Influence of education level on MMSE and MoCA scores of elderly inpatients.

OBJECTIVE: The purpose of this study was to investigate the influence of education level on MMSE and MoCA scores of elderly inpatients. METHOD: This is a cross-sectional study. A total of 260 elderly inpatients were evaluated by the MMSE and MoCA sequentially. RESULTS: The total MMSE scores were highly correlated with the total MoCA scores (r = 0.7629, p < 0.0001), and were correlated with the length of education (r = 0.2723, p < 0.0001). The total MoCA scores were also correlated with the length of education (r = 0.3323, p < 0.0001). Meanwhile, MoCA was also used to reevaluate the elderly inpatients with normal MMSE scores at different education levels. There were no significant differences at different education levels (χ2=1.351, p = 0.5090). Finally, we analyzed the diagnostic consistency of MMSE and MoCA at different education levels, and the results showed that education level was closely related to the consistency of the diagnoses based on the MMSE and MoCA (χ2=10.23, p = 0.0368). CONCLUSIONS: In general, the results of both the MMSE and MoCA were influenced by education level, and this effect was more obvious for the MoCA. However, in the cognitive assessment of elderly patients, the ability to identify impairment with the MoCA is obviously superior to that with the MMSE.

Reliability and validity of the Brief Assessment of Impaired Cognition (Chinese version) for stroke patients.

Objective and accurate cognitive assessment scales are essential for guiding cognitive rehabilitation following stroke. The aim of this study was to evaluate the validity and reliability of the Mandarin Chinese version of the Brief Assessment of Impaired Cognition (BASIC) in stroke patients. The English version of the BASIC scale was translated into Mandarin Chinese, and 56 stroke patients at a stroke treatment center were enrolled in the study. The Mini-Mental State Examination (MMSE) and BASIC scale were used to evaluate the patients' cognitive function, and content validity, structural validity, concurrent validity, internal consistency, interrater consistency and reliability and test-retest reliability were used to evaluate the test results. The correlation coefficients between each item of the BASIC scale and the total score were between 0.416 and 0.804 (p < 0.05). The total score on the BASIC scale was correlated with the total score on the MMSE (r = 0.479, p < 0.05). Four factors were extracted by exploratory factor analysis, and the cumulative variance contribution rate was 74.932%. The factor loading of each item on the corresponding factor was > 0.5, indicating that the scale has good structural validity. Internal consistency was good (Cronbach's α = 0.821), as were interrater (ICC > 0.95) and test-retest reliability (ICC = 0.815-0.941). Therefore, the Chinese version of the BASIC scale has good reliability and validity and can assist in screening for cognitive dysfunction or dementia in stroke patients.

A preliminary study of the Saint Louis University Mental Status examination (SLUMS) for the assessment of cognition in moderate to severe traumatic brain injury patients.

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.

Correlation between vitamin D and cognitive function in patients with traumatic brain injury in China.

OBJECTIVE: This study investigated changes in vitamin D levels in traumatic brain injury (TBI) patients and the relationship between vitamin D levels and cognitive function. METHODS: Thirty-five TBI patients in our hospital were randomly selected, and baseline data were collected. 25-Hydroxyvitamin D (25(OH)D) plasma levels were determined within a month of hospitalization, and awareness and cognitive function were assessed using the Glasgow Coma Scale (GCS) and the Mini Mental State Examination (MMSE), respectively, on the day of blood collection. The data were statistically analyzed. RESULTS: The MMSE and GCS scores were positively correlated (p < 0.05); higher MMSE scores were associated with higher GCS scores. Moreover, the total score was positively correlated with directional ability, memory, and attention, suggesting high internal consistency of the MMSE score, but no significant correlation with other indicators was observed. 25(OH)D was positively correlated with the injury site (p < 0.05), suggesting that frontal damage has a significant impact on the plasma level of 25(OH)D. CONCLUSION: The plasma vitamin D level in TBI patients may indicate frontal lobe damage. The overall plasma level of 25(OH)D in TBI patients was not significantly correlated with cognitive function, but the incidence of cognitive impairment was higher with 25(OH)D level between 10 and 30 ng/ml.

Reliability and validity of the Rowland Universal Dementia Assessment Scale for patients with traumatic brain injury.

Objective and accurate cognitive assessment scales are essential for guiding cognitive rehabilitation following traumatic brain injury (TBI). The aim of this study was to evaluate the reliability and validity of the Rowland Universal Dementia Assessment Scale (RUDAS) for TBI and to verify the clinical application value. Fifty patients with TBI and 32 matched controls were assessed using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and a newly developed Chinese version of RUDAS. These scales were then compared for internal consistency, inter-rater reliability, test‒retest reliability, content validity, construct validity, and diagnostic efficacy. Among the TBI group, the RUDAS demonstrated acceptable internal consistency (Cronbach's α = 0.733), high inter-rater reliability (intraclass correlation coefficients [ICCs] of 0.910‒0.999), and high test‒retest reliability (total score ICC = 0.938). The correlation coefficients between RUDAS total score and individual subscores were all > 0.5 except for body orientation (r = 0.363), indicating generally good content validity. Total RUDAS scores were moderately correlated with both MMSE total scores (r = 0.701, p < 0.001) and MoCA total scores (r = 0.778, p < 0.001), indicating good construct validity. Receiving operating characteristic curve analysis yielded comparable areas under the curve for diagnostic efficacy (RUDAS, 0.844; MMSE, 0.769; MoCA, 0.824; all p > 0.05). A RUDAS score cutoff of 23.5 distinguished TBI patients from controls with 60% sensitivity and 100% specificity. Therefore, the RUDAS demonstrates both good reliability and validity for evaluating cognitive impairments in TBI patients.

Comparative analysis of rowland universal dementia assessment scale and mini-mental state examination in cognitive assessment of traumatic brain injury patients.

BACKGROUND: Rowland Universal Dementia Assessment Scale (RUDAS) has demonstrated usefulness in cognitive assessment. Studies supporting the use of RUDAS as an evaluation tool in traumatic brain injury (TBI) patients remain limited. This study examined whether the Chinese version of RUDAS can be effectively applied to the cognitive assessment of TBI patients in China. OBJECTIVE: To compare the performance of Mini-Mental State Examination (MMSE) and the Chinese version of RUDAS in the cognitive assessment of Chinese patients with TBI so as to provide reference for clinical use. METHODS: 86 inpatients with TBI in a hospital were selected from July 2019 to July 2020 and were enrolled as the TBI group, while another 40 healthy individuals matched with age, sex and education level were selected as the control group. All subjects were assessed by trained rehabilitation physicians with MMSE and RUDAS. RESULTS: (1) Compared with the control group, the scores of MMSE and RUDAS in the TBI group decreased significantly; (2) The results of MMSE and RUDAS in the TBI group were positively correlated (r = 0.611, P < 0.001); (3) Linear correlation suggested that age was negatively correlated with MMSE (r = -0.344, P = 0.001) and RUDAS (r = -0.407, P < 0.001), while education years were positively correlated with MMSE (r = 0.367, P = 0.001) and RUDAS (r = 0.375, P < 0.001). However, according to the multiple linear regression, the results of RUDAS were not affected by the years of education; (4) Receiver operating curve analysis showed that there was no significant difference in the areas under the curve between MMSE and RUDAS. The best cut-off values of MMSE and RUDAS were 27.5 and 24.5, respectively. CONCLUSIONS: MMSE and RUDAS have similar diagnostic efficacy in evaluating cognitive impairment of patients with TBI. Since the Chinese version of RUDAS is not affected by the education level, it is more suitable for TBI patients in China.

Preliminary study of the validity and reliability of the Chinese version of the Saint Louis University Mental Status Examination (SLUMS) in detecting cognitive impairment in patients with traumatic brain injury.

The Saint Louis University Mental Status Examination (SLUMS) has been shown to be useful in the cognitive assessment in older adults and patients with dementia. The aim of this study was to preliminarily explore the effectiveness of the Chinese version of the SLUMS in the detection of cognitive impairment in patients with traumatic brain injury (TBI) and to provide an objective basis for its clinical application in China. In this cross-sectional study, 42 patients with TBI and 30 matched normal controls were administered. Participants were assessed by the Chinese version of the Mini-Mental State Assessment scale (MMSE), Montreal Cognitive Assessment scale (MoCA) and SLUMS. Results showed that the Chinese version of the SLUMS had satisfactory internal consistency (Cronbach's α coefficient: 0.723), excellent interrater reliability (ICC: 0.990-0.998) and intrarater reliability (ICC: 0.968), as well as good validity. In the TBI group, the total SLUMS score was moderately positively correlated with the MMSE score (r = 0.702, p = .000) and highly positively correlated with the MoCA score (r = 0.831, p = .000). Receiver Operating Characteristic (ROC) curve analyses showed that the area under the curve (AUC) of the SLUMS, MMSE and MoCA were 0.872, 0.756 and 0.916, respectively. The optimal cutoff score of 22.5 or fewer points are suggested for the SLUMS to discriminate cognitive impairment, with a sensitivity of 0.844 and a specificity of 0.825. The Chinese version of the SLUMS has excellent reliability and validity, and can be used as a screening tool for cognitive impairment of patients with TBI in China.

Multiple component analysis of attention early after complicated mild traumatic brain injury: a prospective cohort study.

OBJECTIVE: To analyse disorders and components of attention in patients with complicated mild traumatic brain injury. This information is needed to enable clinical workers to evaluate and provide training for attention deficits in patients with mild traumatic brain injury. DESIGN: Randomized controlled trial. SETTING: In-patient and community recruitment. PARTICIPANTS: In-patients with mild traumatic brain injury (n = 44) and community-recruited healthy subjects (n = 45). OUTCOME MEASURES: All participants used a battery of attention tests including the Digit Span Test (DST), Digit Cancellation Test (D-CAT1 and D-CAT2), Symbol Digit Modalities Test (SDMT), and the Paced Auditory Serial Addition Test (PASAT). RESULTS: There were no differences in the results of the D-CAT between the patient and control groups (p > 0.05); however, there were significant differences in the DST, SDMT and PASAT (p < 0.01). CONCLUSION: Patients with mild traumatic brain injury were found to have normal sustained attention and selective attention, but impaired attention span, divided attention, shifting attention and information processing speed, requiring clinical workers to focus more on these deficits.

Preliminary study of the reliability and validity of the Johns Hopkins Adapted Cognitive Exam (Chinese version) in neurological intensive care unit patients.

OBJECTIVE: To evaluate the reliability and validity of the Chinese version of the Johns Hopkins Adapted Cognitive Exam (ACE) in neurological intensive care unit patients. DESIGN: The English version of the ACE was translated and adapted into Chinese. The cognitive function of 40 critically ill NICU patients was assessed using the Chinese version of the ACE and the Mini-mental state examination (MMSE) battery. Scores on the ACE and MMSE were analyzed, and the scale's content validity, construct validity, concurrent validity, internal consistency, inter-rater reliability, and test-retest reliability metrics were determined. RESULT: The coefficients for the Pearson correlations between individual item scores and total score ranged from 0.617 to 0.938, and content validity was good. ACE scores were significantly correlated with MMSE scores(r = 0.822, p<0.05). Five factors were extracted during the principal component analysis, the cumulative contribution of which was 85.90%. Overall, the factor loading of each item was 0.5, and the scale had good construct validity. The Chinese version of the ACE demonstrated good internal consistency (Cronbach'α = 0.756), inter-rater reliability (ICC>0.95), and test-retest reliability (ICC = 0.652-0.979). CONCLUSIONS: The results of this study suggest that the Chinese version of the ACE was a reliable and valid screening tool for cognitive impairment in NICU patients. List of abbreviations: ACE: (Johns Hopkins Adapted Cognitive Exam); NICU : (neurological intensive care unit); MMSE: (Mini-Mental State Examination); SPSS: (the Statistical package for the Social Sciences); ICC: (Intra-class Correlation Coefficients); SCCM: (Society of Critical Care Medicine); PICS: (post-intensive care syndrome); ARDS:(acute respiratory distress syndrome); MoCA; (Montreal Cognitive Assessment); EFA: (exploratory factor analysis).