Search

Introduction: The factor structure of the Positive and Negative Affective Schedule (PANAS) is still a topic of debate. There are several reasons why using Exploratory Graph Analysis (EGA) for scale validation is advantageous and can help understand and resolve conflicting results in the factor analytic literature., Objective: The main objective of the present study was to advance the knowledge regarding the factor structure underlying the PANAS scores by utilizing the different functionalities of the EGA method. EGA was used to (1) estimate the dimensionality of the PANAS scores, (2) establish the stability of the dimensionality estimate and of the item assignments into the dimensions, and (3) assess the impact of potential redundancies across item pairs on the dimensionality and structure of the PANAS scores., Method: This assessment was carried out across two studies that included two large samples of participants., Results and Conclusion: In sum, the results are consistent with a two-factor oblique structure., (© 2021 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

The Mini-Mental State Examination (MMSE) is the most widely used instrument for the screening of older adults with suspected cognitive impairment; the MMSE has been translated and validated in numerous languages and countries. The cultural and sociodemographic characteristics of the sample can influence performance on the test; therefore, applying the MMSE in different populations usually requires adjustments of those variables. From this perspective, the present study aims to review the normative data for the MMSE in the Brazilian older population, including those adaptations to the original test. Database searches were performed in Medline, Web of Knowledge, Scielo and Pepsic for articles assessing healthy elderly Brazilian samples using the MMSE. Heterogeneity across and within the studies was analyzed. Of a total of 1,085 retrieved articles, 14 were included. Significant differences across studies were identified for the characteristics of the samples, the presence of alterations to the MMSE subtests and the presentation of the results. The risk of biases was relevant for all the studies. Considering the large methodological heterogeneity among studies, the generalization of the available normative data for the MMSE may not be appropriate for the general elderly Brazilian population.

Objectives: To evaluate the proportion of children presenting to the emergency department (ED) with altered mental status who demonstrate nonconvulsive seizures on reduced-lead electroencephalography (EEG), and to further investigate the characteristics, treatment, and outcomes in these patients compared with patients without nonconvulsive seizures., Study Design: In this retrospective cohort study, we reviewed the database and medical records of pediatric patients (aged <18 years) in a single ED between May 1, 2016, and April 30, 2018. We first determined the proportion of nonconvulsive seizures among patients with altered mental status (Glasgow Coma Scale <15). We then compared the clinical presentation, demographic data, clinical diagnosis, EEG results, treatment, and outcomes of patients with altered mental status with nonconvulsive seizures and those without nonconvulsive seizures., Results: In total, 16.9% of the patients with altered mental status (41 of 242; 95% CI, 12.2%-21.6%) evaluated by EEG had detectable nonconvulsive seizure, equivalent to 4.4% (41 of 932) of all patients with altered mental status presenting at our hospital. More than 80% of patients monitored for nonconvulsive seizures had a previous history of seizures, often febrile. Patients with nonconvulsive seizures were older (median, 68.5 vs 36.1 months) and had a higher Pediatric Cerebral Performance Category score at presentation (median, 2.0 vs 1.0). In addition, the proportion of patients admitted to the intensive care unit was significantly higher in the patients with nonconvulsive seizures (30.3% vs 15.0%). However, total duration of hospitalization, neurologic sequelae, and 30-day mortality rate did not differ between the 2 groups., Conclusions: A relatively high percentage of pediatric patients with altered mental status in the ED experience nonconvulsive seizures. The use of reduced-lead EEG monitoring in the ED might facilitate the recognition and treatment of nonconvulsive seizures, especially among patients with a history of seizures., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: This study aims to assess the measurement properties of the Major Depression Inventory (MDI) in a clinical sample of primary care patients., Design: General practitioners (GPs) handed out the MDI to patients aged 18-65 years on clinical suspicion of depression., Setting: Thirty-seven general practices in the Central Denmark Region participated in the study., Patients: Data for 363 patients (65% females, mean age: 49.8 years, SD: 17.7) consulting their GP were included in the analysis., Main Outcome Measures: The overall fit to the Rasch model, individual item and person fit, and adequacy of response categories were tested. Statistical tests for local dependency, unidimensionality, differential item functioning, and correct targeting of the scale were performed. The person separation reliability index was calculated. All analyses were performed using RUMM2030 software., Results: Items 9 and 10 demonstrated misfit to the Rasch model, and all items demonstrated disordered response categories. After modifying the original six-point to a five-point scoring system, ordered response categories were achieved for all 10 items. The MDI items seemed well targeted to the population approached. Model fit was also achieved for core symptoms of depression (items 1-3) and after dichotomization of items according to diagnostic procedure., Conclusion: Despite some minor problems with its measurement structure, the MDI seems to be a valid instrument for identification of depression among adults in primary care. The results support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure. Key points The Major Depression Inventory (MDI) is widely used for screening, diagnosis and monitoring of depression in general practice. This study demonstrates misfit of items 9 and 10 to the Rasch model and a need to modify the scoring system The findings support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure. Minor problems with measurement structure should be addressed in future revisions of the MDI.

Objectives: The goal was to identify predictors of poor-quality spirometry in community-dwelling older adults and their respective cutoffs., Methods: This was a cross-sectional population-based study involving 245 elderly subjects (age≥60 years). The spirometric data were categorized as good or poor quality, and cognitive status was assessed using an adapted version (scaled to have a maximum of 19 points) of the Mini-Mental State Examination. Multivariate analysis was used to assess the association between poor-quality spirometry and sociodemographic, behavioral and health characteristics. The best cutoff points for predicting poor-quality spirometry were evaluated by the receiver operating characteristic curve., Results: In this population, 61 (24.9%) subjects with poor-quality spirometry were identified. After multiple logistic regression analysis, only age and Mini-Mental State Examination score were still associated with poor-quality spirometry (p≤0.05). The cutoff for the Mini-Mental State Examination score was 15 points, with an area under the receiver operating characteristic curve of 0.628 (p=0.0017), sensitivity of 74.5% and specificity of 49.5%; for age, the cutoff was 78 years, with an area under the receiver operating characteristic curve of 0.718 (p=0.0001), sensitivity of 57.4% and specificity of 79.9%., Conclusion: Age and Mini-Mental State Examination score together are good predictors of poor-quality spirometry and can contribute to the screening of community-dwelling older adults unable to meet the minimum quality criteria for a spirometric test.

Objectives: To determine if there is an association between hearing loss and poorer cognitive scores on Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) and to determine if poor hearing acuity affects scoring on the cognitive screening tests of MMSE and MoCA., Methods: One hundred fourteen elderly patients (Singapore residents) aged between 55 and 86 years were sampled. Participants completed a brief history questionnaire, pure tone audiometry, and 2 cognitive screening tests-the MMSE and MoCA. Average hearing thresholds of the better ear in the frequencies of 0.5, 1, 2, and 4 kHz were used for data analysis., Results: Hearing loss was significantly associated with poorer cognitive scores in Poisson regression models adjusted for age. Mini-Mental State Examination scores were shown to decrease by 2.8% (P = .029), and MoCA scores by 3.5% (P = .013) for every 10 dB of hearing loss. Analysis of hearing-sensitive components of "Registration" and "Recall" in MMSE and MoCA using chi-square tests showed significantly poorer performance in the hearing loss group as compared to the normal hearing group. Phonetic analysis of target words with high error rates shows that the poor performance was likely contributed by decreased hearing acuity, on top of a possible true deficit in cognition in the hearing impaired., Conclusions: Hearing loss is associated with poorer cognitive scores on MMSE and MoCA, and cognitive scoring is likely confounded by poor hearing ability. This highlights an important, often overlooked aspect of sensory impairment during cognitive screening. Provisions should be made when testing for cognition in the hearing-impaired population to avoid over-referral and subsequent misdiagnoses of cognitive impairment., (Copyright © 2018 John Wiley & Sons, Ltd.)

Individuals with permanent cognitive impairment need to be evaluated and monitored. There exists a number of clinically validated cognitive assessment tools, but they often need to be administered by trained therapists in clinical settings. This serves as a major barrier for frequent, longitudinal monitoring of cognitive function. In this work, we introduce Neuro-World, a collection of innovative 3D mobile games, that allows one to self-administer the assessment of his/her cognitive function. The game performance is analyzed and converted into a clinically-accepted measure of cognitive function, specifically the Mini Mental State Examination (MMSE) score, improving the translational impact of the system in real-world clinical settings. To validate the feasibility of our approach, we collected game-specific performance data from 12 post-stroke patients, which was used to train a supervised machine learning model to estimate the corresponding MMSE score. Our experiment results showed a normalized root mean square error of 5.3% between the actual and estimated MMSE scores. This study enables new clinical and research opportunities for accurate longitudinal assessment of cognitive function via an interactive means of playing mobile games.

Background: A simple, quick, and efficient screening tool for detecting mild cognitive impairment (MCI) and Alzheimer's disease (AD) is essential, especially in the primary care setting. In this study, we examined the neuropsychological profiles of elderly patients and aimed to assess the diagnostic value of the triple test, comprised of the attended alone sign (AAS), head-turning sign, and applause sign (AS), for detecting MCI and AD., Method: Comprehensive geriatric assessment was performed in 354 elderly outpatients, and the presence or absence of AS, AAS and HTS was investigated., Results: Of the 354 patients, 93 patients were considered to be cognitively impaired (MCI: 30; AD: 63); the remaining 261 were cognitively healthy. Relative to those without AS, patients with AS had significantly lower scores on the Mini-Mental State Examination, the clock-drawing test, Instrumental Activities of Daily Living Scale, and Basic Activities of Daily Living Scale (P < 0.001, for each). Similar significant differences were found between patients who were positive and negative for the HTS (P < 0.001) and between those who attended the clinic alone and those who were accompanied (P < 0.001). The sensitivity of the triple test for identifying cognitively impairment (CI), MCI, and AD was 0.61, 0.30, and 0.72, respectively; the specificity was 0.85, 0.68, and 0.83, respectively; and the positive and negative predictive values were 0.69, 0.09, and 0.59, respectively, and 0.79, 0.90, and 0.89, respectively., Conclusions: The present study suggests that the triple test is a simple, quick, and efficient screening tool for detecting cognitive impairment, and the results may reflect deterioration in patients' activities of daily living. Additionally, it could be advantageous in clinical practice because educational level does not affect the test outcome. Therefore, it may be an appropriate test to screen for cognitive impairment in the elderly, both as a bedside diagnostic test and in daily clinical practice, especially in the primary care setting., (© 2018 Japanese Psychogeriatric Society.)

Background: Delirium has a high incidence pathology associated with negative outcomes. Although highly preventable, half the cases are not recognized. One major cause of delirium misdiagnosis is the absence of a versatile instrument to measure it., Aims: Our objective was to translate the nursing delirium screening scale (Nu-DESC) and evaluate its performance in Italian settings., Methods: This was a methodological study conducted in two sequential phases. The first was the Italian translation of Nu-DESC through a translation and back-translation process. The second aimed to test the inter-rater reliability, the sensibility and specificity of the instrument on a convenience sample of 101 hospitalized elderly people admitted to relevant wards of the San Gerardo Hospital in Monza. To evaluate the inter-rater reliability, two examiners tested Nu-DESC on 20 patients concurrently without comparison. To measure the sensibility and specificity of Nu-DESC, the confusion assessment method was used as a gold standard measure., Results: The inter-rater reliability (Cohen Kappa) was 0.87-an excellent agreement between examiners. The study of the ROC curve showed an AUC value of 0.9461 suggesting high test accuracy. Using 3 as a cut-off value, Nu-DESC showed 100 % sensibility and 76 % specificity., Discussion and Conclusion: Further research is needed to test Nu-DESC on a larger sample. However, based on our results, Nu-DESC can be used in research and clinical practice in Italian settings because of its very good and similar performances to previous validation studies. The value of 3 appears to be the optimal cut-off in the Italian context.

Objectives: To examine level of and change in cognitive status using the Mini-Mental State Examination (MMSE) in relation to dementia, mortality, education, and sex in late nonagenarians., Design: Three-year longitudinal study with examinations at ages 97, 99, and 100., Setting: Trained psychiatric research nurses examined participants at their place of living., Participants: A representative population-based sample of 97-year-old Swedes (N = 591; 107 men, 484 women) living in Gothenburg, Sweden., Measurements: A Swedish version of the MMSE was used to measure cognitive status. Geriatric psychiatrists diagnosed dementia according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Mixed models were fitted to the data to model the longitudinal relationship between MMSE score and explanatory variables., Results: Individuals with dementia between age 97 and 100 had lower mean MMSE scores than those without dementia. Those who died during the 3-year follow-up had lower MMSE scores than those who survived. MMSE scores at baseline did not differ between those without dementia and those who developed dementia during the 3-year follow-up. Participants with more education had higher MMSE scores, but there was no association between education and linear change., Conclusion: MMSE score is associated with dementia and subsequent mortality even in very old individuals, although the preclinical phase of dementia may be short in older age. Level of education is positively associated with MMSE score but not rate of decline in individuals approaching age 100., (© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.)

Background: Missing values are commonly encountered on the Mini Mental State Examination (MMSE), particularly when administered to frail older people. This presents challenges for MMSE scoring in research settings. We sought to describe missingness in MMSEs administered in long-term-care facilities (LTCF) and to compare and contrast approaches to dealing with missing items., Methods: As part of the Care and Construction project in Nova Scotia, Canada, LTCF residents completed an MMSE. Different methods of dealing with missing values (e.g., use of raw scores, raw scores/number of items attempted, scale-level multiple imputation [MI], and blended approaches) are compared to item-level MI., Results: The MMSE was administered to 320 residents living in 23 LTCF. The sample was predominately female (73%), and 38% of participants were aged >85 years. At least one item was missing from 122 (38.2%) of the MMSEs. Data were not Missing Completely at Random (MCAR), χ 2 (1110) = 1,351, p < 0.001. Using raw scores for those missing <6 items in combination with scale-level MI resulted in the regression coefficients and standard errors closest to item-level MI., Conclusions: Patterns of missing items often suggest systematic problems, such as trouble with manual dexterity, literacy, or visual impairment. While these observations may be relatively easy to take into account in clinical settings, non-random missingness presents challenges for research and must be considered in statistical analyses. We present suggestions for dealing with missing MMSE data based on the extent of missingness and the goal of analyses., (Copyright © 2016 The Authors. Production and hosting by Elsevier B.V. All rights reserved.)

Purpose: To assess the magnetic resonance imaging (MRI) findings, including diffusion-weighted imaging (DWI) in patients with acute carbon monoxide (CO) poisoning and correlate MRI findings with carboxyhemoglobin levels., Materials and Methods: The MRI examinations and medical records of seven men with a mean age of 43±16.0years (SD) (range: 25-63 years) with acute CO poisoning were reviewed. MRI examinations were analyzed with respect to lesion location, imaging presentation on T1- and T2-weighted images, and diffusion characteristics on DWI and apparent diffusion coefficient (ADC) maps. We also evaluated clinical features and laboratory findings including the presenting symptoms and signs, carboxyhemoglobin level, and treatment., Results: All seven patients presented with mental status change. The level of carboxyhemoglobin ranged between 8.3% and 34.8% (normal<1.5%). All seven patients (7/7, 100%) showed restricted diffusion of the lesions on ADC maps and bilateral involvement of globus pallidus. The mean ratios of ADC values was 0.63±0.15 (SD) (range: 0.46-0.92) on bilateral globi pallidi. Cerebral cortex, cerebral white matter, cerebellum, hippocampus, amygdala, splenium of corpus callosum, midbrain and insula were also involved., Conclusion: Bilateral globi pallidi with restricted diffusion may be a characteristic MRI feature in patients with acute CO poisoning. However, the relationship was not certain between the carboxyhemoglobin levels and the variety or severity of MRI findings., (Copyright © 2016 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

The mental status examination includes general observations made during the clinical encounter, as well as specific testing based on the needs of the patient and physician. Multiple cognitive functions may be tested, including attention, executive functioning, gnosia, language, memory, orientation, praxis, prosody, thought content, thought processes, and visuospatial proficiency. Proprietary and open-source clinical examination tools are available, such as the Mini-Mental State Examination and the Mini-Cog. Physician judgment is necessary in selecting the most appropriate tool for an individual patient. These tools have varying sensitivity and specificity for neurologic and psychiatric disorders, but none are diagnostic for any mental status disorder. Each must be interpreted in the context of physician observation. The mental status examination is useful in helping differentiate between a variety of systemic conditions, as well as neurologic and psychiatric disorders ranging from delirium and dementia to bipolar disorder and schizophrenia. There are no guidelines to direct further testing in the setting of an abnormal mental status examination; therefore, testing is based on clinical judgment.

The clinical utility of the Mini-Mental State Examination (MMSE) and its shorter version (SMMSE) is still debated. There is a need to better understand the neuroanatomical correlates of these cognitive tests. The objective of this cross-sectional study was to determine whether lower MMSE and SMMSE scores correlated with focal brain volume reduction in older adults. Participants from the GAIT study (n = 207; mean, 70.9±5.9 years; 57% female; mean MMSE 26.2±3.9; mean SMMSE 5.1±1.1) were evaluated using the MMSE and SMMSE and received a 1.5-Tesla MRI scan of the brain. Cortical gray and white matter subvolumes were automatically segmented using Statistical Parametric Mapping. Age, gender, education level, and total intracranial volume were included as potential confounders. We found correlations between the MMSE score and specific cortical regions of the limbic system including the hippocampus, amygdala, cingulate gyrus, and parahippocampal gyrus, independently of the diagnostic category (i.e., mild cognitive impairment or Alzheimer disease or controls). Regarding correlations with the SMMSE score, only one cluster in the left hippocampus was identified, which overlapped with the cluster that was positively correlated with the MMSE score. There were no correlations with the volume of white matter. In conclusion, worse MMSE and SMMSE scores were associated with gray matter atrophy mainly in the limbic system. This finding highlights that atrophy of specific brain regions are related to performance on the MMSE and the SMMSE tests, and provides new insights into the cognitive function probed by these tests., Competing Interests: Competing Interests: Dr. Annweiler serves as an unpaid associate editor for the Journal of Alzheimer's Disease, for Maturitas, and for Gériatrie, Psychologie et Neuropsychiatrie du Vieillissement. He has no relevant financial interest in this manuscript. The other authors report no conflict of interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Objective: We investigate dementia patients' use of "I don't know" (IDK) in Mini-Mental State Exams (MMSEs) using objective linguistic indicators to differentiate IDK signalling lack of knowledge (LOK) from IDK used to hedge responses, affect exam progression etc. We hypothesize that increased proportional use of LOK-IDK correlates with worsening dementia severity., Methods: 189 IDK tokens were extracted from 72 MMSE interactions and coded for linguistic/social characteristics. A data-driven, discourse position/relation-based functional taxonomy for IDK in MMSE was developed and the resulting functional distribution was subjected to multiple logistic regression., Results: Use of LOK-IDK (vs. non-LOK-IDK) is significantly correlated (p=0.01) with clinicians' subjective ratings of patients' dementia as 'severe' vs. 'mild'/'moderate', indicating that objective sociolinguistic criteria approximate physician judgments. 92% of 'severe' patients' IDKs signalled LOK, compared to only 68% of 'mild' patients', suggesting that uncritical interpretation of IDK as signalling LOK would result in 8-32% of IDK responses being mis-scored., Conclusion: LOK and non-LOK uses distinguished on the basis of reliable, objective usage patterns are differentially distributed among dementia severity groups., Practice Implications: LOK-IDK serves as a supplemental indicator of dementia severity. Correct interpretation may improve diagnostic accuracy and allow clinicians to respond supportively during cognitive assessment., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Altered mental status is a significant predictor of mortality in hospitalized patients and a prerequisite component to the diagnosis of delirium. However, the detection of altered mental status is often incomplete, inaccurate, and resource intensive., Objective: To identify the clinical utility and feasibility of the Functional Assessment of Mentation (FAM(TM) ), a mobile application for evaluating attention and recall., Design: Prospective observational pilot study., Setting: Tertiary care medical center., Participants: Nine hundred thirty-one adult subjects (612 nonhospitalized and 319 hospitalized)., Measurements: Score distribution and time to FAM(TM) completion were compared between nonhospitalized and hospitalized subjects (as well as between hospitalized subjects discharged home and those not discharged home). Additionally, in the hospitalized subgroup, FAM(TM) was compared to the Glasgow Coma Scale (GCS), using the Short Portable Mental Status Questionnaire (SPMSQ) as our criterion standard for altered mental status assessment., Results: Median time to completion of FAM(TM) was 55 seconds (interquartile range [IQR], 45-67 seconds). Our data identified a graded reduction in score comparing nonhospitalized subjects to hospitalized subjects discharged home and not discharged home (median 5 [IQR 4-7] vs 5 [IQR 3-6] vs 3 [IQR 1-5]; P < 0.001). In the hospitalized subset, FAM(TM) scores were more highly correlated to SPMSQ (Spearman ρ = 0.27, P < 0.001) compared to GCS (Spearman ρ = 0.05, P = 0.40)., Conclusions: FAM(TM) is a rapid and clinically feasible tool that can identify minor alterations in mental status often missed by GCS. Journal of Hospital Medicine 2016;11:463-466. 2016 Society of Hospital Medicine., (© 2016 Society of Hospital Medicine.)

Background: Executive dysfunction predicts stroke risk, dementia, and mortality. The Montreal cognitive assessment detects more visuoexecutive dysfunction than the mini-mental state examination but it is unclear which of the individual Montreal cognitive assessment visuoexecutive items contribute to the better performance of the Montreal cognitive assessment. We therefore determined the relative performance of the Montreal cognitive assessment visuoexecutive sub-tests versus the mini-mental state examination pentagon copying in patients with stroke and transient ischemic attack., Methods: Mini-mental state examination and Montreal cognitive assessment were administered to a prospective, population-based cohort of stroke, and transient ischemic attack patients from the Oxford Vascular Study at six month or five-year follow-up between November 2007 and June 2009. We compared the proportion of participants with incorrect Montreal cognitive assessment visuoexecutive tasks and sub-tasks but correct mini-mental state examination pentagon copying versus the proportion with incorrect MMSE pentagon copying but correct visuoexecutive Montreal cognitive assessment sub-test and individual sub-test items., Results: Among 412 patients assessed with the mini-mental state examination and Montreal cognitive assessment, the Montreal cognitive assessment detected more visuoexecutive dysfunction than the mini-mental state examination (OR 11.4, 95% CI 8.2-15.8, p < 0.001). The likelihood of incorrect mini-mental state examination pentagon copying increased as the numbers of correct MoCA visuoexecutive responses decreased: 2/106 (1.9%) and 9/10 (90.0%) incorrect mini-mental state examination pentagon copying for 5/5 and 0/5 correct Montreal cognitive assessment visuoexecutive tasks, respectively (p for trend 0.005). Each Montreal cognitive assessment visuoexecutive sub-task, including trails (39.6%), cube copying (49.5%), and clock drawing (59.0%), detected more patients with visuoexecutive dysfunction than the mini-mental state examination pentagon copying (20.6%, p < 0.001)., Conclusion: All three of the Montreal cognitive assessment visuoexecutive sub-tests detected more abnormalities than the mini-mental state examination pentagon copying and thus contributed to the over 10-fold superiority of Montreal cognitive assessment over the mini-mental state examination for detection of visuoexecutive dysfunction., (© 2016 World Stroke Organization.)

Aims: To directly compare the 1-year stability of Mini-Mental State Examination (MMSE) score and Saint Louis University Mental Status (SLUMS) examination score and correlate score changes with demographic variables, clinical factors, and functional domains., Methods: A sample of 304 study participants was recruited from residential and clinical settings in Ohio. Follow-up assessments were administered after 1 year with a retention rate of 92% (n = 281). Functional domains included the Instrumental Activities of Daily Living (IADL) scale., Results: MMSE and SLUMS scores correlated with each other (r = 0.65, P < 0.001) and with two functional measures, including the IADL (r = 0.27, r = 0.24, P < 0.001). However, the MMSE and SLUMS frequently placed the same subject into different categories. Rates of reversion and conversion varied between the two tests. The 1-year changes in MMSE raw score correlated with changes in three functional domains as well as age (P < 0.05), while SLUMS raw score changes did not correlate with any functional measures., Conclusion: Our large, longitudinal data set allowed us to compare the tests' stability, which differed between the SLUMS and MMSE. The MMSE may be more sensitive than the SLUMS to 1-year cognitive changes influencing functional abilities., (© 2016 John Wiley & Sons Ltd.)

Background: The underlying core of personality is insufficiently assessed by any single instrument. This has led to the development of instruments adapted for written records in the assessment of personality disorder., Aims: To test the construct validity and inter-rater reliability of a new personality assessment method., Method: This study (four parts) assessed the construct validity of the Schedule for Personality Assessment from Notes and Documents (SPAN-DOC), a dimensional assessment from clinical records. We examined inter-rater reliability using case vignettes (Part 1) and convergent validity in three ways: by comparison with NEO Five-Factor Inventory in 130 Korean patients (Part 2), with agreed ICD-11 personality severity levels in two populations (Part 3) and determining its use in assessing the personality status in 90 British patients with eating disorders (Part 4)., Results: Internal consistency (alpha = .90) and inter-rater reliability (intraclass correlation coefficient ≥ .88) were satisfactory. Each factor in the five-factor model of personality was correlated with conceptually valid SPAN-DOC variables. The SPAN-DOC domain traits in those with eating disorders were categorized into 3 clusters: self-aggrandisement, emotionally unstable, and anxious/dependent., Conclusions: This study provides preliminary support for the usefulness of SPAN-DOC in the assessment of personality disorder. Copyright © 2016 John Wiley & Sons, Ltd., (Copyright © 2016 John Wiley & Sons, Ltd.)

The 37-item version of the Mini-Mental State Examination (MMSE-37) is an extended version of the original test for individuals with low education, which was adapted for different cultures. Despite its favorable psychometric properties, there is a lack of normative data for this instrument. We provide normative data for the MMSE-37 stratified by age, sex, and education in a large population-based cohort of older Spanish adults. The sample consisted of 3,777 participants without dementia (age range: 65-97 years) from different socioeconomic areas of central Spain. Normative data are presented in percentile ranks and divided into nine overlapping age tables with different midpoints, using the overlapping cell procedure. A hierarchical regression was performed to evaluate the effects of sociodemographic variables on MMSE-37 performance. Results showed that age, sex, and education affect test score. The norms presented herein are important for the correct interpretation of MMSE-37 scores when assessing older adults in Spain., (© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose of Review: This article describes a comprehensive approach to the mental status examination and diagnostic workup of patients suspected of having an emerging neurodegenerative dementia. Key strategies for obtaining a history and bedside examination techniques are highlighted., Recent Findings: Classic descriptions of behavioral neurology syndromes were largely based on clinicopathologic correlations of strategic lesions in stroke patients. While still very important, advances in neuroimaging have expanded our armamentarium of cognitive evaluations to include assessments of findings in nonstroke anatomic distributions of disease. These efforts support comprehensive assessments of large-scale cerebral networks in cognitive neurology., Summary: A thorough and focused mental status examination is essential for the evaluation of patients with cognitive symptoms. Selective use of laboratory testing and neuroimaging can aid in the diagnosis of dementia by excluding non-neurodegenerative etiologies. Neurodegenerative disease-specific tests are in development and will enhance diagnosis and efforts for disease-modifying therapy development.

Introduction: Presence of detailed screening instruments to detect cognitive impairment in the older adults' culture and language is very essential. The Saint Louis University Mental Status Examination (SLUMS) is one of cognitive screening scales used. The aim of the study was to establish the validity and reliability of the Turkish version of SLUMS (SLUMS-T)., Methods: Two hundred seventy-four participants aged 60 years and older admitted to our geriatric clinic were screened for cognitive impairment using SLUMS-T and Mini-Mental State Examination. Internal consistency was analyzed with Cronbach α test. Area under curves of receiver operating characteristic analyses were used to test the predictive accuracy of the SLUMS-T for detecting amnestic mild cognitive impairment (aMCI) and Alzheimer disease (AD) to set an appropriate cut-off point., Results: The SLUMS-T scores were positively correlated with the Mini-Mental State Examination scores of the patients with aMCI and patients with AD and controls (r = 0.687, P < .001; r = 0.880, P < .001; respectively). Internal consistency of the SLUMS-T was Cronbach α = 0.85. It was found that SLUMS-T with a cut-off point of 23 had a sensitivity of 66.6% and a specificity of 72.3% for the diagnosis of aMCI, and with a cut-off point of 20 had a sensitivity of 83.8% and a specificity of 87.3% for the diagnosis of AD., Conclusions: SLUMS-T was demonstrated to have sufficient validity and reliability to evaluate cognitive impairment including MCI among Turkish elderly people., (Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.)

Background: Specific cutoff scores on the Mini Mental State Examination (MMSE) and the Logical Memory (LM) test are used to determine inclusion in Alzheimer's disease (AD) clinical trials and diagnostic studies. These screening measures have known psychometric limitations, but no study has examined the diagnostic accuracy of the cutoff scores used to determine entry into AD clinical trials and diagnostic studies., Methods: ClinicalTrials.gov entries were reviewed for phases II and III active and recruiting AD studies using the MMSE and LM for inclusion. The diagnostic accuracy of MMSE and LM-II cutoffs used in AD trials and diagnostic studies was examined using 23,438 subjects with normal cognition, mild cognitive impairment (MCI), and AD dementia derived from the National Alzheimer's Coordinating Center database., Results: MMSE and LM cutoffs used in current AD clinical trials and diagnostic studies had limited diagnostic accuracy, particularly for distinguishing between normal cognition and MCI, and MCI from AD dementia. The MMSE poorly discriminated dementia stage., Conclusions: The MMSE and LM may result in inappropriate subject enrollment in large-scale, multicenter studies designed to develop therapeutics and diagnostic methods for AD.

Background: Development of new treatments for Alzheimer's disease (AD) has broadened into early interventions in individuals with modest cognitive impairment and a slow decline. The 11-item version of the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) was originally developed to measure cognition in patients with mild to moderate AD. Attempts to improve its properties for early AD by removing items prone to ceiling and/or by adding cognitive measures known to be impaired early have yielded a number of ADAS-Cog variants. Using Alzheimer's Disease Neuroimaging Initiative data, we compared the performance of the 3-, 5-, 11- and 13-item ADAS-Cog variants in subjects with early AD. Given the interest in enrichment strategies, we also examined this aspect with a focus on cerebrospinal fluid (CSF) markers., Methods: Subjects with mild cognitive impairment (MCI) and mild AD with available ADAS-Cog 13 and CSF data were analysed. The decline over time was defined by change from baseline. Direct cross-comparison of the ADAS-Cog variants was performed using the signal-to-noise ratio (SNR), with higher values reflecting increased sensitivity to detect change over time., Results: The decline over time on any of the ADAS-Cog variants was minimal in subjects with MCI. Approximately half of subjects with MCI fulfilled enrichment criteria for positive AD pathology. The impact of enrichment was detectable but subtle in MCI. The annual decline in mild AD was more pronounced but still modest. More than 90 % of subjects with mild AD had positive AD pathology. SNRs were low in MCI but greater in mild AD. The numerically largest SNRs were seen for the ADAS-Cog 5 in MCI and for both the 5- and 13-item ADAS-Cog variants in mild AD, although associated confidence intervals were large., Conclusions: The possible value of ADAS-Cog expansion or reduction is less than compelling, particularly in MCI. In mild AD, adding items known to be impaired at early stages seems to provide more benefit than removing items on which subjects score close to ceiling.

Objective: Detection of changes in cognition after transurethral resection (TURP) or 180-Watt green-light XPS laser treatment (GLL) of the prostate is required by the German "Krankenhausbedarfsplan" which demands an interdisciplinary dialogue including special aspects of the operating discipline. This has as yet not been investigated in Germany or in Europe., Methods: Assessments of the cognitive capacity were made by application of the "Mini Mental State Examination" and the "Uhrentest" preoperatively and on postoperative day 2 in addition to documentation of clinical parameters such as patient age, prostate size, duration of surgery, comorbidities, co-medication, changes in haemoglobin and sodium., Results: Patients treated with transurethral resection (n=88) or GLL (n=114) were comparable regarding age, prostate size and operative time. Baseline characteristics of the patients who would be treated with laser showed an increased potential for postoperative cognitive changes: they had an average of 3.8 comorbidities (TURP: 3.11, p=0.005) and were to a greater extent using multiple medications 6.79 (TURP: 5.24, p<0.001). However neither the MMSE nor Uhrentest demonstrated a decrease in the average postoperative score (difference post-preop. MMSE+0.6±1.6 for the GLL and+0.6±1.6 for TURP, p=0.944; difference post- and preoperative Uhrentest+0.43±1.44 for the GLL and 0.13±1.17 for the TURP, p=0.097). Neither the postoperative haemoglobin nor the postoperative sodium, as safety-relevant parameters, demonstrated clinically relevant changes. The differences between the surgical procedures were not statistically significant. 28.6% of the patients with a preoperatively impaired cognition measured by an MMSE-score of≤23.7 incurred a further decline of their cognitive capability in comparison with patients without preoperative cognitive impairment with a further decline in 19.2%., Conclusions: Neither the GLL nor transurethral prostate resection demonstrated changes in cognition by comparing the preoperative Mini Mental State Examination or the Uhrentest. In this study, the baseline characteristics of lasered patients showed a higher number of comorbidities and a higher use of medication, in particular, with anticholinergic potency. Patients with a preoperatively impaired cognition had an increased risk of further worsening of their cognitive capabilities and should be treated carefully., (© Georg Thieme Verlag KG Stuttgart · New York.)

The Mini-Mental State Examination (MMSE) is a 30-item, dichotomously scored test of general cognition. A number of benefits could be gained by modeling the MMSE in an item response theory (IRT) framework, as opposed to the currently used classical additive approach. However, the test, which is built from groups of items related to separate cognitive subdomains, may violate a key assumption of IRT: local item independence. This study aimed to identify the most appropriate measurement model for the MMSE: a unidimensional IRT model, a testlet response theory model, or a bifactor model. Local dependence analysis using nationally representative data showed a meaningful violation of the local item independence assumption, indicating multidimensionality. In addition, the testlet and bifactor models displayed superior fit indices over a unidimensional IRT model. Statistical comparisons showed that the bifactor model fit MMSE respondent data significantly better than the other models considered. These results suggest that application of a traditional unidimensional IRT model is inappropriate in this context. Instead, a bifactor model is suggested for future modeling of MMSE data as it more accurately represents the multidimensional nature of the scale. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Aim: To screen for and determine cognitive dysfunction, cognitive tests and/or informant reports are commonly used. However, these cognitive tests and informant reports are not always available. The present study investigated three screening methods using the Mini-Mental State Examination (MMSE) as the cognitive test, and the Korean dementia screening questionnaire (KDSQ) as the informant report., Methods: Participants were recruited from the Korea Clinical Research Center for Dementia of South Korea, and included 2861 patients with Alzheimer's disease (dementia), 3519 patients with mild cognitive impairment and 1375 controls with no cognitive dysfunction. Three screening methods were tested: (i) MMSE alone (MMSE(cut-off) ); (ii) a conventional combination of MMSE and KDSQ (MMSE+KDSQ(cut-off) ); and (iii) a decision tree with MMSE and KDSQ (MMSE+KDSQ(decision tree) )., Results: For discriminating any cognitive dysfunction from controls, MMSE+KDSQ(cut-off) had the highest area under the receiver operating characteristic curve (0.784). For discriminating dementia from controls, MMSE+KDSQ(cut-off) had the highest area under the receiver operating characteristic curve (0.899). For discriminating mild cognitive impairment from controls, MMSE(cut-off) had the highest area under the receiver operating characteristic curve (0.683). MMSE+KDSQ(decision tree) showed the highest sensitivity for all discriminations. For overall classification accuracy, MMSE+KDSQ(decision tree) had the highest value (70.0%)., Conclusions: These three methods had different advantageous properties for screening and staging cognitive dysfunction. As there might be different availability across clinical settings, these three methods can be selected and used according to situational needs., (© 2015 Japan Geriatrics Society.)

The Mini-Mental State Examination (MMSE) is the most widely used cognitive screening test around the world. In Brazil, different MMSE versions and many cut-off points have been used. A systematic review of papers indexed in Scielo was conducted in order to analyze use of the MMSE in Brazilian empirical studies with elderly people. To search for these texts, the complete name of the instrument and its abbreviation were used. A growth trend in the scientific production during the 1998 to 2013 period was observed. Eleven versions of the MMSE were identified and the Bertolucci et al. version was the most cited. Over half of the studies used schooling as the criteria to establish cut-off points. The studies were predominantly conducted using samples recruited from large cities in the Southeastern region and in the community. Despite the growing trend of research with the elderly using the MMSE, the psychometric properties of this scale of measurement have been the subject of little investigation. Despite the widespread use of the MMSE in Brazil, there is a lack of standardization and evidence of validity for this this scale of measurement.

Background: Mini-mental state exam (MMSE) was used several times but no study has examined cognition on the Montreal Cognitive Assessment (MoCA) in diabetes and diabetic retinopathy (DR). In this study, we compared MMSE with MoCA in patients with DR and searched for an association between the severity of DR and cognitive impairment (CI)., Methods: This cross-sectional study comprised 120 consecutive patients with diabetes. Patients were divided into four groups as no DR, mild DR, severe nonproliferative DR (PDR) and PDR. Each group consisted 30 inviduals. CI was assessed using the MMSE and MoCA., Results: The number of subjects with a score>21 were significantly lower on the MoCA than on the MMSE between groups (all P<0.05). The mean MoCA score was significantly lower than the MMSE score (P<0.001) There was a linear association between the grade of DR and a score<21 on both tests,, Conclusion: MoCA provides more insight into the cognitive function in DR.

The purpose of this study was to assess the psychometric properties of the self-report version of the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD). The measure covers a 1-week time frame, and each of the nine criteria for BPD is rated on a five-point anchored rating scale of 0-4. Seventy-five subjects meeting DSM-IV criteria for BPD were recruited from the community. The convergent validity of the interview and self-report versions of the ZAN-BPD was found to be high (with a median value of 0.70). In terms of reliability, the internal consistency of the nine criteria scores of the ZAN-BPD was found to be good (Cronbach's alpha = 0.84). In addition, 13 of 14 intraclass correlations for same-day test-retest reliability were in the excellent range (> 0.75). Finally, the sensitivity of both versions of the ZAN-BPD to change was assessed 7-10 days after they were first administered and found to be adequate (e.g. r = 0.66 for total score of ZAN-BPD). Taken together, the results of this study suggest that the self-report ZAN-BPD is a promising self-report scale for the assessment of change in the severity of borderline psychopathology over time., (Copyright © 2015 John Wiley & Sons, Ltd.)

This field trial examines the discriminant validity of five trait domains of the originally proposed research algorithm for diagnosing International Classification of Diseases (ICD)-11 personality disorders. This trial was carried out in South Korea where a total of 124 patients with personality disorder participated in the study. Participants were assessed using originally proposed monothetic trait domains of asocial-schizoid, antisocial-dissocial, anxious-dependent, emotionally unstable and anankastic-obsessional groups of the research algorithm in ICD-11. Their assessments were compared to those from the Personality Assessment Schedule interview, and the five-factor model (FFM). A total of 48.4% of patients were found to have pathology in two or more domains. In the discriminant analysis, 64.2% of the grouped cases of the originally proposed ICD-11 domains were correctly classified by the five domain categories using the Personality Assessment Schedule, with the highest accuracy in the anankastic-obsessional domain and the lowest accuracy in the emotionally unstable domain. In comparison, the asocial-schizoid, anxious-dependent and the emotionally unstable domains were moderately correlated with the FFM, whereas the anankastic-obsessional or antisocial-dissocial domains were not significantly correlated with the FFM. In this field trial, we demonstrated the limited discriminant and the convergent validities of the originally proposed trait domains of the research algorithm for diagnosing ICD-11 personality disorder. The results suggest that the anankastic, asocial and dissocial domains show good discrimination, whereas the anxious-dependent and emotionally unstable ones overlap too much and have been subsequently revised., (Copyright © 2015 John Wiley & Sons, Ltd.)

Present in all patient populations, altered mental status (AMS) is a common, but nonspecific emergency department (ED) presentation that can signify serious underlying pathology. Delirium is a more defined mental status change caused by another medical condition that carries a high morbidity and mortality if missed. However, ED physicians miss the condition in more than 50% of cases. The ED physician should maintain a high index of suspicion for delirium, because if missed in the ED, delirium is more likely to be missed on the floors as well. Management of delirium is directed toward treating the underlying course., (Published by Elsevier Inc.)

Background: Personality disorder (PD) is associated with important health outcomes in the general population. However, the length of diagnostic interviews poses a significant barrier to obtaining large scale, population-based data on PD. A brief screen for the identification of people at high risk of PD in the general population could be extremely valuable for both clinicians and researchers., Aim: We set out to validate the Standardised Assessment of Personality - Abbreviated Scale (SAPAS), in a general population sample, using the Structured Clinical Interviews for DSM-IV Personality Disorders (SCID-II) as a gold standard., Method: One hundred and ten randomly selected, community-dwelling adults were administered the SAPAS screening interview. The SCID-II was subsequently administered by a clinical interviewer blind to the initial SAPAS score. Receiver operating characteristic analysis was used to assess the discriminatory performance of the SAPAS, relative to the SCID-II., Results: Area under the curve for the SAPAS was 0.70 (95% CI = 0.60 to 0.80; p < 0.001), indicating moderate overall discriminatory accuracy. A cut point score of 4 on the SAPAS correctly classified 58% of participants. At this cut point, the sensitivity and specificity were 0.69 and 0.53 respectively., Conclusion: The SAPAS operates less efficiently as a screen in general population samples and is probably most usefully applied in clinical populations., (© 2015 The Authors Personality and Mental Health published by John Wiley & Sons Ltd.)

The Minimental State Examination (MMSE), created in 1975 as a tool for briefly evaluating the patient's mental state, has been widely used and is the most frequently cited cognitive test on Medline, as well as being the one with the most versions in different languages (over 70). Through a review of the Medline database, this paper aims to analyse its virtues and shortcomings, in addition to determining its current clinical usefulness, in both the original version and any of its modifications, although here we are mainly concerned with its Spanish adaptations. The MMSE (original or versions) is the most commonly used test for standardised cognitive assessment in the clinical setting, especially in the case of the elderly. It is the test with the most data for screening, staging and monitoring dementias. Yet, because filling it in may take over 10 minutes, it has to compete with shorter, more specific screening tests in the primary care and community setting. In the hospital and specialised setting, there is a need for broader standardised neuropsychological tests that make it possible to detect subtle cognitive disorders in patients with incipient dementia or mild cognitive impairment, as well as to establish a cognitive profile of the different subtypes of dementia. This study proposes a series of recommendations on the clinical use of the Spanish versions of the MMSE in different contexts of application.

Background: Postoperative delirium is one of the most common postoperative complications in geriatric patients. Mini-mental state examination (MMSE) assesses cognitive function in patients and is associated with postoperative delirium. However, whether there is an age-dependent relationship between preoperative MMSE score and postoperative delirium remains unknown., Methods: We therefore set out to investigate the association between preoperative MMSE score and postoperative delirium in young-old (≤80 year-old, 75.46±4.69 years, 27.0% male, n = 63) and old-old (>80 year-old, 84.51±3.46 years, 20.9% male, n = 67) participants, who had repairs of hip fractures under general anesthesia. The Confusion Assessment Method and Memorial Delirium Assessment Scale were administrated before surgery, and on the first, second and fourth days after surgery, to assess the incidence and severity of the delirium, respectively. A receiver operating characteristic curve analysis was used to calculate the optimal cutoff score of MMSE in predicting postoperative delirium., Results: Thirty-four (26.2%) of 130 patients (80.12±6.12 years, 23.8% male) developed postoperative delirium. Preoperative MMSE scores were negatively associated with higher incidences and greater severity of postoperative delirium. The optimal cutoff scores of MMSE associated with postoperative delirium for young-old and old-old participants were 18.4 and 21.4, with a sensitivity of 60% and 83.8%, and a specificity of 92.5% and 62.8%, respectively., Conclusion: The data demonstrated the optimal cutoff score of MMSE associated with postoperative delirium in young-old adults might be lower than that in old-old adults. Pending further investigation, these findings suggest that the association between preoperative MMSE score and postoperative delirium is age-dependent.

Although not as popular as the Mini-Mental State Examination (MMSE), the modified Telephone Interview for Cognitive Status (mTICS) has some distinct advantages when screening cognitive functioning in older adults. The current study compared these 2 cognitive screening measures in their ability to predict performance on a memory composite (ie, delayed recall of verbal and visual information) in a cohort of 121 community-dwelling older adults, both at baseline and after 1 year. Both the MMSE and the mTICS significantly correlated with the memory composite at baseline (r's of .41 and .62, respectively) and at 1 year (r's of .36 and .50, respectively). At baseline, stepwise linear regression indicated that the mTICS and gender best predicted the memory composite score (R (2) = .45, P < .001), and the MMSE and other demographic variables did not significantly improve the prediction. At 1 year, the results were very similar. Despite its lesser popularity, the mTICS may be a more attractive option when screening for cognitive abilities in this age range., (© The Author(s) 2015.)

Background: Dementia is a progressive global cognitive impairment syndrome. In 2010, more than 35 million people worldwide were estimated to be living with dementia. Some people with mild cognitive impairment (MCI) will progress to dementia but others remain stable or recover full function. There is great interest in finding good predictors of dementia in people with MCI. The Mini-Mental State Examination (MMSE) is the best-known and the most often used short screening tool for providing an overall measure of cognitive impairment in clinical, research and community settings., Objectives: To determine the diagnostic accuracy of the MMSE at various thresholds for detecting individuals with baseline MCI who would clinically convert to dementia in general, Alzheimer's disease dementia or other forms of dementia at follow-up., Search Methods: We searched ALOIS (Cochrane Dementia and Cognitive Improvement Specialized Register of diagnostic and intervention studies (inception to May 2014); MEDLINE (OvidSP) (1946 to May 2014); EMBASE (OvidSP) (1980 to May 2014); BIOSIS (Web of Science) (inception to May 2014); Web of Science Core Collection, including the Conference Proceedings Citation Index (ISI Web of Science) (inception to May 2014); PsycINFO (OvidSP) (inception to May 2014), and LILACS (BIREME) (1982 to May 2014). We also searched specialized sources of diagnostic test accuracy studies and reviews, most recently in May 2014: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). No language or date restrictions were applied to the electronic searches and methodological filters were not used as a method to restrict the search overall so as to maximize sensitivity. We also checked reference lists of relevant studies and reviews, tracked citations in Scopus and Science Citation Index, used searches of known relevant studies in PubMed to track related articles, and contacted research groups conducting work on MMSE for dementia diagnosis to try to locate possibly relevant but unpublished data., Selection Criteria: We considered longitudinal studies in which results of the MMSE administered to MCI participants at baseline were obtained and the reference standard was obtained by follow-up over time. We included participants recruited and clinically classified as individuals with MCI under Petersen and revised Petersen criteria, Matthews criteria, or a Clinical Dementia Rating = 0.5. We used acceptable and commonly used reference standards for dementia in general, Alzheimer's dementia, Lewy body dementia, vascular dementia and frontotemporal dementia., Data Collection and Analysis: We screened all titles generated by the electronic database searches. Two review authors independently assessed the abstracts of all potentially relevant studies. We assessed the identified full papers for eligibility and extracted data to create two by two tables for dementia in general and other dementias. Two authors independently performed quality assessment using the QUADAS-2 tool. Due to high heterogeneity and scarcity of data, we derived estimates of sensitivity at fixed values of specificity from the model we fitted to produce the summary receiver operating characteristic curve., Main Results: In this review, we included 11 heterogeneous studies with a total number of 1569 MCI patients followed for conversion to dementia. Four studies assessed the role of baseline scores of the MMSE in conversion from MCI to all-cause dementia and eight studies assessed this test in conversion from MCI to Alzheimer´s disease dementia. Only one study provided information about the MMSE and conversion from MCI to vascular dementia. For conversion from MCI to dementia in general, the accuracy of baseline MMSE scores ranged from sensitivities of 23% to 76% and specificities from 40% to 94%. In relationship to conversion from MCI to Alzheimer's disease dementia, the accuracy of baseline MMSE scores ranged from sensitivities of 27% to 89% and specificities from 32% to 90%. Only one study provided information about conversion from MCI to vascular dementia, presenting a sensitivity of 36% and a specificity of 80% with an incidence of vascular dementia of 6.2%. Although we had planned to explore possible sources of heterogeneity, this was not undertaken due to the scarcity of studies included in our analysis., Authors' Conclusions: Our review did not find evidence supporting a substantial role of MMSE as a stand-alone single-administration test in the identification of MCI patients who could develop dementia. Clinicians could prefer to request additional and extensive tests to be sure about the management of these patients. An important aspect to assess in future updates is if conversion to dementia from MCI stages could be predicted better by MMSE changes over time instead of single measurements. It is also important to assess if a set of tests, rather than an isolated one, may be more successful in predicting conversion from MCI to dementia.

Aim: To determine the extent of interviewer error on the Short Portable Mental Status Questionnaire (SPMSQ), the association between interviewer-level variables and SPMSQ score, compare the prevalence of SPMSQ cognitive status categories before and after correction for interviewer error, and identify SPMSQ items prone to interviewer error., Methods: Data of 4542 older adults from a national survey in Singapore were utilized. Multilevel models, which adjusted for respondent-level variables known to be associated with cognitive status, were utilized to determine the intraclass correlation on the SPMSQ, association of interviewer-level variables (age, ethnicity, education and number of interviews carried out) with SPMSQ and identify SPMSQ items prone to interviewer error., Results: The intraclass correlation, after adjusting for respondent-level variables, was 0.265. Interviewer educational status was associated with SPMSQ score. Correction for interviewer error resulted in an "improvement" in cognitive status of a substantial proportion of those initially classified as moderately or severely impaired. Two of the SPMSQ items, "Please count backward from 20 by 3" and "When were you born?" were particularly prone to interviewer error., Conclusions: Investigators using the SPMSQ, and potentially, other instruments, for assessing cognitive function in surveys of older adults and using face-to-face interviews for data collection should be cognizant of the sensitivity of such instruments to interviewer error. Intensive training of interviewers to standardize instrument administration as well as assessment for interviewer error and its correction, using appropriate statistical models, such as multilevel models, is warranted., (© 2014 Japan Geriatrics Society.)

Background: Patients with dementia with Lewy bodies (DLB) may display a different cognitive pattern from Alzheimer's disease (AD) with more severe impairment performing visuospatial/visuoconstructive tasks. The aim of this study was to investigate whether the analysis of the MMSE pentagon copy could be a useful diagnostic screening tool in prodromal DLB., Methods: Fifty-three patients with Mild Cognitive Impairment (MCI) were followed over 3-years until a diagnosis of DLB (MCI-DLB: n = 30) and AD (MCI-AD: n = 23) were made according to standard criteria. At the first assessment patients underwent a thorough cognitive assessment including the Qualitative Scoring MMSE Pentagon Test (QSPT), the NPI, the UPDRS as well as questionnaires to determine fluctuations and sleep disorders., Results: The percentage of subjects who were unable to determine the correct number of angles in the pentagon copy test was 45.1% of MCI-DLB and 8.3% of MCI-AD patients (sensitivity 41.1%; specificity 91%). Attentive/executive functions and visual-spatial abilities were worse in the MCI-DLB group, while episodic memory impairment was greater in MCI-AD. Subtle extrapyramidal signs (63%) and RBD symptoms (56%) were the most frequent clinical features supporting the diagnosis of MCI-DLB., Conclusions: We suggest that a poor performance in determining the number of angles when performing the pentagon copying test, together with the presence of subtle extrapyramidal signs and symptoms of RBD may serve as a predictive tool for early DLB., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: All versions of the Montreal Cognitive Assessment (MoCA) lack population-based data of 80-plus individuals. The norms and cut-off scores for mild cognitive impairment (MCI) and dementia of the MoCA are different among five Chinese versions., Objective: To provide the cut-off scores in detecting MCI and dementia of the Peking Medical Union College Hospital version of the MoCA (MoCA-P)., Methods: In a cross-sectional survey, Chinese veterans aged ≥60 years completed the MoCA-P and the Mini-Mental State Examination (MMSE)., Results: Among 7,445 elderly veterans, 5,085 (68.30%) were aged ≥80 years old, 2,621 (35.20%) had 6 years of education or less, 6,847 (91.97%) were male, and 2,311 (31.04%) and 984 (13.22%) veterans were diagnosed as having MCI and dementia, respectively. Adding two points and one point to the MoCA scores for the primary and middle school groups, respectively, can fully adjust for the notable impact of education but cannot compensate for the effect of age. In the three age groups (60-79, 80-89, and ≥90 years old), the optimal MoCA-P cut-off scores for detecting MCI were ≤25, ≤24, and ≤23, respectively, and for detecting dementia were ≤24, ≤21, and ≤19, respectively, which demonstrated relatively high sensitivities and specificities. The areas under the curves for the MoCA-P for detecting MCI and dementia (0.937 and 0.908, respectively) were greater than those for the MMSE (0.848 and 0.892, respectively)., Conclusion: Compared with the MMSE, the MoCA-P is significantly better for detecting MCI in the elderly, particularly in the oldest old population, and it also displays more effectiveness in detecting dementia.

The Mini Mental State Examination (MMSE) is the most broadly used cognitive screening instrument in clinical and research contexts. The MMSE was administered to a community-based sample of cognitively healthy adults (n = 850), stratified according to several sociodemographic variables, with a distribution similar to that observed in the Portuguese population. This study aimed to analyze the influence of sociodemographic (age, gender, education level, marital and employment status, geographic region, geographic localization, and residence area) and health variables (subjective memory complaints of the participant and evaluated by the informant, depressive symptoms, and family history of dementia) on the participants' performance on the MMSE and to establish normative data for the Portuguese population. Education level and age significantly contributed to the prediction of the MMSE scores and explained 26% of its variance. Regarding health variables, only the subjective memory complaints of the participant showed a small contribution (4%) to the variance of the MMSE scores. According to these results, age and education were considered in the development of the normative data of the MMSE for the Portuguese population.

Background and Purpose: Montreal Cognitive Assessment (MoCA) has been proposed as a screening tool in vascular cognitive impairment. Diffusion tensor imaging is sensitive to white matter microstructural damage. We investigated if diffusion tensor imaging-derived indices are more strongly associated with performances on MoCA or on the widely used mini mental state examination in patients with mild cognitive impairment and small vessel disease., Methods: Mild cognitive impairment patients with moderate/severe degrees of white matter hyperintensities on MRI were enrolled. Lacunar infarcts, cortical atrophy, medial temporal lobe atrophy and median values of mean diffusivity and fractional anisotropy of the cerebral white matter were studied and correlated with cognitive tests performances., Results: Seventy-six patients (mean age 75.1±6.8 years, mean years of education 8.0±4.3) were assessed. In univariate analyses, a significant association of both MoCA and mini mental state examination scores with age, education, cortical atrophy, and medial temporal lobe atrophy was found, whereas mean diffusivity and fractional anisotropy were associated with MoCA. In partial correlation analyses, adjusting for all demographic and neuroimaging variables, both mean diffusivity and fractional anisotropy were associated only with MoCA (mean diffusivity: r= -0.275, P=0.023; fractional anisotropy: r=0.246, P=0.043)., Conclusions: In patients with mild cognitive impairment and small vessel disease, diffusion tensor imaging-measured white matter microstructural damage is more related to MoCA than mini mental state examination performances. MoCA is suited for the cognitive screening of patients with small vessel disease., (© 2014 American Heart Association, Inc.)

There are numerous measures for detecting the presence of dementia and quantifying its severity and progression. We analyzed the relations between scores on 5 commonly used measures (Mini-Mental State Examination, Montreal Cognitive Assessment, Alzheimer's Disease Assessment Scale-Cognitive Subscale, Activities of Daily Living Scale, and Global Deterioration Scale) of 101 successive admissions to a memory clinic. Patients were included in the analysis only if they received a diagnosis of mild cognitive impairment (MCI) due to Alzheimer's disease (AD) pathophysiological process or probable AD and if they received all measures. Regression analysis yielded 20 linear equations that allow for conversion between test scores on any 2 measures. Further, participants were grouped by MMSE scores with regard to level of disease severity, allowing for the creation of a quick reference table for estimating an approximate score range between measures. Results from this study provide a useful tool for clinicians when comparing between multiple different instruments that measure the mental status and functional ability of individuals with AD and MCI due to AD pathology., (© The Author(s) 2014.)

Objectives: To evaluate the association between vitamin D level and cognitive impairment in individuals aged 60 and older., Design: Cross-sectional cohort study., Setting: Chinese Longitudinal Healthy Longevity Survey, a community-based cohort study in areas in China where the density of centenarians is exceptionally high., Participants: Individuals with mean age of 84.9 ± 12.7 (N = 2,004)., Measurements: Participants' cognitive state was evaluated using the Mini-Mental State Examination (MMSE). Vitamin D was measured in plasma using an enzyme-linked immunoassay., Results: The cross-sectional association between quartiles of plasma vitamin D level and cognitive impairment (MMSE score <18) was modeled using logistic regressions. Plasma vitamin D levels were lower in individuals with cognitive impairment (31.9 ± 15.3 nmol/L) than in those without (45.6 ± 19.6 nmol/L). There was a reverse association between plasma vitamin D and cognitive impairment. After adjusting for age, sex, chronic conditions, smoking and drinking habits, outdoor activities, depression, and activity of daily living limitations, the association remained significant. The multivariable-adjusted odds ratio for lowest versus highest vitamin D levels was 2.15 (95% confidence interval (CI) = 1.05-4.41) for cognitive impairment, and the multivariable odds ratio associated with a 1-standard deviation decrement in plasma vitamin D was 1.32 (95% CI = 1.00-1.74) for cognitive impairment., Conclusion: Low plasma vitamin D levels were associated with greater odds of cognitive impairment. Further prospective studies in Asian populations are needed to examine the causal direction of this association., (© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.)

Objective: To analyse the evidence concerning the accuracy of the Mini-Mental State Examination (MMSE) as a diagnostic and screening test for the presence of delirium in adults., Method: Two authors searched MEDLINE, PsychINFO and EMBASE from inception till March 2014. Articles were included that investigated the diagnostic validity of the MMSE to detect delirium against standardised criteria. A diagnostic validity meta-analysis was conducted., Results: Thirteen studies were included representing 2017 patients in medical settings of whom 29.4% had delirium. The meta-analysis revealed the MMSE had an overall sensitivity and specificity estimate of 84.1% and 73.0%, but this was 81.1% and 82.8% in a subgroup analysis involving robust high quality studies. Sensitivity was unchanged but specificity was 68.4% (95% CI = 50.9-83.5%) in studies using a predefined cutoff of <24 to signify a case. In high-risk samples where delirium was present in 25% of patients, then the Positive predictive value and Negative predictive value would be 50.9% (48.3-66.2%) and 93.2% (90.0-96.5%)., Conclusion: The MMSE cannot be recommended as a case-finding confirmatory test of delirium, but may be used as an initial screen to rule out high scorers who are unlikely to have delirium with approximately 93% accuracy., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: The Montreal Cognitive Assessment (MoCA) is increasingly being used as a cognitive screening test in Parkinson disease (PD). The MoCA's popularity likely reflects its ability to detect executive dysfunction, a relative deficiency of the Mini-Mental State Examination (MMSE)., Objective: To compare neurochemical and neuropsychological functions in non-demented PD patients with mild cognitive impairment (PD-MCI) and without, as defined by MoCA (PD-MCI = MoCA<26)., Methods: Non-demented PD subjects underwent combined MoCA and MMSE, detailed cognitive testing and [¹¹C]methyl-4-piperidinyl propionate acetylcholinesterase and [¹¹C]dihydrotetrabenazine monoaminergic PET imaging., Results: Eighteen subjects met MoCA PD-MCI criteria but had MMSE scores in the normal range, compared to 29 subjects with normal MoCA and MMSE scores. The MoCA-defined PD-MCI group had reduced performance in global cognition (t = 2.91, P = 0.0056), most significantly in executive function (t = 3.18, P = 0.002), as well as significant reduction in dorsal caudate nucleus dopaminergic innervation (t = 2.72, P = 0.009) compared to the PD without MCI group. Both MoCA and MMSE had poor diagnostic accuracy for PD-MCI (65.3%) when using the Level 2 Movement Disorder Society Task Force definition., Conclusion: PD subjects with normal range MMSE but abnormal MoCA scores had evidence of caudate nucleus dopaminergic denervation and mild cognitive changes, predominantly in executive function. The MoCA may be able to preferentially detect executive dysfunction compared to the MMSE, but the MoCA has limited diagnostic accuracy for PD-MCI, and should not be used alone to make this diagnosis., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

We aimed to evaluate whether the performance of the mini-mental state examination (MMSE) could identify risky mild cognitive impairment (MCI). We recruited 122 amnestic MCI-single domain (ASM), 303 amnestic MCI-multiple domains (AMM), and 94 non-amnestic MCI (NAM). Two-step cluster and linear discriminant analyses were used for identifying the clusters of the MMSE with age and education, as well as establishing prediction models for each cluster. Conversion into dementia was compared among clusters. Cluster analyses revealed the following three: cluster 1 = 205 AMM (100 %); cluster 2 = 61 NAM (33.3 %) and 122 ASM (66.7 %); and cluster 3 = 33 NAM (25.2 %) and 98 AMM (74.8 %). Cluster 3 showed a significantly lower ability with regards to orientation to time and place, registration of three words, attention/calculation, language, and copying interlocking pentagons, than clusters 1 and 2. However, for delayed recall, cluster 1 was significantly more impaired than cluster 2. Patients in the cluster 1 showed the most common conversion into dementia [odds ratio (OR) = 2.940 vs. cluster 2, OR = 2.271 vs. cluster 3]. This study showed that clustering by performance in MMSE could help define groups at higher risk for conversion to dementia. Therefore, MMSE can be considered as a promising screening tool including subtyping for MCI when detailed neuropsychological tests are not feasible.

Cognitive impairment, including dementia, is common in Parkinson's disease (PD). The Mini-Mental State Examination (MMSE) has been recommended as a screening tool for Parkinson's disease dementia (PDD), with values below 26 indicative of possible dementia. Using a detailed neuropsychological battery, we examined the range of cognitive impairment in PD patients with an MMSE score of 26 or higher. In this multicenter, cross-sectional, observational study, we performed neuropsychological testing in a sample of 788 PD patients with MMSE scores of 26 or higher. Evaluation included tests of global cognition, executive function, language, memory, and visuospatial skills. A consensus panel reviewed results for 342 subjects and assigned a diagnosis of no cognitive impairment, mild cognitive impairment, or dementia. Sixty-seven percent of the 788 subjects performed 1.5 standard deviations below the normative mean on at least one test. On eight of the 15 tests, more than 20% of subjects scored 1.5 standard deviations or more below the normative mean. Greatest impairments were found on Hopkins Verbal Learning and Digit Symbol Coding tests. The sensitivity of the MMSE to detect dementia was 45% in a subset of participants who underwent clinical diagnostic procedures. A remarkably wide range of cognitive impairment can be found in PD patients with a relatively high score on the MMSE, including a level of cognitive impairment consistent with dementia. Given these findings, clinicians must be aware of the limitations of the MMSE in detecting cognitive impairment, including dementia, in PD., (© 2014 International Parkinson and Movement Disorder Society.)