Mild functional decline and driving performance of older drivers without a diagnosed dementia: Study of leukoaraiosis and cognitive function

Motor vehicle collisions involving older drivers have increased and become an important social issue. It is known that the decline of cognitive function, including dementia, affects driving performance. A series of studies using the Mini-Mental State Examination (MMSE) and other tests of dementia have attempted to prevent motor vehicle collisions by identifying as early as possible older drivers who may be unable to maintain their driving performance. Further, the performance of older drivers may deteriorate even if they do not have a diagnosis of dementia. Therefore we focused on the relationship between cognitive functioning assessed by the MMSE and diagnosis of leukoaraiosis (LA), or changes in the cerebral white matter, with different aspects of driving behavior resulting from aging. Qualified driving instructors evaluated participants’ driving behaviors on an outdoor driving course at a driving school. Visual search duration and angle at intersections were obtained by wearable wireless sensors. Vehicle speed and minimum vehicle speed were recorded from vehicle speed pulse signals. Duration of signaling and visual searches at unsignalized intersections were recorded using an in-vehicle camera. We assessed instructors’ evaluations and the scores on two instruments to evaluate the effects of MMSE scores and the grade of LA on driving performance were verified. The results suggest that lower MMSE scores and higher LA grade can predict some aspects of poor driving performance in older drivers before they experience dementia or an evident decline in cognitive functioning. Based on these results, we discuss countermeasures that may prevent motor vehicle collisions involving older drivers.     

Influence of IQ in interpreting MMSE scores in patients with multiple sclerosis

The Mini-Mental State Examination (MMSE) and Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) were administered to 46 outpatients diagnosed with multiple sclerosis (MS). MMSE total raw score was significantly and positively correlated with all WAIS-IV indexes, even when controlling for the effects of participant educational level, with the strongest relationship being with Full Scale IQ. These results suggest that clinicians consider patient intellectual functioning, in particular Full Scale IQ, when diagnosing neurocognitive impairment based on screening with the MMSE in individuals with MS.     

遗忘症患者外显与内隐记忆分离的实验研究：自由回忆与再认任务

采用WMS－CR和MMSE筛选了9名遗忘症患者,采用自由回忆和再认两项任务观察了他们及正常对照组的外显记忆。结果发现：遗忘症患者两项外显记忆任务操作呈分离现象,自由回忆任务操作明显受损,再认任务的操作尽管较对照组低,但与对照组差异未达显著性水平。推论;①外显记忆受患者损伤的颞叶或间脑结构调节。②再认任务至少包含两种性质不同的潜在加工过程,一种为意识性重组加工,另一种为无意识自动加工,两者相互独立地贡献再认任务的操作。正常人意识性重组加工的贡献占优势,掩盖了无意识的作用。遗忘症患者意识性重组加工损伤,无意识自动加工部分代偿作用。③先前研究未对遗忘症患者进行认知功能的筛选,患者对再认障碍可能源于其他认知功能障碍,而非记忆障碍之故。     

遗忘症患者外显与内隐记忆实验研究:语义性启动效应任务

采用ＷＭＳ—ＣＲ和ＭＭＳＥ对临床脑损伤患者进行了认知功能与记忆功能两方面的筛选,获得９名遗忘症患者。然后采用偏好和自由联想两项语义性启动效应任务进行测验,发现遗忘症患者在外显记忆受损情况下,的确存在语义性启动效应,且与正常对照相近。推论语义性启动效应任务与遗忘患者损伤的颞叶或间脑结构无关。同时还讨论了启动效应任务,认为偏好任务采用言语性材料不是理想的方法。     

Validation of a telephone screening test for Alzheimer's disease

ABSTRACT

Financial constraints, mobility issues, medical conditions, crime in local areas can make cognitive assessment difficult for elders and telephone interviews can be a good alternative. This study was carried out to evaluate the reliability, validity and clinical utility of a Brazilian telephone version of the Mini Mental State Examination (Braztel-MMSE) in a community sample of healthy elderly participants and AD patients. The MMSE and the Braztel-MMSE were applied to 66 AD patients and 67 healthy elderly participants. The test–retest reliability was strong and significant (r = .92, p = .01), and the correlation between the Braztel-MMSE and the MMSE were significant (p = .01) and strong (r = .92). The general screening ability of the Braztel-MMSE was high (AUC = 0.982; CI95% = 0.964–1.001). This telephone version can therefore be used as a screening measure for dementia in older adults that need neuropsychological screening and cannot present for an evaluation.     

Associations of depression,anxiety and PTSD with neurological disability and cognitive impairment in survivors of moyamoya disease

Depression, anxiety and posttraumatic stress disorder (PTSD) are common complications of cerebrovascular diseases. However, they were seldom explored in Moyamoya Disease (MMD) survivors. In this study, we measured the prevalence of depression, anxiety and PTSD in MMD survivors. We evaluated the association of mental disorders with neurological disability and cognitive impairment, and further find out the independent protective and risk factors of neurological disability and cognitive impairment. In MMD survivors, the prevalence of these three mental disorders is high, 46.7% for depression, 50% for anxiety and 47.5% for PTSD. Anxiety and PTSD were significantly associated with more severe neurological disability (p = 0.039 and < 0.001); depression and anxiety were significantly associated with greater cognitive deficiency (p = 0.004 and 0.002). We further found PTSD was the only risk factor associated with neurological disability, and the corresponding odds ratio (OR) and 95% confidence interval (CI) was 81.74 (9.91–674.17); depression and anxiety were risk factors associated with cognitive impairment, and the corresponding OR and 95%CI were 2.73 (1.10–6.81) and 3.37 (1.29–8.78). Therefore, these three mental disorders were associated with more severe neurological disability and greater cognitive deficiency in MMD survivors.     

Comparative study of the cognitive performance of Greek Australian and Greek national elderly: Implications for neuropsychological practice

In the area of dementia diagnosis and assessment of cognitive functioning of elderly culturally and linguistically diverse individuals (CALDI) little is known about cognitive test performance differences between migrants and peers from their country of origin. This study investigated whether community dwelling elderly Greek Australian (GA) performance on tests of cognition was comparable to that of elderly Greek national ‘normal’ individuals without a diagnosis of dementia (Gn). Based on available cross‐cultural literature it was hypothesised that GA would obtain lower scores on the Cambridge Cognitive Examination of the Elderly and the Mini‐Mental Status Examination compared to Gn due to issues relating to the migrant experience such as acculturation, reduced language fluency and proficiency. The results of the current study supported the hypothesis arguing for caution when interpreting CALDI performance on tests that have not been normed in that particular group because there may be a greater risk of false‐positive diagnoses.     

Rowland Universal Dementia Assessment Scale,Mini‐Mental State Examination and General Practitioner Assessment of Cognition in a multicultural cohort of community‐dwelling older persons with early dementia

Early dementia can be difficult to diagnose in older persons from culturally and linguistically diverse (CALD) backgrounds. The Folstein Mini‐Mental State Examination (MMSE), the General Practitioner Assessment of Cognition (GPCOG) and the Rowland Universal Dementia Assessment Scale (RUDAS) were compared in 151 older, community‐dwelling persons. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy, while logistic regression was used to evaluate the influence of age, gender, CALD status and years of education. All three instruments were equally accurate in predicting dementia (ROC area under curve 0.92–0.97, p > 0.05 for all comparisons). At the recommended cut‐offs, the RUDAS was best for ruling in dementia (positive LR = 8.77), while the GPCOG was best for ruling out dementia (negative LR = 0.03). All three instruments were influenced by concomitant depression. Whereas the MMSE was influenced by CALD status, the RUDAS and GPCOG were not. While the GPCOG combines participant and informant data, the RUDAS is a stand‐alone measure specifically designed for, and validated in, multicultural populations.     

Sex Differences in Cognitive Performance Among the Very Old--Mini-Mental State Examination in a Population Aged 85 Years and Over

We examined 553 persons aged 85 years or more, who comprised 92% of all 601 citizens of a Finnish city Vantaa. The Mini-Mental State Examination (MMSE), Index of Activities of Daily Living (ADL), and the Instrumental Activities of Daily Living (IADL) scale were completed. Diagnoses of dementia and depression were made according to the DSM-III-R criteria. Mean MMSE score for men was 20.1 and for women was 16.8 (difference = 3.3 points). When demented subjects (N = 210) were excluded, the difference reduced to 2.2 points. When depressed subjects were also excluded, the difference further reduced to 1.9 points. Education and institutionalization explained some of this difference, but sex also had an independent effect on the MMSE score. The home-dwelling women had lower functional capacity compared with respective men, as measured by the ADL scale. No differences were found in the IADL scale. It seems that men over 85 years of age represent a very select population. Men probably die earlier in the course of any deteriorating illness. It is also possible that our measurements of cognitive capacity favor men among very old people.