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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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TL;DR: The results suggest that functional activity of the bilateral superior parietal lobules is closely related to performance time on the TMT-A, which might be a promising index of dysfunction of the superiorParietal area among mild AD patients.
Abstract: Background/Aims: The Trail Making Test (TMT) has long been used to investigate deficits in cognitive processing speed and executive function in humans. However, t

2,862 citations

Journal ArticleDOI
TL;DR: Transfer of adult patients with severe but potentially reversible respiratory failure, whose Murray score exceeds 3.0 or who have a pH of less than 7.20 on optimum conventional management, to a centre with an ECMO-based management protocol is recommended to significantly improve survival without severe disability.

2,783 citations

Journal ArticleDOI
TL;DR: High-intensity resistance exercise training is a feasible and effective means of counteracting muscle weakness and physical frailty in very elderly people, in contrast to multi-nutrient supplementation without concomitant exercise, which does not reduce muscle weakness orPhysical frailty.
Abstract: Background Although disuse of skeletal muscle and undernutrition are often cited as potentially reversible causes of frailty in elderly people, the efficacy of interventions targeted specifically at these deficits has not been carefully studied. Methods We conducted a randomized, placebo-controlled trial comparing progressive resistance exercise training, multinutrient supplementation, both interventions, and neither in 100 frail nursing home residents over a 10-week period. Results The mean (±SE) age of the 63 women and 37 men enrolled in the study was 87.1 ±0.6 years (range, 72 to 98); 94 percent of the subjects completed the study. Muscle strength increased by 113 ±8 percent in the subjects who underwent exercise training, as compared with 3 ±9 percent in the nonexercising subjects (P<0.001). Gait velocity increased by 11.8 ±3.8 percent in the exercisers but declined by 1.0 ±3.8 percent in the nonexercisers (P = 0.02). Stair-climbing power also improved in the exercisers as compared with the nonexercis...

2,722 citations

Journal ArticleDOI
12 May 1993-JAMA
TL;DR: Results presented should prove to be useful to clinicians who wish to compare an individual patient's MMSE scores with a population reference group and to researchers making plans for new studies in which cognitive status is a variable of interest.
Abstract: Objective —To report the distribution of Mini-Mental State Examination (MMSE) scores by age and educational level Design —National Institute of Mental Health Epidemiologic Catchment Area Program surveys conducted between 1980 and 1984 Setting —Community populations in New Haven, Conn; Baltimore, Md; St Louis, Mo; Durham, NC; and Los Angeles, Calif Participants —A total of 18 056 adult participants selected by probability sampling within census tracts and households Main Outcome Measures —Summary scores for the MMSE are given in the form of mean, median, and percentile distributions specific for age and educational level Results —The MMSE scores were related to both age and educational level There was an inverse relationship between MMSE scores and age, ranging from a median of 29 for those 18 to 24 years of age, to 25 for individuals 80 years of age and older The median MMSE score was 29 for individuals with at least 9 years of schooling, 26 for those with 5 to 8 years of schooling, and 22 for those with 0 to 4 years of schooling Conclusions —Cognitive performance as measured by the MMSE varies within the population by age and education The cause of this variation has yet to be determined Mini-Mental State Examination scores should be used to identify current cognitive difficulties and not to make formal diagnoses The results presented should prove to be useful to clinicians who wish to compare an individual patient's MMSE scores with a population reference group and to researchers making plans for new studies in which cognitive status is a variable of interest (JAMA 1993;269:2386-2391)

2,717 citations

Journal ArticleDOI
15 Nov 1995-JAMA
TL;DR: Patients with asymptomaticCarotid artery stenosis of 60% or greater reduction in diameter and whose general health makes them good candidates for elective surgery will have a reduced 5-year risk of ipsilateral stroke if carotid endarterectomy performed with less than 3% perioperative morbidity and mortality is added to aggressive management of modifiable risk factors.
Abstract: Objective —To determine whether the addition of carotid endarterectomy to aggressive medical management can reduce the incidence of cerebral infarction in patients with asymptomatic carotid artery stenosis Design —Prospective, randomized, multicenter trial Setting —Thirty-nine clinical sites across the United States and Canada Patients —Between December 1987 and December 1993, a total of 1662 patients with asymptomatic carotid artery stenosis of 60% or greater reduction in diameter were randomized; follow-up data are available on 1659 At baseline, recognized risk factors for stroke were similar between the two treatment groups Intervention —Daily aspirin administration and medical risk factor management for all patients; carotid endarterectomy for patients randomized to receive surgery Main Outcome Measures —Initially, transient ischemic attack or cerebral infarction occurring in the distribution of the study artery and any transient ischemic attack, stroke, or death occurring in the perioperative period In March 1993, the primary outcome measures were changed to cerebral infarction occurring in the distribution of the study artery or any stroke or death occurring in the perioperative period Results —After a median follow-up of 27 years, with 4657 patient-years of observation, the aggregate risk over 5 years for ipsilateral stroke and any perioperative stroke or death was estimated to be 51% for surgical patients and 110% for patients treated medically (aggregate risk reduction of 53% [95% confidence interval, 22% to 72%]) Conclusion —Patients with asymptomatic carotid artery stenosis of 60% or greater reduction in diameter and whose general health makes them good candidates for elective surgery will have a reduced 5-year risk of ipsilateral stroke if carotid endarterectomy performed with less than 3% perioperative morbidity and mortality is added to aggressive management of modifiable risk factors ( JAMA 1995;273:1421-1428)

2,714 citations

References
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Book
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