The comparison of the 1972 Hodkinson's Abbreviated Mental Test Score (AMTS) and its variants in screening for cognitive impairment.

BACKGROUND: Since its introduction by Hodkinson in 1972, Abbreviated Mental Test Score (AMTS) and its English and other language versions have been widely used in research and clinical practice alike. However, whether the various versions of AMTS yield equivalent information has never been tested. METHODS: We performed cross-sectional assessment of inpatients aged 65+ years with seven AMTS versions and the Mini-Mental State Examination (MMSE) after correction for age and education (MMSEc). We used the MMSEc cut-off score of < 24 as comparator and fitted linear regression models from which we obtained the receiver operating characteristics, and further compared the c-statistics obtained for each version of AMTS. We used Spearman's correlation to check the relation between different AMTS versions. RESULTS: The mean (SD) age of 72 (52.8% women) patients was 76.2 (7.6) years. The average time spent on education was 11.3 (3.5) years. The AMTS score across versions varied between 7.4 (2.0) and 8.2 (1.7). The MMSE averaged 24.1 (4.6) and the MMSEc averaged 25.2 (4.1). We found that the c-statistic across AMTS versions with dichotomised MMSEc as comparator ranged from 0.83 to 0.85 and did not significantly differ from the c-statistic of 0.87 for original AMTS (all p > 0.16). We found AMTS versions to be significantly correlated (all r between 0.83 and 0.99, all p < 0.0001). CONCLUSIONS: We found AMTS to be a reliable and useful tool in the screening for possible cognitive impairment. This seems to be true irrespective of whether we use the original test or any of its studied modifications.

[Preoperative anxiety assessed by questionnaires and patient declarations]. / Kwestionariuszowy i deklaratywny poziom leku chorych przed operacja.

BACKGROUND: The perioperative period can be anxiety-provoking for any patient scheduled for surgery. The anxiety can be divided into three categories: physiological, psychological and behavioural. For objective assessment, special questionnaires have been used, yet since they are too complicated for everyday use, simpler methods have been proposed. We have compared three measurements of anxiety to determine their equivalence in assessing anxiety before surgery: the State Trait Anxiety Inventory (STAI), the Visual Analogue Scale (VAS) and patient declaration in the form of an answer to a single question. METHODS: Thirty-eight ASA I and II adult patients, of both sexes, aged 18-60 years, and scheduled for elective abdominal or ENT surgery, were enrolled into the study. All patients were interviewed one day before the procedure and were asked to complete the STAI questionnaire, rate their fear on the VAS, and answer the question: "Are you afraid of anything?" The Kolmogorow-Smirnov test, t-Student test and r-Pearson correlation test were used for statistical analysis. RESULTS: Sixty six per cent of the questioned patients expressed a feeling of fear and their mean STAI-T (traid) score was 42.9 +/- 7.9, STAI-S (scale) 44.6 +/- 10.5. The VAS score was 3.7 +/- 2.6. Among those who did not declare a feeling of fear, the scores were: STAI-T: 36.9 +/- 8.2, STAI-S: 41.0 +/- 6.3, and VAS: 1.5 +/- 1.7. Females expressed a feeling of fear more often than males (p=0.03). There were no statistically significant differences related to age, the type of scheduled surgery or ASA score. The results obtained by all methods were closely correlated. CONCLUSION: We conclude that, since the results of anxiety measurement were comparable in all tests, a simple question or the VAS scale should be sufficient for proper assessment of preoperative anxiety.

[Cardiac arrest in chronic metabolic alkalosis due to sodium bicarbonate abuse]. / Zatrzymanie krazenia w przebiegu zasadowicy metabolicznej i zaburzen elektrolitowych u osoby spozywajacej sode oczyszczona.

BACKGROUND: Moderate metabolic alkalosis has not been considered as a life-threatening situation by many authors, but when it persists and pH increases above 7.65, the situation may become critical. CASE REPORT: We present a case of a 61-yr-old alcoholic male patient, who had been consuming approximately 200 g of sodium bicarbonate daily for twenty years, due to persisitent heartburn and abdominal pains. The patient was admitted to the ITU after home cardiac arrest and resuscitation. On admission he was unconscious and in respiratory distress, with a GCS of 5. Blood gases revealed that his pH was 7.64, HCO3 44 mmol L(-1), K+ 2.4 mmol L(-1)l, Cl- 44 mmol L(-1), and lactate concentration over 15 mmol L(-1). He was treated with controlled hypercapnia, up to a PaCO2 of 63 mm Hg, sedation, and administration of a large amount of chloride (864 mmol during the first day). The patient regained consciousness after 48 h, was extubated and transferred to the internal medicine department where he died 3 days later. DISCUSSION: Chronic alkali abuse can lead to various metabolic disturbances, neurologic disturbances and cardiovascular compromise. In the described case, the exact cause of cardiac arrest remained unknown, but may have been caused by alkalosis combined with hypoxia, hypokalemia and poor general condition. The extreme metabolic alkalosis (pH 7.8) could also have been enhanced by the administration of i.v. sodium bicarbonate during resuscitation. The treatment of choice in such cases should consist of vigorous chloride containing fluid resuscitation, ammonium chloride and hemodialysis.