The mental status examination relies on the physician's clinical judgment for observation and interpretation. When concerns about a patient's cognitive functioning arise in a clinical encounter, further evaluation is indicated. This can include evaluation of a targeted cognitive domain or the use of a brief cognitive screening tool that evaluates multiple domains. To avoid affecting the examination results, it is best practice to ensure that the patient has a comfortable, nonjudgmental environment without any family member input or other distractions. An abnormal response in a domain may suggest a possible diagnosis, but neither the mental status examination nor any cognitive screening tool alone is diagnostic for any condition. Validated cognitive screening tools, such as the Mini-Mental State Examination or the St. Louis University Mental Status Examination, can be used; the tools vary in sensitivity and specificity for detecting mild cognitive impairment and dementia. There is emerging evidence for the validity of cognitive screening performed during telemedicine visits, but it should not replace in-person evaluation of patients who have comorbidities that would preclude reliable testing via telephone or video. The workup after abnormal results of a mental status examination or cognitive screening tool is based on clinical judgment and primarily focuses on ruling out reversible causes of impairment and considering the need for further neuropsychiatric evaluation.
Cognitive Dysfunction , Dementia , Humans , Dementia/diagnosis , Mental Status Schedule , Cognitive Dysfunction/diagnosis , Cognition , Primary Health Care , Neuropsychological Tests
BACKGROUND: Alzheimer's disease (AD) and related dementias are progressive neurological disorders with stage-specific clinical features and challenges. An important knowledge gap is the "window of time" within which patients transition from mild cognitive impairment or mild AD to moderate or severe AD. Better characterization/establishment of transition times would help clinicians initiating treatments, including anti-amyloid therapy. OBJECTIVE: To describe cognitive test score-based AD stage transitions in Veterans with AD in the US Veterans Affairs Healthcare System (VAHS). METHODS: This retrospective analysis (2010-2019) identified Veterans with AD from the VAHS Electronic Health Record (EHR) notes. AD stage was based on Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), or Saint Louis University Mental Status (SLUMS) Examination scores in the EHR. RESULTS: We identified 296,519 Veterans with cognitive test-based AD staging. Over the 10-year study, the proportion of veterans with MMSE scores declined from 24.9% to 9.5% while those with SLUMS rose from 9.0% to 17.8%; and MoCA rose from 5.0% to 25.4%. The average forward transition times between each stage were approximately 2-4 years, whether assessed by MMSE, MoCA, or SLUMS. CONCLUSION: The average transition time for cognitive test-based assessments of initial cognitive decline, early-stage AD, and moderate/severe AD in the VAHS is 2-4 years. In view of the short window for introducing disease-modifying therapy and the significant benefits of early treatment of AD, our data suggest a critical need for treatment guidelines in the management of AD.
Alzheimer Disease , Cognitive Dysfunction , Veterans , Humans , United States , Alzheimer Disease/diagnosis , Alzheimer Disease/psychology , Retrospective Studies , Mental Status Schedule , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/psychology , Neuropsychological Tests
Resumen: En 2022 el Código Penal cubano incorporó una nueva fórmula de inimputabilidad. Este artículo aborda el problema de cómo interpretarla y aplicarla durante las pericias psiquiátricas a imputados. Es su objetivo analizar desde la Psiquiatría dicha fórmula penal para su interpretación forense. Se muestran las críticas que, en publicaciones y ámbitos académicos, fueron hechas a la anterior fórmula; así como la norma complementaria del organismo rector para su interpretación pericial. Se expone y analiza la actual fórmula, elaborada con asesoría de psiquiatras al proceso legislativo, para superar aquellas críticas, pero que, precisamente por diferente, demanda actualizar su interpretación y los métodos periciales para calificar casos acertadamente, detectar simulación y ser controlable como prueba por los jueces. Un criterio de interpretación fue elaborado por el autor y se le sometió a grupos de expertos para consensuar una propuesta final normativa, consistente en considerar pericialmente pretenso inimputable a quién actuó ilícitamente por un trastorno psicótico diagnosticado que se manifestó directamente en el delito, lo que debe quedar demostrado en el informe. En su generalidad, estos criterios pueden aplicarse a valoración de inimputabilidad según otros códigos penales.
Introduction: In 2022 a new Cuban Penal Code incorporated a new requirement of non-imputability. This article approaches to the problem of how to interpret and apply this new non-imputability formula to the psychiatric examination of defendants and has the objective of analyzing it in forensic interpretation. It shows the academic and publisher's criticism made of the previous Cuban non-imputability formula and the complementary precept of the health ministry for forensic interpretation. The new non-imputability formula, elaborated with psychiatrists' assistance during a legislative process to surpass those previous criticisms, is exposed and analyzed. This new different penal requirement put under obligation to change in forensic interpretations and methods to identify criminal non-imputability, pretenders and to be a clue controlled by judges. A new forensic interpretation criterion was elaborated and submitted to groups of psychiatrist experts, to obtain a normative proposition that considered in possible non-imputability of the person who committed the crime during a diagnosed psychotic disorder that was the certain direct determinant of the fact. The psychiatric report may show all mentioned below and, in general view, according to other penal codes, these criteria can be applied in the forensic expertise relative to non-imputability.
Psychotic Disorders/diagnosis , Imputability , Mental Status Schedule , Cuba , Civil Codes
OBJECTIVES: To compare the sensitivity and specificity of the Saint Louis University Mental Status (SLUMS) examination, the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) in adults with moderate to severe traumatic brain injury (TBI). METHODS: In this cross-sectional study, 98 patients with moderate to severe TBI and 30 matched controls were evaluated. All participants were assessed using the MMSE, the MoCA and the SLUMS examination. RESULTS: The SLUMS, MoCA and MMSE scores of the TBI group were significantly lower than those of the control group, indicating that the cognitive function of patients with TBI was significantly impaired. The receiver operating characteristic (ROC) curve analysis indicated that the areas under the curve for the SLUMS examination, the MoCA and the MMSE were all greater than 0.8. There were no significant differences among the instruments, indicating that all three were equally effective for diagnosing cognitive impairment in patients with moderate to severe TBI. According to the ROC curve analysis, the optimal cutoff values for the SLUMS examination, the MoCA and the MMSE were 24.5, 21.5 and 28.5, respectively. At that cutoff value, the sensitivity and specificity of the SLUMS examination were well balanced, with both exceeding 80%. CONCLUSIONS: The SLUMS examination is better suited than the MMSE or the MoCA for assessing cognitive function in patients with moderate to severe TBI.
Brain Injuries, Traumatic , Cognitive Dysfunction , Adult , Humans , Cross-Sectional Studies , Universities , Poverty Areas , Mental Status Schedule , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/etiology , Cognitive Dysfunction/psychology , Cognition , Brain Injuries, Traumatic/complications , Brain Injuries, Traumatic/diagnosis
BACKGROUND: Among the elderly, dementia is a common and disabling disorder with primary manifestations of cognitive impairments. Diagnosis and intervention in its early stages is the key to effective treatment. Nowadays, the test of cognitive function relies mainly on neuropsychological tests, such as the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). However, they have noticeable shortcomings, e.g., the biases of subjective judgments from physicians and the cost of the labor of these well-trained physicians. Thus, advanced and objective methods are urgently needed to evaluate cognitive functions. METHODS: We developed a cognitive assessment system through measuring the saccadic eye movements in three tasks. The cognitive functions were evaluated by both our system and the neuropsychological tests in 310 subjects, and the evaluating results were directly compared. RESULTS: In general, most saccadic parameters correlate well with the MMSE and MoCA scores. Moreover, some subjects with high MMSE and MoCA scores have high error rates in performing these three saccadic tasks due to various errors. The primary error types vary among tasks, indicating that different tasks assess certain specific brain functions preferentially. Thus, to improve the accuracy of evaluation through saccadic tasks, we built a weighted model to combine the saccadic parameters of the three saccadic tasks, and our model showed a good diagnosis performance in detecting patients with cognitive impairment. CONCLUSION: The comprehensive analysis of saccadic parameters in multiple tasks could be a reliable, objective, and sensitive method to evaluate cognitive function and thus to help diagnose cognitive impairments.
Cognitive Dysfunction , Saccades , Humans , Aged , Mental Status Schedule , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/psychology , Neuropsychological Tests , Cognition
OBJECTIVES: Compared to its alternatives (e.g., Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA]), little is known about the psychometric properties and factor structure of the Saint Louis University Mental Status (SLUMS) Examination. The purpose of the current study is to describe the internal consistency, factor structure, and temporal stability of the SLUMS, a widely used cognitive screening measure. METHODS: We examined the SLUMS of 108 mostly White male Veterans seen for home-based primary care services, 101 of whom had complete data and 28 who completed retesting approximately one year later. RESULTS: At time one, Veterans averaged 76.44 (SD = 9.88) years of age and 13.07 (SD = 2.26) years of formal education. Results indicated that the SLUMS had acceptable internal consistency (α = .709) and temporal stability (ρ =.723), with strongest evidence for a one-factor structure. CONCLUSIONS: The SLUMS appears to have adequate reliability and clear one-factor structure in this sample. Additional research with diverse samples is needed to characterize the psychometrics of the SLUMS more comprehensively. CLINICAL IMPLICATIONS: The SLUMS appears to be an efficient method for approximating global cognitive functioning among medically complex older adults.
Poverty Areas , Humans , Male , Aged , Reproducibility of Results , Universities , Mental Status Schedule , Mental Status and Dementia Tests
Introducción: Los trastornos mentales se encuentran entre las principales causas de discapacidad a nivel mundial. Es conocido que los trastornos mentales graves (TMG) se asocian a una alta discapacidad, pero el impacto de los trastornos mentales comunes (TMC) no es desdeñable. En este trabajo comparamos la discapacidad medida con la escala WHODAS 2.0 en ambos grupos diagnósticos desde la consulta de enfermería de un Centro de Salud Mental.Material y métodos: Se recogieron los datos sociodemográficos, el diagnóstico clínico y las puntuaciones de discapacidad de los pacientes atendidos por la enfermera especialista de Salud Mental en el Hospital Infanta Elena de Valdemoro (Madrid) y se comparó la discapacidad en pacientes con TMG y TMC, mediante el test t de Student.Resultados: Se reclutaron un total de 133 pacientes. Los pacientes con TMC mostraron una mayor discapacidad respecto a los pacientes con TMG, siendo esta diferencia significativa para el dominio del trabajo (p<0,001) y de participación en la sociedad (p=0,041).Conclusiones: En este estudio mostramos que el nivel de discapacidad asociado con el TMC fue más alto en ciertas áreas en comparación con el TMG, siendo esta diferencia especialmente relevante para los dominios «trabajo» y «participación». Esto puede servir para adecuar las intervenciones dirigidas a estas personas y podría mejorar su calidad de vida. (AU)
Introduction: Mental disorders are among the leading causes of disability worldwide. Despite the fact that severe mental disorders (SMD) are associated with high disability, the impact of common mental disorders (CMD) is not negligible. In this work, we compare the disability measured with the WHODAS 2.0 scale of both diagnostic groups at the Mental Health Nurse facility.Material and methods: Sociodemographic data, clinical diagnosis and disability scores were collected, using the WHODAS 2.0 scale, of the patients attended by the Mental Health specialist nurse at the Infanta Elena de Valdemoro Hospital (Madrid) and disability was compared in patients with SMD and CMD, using the Student t test.Results: Our study sample consisted of 133 patients. Patients with CMD showed greater disability compared to patients with SMD. It was observed that the disability associated with CMD is higher, compared to SMD, this difference being significant for the domain of work (p<0.001) and participation in society (p=0.041).Conclusions: In this study we showed that the level of disability associated with CMD was higher in certain areas compared to SMD, this difference was of special relevance for the «Work» and «Participation» domains. This may serve to adapt the interventions aimed at these people and improve their quality of life. (AU)
Humans , Young Adult , Adult , Middle Aged , Mental Disorders/classification , Mental Disorders/diagnosis , Disabled Persons , Nurses/psychology , Mental Status Schedule
BACKGROUND: The Montreal Cognitive Assessment (MoCA) is sensitive to cognitive impairment; however, it is also sensitive to demographic and socio-cultural factors. This necessitates reliable sub-population norms, but these are often lacking for older adults. OBJECTIVE: To present demographically adjusted regression-based MoCA norms for cognitively healthy Swedish older adults. METHODS: A pseudo-random sample of community-dwelling 80- to 94-year-olds, stratified by age and gender, was invited to the study. Initial telephone interviews and medical records searches (nâ=â218) were conducted to screen for cognitive impairment. Nâ=â181 eligible participants were administered a protocol including the Swedish version of the MoCA and assessments of global cognition (Mini-Mental State Examination, MMSE) and depression (Patient Health Questionnaire-9, PHQ-9). Individuals scoring in the range of possible cognitive impairment on the MMSE or more than mild depression on the PHQ-9 were excluded (nâ=â23); three discontinued the test-session. RESULTS: Norms were derived from the remaining nâ=â158. They were evenly distributed by gender, on average 85 years old, and with a mean education of 11 years. MoCA scores were independently influenced by age and education, together explaining 17.2% of the total variance. Higher age and lower education were associated with lower performance and 46% performed below the original cut-off (<â26/30). CONCLUSION: The negative impact of increasing age on MoCA performance continues linearly into the nineties in normal aging. Demographic factors should be considered when interpreting MoCA performance and a tool for computing demographically corrected standard scores is provided.
Cognitive Dysfunction , Aged , Aged, 80 and over , Cognition , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/epidemiology , Humans , Mental Status Schedule , Mental Status and Dementia Tests , Neuropsychological Tests , Sweden/epidemiology
OBJECTIVES: This systemic review qualitatively synthesizes existing psychometric support for the Saint Louis University Mental Status (SLUMS) Examination, a cognitive screening measure which presents as a free alternative to other widely used dementia screening measures including the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). METHODS: A total of 90 peer-reviewed articles on the SLUMS were identified from PsycINFO and PubMed databases. RESULTS: Sixty-eight records were identified and reviewed by the lead author for eligibility. Studies that included at least one psychometric property of the SLUMS (n = 20) were included in this review. CONCLUSIONS: Support for the SLUMS remains preliminary; however, it appears to have adequate validity, and adequate sensitivity and specificity in detecting cognitive impairment. Numerous shortcomings were identified, including lack of sufficient normative data, information on test-reliability, explored factor structure, and limited application of criterion measures (e.g., imaging studies, biomarkers). Research is needed to establish diverse normative samples and describe the reliability and validity of the SLUMS to strengthen the empirical support for its use. CLINICAL IMPLICATIONS: Until its psychometric properties are better established the SLUMS should be used cautiously when screening for cognitive impairment.
Poverty Areas , Humans , Mental Status Schedule , Psychometrics , Reproducibility of Results , Universities
ResumenAntecedentes/Objetivo: Este estudio examinó el papel de diferentes estrategias de afrontamiento psicológico en la salud mental y física durante las fases iniciales de la crisis de COVID-19. Método: 11.227 personas de 30 países representando todos los con-tinentes participaron en el estudio y completaron medidas de malestar psicológico (de-presión, estrés y ansiedad), soledad, bienestar, salud física, medidas de afrontamiento centrado en el problema y en la emoción, y una medida denominada Escala del Afronta-miento Centrado en el Sentido (MCCS) que fue desarrollada en este estudio. El análisis de validación de la MCCS se realizó en todos los países, y los datos se evaluaron mediante un modelo multinivel. Resultados: La MCCS mostró una estructura unifactorial en 30 países con buenos resultados de validez test-retest, concurrente y divergente. Los análisis mos-traron resultados mixtos en cuanto a las estrategias de afrontamiento centradas en la emoción y en el problema. La MCCS fue el predictor positivo más fuerte de salud física y mental, independientemente de las características demográficas y las variables a nivel de país. Conclusiones: Los resultados sugieren que la MCCS es una medida fiable para medir afrontamiento centrado en el sentido. Estos resultados pueden servir para dirigir políticas que promuevan un afrontamiento eficaz con el fin de mitigar el sufrimiento colectivo durante la pandemia.© 2021 Asociación Española de Psicología Conductual. Published by Elsevier España, S.L.U. This is an open access article under the CC BY−NC−ND license (http://creativecommons.org/licenses/by−nc−nd/4.0/)
AbstractBackground/Objective: This study examined the role of different psychological coping mechanisms in mental and physical health during the initial phases of the COVID-19 crisis with an emphasis on meaning-centered coping. Method: A total of 11,227 people from 30 countries across all continents participated in the study and completed measures of psychological distress (depression, stress, and anxiety), loneliness, well-being, and physical health, together with measures of problem-focused and emotion-focused coping, and a measure called the Meaning-centered Coping Scale (MCCS) that was developed in the present study. Validation analyses of the MCCS were performed in all countries, and data were assessed by multilevel modeling (MLM). Results: The MCCS showed a robust one-factor structure in 30 countries with good test-retest, concurrent and divergent validity results. MLM analyses showed mixed results regarding emotion and problem-focused coping strategies. However, the MCCS was the strongest positive predictor of physical and mental health among all coping strategies, independently of demographic characteristics and country-level variables. Conclusions: The findings suggest that the MCCS is a valid measure to assess meaning-centered coping. The results also call for policies promoting effective coping to mitigate collective suffering during the pandemic.© 2021 Asociación Española de Psicología Conductual. Published by Elsevier España, S.L.U. This is an open access article under the CC BY−NC−ND license (http://creativecommons.org/licenses/by−nc−nd/4.0/).
Health Sciences , Coronavirus 229E, Human , Severe acute respiratory syndrome-related coronavirus , Coronavirus , Mental Status Schedule , Depression , Anxiety , Stress, Psychological , Stress Disorders, Traumatic
BACKGROUND: The role of semantic knowledge in emotion recognition remains poorly understood. The semantic variant of primary progressive aphasia (svPPA) is a degenerative disorder characterized by progressive loss of semantic knowledge, while other cognitive abilities remain spared, at least in the early stages of the disease. The syndrome is therefore a reliable clinical model of semantic impairment allowing for testing the propositions made in theoretical models of emotion recognition. OBJECTIVE: The main goal of this study was to investigate the role of semantic memory in the recognition of basic emotions conveyed by music in individuals with svPPA. METHODS: The performance of 9 individuals with svPPA was compared to that of 32 control participants in tasks designed to investigate the ability: a) to differentiate between familiar and non-familiar musical excerpts, b) to associate semantic concepts to musical excerpts, and c) to recognize basic emotions conveyed by music. RESULTS: Results revealed that individuals with svPPA showed preserved abilities to recognize familiar musical excerpts but impaired performance on the two other tasks. Moreover, recognition of basic emotions and association of musical excerpts with semantic concepts was significantly better for familiar than non-familiar musical excerpts in participants with svPPA. CONCLUSION: Results of this study have important implications for theoretical models of emotion recognition and music processing. They suggest that impairment of semantic memory in svPPA affects both the activation of emotions and factual knowledge from music and that this impairment is modulated by familiarity with musical tunes.
Aphasia, Primary Progressive/complications , Emotions/physiology , Memory Disorders/etiology , Music , Semantics , Aged , Aphasia, Primary Progressive/diagnostic imaging , Atrophy/etiology , Atrophy/pathology , Case-Control Studies , Female , Humans , Knowledge , Language Tests , Male , Mental Status Schedule , Middle Aged , Models, Theoretical , Recognition, Psychology
BACKGROUND: Older people with subjective memory complaints (SMC) and Instrumental Activities of Daily Living impairments (IADL-I) have an increased risk of developing dementia. Previous reports suggest that the predictive value of SMC and IADL-I may differ between sexes, leaving possible consequences for personalized risk prediction and prognosis. However, none of these studies addressed the competing risk of death, which may substantially differ between sexes. OBJECTIVE: We investigated sex-differences in the association between IADL-I, SMC, and incident dementia and mortality as competing risk. METHODS: 3,409 community-dwelling older people without dementia (mean age 74.3±2.5), were followed for 6.7 years (median). Baseline SMC were assessed using the 15-item Geriatric Depression Scale memory question, and IADL-I using the Academic Medical Center Linear Disability Score. Potential sex-differences in the predictive value of SMC and IADL-I were assessed using Cox regression models with an interaction term for sex. RESULTS: HRs for isolated SMC and SMCâ+âIADL-I and risk of dementia were higher in women (HR: 2.02, 95% CIâ=â0.91-4.46, pâ=â0.08; HR:2.85, 95% CIâ=â1.65-4.91, pâ<â0.001) than in men (HR:1.52, 95% CIâ=â0.86-2.69, pâ=â0.18; HR:1.24, 95% CIâ=â0.62-2.49, pâ=â0.54), but these sex-differences were not significant. Conversely, HRs for isolated IADL-I and risk of mortality were higher in men (HR:1.56, 95% CIâ=â1.18-2.05, pâ=â0.002) than in women (HR:1.14, 95% CIâ=â0.80-1.62, pâ=â0.48), but again, these sex-differences were not significant. CONCLUSION: The predictive value of SMC and IADL-I for the risk of dementia and mortality was not significantly modified by sex. However, the competing risk of death for these factors differed considerably between men and women, suggesting it is an essential factor to consider when comparing sex-differences in IADL/dementia risk.
Activities of Daily Living , Cognitive Dysfunction/diagnosis , Dementia/diagnosis , Dementia/epidemiology , Memory Disorders/epidemiology , Sex Characteristics , Aged , Cognitive Dysfunction/epidemiology , Female , Humans , Independent Living , Male , Mental Status Schedule , Neuropsychological Tests , Proportional Hazards Models , Risk Factors
Resumen | Introducción. Los pacientes con cáncer presentan niveles significativos de malestar emocional. La National Comprehensive Cancer Network (NCCN) desarrolló un instrumento (Distress Management) para evaluarlo de forma rápida en pacientes oncológicos. Para su utilización en Colombia, se hizo la adaptación transcultural y se validó. Objetivo. Determinar las características operativas del instrumento de malestar emocional, versión 2.2018, en pacientes atendidos en el Instituto Nacional de Cancerología. Materiales y métodos. Previa autorización de la NCCN, se procedió a la traducción, adaptación transcultural y evaluación de las características operativas del instrumento. Se incluyeron 343 pacientes con diagnóstico de cáncer atendidos en el Instituto Nacional de Cancerología, quienes diligenciaron el instrumento adaptado transculturalmente. Se efectuó un estudio de prueba diagnóstica como patrón de referencia mediante una entrevista semiestructurada. Resultados. Los pacientes tenían una edad promedio de 49,7 años (DE=15) y la mayoría (67 %) eran mujeres. El instrumento tuvo un área bajo la curva ROC de 0,81 (IC95% 0,77-0,86); el punto de corte óptimo fue de 3,5, el cual se aproximó a 4; la sensibilidad fue de 0,81 (IC95% 0,76-0,85) y la especificidad de 0,69 (IC95% 0,64-0,74). El porcentaje de acuerdo entre el resultado de la entrevista y el instrumento fue de 73 % (kappa=0,64; p<0,001). Conclusiones. El instrumento de malestar emocional permitió detectar el malestar emocional moderado a grave que requiere intervención y manejo. Este instrumento fue adaptado y validado en pacientes con cáncer en Colombia, conservándose el punto de corte en ≥4 como en la versión original.
Abstract | Introduction: Cancer patients have significant levels of emotional distress. The National Comprehensive Cancer Network (NCCN) developed the distress management tool to quickly assess significant distress in oncological patients who require intervention. For its use in Colombia, we made its cross-cultural adaptation and validation. Objective: To determine the operative characteristics of the distress management tool, version 2.2018, in patients seen at the Instituto Nacional de Cancerología (INC) in Colombia. Materials and methods: Counting with the authorization from the NCCN, we translated, made the cross-cultural adaptation, and evaluated the operational characteristics of the tool. We included 343 cancer patients seen at the INC, who filled out the cross-culturally adapted instrument. A diagnostic test study was carried out with a semi-structured interview as a reference. Results: The patients had an average age of 49.7 years (SD=15) and the majority were women (67%). The instrument had an area under the ROC curve of 0.81 (95% CI: 0.77 - 0.86); its optimal cut-off point was 3.5 approached to 4 when using integers on the scale; its sensitivity was 0.81 (95% CI: 0.76 - 0.85), and its specificity, 0.69 (95% CI: 0.64 - 0.74). The agreement percentage between the result of the interview and the instrument was 73% (kappa = 0.64; p< 0.001). Conclusions: The distress management tool allowed for the detection of moderate to severe distress requiring intervention and management. This instrument was adapted and validated in cancer patients in Colombia keeping the cutoff point at ≥ 4 as in the original version.
Mental Status Schedule , Neoplasms , Cross-Cultural Comparison , Sensitivity and Specificity , Validation Study , Psychological Distress
Potential precipitating factors for the recent onset of altered mental status (AMS) include primary central nervous system insults, systemic infections, metabolic disturbances, toxin exposure, medications, chronic systemic diseases, and psychiatric conditions. Delirium is also an important manifestation of AMS, especially in older people who are hospitalized. Clinicians should identify and treat reversible causes of the AMS, some of which require urgent intervention to minimize morbidity and mortality. A history and physical examination guide diagnostic testing. Laboratory testing, chest radiography, and electrocardiography help diagnose infections, metabolic disturbances, toxins, and systemic conditions. Neuroimaging with computed tomography or magnetic resonance imaging should be performed when the initial evaluation does not identify a cause or raises concern for intracranial pathology. Lumbar puncture and electroencephalography are also important diagnostic tests in the evaluation of AMS. Patients at increased risk of AMS benefit from preventive measures. The underlying etiology determines the definitive treatment. When intervention is needed to control patient behaviors that threaten themselves or others, nonpharmacologic interventions are preferred to medications. Physical restraints should rarely be used and only for the shortest time possible. Medications should be used only when nonpharmacologic treatments are ineffective.
Behavioral Symptoms , Delirium , Dementia , Neuroimaging/methods , Risk Adjustment/methods , Adult , Aged , Behavioral Symptoms/etiology , Behavioral Symptoms/therapy , Chemically-Induced Disorders/complications , Chemically-Induced Disorders/diagnosis , Consciousness Disorders/diagnosis , Consciousness Disorders/etiology , Delirium/blood , Delirium/etiology , Delirium/psychology , Delirium/therapy , Dementia/complications , Dementia/diagnosis , Diagnosis, Differential , Humans , Interdisciplinary Communication , Mental Status Schedule , Metabolic Diseases/complications , Metabolic Diseases/diagnosis , Neurologic Examination/methods , Patient Care Management/methods , Psychotropic Drugs/therapeutic use , Risk Assessment/methods
BACKGROUND: The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are the most commonly used scales to detect mild cognitive impairment (MCI) in population-based epidemiologic studies. However, their comparison on which is best suited to assess cognition is scarce in samples from multiple regions of China. METHODS: We conducted a cross-sectional analysis of 4923 adults aged ≥55 years from the Community-based Cohort Study on Nervous System Diseases. Objective cognition was assessed by Chinese versions of MMSE and MoCA, and total score and subscores of cognitive domains were calculated for each. Education-specific cutoffs of total score were used to diagnose MCI. Demographic and health-related characteristics were collected by questionnaires. Correlation and agreement for MCI between MMSE and MoCA were analyzed; group differences in cognition were evaluated; and multiple logistic regression model was used to clarify risk factors for MCI. RESULTS: The overall MCI prevalence was 28.6% for MMSE and 36.2% for MoCA. MMSE had good correlation with MoCA (Spearman correlation coefficient = 0.8374, p < 0.0001) and moderate agreement for detecting MCI with Kappa value of 0.5973 (p < 0.0001). Ceiling effect for MCI was less frequent using MoCA versus MMSE according to the distribution of total score. Percentage of relative standard deviation, the measure of inter-individual variance, for MoCA (26.9%) was greater than for MMSE (19.0%) overall (p < 0.0001). Increasing age (MMSE: OR = 2.073 for ≥75 years; MoCA: OR = 1.869 for≥75 years), female (OR = 1.280 for MMSE; OR = 1.163 for MoCA), living in county town (OR = 1.386 and 1.862 for MMSE and MoCA, respectively) or village (OR = 2.579 and 2.721 for MMSE and MoCA, respectively), smoking (OR = 1.373 and 1.288 for MMSE and MoCA, respectively), hypertension (MMSE: OR = 1.278; MoCA: OR = 1.208) and depression (MMSE: OR = 1.465; MoCA: OR = 1.350) were independently associated with greater likelihood of MCI compared to corresponding reference group in both scales (all p < 0.05). CONCLUSIONS: MoCA is a better measure of cognitive function due to lack of ceiling effect and with good detection of cognitive heterogeneity. MCI prevalence is higher using MoCA compared to MMSE. Both tools identify concordantly modifiable factors for MCI, which provide important evidence for establishing intervention measures.
Cognitive Dysfunction , Aged , China/epidemiology , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/epidemiology , Cohort Studies , Cross-Sectional Studies , Female , Humans , Mental Status Schedule , Mental Status and Dementia Tests , Middle Aged , Neuropsychological Tests
INTRODUCTION: This multicenter, retrospective study assessed the prevalence of post-stroke cognitive impairment (PSCI) 6 months after acute ischemic stroke (AIS) and its risk factors to build a bedside early predictive model for PSCI using the Montreal Cognitive Assessment (MoCA). METHODS: Records of consecutive patients with AIS treated at 4 stroke centers in Shanghai had MoCA assessments within 2 weeks after AIS onset and 6 months later were reviewed. Prevalence of PSCI (MoCA<22) was calculated and risk factors were identified by multivariate logistic regression analysis. The modeling and validation and identified risk factors were included in a predictive model using multivariate regression. RESULTS: There were 383 patients included and prevalence of PSCI 6 months after AIS was 34.2%, significantly lower than prevalence of patients with acute cognitive impairment (49.6%). Aging, less education, higher glucose level and severe stroke were PSCI risk factors, while level of low-density lipoprotein cholesterol (LDL-C) had a paradox effect on the risk of PSCI. 40.0% of the patients with cognitive impairment at acute phase reverted to normal, and patients with LDL-C 1.8-2.5 mmol/L were more likely to revert. The predictive model we built, DREAM-LDL (Diabetes [fasting blood glucose level], Rating [NIHSS], level of Education, Age, baseline MoCA and LDL-C level), had an AUROC of 0.93 for predicting PSCI at 6 months. CONCLUSION: PSCI was common among AIS patients 6 months after AIS. We provided a practical tool to predict PSCI based on MoCA and risk factors present during acute phase of AIS.
Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/etiology , Stroke/complications , Age Factors , Aged , Aged, 80 and over , Area Under Curve , China/epidemiology , Diagnostic Tests, Routine/methods , Educational Status , Female , Humans , Logistic Models , Male , Mental Status Schedule , Middle Aged , Multivariate Analysis , Neuropsychological Tests , Prevalence , ROC Curve , Retrospective Studies , Risk Factors , Time Factors
BACKGROUND: A key challenge in studies that model outcomes, disease progression, and cost-effectiveness of existing and emerging dementia treatments is the lack of conversion criteria to translate, or 'crosswalk', scores on multiple measurement scales. Clinical status in dementia is commonly characterized in the cognitive, functional, and behavioral domains. OBJECTIVE: We conducted a systematic review of peer-reviewed dementia measure crosswalks in the three domains. METHODS: We systematically reviewed published literature for crosswalks between scales used to measure cognitive, functional, or behavioral outcomes in Alzheimer's and related dementias. The search was conducted in PubMed, and additional crosswalks were identified through snowballing and expert input from dementia modelers. RESULTS: Of the reviewed articles, 2,334 were identified through a PubMed search, 842 articles were sourced from backward and forward citation snowballing, and 8 additional articles were recommended through expert input. 31 papers were eligible for inclusion, listing 74 unique crosswalks. Of those, 62 (83.8%) were between endpoints of the cognitive domain and 12 (16.2%) were either between endpoints of the functional domain or were hybrid in nature. Among crosswalks exclusively in the cognitive domain, a majority involved the Mini-Mental State Examination (MMSE) (37 crosswalks) or the Montreal Cognitive Assessment (MoCA) and its variants (25 crosswalks). MMSE was directly compared to MoCA or MoCA variants in 16 crosswalks. CONCLUSION: Existing crosswalks between measures of dementia focus largely on a limited selection of outcome measures, particularly MMSE and MoCA. Few crosswalks exist in the functional domain, and no crosswalks were identified for solely behavioral measures.
Alzheimer Disease , Mental Status Schedule/standards , Mental Status and Dementia Tests/standards , Outcome Assessment, Health Care , Alzheimer Disease/classification , Alzheimer Disease/diagnosis , Disease Progression , Humans
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.
Mental Status Schedule , Factor Analysis, Statistical , Humans , Reproducibility of Results
INTRODUCTION: Benign Paroxysmal Positional Vertigo (BPPV) is a commonly encountered peripheral vestibular disorder. People exposed to massive earthquakes experience intense and long-term problem associated with dizziness. The purpose of our study is to investigate this relationship and to demonstrate the efficacy of the treatment modalities used in the management of patients with post-earthquake dizziness. METHODOLOGY: The study was carried out by examining the retrospective records of patients who presented with dizziness to the otorhinolaryngological outpatient unit before and after the Elazig earthquake that occurred on 24th Jan 2020. Parameters evaluated include patients' age and gender, onset of dizziness, accompanying symptoms and comorbidities, videonystagmography (VNG) findings, pre- and post-treatment Visual Analogue Scale (VAS), Dizziness Handicap Inventory (DHI), and Hospital Anxiety and Depression Scale (HADS). RESULTS: The number of patients who presented with dizziness to our outpatient clinic after the earthquake and were included in our study totaled 84. The number of patients who visited the outpatient clinic before the earthquake was identified to be 75. In the earthquake related group, while there was a statistically significant difference between residual symptoms (RS) and the need for repetitive repositioning maneuvers, there was no statistically significant difference detected for age, gender, and comorbidities. Also, no statistically significant difference was found in the pre- and post-treatment assessments of VAS, DHI, and HADS median values in the earthquake group. CONCLUSION: There was a remarkable increase in the number of patients presenting with dizziness in the early post-earthquake period. Management of these patients may differ from the classic BPPV. Residual symptoms appearing after performing repositioning maneuvers can be more commonly seen among these patients.
Benign Paroxysmal Positional Vertigo , Earthquakes , Patient Positioning/methods , Vestibular Diseases , Age Factors , Benign Paroxysmal Positional Vertigo/diagnosis , Benign Paroxysmal Positional Vertigo/epidemiology , Benign Paroxysmal Positional Vertigo/etiology , Benign Paroxysmal Positional Vertigo/physiopathology , Comorbidity , Disability Evaluation , Female , Humans , Male , Mental Status Schedule/statistics & numerical data , Middle Aged , Otolaryngology/methods , Patient Care Management/methods , Retrospective Studies , Sex Factors , Symptom Assessment/methods , Turkey/epidemiology , Vestibular Diseases/epidemiology , Vestibular Diseases/physiopathology , Vestibular Diseases/psychology , Vestibular Diseases/therapy , Visual Analog Scale
BACKGROUND: Detecting cognitive impairment is a priority for health systems. The aim of this study is to create normative data on screening tests (MMSE, GDS and MFE) for middle-aged and older Spanish adults, considering the effects of sociodemographic factors. METHOD: A total of 2,030 cognitively intact subjects who lived in the community, aged from 50 to 88 years old, participated voluntarily in SCAND consortium studies. The statistical procedure included the conversion of percentile ranges into scalar scores. Secondly, the effects of age, educational level and gender were verified. Linear regressions were used to calculate the scalar adjusted scores. Cut-off values for each test were also calculated. RESULTS: Scalar scores and percentiles corresponding to MMSE, GDS-15 and MFE are shown. An additional table is provided which shows the points that must be added or subtracted from MMSE score depending on the subject's educational level. CONCLUSIONS: The current norms should provide clinically useful data for evaluating Spanish people aged 50 to 88 years old and should contribute to improving the detection of initial symptoms of cognitive impairment in people living in the community, taking into account the influence of gender, age and educational level
ANTECEDENTES: detectar el deterioro cognitivo es una prioridad del sistema sanitario. El objetivo de este estudio es la presentación de datos normativos de pruebas de cribado (MMSE, GDS y MFE) para adultos españoles de mediana edad y adultos mayores, considerando los efectos de factores sociodemográficos. MÉTODO: en los estudios realizados por el consorcio SCAND participaron voluntariamente 2.030 personas cognitivamente sanas, de 50 a 88 años, residentes en su comunidad. El procedimiento estadístico supuso la conversión de rangos percentiles en puntuaciones escalares. Posteriormente, se comprobaron los efectos de la edad, el nivel educativo y el género. Se utilizaron regresiones lineales para calcular las puntuaciones escalares ajustadas. También se calcularon los puntos de corte para cada prueba. RESULTADOS: se muestran las puntuaciones escalares y los percentiles correspondientes a MMSE, GDS-15 y MFE. Además, se presenta una tabla que muestra los puntos que deben sumarse o restarse a la puntuación del MMSE dependiendo del nivel educativo del individuo. CONCLUSIONES: los datos normativos presentados tienen una utilidad clínica para evaluar a población española de 50 a 88 años, y contribuyen a mejorar la detección de los síntomas iniciales del deterioro cognitivo teniendo en cuenta la influencia del género, la edad y el nivel educativo
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Cognitive Dysfunction/diagnosis , Mental Status and Dementia Tests/standards , Cognitive Aging/psychology , Mental Status Schedule/standards , Neuropsychological Tests/standards , Cognitive Dysfunction/psychology , Geriatric Assessment/statistics & numerical data , Linear Models , Educational Status
