Background
The Mini Mental State Examination (MMSE) is a cognitive test that is commonly used as part of the evaluation for possible dementia.

Objectives
To determine the diagnostic accuracy of the Mini-Mental State Examination (MMSE) at various cut points for dementia in people aged 65 years and over in community and primary care settings who had not undergone prior testing for dementia.

Search methods
We searched the specialised register of the Cochrane Dementia and Cognitive Improvement Group, MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), LILACS (BIREME), ALOIS, BIOSIS previews (Thomson Reuters Web of Science), and Web of Science Core Collection, including the Science Citation Index and the Conference Proceedings Citation Index (Thomson Reuters Web of Science). We also searched specialised sources of diagnostic test accuracy studies and reviews: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). We attempted to locate possibly relevant but unpublished data by contacting researchers in this field. We first performed the searches in November 2012 and then fully updated them in May 2014. We did not apply any language or date restrictions to the electronic searches, and we did not use any methodological filters as a method to restrict the search overall.

Selection criteria
We included studies that compared the 11-item (maximum score 30) MMSE test (at any cut point) in people who had not undergone prior testing versus a commonly accepted clinical reference standard for all-cause dementia and subtypes (Alzheimer disease dementia, Lewy body dementia, vascular dementia, frontotemporal dementia). Clinical diagnosis included all-cause (unspecified) dementia, as defined by any version of the Diagnostic and Statistical Manual of Mental Disorders (DSM); International Classification of Diseases (ICD) and the Clinical Dementia Rating.

Data collection and analysis
At least three authors screened all citations.Two authors handled data extraction and quality assessment. We performed meta-analysis using the hierarchical summary receiver-operator curves (HSROC) method and the bivariate method.

Main results
We retrieved 24,310 citations after removal of duplicates. We reviewed the full text of 317 full-text articles and finally included 70 records, referring to 48 studies, in our synthesis. We were able to perform meta-analysis on 28 studies in the community setting (44 articles) and on 6 studies in primary care (8 articles), but we could not extract usable 2 x 2 data for the remaining 14 community studies, which we did not include in the meta-analysis. All of the studies in the community were in asymptomatic people, whereas two of the six studies in primary care were conducted in people who had symptoms of possible dementia. We judged two studies to be at high risk of bias in the patient selection domain, three studies to be at high risk of bias in the index test domain and nine studies to be at high risk of bias regarding flow and timing. We assessed most studies as being applicable to the review question though we had concerns about selection of participants in six studies and target condition in one study.

The accuracy of the MMSE for diagnosing dementia was reported at 18 cut points in the community (MMSE score 10, 14-30 inclusive) and 10 cut points in primary care (MMSE score 17-26 inclusive). The total number of participants in studies included in the meta-analyses ranged from 37 to 2727, median 314 (interquartile range (IQR) 160 to 647). In the community, the pooled accuracy at a cut point of 24 (15 studies) was sensitivity 0.85 (95% confidence interval (CI) 0.74 to 0.92), specificity 0.90 (95% CI 0.82 to 0.95); at a cut point of 25 (10 studies), sensitivity 0.87 (95% CI 0.78 to 0.93), specificity 0.82 (95% CI 0.65 to 0.92); and in seven studies that adjusted accuracy estimates for level of education, sensitivity 0.97 (95% CI 0.83 to 1.00), specificity 0.70 (95% CI 0.50 to 0.85). There was insufficient data to evaluate the accuracy of the MMSE for diagnosing dementia subtypes.We could not estimate summary diagnostic accuracy in primary care due to insufficient data.

Authors' conclusions
The MMSE contributes to a diagnosis of dementia in low prevalence settings, but should not be used in isolation to confirm or exclude disease. We recommend that future work evaluates the diagnostic accuracy of tests in the context of the diagnostic pathway experienced by the patient and that investigators report how undergoing the MMSE changes patient-relevant outcomes.

/pdf/mini-mental-state-examination-mmse-for-the-detection-of-2hf8fes1sc.pdf

Mini‐Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations

Brain health: the importance of recognizing cognitive impairment: an IAGG consensus conference.

Cognitive impairment creates significant challenges for patients, their families and friends, and clinicians who provide their health care Early recognition allows for diagnosis and appropriate treatment, education, psychosocial support, and engagement in shared decision-making regarding life planning, health care, involvement in research, and financial matters An IAGG-GARN consensus panel examined the importance of early recognition of impaired cognitive health Their major conclusion was that case-finding by physicians and health professionals is an important step toward enhancing brain health for aging populations throughout the world This conclusion is in keeping with the position of the United States' Centers for Medicare and Medicaid Services that reimburses for detection of cognitive impairment as part the of Medicare Annual Wellness Visit and with the international call for early detection of cognitive impairment as a patient's right The panel agreed on the following specific findings: (1) validated screening tests are available that take 3 to 7 minutes to administer; (2) a combination of patient- and informant-based screens is the most appropriate approach for identifying early cognitive impairment; (3) early cognitive impairment may have treatable components; and (4) emerging data support a combination of medical and lifestyle interventions as a potential way to delay or reduce cognitive decline

Brain health: the importance of recognizing cognitive impairment: an IAGG consensus conference

Os estudantes de Medicina compoem um grupo susceptivel aos transtornos do sono, em razao da carga curricular em horario integral, das atividades extracurriculares e da forte pressao e estresse, com exigencia de alto rendimento e tempo demandado em estudos. O objetivo deste trabalho foi avaliar os habitos do sono dos estudantes da graduacao e residentes da Faculdade de Medicina da Universidade Federal de Goias, a fim de identificar os principais fatores que afetam a qualidade do sono. Foram analisados 276 estudantes, sendo 234 (84,7%) academicos e 42 (18,2%) residentes. Aplicou-se o questionario Indice de Qualidade do sono de Pittsburg (PSQI) e a escala de sonolencia de Epworth. A analise dos questionarios revelou associacao estatisticamente significante entre sonolencia e qualidade do sono (RR:1,108; IC 95% 1,0047 - 1,2240). O trabalho demonstrou que estudantes com sonolencia diurna excessiva apresentam pior qualidade de sono; e uma variacao significativa da prevalencia da sonolencia diurna excessiva e da qualidade ruim do sono entre as amostras de primeiro ano de graduacao e residentes.

/pdf/avaliacao-da-qualidade-do-sono-em-estudantes-de-medicina-4j70rrcifu.pdf

Avaliação da qualidade do sono em estudantes de Medicina

Relationship between chronotype and quality of sleep in medical students at the Federal University of Paraiba, Brazil.

Dementia is a global public health problem and detection in the primary care setting, particularly in developing countries, is challenging. The aim of this research was to produce the cross-cultural validation of the AD8 interview to the Brazilian Portuguese Language. The original version of the AD8 was submitted to translation, back-translation, and application of the questionnaire to 20 elderly informants for face validation. The AD8-Brazil was then evaluated in 109 community-dwelling elderly with a sociodemographic questionnaire, clinical examination, Mini Mental State Examination (MMSE), Katz Inventory of Activities of Daily Living (ADL), and Clinical Dementia Rating scale (CDR). The AD8-Brazil was compared with the other instruments and with the clinical diagnosis (DSM-IV) for criterion validation. There was significant agreement of AD8-Brazil with diagnosis of dementia (p 0 (area under the curve 86.1%) and between CDR 0 and CDR 0.5 (area under the curve 76.9%). The administration of the questionnaire took 2.3 ± 0.1 minutes. The Brazilian version of the AD8 is a valid, reliable, quick, and easy screening instrument for dementia.

AD8-Brazil: cross-cultural validation of the ascertaining dementia interview in Portuguese.

Padrão do ciclo sono-vigília e sonolência excessiva diurna em estudantes de medicina

http://www.scielo.br/pdf/rbp/v24n1/11309.pdf

Characterization of depressive syndrome in schizophrenic outpatients

Realizou-se uma revisao da literatura acerca da presenca de depressao em pacientes esquizofrenicos e, em particular, da depressao pos-esquizofrenica (DPE). A pesquisa foi realizada por meio do Medline, envolvendo os anos de 1966 e 2000, com o objetivo de identificar artigos originais e de revisao. Focalizaram-se os seguintes topicos: dados historicos, principais estudos, quadro clinico e curso evolutivo, diagnostico e diagnostico diferencial, etiopatogenia e prognostico. Conclui-se que a depressao pos-esquizofrenica tem plena autonomia sindromica, deve ser considerada uma manifestacao clinica das formas delirantes da esquizofrenia e integra o curso evolutivo de um transtorno esquizofrenico.

/pdf/depressao-em-esquizofrenia-depression-in-schizophrenia-1vjy42x10r.pdf

Depressão em esquizofrenia Depression in schizophrenia

(Suassuna, 1996). However, art produced by mental patients has also been termed psychopathological art, an expression which greatly displeases me for there is no such thing as sick, psychotic or mad art and neither can a work of art be said to be mentally ill. For this reason, I would rather refer to it by the scholarly term previously referred.In the context of art produced by the mentally ill, it is extremely important to tell the artist – amateur or professional – who has exercised his technical skills from the insane that eventually became an artist, i.e., a psychiatric patient who either spontaneously or through occupational therapy started producing plastic arts or literary works. It is evident that both the works produced before the presentation of any pathological symptoms and the ones produced after them provide clear clues as to the morbid processes which have been developing in the patient’s mind (conscious and unconscious psychic life).

/pdf/camille-claudel-a-revulsion-of-nature-the-art-of-madness-or-3d055yahgf.pdf

Othon Bastos

Papers

AD8-Brazil: cross-cultural validation of the ascertaining dementia interview in Portuguese.

Padrão do ciclo sono-vigília e sonolência excessiva diurna em estudantes de medicina

Characterization of depressive syndrome in schizophrenic outpatients

Depressão em esquizofrenia Depression in schizophrenia

Camille Claudel: a revulsion of nature. The art of madness or the madness of art?