Marshal Folstein

Bio: Marshal Folstein is an academic researcher from King's College London. The author has contributed to research in topics: Cognition & Apathy. The author has an hindex of 2, co-authored 3 publications receiving 71069 citations.

A practical method for grading the cognitive state of patients for the clinician

Abstract: EXAMINATION of the mental state is essential in evaluating psychiatric patients.1 Many investigators have added quantitative assessment of cognitive performance to the standard examination, and have documented reliability and validity of the several “clinical tests of the sensorium”.2*3 The available batteries are lengthy. For example, WITHERS and HINTON’S test includes 33 questions and requires about 30 min to administer and score. The standard WAIS requires even more time. However, elderly patients, particularly those with delirium or dementia syndromes, cooperate well only for short periods.4 Therefore, we devised a simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely. It is “mini” because it concentrates only on the cognitive aspects of mental functions, and excludes questions concerning mood, abnormal mental experiences and the form of thinking. But within the cognitive realm it is thorough. We have documented the validity and reliability of the MMS when given to 206 patients with dementia syndromes, affective disorder, affective disorder with cognitive impairment “pseudodementia”5T6), mania, schizophrenia, personality disorders, and in 63 normal subjects.

Clinical assessment of irritability, aggression, and apathy in Huntington and Alzheimer disease.

Abstract: Thirty-one patients with Alzheimer disease (AD) and 26 patients with Huntington disease (HD) were assessed using new scales to measure apathy and irritability. An existing scale was used to assess aggression. A similar prevalence of apathy and irritability was found in the two groups. The HD patients were more aggressive than the AD patients. In a subsample of the two groups, matched for degree of cognitive impairment, the HD patients were found to be more apathetic than the AD group. Irritability was related to be the premorbid trait of "bad temper" in HD but not in AD. There was no interrelationship among the three symptoms in either group. The scales for irritability and apathy have both interrater and test-retest reliability. They are able to differentiate patients with AD and HD from normal, disease-free control subjects. The usefulness of these scales, in relation to preexisting scales, is discussed.

Neuropsychological andneuroradiologica l correlates inHuntington's disease

Abstract: SUMMARY Measurements ofcortical andsubcortical atrophy weremadeonCTscansof 34patients withHuntington's disease. Significant correlations werefoundbetween thebicaudate ratio (BCR) andan eyemovementscale (r= 044,p < 001), andactivities ofdaily living scale (r= 0-57, p < 0-001) andtheMini-Mental State Exam(r= 0A49, p < 0-01). Nocorrelations werefoundbetweenBCR values andseverity ofchorea or voluntary motorimpairment. A detailed neuropsychological evaluation of18Huntington's disease patients showedsignificant correlations between theBCR andSymbolDigit Modalities test(r = 065,p < 0-01), andpartsA (r= 0-72, p < 0-001) andB (r= 0-80, p < 00001) oftheTrail MakingTest. Thesedatasupport workin primates that demonstrates therole ofthecaudate nucleus incognitive andoculomotor functions, butnotinmotorcontrol (which isgoverned byputamino-subthalamic systems). Thespecific cognitive skills correlated withcaudate atrophy inHuntington's disease arethose reported inprimate worktobeserved bythefrontal-caudate loopsystem: eyemovements, conceptual tracking, set shifting andpsychomotor speed. Huntington's disease isa progressive neurodegenerative disorder inherited asanautosomal dominant trait. Symptoms whichusually begininthe fourth orfifth decade oflife, include abnormal movements,cognitive deficits and psychiatric disturbances.' The neuropathological hallmark of Huntington's disease isneostriatal neuronal loss, but morewidepathology, especially ofthefrontal cortex, isalso found.2 3 Themajorneuropsychological deficits inHuntington's disease areslowthinking, impaired ability to operate onacquired knowledge andtoshift attention, anddeficits inlearning newverbal andnon-verbal information.4 These psychological deficits havebeen traditionally attributed topathology in cortical structures, while motordeficits havebeenassociated with striatal pathology. However, workinprimates has

Clinical diagnosis of Alzheimer's disease : report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease

Abstract: Clinical criteria for the diagnosis of Alzheimer's disease include insidious onset and progressive impairment of memory and other cognitive functions. There are no motor, sensory, or coordination deficits early in the disease. The diagnosis cannot be determined by laboratory tests. These tests are important primarily in identifying other possible causes of dementia that must be excluded before the diagnosis of Alzheimer's disease may be made with confidence. Neuropsychological tests provide confirmatory evidence of the diagnosis of dementia and help to assess the course and response to therapy. The criteria proposed are intended to serve as a guide for the diagnosis of probable, possible, and definite Alzheimer's disease; these criteria will be revised as more definitive information become available.

The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment

Abstract: Objectives: To develop a 10-minute cognitive screening tool (Montreal Cognitive Assessment, MoCA) to assist first-line physicians in detection of mild cognitive impairment (MCI), a clinical state that often progresses to dementia. Design: Validation study. Setting: A community clinic and an academic center. Participants: Ninety-four patients meeting MCI clinical criteria supported by psychometric measures, 93 patients with mild Alzheimer's disease (AD) (Mini-Mental State Examination (MMSE) score≥17), and 90 healthy elderly controls (NC). Measurements: The MoCA and MMSE were administered to all participants, and sensitivity and specificity of both measures were assessed for detection of MCI and mild AD. Results: Using a cutoff score 26, the MMSE had a sensitivity of 18% to detect MCI, whereas the MoCA detected 90% of MCI subjects. In the mild AD group, the MMSE had a sensitivity of 78%, whereas the MoCA detected 100%. Specificity was excellent for both MMSE and MoCA (100% and 87%, respectively). Conclusion: MCI as an entity is evolving and somewhat controversial. The MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE.

The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons

Abstract: This study evaluated a modified, timed version of the "Get-Up and Go" Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital (mean age 79.5 years). The patient is observed and timed while he rises from an arm chair, walks 3 meters, turns, walks back, and sits down again. The results indicate that the time score is (1) reliable (inter-rater and intra-rater); (2) correlates well with log-transformed scores on the Berg Balance Scale (r = -0.81), gait speed (r = -0.61) and Barthel Index of ADL (r = -0.78); and (3) appears to predict the patient's ability to go outside alone safely. These data suggest that the timed "Up & Go" test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time. The test is quick, requires no special equipment or training, and is easily included as part of the routine medical examination.