Aged: A Register-Based Study

Memory complaint is one of the earliest symptoms of dementia. The causes and prognosis of memory complaint in the middle-aged population remain largely unknown. We reviewed the register-based data of 2129 patients with memory complaints. Among them, 404 participants were between 40 and 65 years old. The participants were separated into three groups: subjective cognitive decline (SCD), neurodegenerative diseases (ND), and non-neurodegenerative diseases (NND). One-year decline was defined as a decrease of ≥1 on the mini-mental state examination (MMSE). At baseline, 131 participants (32%) were diagnosed with SCD, 141 (35%) with ND, and 132 (33%) with NND. The 1-year cognitive decline rate was higher among patients with ND (36.8%) than in the SCD (7.3%, p = 1.3 × 10−8) and NND groups (7.6%, p = 1.1 × 10−7). One-year decline did not differ between the SCD and NND groups. Lower baseline MMSE score predicted increased risk of 1-year cognitive decline (odds ratio (OR) = 1.126, 95% confidence interval (CI) = 1.076–1.178, p = 2.52 × 10−7). Memory complaint in middle age carried a risk of 1-year cognitive decline, and baseline MMSE is an independent predictor of decline. An initial diagnosis of SCD held the same risk effect for decline as NND. These findings highlighted the necessity for neuropsychological tests in those with memory complaints presenting to the clinic.

The 100-plus Study of cognitively healthy centenarians: rationale, design and cohort description

ABSTRACTRATIONALEAlthough the incidence of dementia increases exponentially with age, some individuals reach >100 years with fully retained cognitive abilities. To identify the characteristics associated with the escape or delay of cognitive decline, we initiated the 100-plus Study (www.100plus.nl).DESIGNThe 100-plus Study is an on-going prospective cohort study of Dutch centenarians who self-reported to be cognitively healthy, their first-degree family members and their respective partners. We collect demographics, life history, medical history, genealogy, neuropsychological data and blood samples. Centenarians are followed annually until death. PET-MRI scans and feces donation are optional. Almost 30% of the centenarians agreed to post-mortem brain donation.COHORT DESCRIPTIONTo date (September 2018), 332 centenarians were included in the study. We analyzed demographic statistics of the first 300 centenarians (25% males) included in the cohort. Centenarians came from higher socio-economic classes and had higher levels of education compared to their birth cohort; alcohol consumption of centenarians was similar, and most males smoked during their lifetime. At baseline, the centenarians had a median MMSE score of 25 points (IQR: 22.0-27.5); the large majority lived independently, retained hearing and vision abilities and was independently mobile. Mortality was associated with cognitive functioning: centenarians with a baseline MMSE score ≥26 and <26 points had a mortality percentage of respectively 17% and 42% per annual year in the second year after baseline (p=0.003). The cohort was 2.1-fold enriched with the neuroprotective APOE-ε2 allele relative to 60-80 year-old population controls (p=4.8×10-7), APOE-ε3 was unchanged and the APOE-ε4 allele was 2.3-fold depleted (p=6.3×10-7).CONCLUSIONSComprehensive characterization of the 100-plus cohort of cognitively healthy centenarians might reveal protective factors that explain the physiology of long-term preserved cognitive health.

Clinical audit on nice guidance on anticholinesterases in a memory clinic

IntroductionThe National Institute for Clinical Excellence (NICE) has laid down certain guidelines for prescribing Anti-cholinesterases in patients with dementia. Keeping in mind the NICE guidance, an audit was conducted to see whether these were followed.Aims and objectivesTo ascertain the level of compliance to the NICE guidance and ensure they are adhered to.MethodThe data was collected from patients attending the memory clinic at Park Royal Centre for Mental Health in Central London over a six month period. Sixteen patients were randomly selected for this audit. The baseline MMSE score was recorded and also the medication prescribed.ResultsThe baseline MMSE score in all the 16 (100%) patients was above the recommended score of 12.The MMSE score was done in 12(75%) patients during follow up at 4–6 months.Of the 12 available MMSE scores at follow up, none were below 12 and hence continued treatment.In 2 (12.5%) patients there was an improvement, in 6 (37.5%) patients there was a fall and in 4 (25%) patients there was no change in the MMSE score at follow up.ConclusionIt was found that the NICE guidance was followed in most (75%) patients.

Beneficial Effects of Memantine in Every Day Medical Practice: Results from a Large Greek Observational Study

Memantine, NMDA-R antagonist, is approved for the treatment of moderate-to-severe Alzheimer's disease (MMSE< 20) (AD). The purpose of this study was to evaluate the efficacy and safety of memantine when used in routine clinical practice.The 6-months, observational, open-label, multicentre study in 202 specialist centers in Greece evaluated the efficacy of memantine using the MMSE and Instrumental Activities of Daily Living (IADL) scale at baseline, 3 and 6 months. Safety was evaluated by spontaneously reported adverse events (AEs). Statistical efficacy analyses were performed in the Intent-To-Treat (ITT) (at least one post-baseline evaluation) and Per Protocol (PP) datasets (evaluations at both 3 and 6 months).The study included 2570 AD patients (age: 74.8±6.8, 54.6% women, baseline MMSE score: 18.0±5.0). 34.2% had received previous treatment with acetylocholinesterase inhibitors (AChEIs), while for 65.8% memantine was the first treatment option. At baseline 91.5% were prescribed memantine as monotherapy, the remainder also received AChEIs. During the 6 months of the study, 80.9% continued memantine monotherapy. MMSE score was significantly improved from baseline at 3 (17.9±5.1 vs 19.2±5.0, p< 0.001, repeated measures analysis of variance Hotelling's test, ITT) and 6 months (17.9±5.1 vs 19.7±5.1). At 6 months, 67% of the ITT population had improved their MMSE score and 18.6% had no change. 19 patients (0.7%) terminated the therapy prematurely due to AEs. AEs were reported in 182 (7.1%) patients: the most common was dizziness (1.45%). 8 (0.3%) of the AEs were severe.These results in naturalistic settings support the excellent efficacy and tolerability profile of memantine.

Subjective memory complaints in the elderly: Depressive symptoms and future dementia

BackgroundPopulation studies indicate that subjective memory complaints by elderly people are correlated with cognitive performance. These complaints have some predictive power regarding the development of dementia. The present study attempted to replicate this finding, and investigated which variables determine subjective memory complaints.MethodParticipants in the Amsterdam Study of the Elderly (n=2114; 65–84 years of age), who were not demented and had a normal MMSE score (> 23) at baseline, were re-examined after four years. Subjective complaints were measured using a previously developed scale. Dementia and depression were measured using the Geriatric Mental State Schedule (GMS). Premorbid intelligence was measured by the Dutch Adult Reading Test (DART)ResultsMemory complaints at baseline contributed a small but significant amount of diagnostic information with respect to the prediction of future dementia. Depressive symptoms at baseline had no predictive value when these memory complaints were accounted for. Subjective memory complaints were associated with depression, baseline MMSE score, and premorbid intelligence.ConclusionsSubjective memory complaints are not just secondary to depression, but in part reflect realistic self-observations of cognitive decline.