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Journal ArticleDOI

“Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician

TL;DR: 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.
About: This article is published in Journal of Psychiatric Research.The article was published on 1975-11-01. It has received 76181 citations till now. The article focuses on the topics: Cognitive decline & Cognitive Intervention.
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Journal ArticleDOI
TL;DR: In this article, the authors investigated how structured viewing of paintings in a public art gallery, followed by an art-making visual response, might affect cognition and found that episodic memory could be enhanced through aesthetic responses to visual art, although effects on verbal fluency were more ambiguous.
Abstract: Aesthetic responses associated with viewing visual art have recently been shown to have positive effectsfor people with dementia. The current exploratory study investigated how structured viewing of paintingsin a public art gallery, followed by an art-making visual response, might affect cognition. Through anovel use of audio recordings and content analysis, utilizing a mixed-methods pre-post design with4-week follow-up, the study sought to explore if art viewing and art making, in an art gallery setting, hadan impact on episodic memory and verbal fluency. The findings suggested that episodic memory couldbe enhanced through aesthetic responses to visual art, although effects on verbal fluency were moreambiguous. Family caregivers (FC), who were also part of the study, substantiated these findings but alsoreported that their family member with dementia showed improved mood, confidence, and reducedisolation during the art gallery sessions. The results support the need for additional research to furtherinvestigate the potential positive impact of visual art and aesthetic stimulation on people with a dementia.Keywords: aesthetics, content analysis, dementia, verbal fluency, episodic memorySupplemental materials: http://dx.doi.org/10.1037/a0027499.supp

96 citations

Journal ArticleDOI
TL;DR: A human population-based cohort with graded severity of existing Cognitive impairment and a mouse model with progressing neurodegeneration both indicate that the risk of delirium increases with greater severity of pre-existing cognitive impairment and neuropathology.
Abstract: Background: Delirium is a profound neuropsychiatric disturbance precipitated by acute illness. Although dementia is the major risk factor this has typically been considered a binary quantity (i.e., cognitively impaired versus cognitively normal) with respect to delirium risk. We used humans and mice to address the hypothesis that the severity of underlying neurodegenerative changes and/or cognitive impairment progressively alters delirium risk. Methods: Humans in a population-based longitudinal study, Vantaa 85þ, were followed for incident delirium. Odds for reporting delirium at follow-up (outcome) were modeled using random-effects logistic regression, where prior cognitive impairment measured by Mini-Mental State Exam (MMSE) (exposure) was considered. To address whether underlying neurodegenerative pathology increased susceptibility to acute cognitive change, mice at three stages of neurodegenerative disease progression (ME7 model of neurodegeneration: controls, 12 weeks, and 16 weeks) were assessed for acute cognitive dysfunction upon systemic inflammation induced by bacterial lipopolysaccharide (LPS; 100 mg/kg). Synaptic and axonal correlates of susceptibility to acute dysfunction were assessed using immunohistochemistry. Results: In the Vantaa cohort, 465 persons (88.4 � 2.8 years) completed MMSE at baseline. For every MMSE point lost, risk of incident delirium increased by 5% (p ¼ 0.02). LPS precipitated severe and fluctuating cognitive deficits in 16-week ME7 mice but lower incidence or no deficits in 12-week ME7

96 citations

Journal ArticleDOI
TL;DR: The CERad battery is a valid and reliable neuropsychological tool that may assist in the detection and diagnosis of Alzheimer's disease in Australian populations and risk factors for cognitive decline indicated by the CERAD battery include age, education and gender.
Abstract: Objective: The current study examined the performance of a healthy ageing population on the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological test battery in order to determine norms for use in an Australian setting. The effects of age, education, gender and mood on cognitive performance in healthy older individuals were also explored.Method: The CERAD neuropsychological battery was administered to a sample of healthy elderly subjects (n = 243). Subjects also completed an anxiety inventory and a depression scale. Means and standard deviations of different age, gender and education groups are reported as normative data. A Principal Components Analysis (PCA) was also calculated. Linear regression was applied to the five factors extracted from the PCA using age, education, gender and mood as independent variables.Results: All recorded means were within 1 SD of those reported in the original CERAD normative study. Five factors that loaded on measures of memory and learning,...

96 citations


Cites methods from "“Mini-mental state”: A practical me..."

  • ...These factors loaded on measures of memory and learning (word list recall, word list learning trials 1–3 and word recognition-yes), language (verbal fluency, categorical naming), praxis (constructional line drawing, word recognition-no), executive function (MMSE subscales attention/concentration and recall) and registration/orientation (MMSE subscales orientation, registration and language)....

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  • ...Exclusion criteria included meeting the National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer’s Disease and Related Disorders A s s o c i a t i o n (NINCDS–ADRDA) criteria for dementia [15], a score below 28 on the Mini-Mental State Examination (MMSE) [16] or above the age-appropriate limit on the Short Blessed Test (SBT) [17], the presence of two or more abnormal neurological signs indicated by the CERAD neurological examination [18], past or current history of stroke, hypertension, major vascular disorder, heart disease, head injury, e p i l e p s y, diabetes, thyroid disease, major depressive or anxiety disorder or any other psychiatric illness....

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  • ...The SBT [ 1 7 ] , a cognitive screening test not unlike the MMSE, on which higher scores indicate more errors and a greater likelihood of cognitive decline, was also administered....

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  • ...On factors 2 and 5, both of which consisted wholly of MMSE subscales, no Beta values reached significance (see Table 3)....

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  • ...Group means and (SD) for education, age and gender categories on Consortium to Establish a Registry for Alzheimer’s Disease measures, the Nelson Adult Reading Test and the Short Blessed Test ≥ 12years education < 12years education 50–69 years 70 + years 50–69 years 70 + years Male Female Male Female Measure n = 34 n = 77 n = 10 n = 15 n= 77 n= 31 MMSE 28.9(1.2) 28.8(1.2) 27.7(1.3) 28.1(2.0) 28.4(1.2) 27.9(1.8) Fluency 20.9(5.9) 23.1(5.6) 20.8(5.4) 19.5(4.9) 19.0(4.2) 18.4(5.7) Naming 14.5(0.7) 14.6(0.6) 14.7(0.5) 14.1(1.2) 14.3(0.9) 14.0(1.1) Praxis 9.7(1.3) 9.90(1.0) 9.3(2.2) 9.2(1.3) 9.6(1.1) 8.9(1.7) Word learn 1 5.6(1.3) 6.7(1.4) 4.3(1.3) 6.3(1.3) 6.2(1.4) 5.7(1.5) Word learn 2 7.2(1.4) 8.1(1.4) 5.0(1.6) 7.9(1.5) 7.5(1.4) 7.0(1.3) Word learn 3 7.7(1.3) 9.1(1.1) 5.4(1.6) 7.9(2.0) 8.2(1.3) 7.2(1.7) Delay recall 6.9(1.6) 8.2(1.4) 4.9(1.9) 6.9(2.5) 7.1(1.6) 5.9(2.3) Savings 89.9(17.0) 90.3(11.4) 94.0(36.9) 85.3(29.8) 86.1(16.4) 82.6(33.5) Rec-yes 9.8(0.5) 9.8(0.4) 9.2(0.9) 9.7(0.5) 9.8(0.5) 9.1(2.1) Rec-no 9.8(0.5) 9.9(0.1) 9.8(0.4) 10.0(0.0) 9.9(0.5) 9.6(0.7) FSIQ 120.6(4.6) 122.4(3.67 122.0(4.3) 121.5(4.3) 126.9(5.8) 119.2(4.7) SBT 2.1(2.8) 1.3(2.2) 2.4(2.8) 1.7(2.6) 2.4(2.6) 3.2(3.8) MMSE, Mini-Mental State Examination; fluency, categorical verbal fluency; Naming, modified Boston naming; Praxis, constructional praxis line drawing; Word learn 1–3, word list learning trials 1–3; Delay recall, delayed recall of word lists; Savings, delay recall/word learn 3 x 100; Rec-yes/no, word list recognition yes and no; FSIQ, Nelson Adult Reading Test fullscale intelligence; SBT, Short Blessed Test....

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Journal ArticleDOI
TL;DR: The aim is to improve nighttime sleep in nursing home patients and to provide evidence-based advice on how to improve the quality of sleep in the night.
Abstract: OBJECTIVES: To improve nighttime sleep in nursing home patients. DESIGN: Controlled clinical trial. SETTING: Eight community nursing homes enrolled two at a time. PARTICIPANTS: Of 1,077 patients assessed in the eight nursing homes, 638 (59%) were eligible, and consent was obtained for 273 (43% of those eligible). Of the 230 who underwent baseline assessments, 173 completed the immediate-intervention phase of the trial (77 in the intervention group and 96 in the control group). A total of 160 subjects completed the intervention (77 in the immediate-intervention group and 83 in the delayed-intervention phase). INTERVENTION: Trained research staff provided the intervention, which included daytime physical activity and attempts to keep subjects out of bed, evening bright light exposure, a consistent bedtime routine, nighttime care routines designed to minimize sleep disruption, and strategies to reduce nighttime noise. Subjects from one nursing home received the intervention (Group 1), whereas subjects in the second nursing home served as a control group (Group 2); then Group 2 received the intervention. MEASUREMENTS: Primary outcomes included measures of sleep recorded using wrist actigraphy in all subjects and polysomnography in a subgroup of subjects. Secondary measures included assessments of mood and behavior using the Neuropsychiatric Inventory, the Geriatric Depression Scale, and behavioral observations. RESULTS: There were no significant differences in any of the primary actigraphic sleep outcome measures between the intervention and control group after the immediate-intervention phase of the trial. In the 160 subjects who completed the intervention, there were no significant changes in any actigraphic measure of nighttime sleep, nor were there any significant changes in measures of sleep in the 45 subjects who had baseline and intervention polysomnography. CONCLUSION: This multicomponent, nonpharmacological intervention conducted by trained research staff had no effect on nighttime sleep in this sample of nursing home patients. Enhanced nonpharmacological interventions should be developed and tested and combined with environmental interventions to mitigate noise when feasible. Adjunctive drug therapy may be needed to improve sleep in a substantial proportion of this population and should be tested in addition to nonpharmacological interventions in rigorous clinical trials.

96 citations

Journal ArticleDOI
TL;DR: In older adults, decreased ability to perceive limb position may be related to a sedentary lifestyle and declines associated with memory and transfer of proprioceptive information, and performing tasks specific to the upper limbs may reduce age-related declines in proprioception.
Abstract: Our understanding of age-related declines in upper limb proprioceptive abilities is limited. Furthermore, the extent to which physical activity might ameliorate age-related changes in proprioception is not known. Upper limb proprioceptive acuity was examined in young and older (active and sedentary) right-handed adults using a wrist-position-matching task that varied in terms of processing demands. Older individuals were also classified according to their participation in tasks specific to the upper limb. Errors were greater for older than younger individuals. Older sedentary adults showed greater errors and performed movements less smoothly than older active adults. The nonspecific group showed greater errors and longer movement times than the upper-limb-specific group. In older adults, decreased ability to perceive limb position may be related to a sedentary lifestyle and declines associated with memory and transfer of proprioceptive information. Performing tasks specific to the upper limbs may reduce a...

96 citations

References
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01 Jan 1965

84 citations

Journal ArticleDOI
TL;DR: Three parallel forms of the clinical tests of the sensorium were devised, tried out and modified on two groups of 24 subjects and correlated moderately well when repeated.
Abstract: Three parallel forms of the clinical tests of the sensorium were devised, tried out and modified on two groups of 24 subjects. The final versions were further assessed by using each form in turn with 108 psychiatric patients. The three forms of tests gave scores with very similar means and standard deviations. They correlated moderately well when repeated.

57 citations

Journal ArticleDOI
TL;DR: The present paper has attempted to attack the problem of differential “memory function” by examining the discriminating power of certain test results as between “functional”, “doubtful” and “organic” groups of elderly patients, showing that the best discrimination between the groups is achieved by a simple perceptual task.
Abstract: 1. The aim of the research is to examine the relationship of certain aspects of mental functioning to the psychiatric illnesses of old age. The present paper has attempted to attack the problem of differential “memory function” by examining the discriminating power of certain test results as between “functional”, “doubtful” and “organic” groups of elderly patients. 2. The design of the present study shows that spuriously positive results may arise from inadequate control over factors contributing to the selection of the criterion groups. 3. The investigation fails to confirm, for the patients tested, the diagnostic usefulness of certain tests in common use. 4. The results fail to confirm the predictions of “Ribot's Law” as applied to memory in these elderly patients. 5. The study shows significant differences between the means of the results of the psychiatric groups on some tasks which appear to involve “memory function”. These differences cannot be accounted for merely in terms of group differences in general intelligence. The nature of the possible underlying “memory function” remains to be further examined. 6. The investigation so far shows that the best discrimination between the groups is achieved by a simple perceptual task (Bender Gestalt). 7. The study fails to show differences between groups on any of the tests which are sufficiently great to enable these tests to be immediately employed as useful diagnostic instruments.

55 citations

Journal ArticleDOI
TL;DR: It is shown that tests for senility should be short, especially those with oral questions, because of straying attention, impaired comprehension, and short retention, andPerseveration is greatly increased in senescence; it can be brought out merely by having a succession of short, varied items.
Abstract: A tentative battery of 25 short tests for the measurement of senescence is described ( cf. Table I). The scale is the result of the application of nearly 80 tests to senile patients in three London hospitals. It was administered in full to 38 patients in all, and the present findings refer to a group of 20 less seriously demented ones, with an age range of 68 to 83. The tests are classified into three groups according to the degree of difficulty experienced by the seniles (Table II). The divisions were made on the basis of a number of criteria which emerged during the working up of the results, and are only pointers to the kind of functions involved. Briefly, the most difficult tests were those in which subjects were required to break away from old mental habits and adapt to unfamiliar situations, tests of recent memory (logical), of judgment, planning, and reasoning, or embodying difficult or lengthy instructions. Less difficulty was found with such tests as rote memory, fluency of associations, simple arithmetic, and vocabulary. Performance seemed to be least affected on tests of visual recognition, old mental habits, and simple motor tasks. It is shown that tests for senility should be short, especially those with oral questions, because of straying attention, impaired comprehension, and short retention. Perseveration is greatly increased in senescence; it can be brought out merely by having a succession of short, varied items. There is a loss of steadiness and speed on the motor side. The disturbing effect of tests with a time element on the slower acting senile is noted. The present mental status of the patients is estimated on eleven tests which are scored on the (outmoded) mental age method (Table I): the average of these is between M.A. 10 and 11. This figure is compared with previous reports on the decline of intelligence. An estimate of the former mental status of each patient is made by means of efficiency quotients on part of the “Bellevue” scale. These relate each score to the average level for the peak age-group of 20 to 24 years (Table III). The use of the vocabulary score as an index of former level is discussed. A comparison of score variation within individuals with variation between individuals shows a ratio of the former to the latter of approximately 85 per cent. Variability of scores within individuals increases with age inside the patient group, also with lower intelligence. A shortened version of the scale, which takes about 40 minutes, is indicated (Table I).

19 citations