Dissertations / Theses on the topic 'Mini-Mental State Examination (MMSE)'

It was the goal of this study to examine the ecological validity of a number of measures of mental status for geriatric individuals. Subjects were 40 alert, ambulatory male VA patients. Mental status instruments included the Mini-Mental State Examination (MMSE), the Wechsler Memory Scale (WMS) and the Vocabulary subtest of the WAIS-R. Measures of functional behavior included the Woodcock-Johnson Scales of Independent Behavior (SIB) and the Parachek Geriatric Behavior Rating Scale (PGBRS). Significant relationships were found between the MMSE and the SIB, between the WMS and the SIB, and between the WMS and the PGBRS. It was found that estimation of functional behavior can be enhanced significantly through the use of battery of mental status instruments.

Introdução: O comprometimento cognitivo (CC) na Esclerose Múltipla (EM) possui taxas de prevalência de 43% a 70% e pode surgir desde a Síndrome Clinicamente Isolada (CIS) aos estágios iniciais da EM. O CC na EM pode evoluir independentemente dos sinais e sintomas motores, dos resultados do EDSS e ausência de lesões ativas (captantes) na Ressonância Magnética. Neste contexto, o Multiple Sclerosis National Questionaire (MSNQ) e o protocolo Brief International Cognitive Assesment for Multiple Sclerosis (BICAMS) são instrumentos internacionais empregados para a triagem e o monitoramento nos centros de atendimento para os pacientes com EM. Estudos posteriores e reuniões do mesmo comitê concluíram que o MSNQ possui várias limitações por ser uma medida não objetiva e a triagem única pelo Symbol Digit Modalities Test (SDMT) por si só não é capaz de acessar outras áreas que podem estar comprometidas na EM. Com a segunda revisão do MMSE, e na falta de instrumentos de triagem objetivos capazes de triar os pacientes que precisassem ser melhor acompanhados pelo BICAMS, buscou-se no presente estudo criar a partir do BICAMS e do MMSE-2 uma medida rápida para triagem, que tivesse medidas de memória episódica, velocidade de processamento, atenção e memória operacional. Objetivo: Para obter uma ferramenta de triagem para este propósito (MMSE-MS) foram conduzidos estudos de adaptação segundo o estímulo: estudo de protótipos, estudo de adaptação, propriedades psicométricas e normas do MMSE-2 (como a nossa ferramenta experimental) e estudo preliminar de desenvolvimento de uma ferramenta objetiva de triagem para EM, com base no MMSE-3. Métodos: Todos os estudos de tradução e adaptação foram conduzidos seguindo um mesmo método, já amplamente utilizado pela literatura. O primeiro estudo consistiu no estudo convencional e de protótipos para verificar qual possuía melhor estimativa de equivalência entre as culturas. O segundo estudo consistiu em adaptar, verificar as propriedades psicométricas e estabelecer normas para o MMSE-2. Similarmente ao estudo anterior, um juiz internacional discutiu os resultados do estudo de adaptação para estabelecimento dos parâmetros de transculturalidade. O último estudo foi realizado com o objetivo de obter uma ferramenta com estimativas de sensibilidade e especificidade similares ao BICAMS, mas que fosse designada à triagem dos pacientes que são elegíveis para ser acompanhados pelo BICAMS. Para tal participaram do primeiro estudo, 374 voluntários da comunidade e 25 pacientes com EM. No segundo e terceiro estudo, participaram 128 pacientes com EM e 602 voluntários saudáveis. Todos os estudos clínicos e com as amostras da comunidade foram realizados no período de 2013 à 2015 e contaram com a parceria em pesquisa do Instituto Brasileiro de Neuropsicologia (IBNeuro) e do Laboratório de Instrumentação e Avaliação Psicológica (LABIAP). A coleta de pacientes foi realizada no Ambulatório de Neuroimunologia do Hospital das clínicas da Faculdade de Medicina de Ribeirão Perto (FMRP-USP). Resultados: No primeiro estudo, foram mantidas 5 palavras das 15 da versão original. A razão para as modificações na lista Brasileira foram as diferenças entre a divisão silábica, extensão das palavras e presença de protótipos. Verificou-se ainda que até a quarta palavra evocada na nossa cultura em cada categoria semântica foram as mesmas que foram evocadas na língua nativa do instrumento, mas a ordem da frequência variou dentro de cada categoria, mostrando que embora existam palavras que são prototípicas às duas culturas na classificação semântica global, o contexto cultural interfere muito quando partimos para as especificidades dentro de cada classificação e categoria semântica. O MMSE-2 também apresentou estimativas de validade e precisão comum às duas culturas. No quarto estudo, as medidas do MMSE-2 que tiveram melhor relação com o BICAMS e índices de sensibilidade e especificidade parecidos foram as medidas da tarefa de evocação, atenção e cálculo, memória de histórias e codificação dígitos-símbolos. As correlações selecionadas foram aquelas classificadas em moderadas e fortes. Como segundo critério, as medidas do MMSE-2 foram comparadas às medidas do BICAMS pela curva ROC. As medidas do MMSE- 2 que tiveram especificidade e sensibilidade significativas (p<0,001) foram as elegíveis para compor o teste de triagem. Como a tarefa de codificação dígitos-símbolos é susceptível à demanda motora, optou-se pelo uso da forma oral do SDMT em conjunto. Deste modo, no nosso instrumento de triagem, normas para este instrumento foram criadas a partir da soma dos itens do MMSE-MS com o SDMT oral. Conclusão: A integração de dados desses diversos estudos evidencia cautela quanto aos procedimentos de adaptação empregados para adaptação transcultural das tarefas que são de origem verbal e semântica. Há também evidências da necessidade de instrumentos capazes de triar esses pacientes. Para tal, o MMSE-EM mostrou-se válido, preciso, com índices de sensibilidade e especificidade similares ao BICAMS, com normas ajustadas ao contexto Brasileiro.
Background: The cognitive impairment (CI) in Multiple Sclerosis (MS) has the prevalence rate from 43% to 70% and may occur from the Clinically Isolated Syndrome (CIS) to the early stages of MS. The CI in MS can advance independently of motor signs and symptoms, EDSS scores and MRI stable. In this context, the National Multiple Sclerosis Questionnaire (MSNQ) and the International Brief Cognitive Assesment for Multiple Sclerosis (BICAMS) are international tools used to screening and monitoring MS patients in care centers. Further studies and meetings provided by same committee alluded that MSNQ has several limitations for being a non-objective measure and the screening using the Symbol Digit Modalities Test (SDMT) alone is not effective because other areas that may be impaired in MS is not screened. With the second revision of the MMSE, and the lack of objective screening tools to quikly screening MS patients that needed to be monitored by BICAMS, we aimed in the presente study to create a fast measurement to screening the episodic memory, processing speed, attention and working memory from BICAMS and MMSE-2. Objective: To obtain brief a screening tool for MS (MMSE-MS) were conducted four studies using different tools: first the prototype study to development of CVLT-2 lists, adaptation, psychometric properties and normative data of BICAMS to the Braziliam context (as our gold standard), Cross cultural adaptation, psychometric properties, and normative data of MMSE-2 (the experimental tool) and the preliminary study of development of MMSE-MS. Methods: All translation and adaptation studies were conducted following the same method, as widely used in the literature. The first study consisted of conventional adaptation and prototypical norms, aiming to see which had the best estimates of equivalence between the cultures. The second study with BICAMS protocol show that MS scored significantly lower on all BICAMS tests. At the end of the study, the results were discussed with a member of the international committee to confirm the evidences of transculturality between the original and Brazilian versions. The third study consisted of Adapt, to investigate the psychometric properties and stablish normative data to the MMSE-2. Similarly to the previous study, an international judge discussed the results of the study of adaptation to identify the estimatives of transculturality. The fourth and last study was conducted in order to obtain a tool with sensitivity and similar specificity estimates BICAMS, but it was designed to screen patients who are eligible to be accompanied by BICAMS. Participated of the first study, 374 healthy volunteers and 25 patients with MS. In the second and third study participated 128 MS patients and 602 healthy volunteers. All clinical studies and community samples were carried out from 2013 to 2015 and had the partnership of the Brazilian Institute of Neuropsychology (IBNeuro) and the Laboratory of Instrumentation and Psychological Assessment (LABIAP). The collection of patients was performed at the Neuroimmunology Outpatient Clinic from Ribeirão Preto Medical School (FMRP-USP). Results: In the first study, were kept 5 words of 15 from the original American version. The reason for these changes in the Brazilian list were the differences between the syllabic division, extension of the words and the presence of prototypicall words. Was also found that until the fourth word evoked in our culture, in each semantic category were the same as those mentioned in the native language, but the order of the frequency varied within each category, indicating that although there are words that are prototypically commom between the two cultures in the overall semantic classification, the cultural context changes when we analyse the specifics prototipically words inside of each classification and semantic categories. To the second study, the BICAMS showed similar estimates of reliability and validity for current use as monitoring tool for MS in the Brazilian contexto, supporting the diagnostic validity of the Brazilian-Portuguese adaptation The normative data were satisfactory (p <0.001) in relation to the vocational status. The third study, with MMSE-2 also provided good estimates of validity and precision to the both cultures. To the fourth study, the MMSE-2 was compared to the BICAMS. The MMSE-2 tasks which had similar sensitivity and specificity to the BICAMS protocol was the recalling, attention and calculation, history memory and processing speed (Symbol Digit-coding). The selected tasks were those classified as moderate and Strong correlations. The second procedure consisted on comparisions among the MMSE-2 measurements and BICAMS using ROC curve. So, the MMSE-2 measures that had significant (p <0.001) specificity and sensitivity and similar area under the curve (ROC) were eligible to composse the screening tool. As the digit-symbol coding task is susceptible to motor demand, we decided to include the oral SDMT to the task. Thus, to get our screening tool, normative data for this instrument were created from the sum of the MMSE-MS items with oral SDMT. Conclusion: The overall of the data from these studies calls attention to the necessity of the caution to the adaptation procedures used in cross-cultural adaptation of the tasks that has verbal and semantic stimuli. There is also the need of tools abel to screening MS patients. For this, these preliminar data for MMSE-MS showed evidences of validation, similar sensitivity and and specificity, with normative data culturally adjusted to the Brazilian context.

The present study investigated the criterion-based validity of the Mini-Mental State Examination (MMSE), the Cognitive Capacity Screening Examination (CCSE), and the Neurobehavioral Cognitive Status Examination (NCSE) in a sample of older adults with suspected cognitive impairment. As cognitive screening tests, the MMSE, CCSE, and NCSE should predict performance relative to a more thorough testing procedure. In the present study, performance on the Halstead-Reitan Neuropsychological Test Battery (HRNTB) was employed as the criterion measure. Scores on the General Neuropsychological Deficit Scale (G-NDS), a global performance measure computed from the HRNTB, served as the standard by which to judge the presence of cognitive impairment. The sensitivity, specificity, and predictive value of each screening test, as well as how well each screening test correlated with the G-NDS, were investigated. Results of this investigation found that, although the MMSE, CCSE, and NCSE were all significantly correlated with the G-NDS, only the NCSE demonstrated an appropriate balance between high sensitivity and specificity. When a rigorous neuropsychological evaluation was employed as the criterion standard, the NCSE accurately detected the presence of cognitive impairment: in 82% of the cases. The MMSE and CCSE, however, failed to detect cognitive deficits in approximately 80% of the cases. These findings strongly suggest that the MMSE and CCSE may have limited utility in the identification of cognitive impairment in older adults. The heightened sensitivity of the NCSE appears to be the result of several unigue features of the instrument, including a multidimensional scoring system and a graded series of increasingly difficult items within each ability area. Future studies need to examine the utility of the NCSE in other geriatric settings, as well as with more diverse populations suffering from a variety of organic mental syndromes.

Teniendo en consideración las tendencias poblacionales de aumento del segmento de adultos mayores asi como la prevalencia de trastornos demenciales, se planteó como objetivo la adaptación del Mini-Mental State Examination, instrumento ampliamente utilizado en la atención clínica y en la investigación clínica y epidemiológica. Se aplicó el MMSE a tres muestras: 345 sujetos sanos, 50 pacientes con diagnóstico de demencia de tipo Alzheimer y 45 pacientes con depresión mayor, todos mayores de 55 años. Se estudiaron ítems alternativos para ser utilizados con sujetos analfabetos, que no mostraron ser adecuados estadísticamente. La consistencia interna de la prueba fue de 0,62 con el alfa de Cronbach. Se analizó la validez de constructo, aislándose cinco factores. En la comparación con un criterio externo de deterioro, casos con diagnóstico de demencia, se encontró más adecuado el puntaje de corte de 23, que arroja 86% de sensibilidad y 94% de especificidad. Los puntajes MMSE disminuyen con la edad y son más altos con mayores niveles educativos; los analfabetos rinden significativamente menos. Los puntajes de los grupos sano y deprimido son semejantes, diferenciándose ambos grupos significativamente del grupo demencia. Los errores en las respuestas son más frecuentes y variados en el grupo demencia.
Tesis

The goal of the research reported in this thesis is to contribute to early and accurate detection of dementia. Early detection of dementia is essential to maximising the effectiveness of treatment against memory loss. This goal is pursued by interpreting the Mini-Mental State Examination (MMSE) in novel ways. The MMSE is the most widely used screening tool for dementia, it is a questionnaire of 30 items. The objectives of the research are as follows: to reduce the dimensions of the MMSE to the most relevant ones in order to inform a predictive model by using computational methods on a data set of MMSE results, to construct a model predicting a diagnosis informed by the features extracted from the previous step by applying, comparing and combining traditional and novel modelling methods, to propose a semantic analysis of the sentence writing question in the MMSE in order to utilise information recorded in MMS examinations which has not been considered previously. Traditional methods of analysis are inadequate for questionnaire data such as the MMSE due to assumptions of normally distributed data. Alternative methods for analysis of discrete data are investigated and a novel method for computing information theoretic measures is proposed. The methods are used to demonstrate that an automated analysis of the MMSE sentence improves the accuracy of differentiating between types of dementia. Finally, models are proposed which integrate the semantic annotations with the MMSE data to derive rules for difficult to distinguish types of dementia.

Alzheimer´s disease (AD) is today the world’s most common disease within dementia as it affects most number of people that are demented. There are no cure to AD, just symptomatic treatment are available. Scientists are still discussing the reason behind AD and many different theories exist. The most popular one is the amyloid cascade hypothesis. To diagnose AD many different types of scales are used to determine a person´s cognitive skills, also blood- and spinal cord samples are taken. One of the most popular scale that is used to diagnose AD is named mini mental state exam (MMSE). MMSE consists of several domains including: orientation, reading, mental arithmetic, writing and figure copying. The maximum of points are 30 and a score of 24 or less indicates some type of dementia. Today acetylcholinesteraseinhibitors like donepezil, rivastigmine and galantamine are used to treat people with mild to moderate AD. People with severe AD are recommended treatment with a NMDA-receptor-antagonist, memantine. The result from this study includes a summary of results from five studies. All of them studied the effect of donepezil over time and three of them also studied donepezils effect compared to placebo. Patients that were included had mild- moderate AD and in one study they measured a continued treatment with donepezil. All studies measured the results with scales and tests, including MMSE, that assessed patient’s cognitive ability. The results showed that patients treated with donepezil had significantly improved their scores on the scale MMSE at the end of the studies compared from baseline in three studies. When compared with placebo patients treated with donepezil got significantly better scores on MMSE. These changes were small even if significantly proven. The conclusion of this work was that MMSE is not optimal for measuring changes in AD if the patient is treated with donepezil because of the small changes. MMSE have difficulties to detect the small changes (a change of ≤ 3 points) and therefore other scales and tests are in need. Donepezil showed a significantly improvement in the beginning of the studies but after a few weeks that improvement had decreased or disappeared. It could be in everyone´s favor to start medication in an early stage of the disease and then after a while make a new assessment of the patient’s health.

It is necessary to assess the intellectual functioning of dementia patients. However, psychometric instruments such as the Wechsler Adult Intelligence Scale - revised (WAIS-R) are often too demanding for dementia patients, precluding its utility. Clinicians and researchers have indirectly estimated a dementia patient's IQ from the Mini-Mental State Examination (MMSE). This measure is an eleven item screen instrument of global cognitive functioning. Fairly accurate estimates of IQ have been predicted using the MMSE total score.The purpose of the present study was to determine if it is possible to more accurately predict intellectual functioning when the individual MMSE items were used to predict Full Scale, Verbal, and Performance IQ using multiple regression analyses. Forty elderly dementia patients were administered both the MMSE and the WAIS-R. The MMSE total score was entered into a simple linear regression to predict FSIQ. In addition, the eleven item scores of the MMSE were entered into separate stepwise regressions to predict FSIQ, VIQ, and PIQ. The increment in the amount of variance accounted for in the FSIQ between the simple and multiple regression equations were evaluated for statistical significance.The results of these investigations revealed that while the multiple regression equations using MMSE item scores predicted a significant amount of the variance in IQ, they were not statistically superior to using the MMSE total score alone. The MMSE total score was found to account for 76.2% of the variance in Full Scale IQ. The MMSE items that were found to add significantly to the variance in intellectual level accounted for 80.9 %, 75.1 %, and 73.4 % of FSIQ, VIQ, and PIQ respectively. The results of the present study replicated other research that found the MMSE total score to accurately predict intellectual functioning in dementia patients.
Department of Counseling Psychology and Guidance Services

Realiza la evaluación de un instrumento psicométrico, bajo la teoría clásica de los test, brinda información sobre la confiabilidad y la validez del instrumento, también provee información de su capacidad predictiva si se compara con un criterio de referencia. El análisis aplicado a un instrumento bajo el modelo Rasch brinda información adicional como el nivel de dificultad del instrumento en función de la dificultad de los ítems que lo componen, además se obtienen estimaciones invariantes y comparables sobre el atributo evaluado por el instrumento para los individuos, a pesar que los sujetos provengan de diferentes grupos poblacionales. Los resultados obtenidos al aplicar el modelo Rasch en el Mini Mental State Examination, determinaron que el instrumento posee una baja dificultad teniendo una gran precisión para el diagnóstico del nivel cognoscitivo considerado como deterioro severo, identificando como ítems de mayor dificultad aquellos que comprenden el cálculo, la evocación y la praxis, no ajustándose al modelo Rasch.
Trabajo de suficiencia profesional

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
Objective: This study was performed to provide a detailed analysis of the MoCA versus the MMSE, including an item analysis and an examination of threshold scores appropriate for use in different clinical settings. Methods: 135 subjects enrolled in a longitudinal clinicopathologic study were administered the MoCA and MMSE. Subjects were classified as cognitively impaired or cognitively normal based on neuropsychological testing and consensus conference diagnosis. Results: 89 subjects were cognitively normal, 46 cognitively impaired (20 dementia, 26 MCI). ROC analysis showed that, for any threshold value selected for the MMSE to identify cognitive impairment, a MoCA value with better sensitivity and specificity could be identified. Recall performed best among individual items on the MMSE, and Orientation performed best on the MoCA. Overall, the best discrimination was obtained using a weighted combination of four items (2*MoCA-Orientation + MMSE-Recall + MoCA-Language + 0.5* MoCA-Visuospatial/Executive; AUC 0.94). A MoCA threshold score of 26 had a sensitivity of 98% and specificity of 52% for identifying cognitive 5 impairment. A MoCA threshold score of 21 had a sensitivity of 57% and specificity of 96%. Conclusions: The MoCA was superior to the MMSE in detecting cognitive impairment. Individual domains on the MoCA and MMSE made substantially different contributions to each instrument’s sensitivity, and a weighted subset of items from both instruments performed best in detecting cognitive impairment. A lower MoCA threshold score may be appropriate in a population with a higher prevalence of cognitive impairment such as a memory clinic.

Accurate, early diagnosis of Alzheimer's Disease is becoming increasingly important in light of its growing prevalence among the expanding older-aged adult population. Due to its ability to assess multiple domains of cognitive functioning and provide a profile of impairment rather than a simple global score, the Neurobehavioral Cognitive Status Examination (NCSE) is suggested to better assess such patterns of cognitive deficit for the purpose of diagnosis. The performance of the NCSE was compared with that of the Mini-Mental State Examination (MMSE) for diagnostic sensitivity in a sample of patients diagnosed as having probable Alzheimer's Disease. The strength of correlation between severity of cognitive impairment on these tests and report of behavior problems on the Memory and Behavior Problems Checklist (MBPC) was also explored, as was performance on the NCSE and report of behavior problems using the MBPC in predicting Single Photon Emission Computed Tomography (SPECT) scan results. The NCSE was found to exhibit greater sensitivity to physician diagnosis of probable Alzheimer's Disease relative to two versions (Serial 7's or WORLD) of the MMSE (.90, .77 and .68, respectively). While both measures were found to correlate significantly with the report of behavior problems, only a moderate proportion (NCSE = .22 and MMSE = .33) of the explained variance was accounted for by either test. Severity of cognitive impairment on the NCSE was found to be significant, though small in estimate of its effect size, for predicting the absence/presence of pathognomic findings on SPECT scans. In contrast, the report of behavior problems on the MBPC did not significantly predict SPECT scan outcomes. The NCSE would appear to be a sensitive tool for the identification of the extent and severity of cognitive impairment found among demented individuals; however, it may be "over"-sensitive to such diagnosis. Although relationships between cognitive impairment and behavior problems and/or neuroradiological findings are observed, their meaningfulness remains with the need for further, more detailed, study using standardized criteria for comparison purposes.

Scopo del nostro studio è quello di valutare i disturbi cognitivi in relazione al tasso di microembolia cerebrale in due gruppi di pazienti trattati per lesione carotidea asintomatica con endoarterectomia (CEA) o stenting (CAS). Comparando le due metodiche mediante l’utilizzo di risonanza magnetica in diffusione (DW-MRI), neuromarkers (NSE e S100β) e test neuropsicometrici. MATERIALE E METODI: 60 pazienti sono stati sottoposti a rivascolarizzazione carotidea (CEA n=32 e CAS n=28). Sono stati tutti valutati con DW-MRI e Mini-Mental State Examination (MMSE) test nel preoperatorio, a 24 ore, a 6 ed a 12 mesi dall’intervento. In tutti sono stati dosati i livelli sierici di NSE e S100β mediante 5 prelievi seriati nel tempo, quello basale nel preoperatorio, l’ultimo a 24 ore. L’ananlisi statistica è stata effettuata con test t di Student per confronti multipli per valori continui e con test χ2 quadro e Fisher per le variabili categoriche. Significatività P <0,05. RISULTATI: Non vi è stato alcun decesso. Un paziente del gruppo CAS ha presentato un ictus ischemico. In 6 pazienti CAS ed in 1 paziente CEA si sono osservate nuove lesioni subcliniche alla RMN-DWI post-operatoria (21,4% vs 3% p=0,03). Nel gruppo CAS le nuove lesioni presenti alla RMN sono risultate significativamente associate ad un declino del punteggio del MMSE (p=0,001). L’analisi dei livelli di NSE e S100β ha mostrato un significativo aumento a 24 ore nei pazienti CAS (P = .02). A 12 mesi i pazienti che avevano presentato nuove lesioni ischemiche nel post-operatorio hanno mostrato minor punteggio al MMSE, non statisticamente significativo. CONCLUSIONI: I neuromarkers in combinazione con MMSE e RMN-DWI possono essere utilizzati nella valutazione del declino cognitivo correlato a lesioni silenti nell’immediato postoperatorio di rivascolarizzazione carotidea. Quest’ultime dovrebbero essere valutate quindi non solo rispetto al tasso di mortalità e ictus, ma anche rispetto al tasso di microembolia.
The aim of our study is to evaluate cognitive impairment in relation to the rate of cerebral injury in two groups of patients treated for asymptomatic carotid lesion with endarterectomy (CEA) or stenting (CAS). Comparing the two methods through the use of diffusion-weighted magnetic resonance (DW-MRI), neurobiochemical-markers (NSE and S100β) and neuropsychometric tests. MATERIALS AND METHODS: 60 patients underwent carotid revascularization (CEA and CAS n = 32 n = 28). All were assessed by DW-MRI and Mini-Mental State Examination (MMSE) test preoperatively, at 24 hours, at 6 and 12 months postoperatively. Venous blood samples to assess serum levels of NSE and S100β protein were collected for each patient preoperatively and five times in a 24-hour period postoperatively. The relationship between serum marker levels and neuropsychometric and imaging tests and differences between the two groups of patients were analyzed by Student's t test for multiple comparisons for continuous values and χ2 test and Fisher for categorical variables. Significance P <0.05. RESULTS: There was no death. One patient in the CAS group has presented a stroke. In 6 patients CAS and 1 patient CEA have observed new subclinical brain injury on MRI-DWI postoperatively (21.4% vs 3% p = 0.03). In the CAS group, the new brain lesions were significantly linked at MMSE score decline (p = 0.001). The levels of NSE and S100β showed a significant increase at 24 hours in CAS patients (P = .02). The patients who had new lesion postoperatively showed a nonsignificant lower MMSE score at 12 months. CONCLUSIONS: Biochemical markers combined with MMSE and MRI-DWI can be used in the assessment of cognitive decline related to silent injurues after carotid revascularization. These procedures should be evaluated not only with respect to mortality and stroke, but also with respect to the rate of microembolism.

The population of China is ageing. Accompanying this aging population, dementia and frailty have a growing importance. However there is little consensus on the association between dementia and frailty, in terms of how the criteria that are part of this two syndromes overlap, as both disorders are age-related and increase the risk for falls, further leading to loss of independence. To meet the above needs, the thesis describes research into different frailty diagnostic criteria, as well as its association with dementia symptoms. We examined cognitive measures that can be used for assessment of Mild Cognitive Impairment (MCI) and dementia screening (the Hopkins Verbal Learning Test, HVLT) and compared its discriminant ability with the commonly used cognitive screening tool, the Mini-Mental State Examination (MMSE) in distinguishing Cognitive Impairment (including MCI and dementia) from No Cognitive Impairment (NCI, normal controls) in two community-dwelling elderly Chinese populations and in one institutionalised elderly population in Shanghai, China. Subsequently we investigated whether physical and cognitive symptoms clustered together to form frailty phenotypes. We employed indicators that have been widely used to diagnose frailty, including physical measures (grip strength, Time-Up and Go test, 15 feet gait speed test and Berg balance test), and psychological measures (the HVLT and the MMSE) to predict cognitive impairment (CI) and frailty. Additionally, we described demographics (age, gender, education) and other potential modifiers when detecting cognitive impairment and functional disability. We then built up a model for possible frailty phenotype using various indicators. Lastly, we examined whether demographic (age, gender, education and profession), and lifestyle (smoking/alcohol history, exercise frequency, and dietary habit) could be used to predict future cognitive impairment. It was found that advanced age, lower education (no or primary level), and being vegetarian were significant risk factors for cognitive impairment. Furthermore, whereas high consumption of green vegetables is a protector against cognitive impairment, high intake of tofu was negatively related to cognitive performance among community-dwelling elderly in China. To meet the above needs, the thesis describes research into different frailty diagnostic criteria, as well as its association with dementia symptoms. We examined cognitive measures that can be used for assessment of Mild Cognitive Impairment (MCI) and dementia screening (the Hopkins Verbal Learning Test, HVLT) and compared its discriminant ability with the commonly used cognitive screening tool, the Mini-Mental State Examination (MMSE) in distinguishing Cognitive Impairment (including MCI and dementia) from No Cognitive Impairment (NCI, normal controls) in two community-dwelling elderly Chinese populations and in one institutionalised elderly population in Shanghai, China. Subsequently we employed these two cognitive measures to investigate whether they were part of the frailty syndrome among elderly from the community-based studies. We investigated whether physical and cognitive symptoms clustered together to form frailty phenotypes. We employed indicators that have been widely used to diagnose frailty, including physical measures (grip strength, Time-Up and Go test, 15 feet gait speed test and Berg balance test), and psychological measures (the HVLT and the MMSE) to predict cognitive impairment (CI). We found four distinct subtypes of elderly characterised by increasing care needs: 1. Persona elderly as defined by age >78, year of education<6 years, grip strength <11.8 KG, and a MMSE total score <25; 2. Persona Physical frailty (fitness), defined by a total score on the Timed-Up and Go (TUG) test >12.7 seconds and 15 feet gait speed >4.4 seconds; 3. Persona Cognitive impairment, defined by a MMSE total score <25, a HVLT Immediate Recall (IR) score <15, and a HVLT Delayed Recall (DR) <5; 4. Persona Physical frailty (balance,) defined by a Berg Balance test score of <53. Additionally, we described demographics (age, gender, education) and other potential modifiers when detecting cognitive impairment and functional disability. We then built up a model for possible frailty phenotype using various indicators, Frailty here was defined as: 1. Low BMI as measured by this algorithm: BMI= Weight (kg)/Height (m)2 2. Weakness (upper and lower body): grip strength in the lowest quintile, adjusted for gender; and TUG get up with assistance or unable to get up 3. Slowness (lower body): TUG score in the lowest quintile, adjusted for gender; and 15 feet gait speed in the lowest quintile, adjusted for gender; 4. Poor balance: Berg Balance test score in the lowest quintile, adjusted for gender; 5. Low physical activity: engaging in exercise less than once per week. An individual with 4 or more present frailty components out of a total of 7 was considered to be frail , whereas equal or less than 3 characteristics were hypothesized to be pre-frail . Those with no present frailty components were considered as robust. Lastly, we examined whether demographic (age, gender, education and profession), and lifestyle (smoking/alcohol history, exercise frequency, and dietary habit) could be used to predict future cognitive impairment (as defined by a HVLT IR score of ≤19). The results of our studies show that compared to the MMSE, the HVLT is superior in differentiating MCI and dementia from NCI, and is also less affected by demographic factors in detecting frailty. Furthermore, in the current study, physical, psychological, demographic and other modifiable risk factors cluster together into different phenotypes of cognitive impairment and functional disability in these cohorts. A phenotype of frailty is built up using BMI, grip strength, TUG, 15 feet gait speed, balance and exercise frequency as indicators. The most common was the elderly phenotype followed by the cognitively impaired. A novel finding of the current study is that only 4.8% (8 out 168) of the whole sample fulfilled all three categories in the current study (cognitive impairment, functional disability and frailty). Finally, advanced age, lower education (no or primary level), and being vegetarian were significant risk factors for cognitive impairment. Furthermore, whereas high consumption of green vegetables is a protector against cognitive impairment, high intake of tofu was negatively related to cognitive performance among community-dwelling elderly in China.

碩士
國立臺灣大學
生物產業機電工程學研究所
103
The dramatic rise in life expectancy in the past few decades has resulted in a huge number of individuals achieving the age at which neurodegenerative disorders become common. Alzheimer''s disease (AD) is one of the most common neurodegenerative disease discovered more than 1 century ago and also one of the most common diseases in the one of the most common elderly disease in the world. Slowly but surely, AD patients will lose their memory and their cognitive abilities, and even their personalities may change dramatically. These changes are due to the progressive dysfunction and death of nerve cells that are responsible for the storage and processing of information Currently, AD affects about 24 to 35 million people around the world. Combined with an aging population, prevalence is expected to increase to 1 in 85 people by 2050. In order to deal with the massive growth of the AD patients, it is important to find the mechanism of Alzheimer’s disease development. Alzheimer’s disease is known as a genetically complex and heterogeneous disorder disease. The late-onset Alzheimer disease is modulated by genetic variants with relatively low penetrance but high prevalence. Based on previous studies, the only firmly established genetic susceptibility factor for Alzheimer disease is the ε-4 allele of APOE. Beyond this, hundreds of other putative risk alleles in other genes were reported. But the relationships between these published alleles and the Alzheimer’s disease still remain unclear. In this study, the data both clinical and genetic data we used are provided by the Alzheimer''s Disease Neuroimaging Initiative (ADNI). To tackle the complex genetic variations of AD, this study tends to link not only the genetic (Genome-wide association study, GWAS) but also clinical data to the change of cognitive scores 24 months after initial assessment by the machine learning algorithm, SVR (Support Vector Machine Regression, SVR). We extracted 39 SNPs from 1.5 million SNPs that were shown to be highly correlated to the degeneration of Alzheimer’s disease. We built the predictive model using both clinical and genetic data, and the resultant Pearson correlation coefficient between targets and prediction scores is about 0.5 on training data set and 0.43, 0.35 on two independent test data sets. With difference threshold, we extracted 866 SNPs from 1.5 million SNPs in 120 genes that were shown to be highly correlated to the degeneration of Alzheimer’s disease. The constructed model not only can help to predict cognitive trajectory and provide new approaches for early identification of AD, but also provides an efficient solution to select the samples for clinical trials and possibilities for earlier disease treatment.

Tese de mestrado, Psicopatologia, Universidade de Lisboa, Faculdade de Medicina, 2019
Between 1961 and 2016, there was an increase of 121.2% in the Portuguese population over 60 years (PORDATA, 2016; INE, 2017). In parallel with the increase in life expectancy, diseases associated with aging are also increasingly frequent, including neurodegenerative diseases such as Alzheimer's disease (AD). Generally, the first complaint in patients who will develop clinical AD is that of lack of memory, difficulty in retaining information or rapid forgetting of recent information. However, memory complaints, are very common in this population, not always represent an indicator of the onset of a dementia process (O'Connor et al 1990, Bolla et al 1991, Gagnon et al 1994, Schmand et al., 1996). These complaints may occur due to the natural aging process, anxiety disorders or depression, although some studies also indicate that, in some cases, they may be associated with a degenerative process (Grut et al., 1993; C et al 2000, Reid et al., 2006, Youn et al., 2009, Breton et al 2018). On the other hand, if memory complaints are more intense and objectified by neuropsychological tests, they may correspond to the initial phase of a neurodegenerative process, being called the "Mild Cognitive Impairment" (MCI) (Petersen et al., 1999, 2001). This condition often progresses to dementia, usually Alzheimer's Disease (AD) (Schmand et al., 1996; Reid et al., 2006; Mitchell et al., 2008, Youn et al., 2009; Silva et al., 2014). In consultations with your physician it may be difficult to assess these complaints, which leads to delays in diagnosis and possible therapeutic interventions (Riedel-Heller et al 1999, Mendes et al 2008). In this context, it may be important for the physician to have a brief screening tool that allows to objectify complaints within a short period of time (Deveugele et al 2002). Brief tests of neuropsychological evaluation are important for the screening or confirmation of cases with suspected cognitive impairment, and also allows the referral of cases to specialized consultations (neurology, neuropsychology, psychiatry) (Deveugele et al., 2002; Wilkinson et al., 2004, Iliffe, 2009, Freitas, 2015). In the literature there are many references to brief tests, although few validated for the Portuguese population. MMSE is probably the most used (Guerreiro et al., 1994; Morgado et al., 2009; Freitas et al, 2015). This test has an application time of about 10 to 15 minutes, which is still considered time consuming for consultation, particularly in General and Family Medicine (GFM) visits. In view of these limitations, we consider it important to have a short instrument with satisfatory sensitivity and specificity values in the Portuguese population for the detection of cognitive impairments. The objective of this study is to build a short version of this test, based on the Portuguese version of the MMSE (Guerreiro et al., 1994), with an application time that does not exceed 5 minutes and has similar sensitivity and specificity values, or higher, than those of the original version in the discrimination between subjects with MCI and normal subjects (without memory complaints and without objective cognitive impairment).
O envelhecimento em Portugal, de acordo com os dados do Instituto Nacional de Estatística, tem vindo a aumentar (INE, 2017). Entre 1961 e 2016, verificou-se um aumento de 121,2% na população acima dos 60 anos (PORDATA, 2016). Em paralelo com o aumento da esperança de vida, as doenças associadas ao envelhecimento também são cada vez mais frequentes e, entre elas, as doenças neurodegenerativas, nomeadamente a doença de Alzheimer (DA). Geralmente, a primeira queixa em doentes que vão desenvolver DA clínica é a de falta de memória, sendo referido dificuldade em reter a informação ou esquecimento rápido da informação recente. No entanto, as queixas de memória, muito frequentes nesta população, nem sempre representam um indicador de início de um processo demencial (O’Connor et al 1990; Bolla et al 1991; Gagnon et al 1994; Schmand et al., 1996; Schofield et al 1997; Ginó et al., 2010; Breton et al., 2018). Estas queixas podem ocorrer devido ao processo natural de envelhecimento, a perturbações da ansiedade ou a depressão, embora alguns trabalhos também refiram que, em alguns casos, poderão estar associadas a um processo degenerativo (Grut et al 1993; Schmand et al. 1996; Jonker C et al 2000; Reid et al. 2006; Youn et al., 2009; Breton et al 2018). Por outro lado, se as queixas de memória forem mais intensas e objetivadas por testes neuropsicológicos, poderão corresponder à fase inicial de um processo neurodegenerativo designando-se o quadro por “Defeito Cognitivo Ligeiro” (DCL) (Petersen et al., 1999, 2001). Este quadro frequentemente progride para demência, geralmente Doença de Alzheimer (DA) (Schmand et al., 1996; Reid et al., 2006; Mitchell et al 2008, Youn et al., 2009; Silva et al., 2014). Nas consultas com o seu médico assistente pode ser difícil valorizar estas queixas, o que leva a atrasos de diagnóstico e de possíveis intervenções terapêuticas (Riedel-Heller et al 1999; Mendes et al 2008). Neste contexto, poderá será importante o médico dispor de um instrumento breve, de rastreio, que lhe permita objetivar as queixas, em curto período de tempo (Deveugele et al 2002). Os testes breves de avaliação neuropsicológica são importantes para fazer o screening, ou até confirmarem, casos com suspeita de deterioração cognitiva, permitindo também o encaminhamento de casos para consultas de especialidade (neurologia, neuropsicologia, psiquiatria) (Deveugele et al., 2002; Wilkinson et al., 2004; Iliffeet al., 2009; Freitas et al., 2015). Na literatura encontram-se muitas referências a testes breves, embora poucos validados para a população portuguesa. O MMSE é provavelmente o mais utilizado (Guerreiro et al, 1994; Morgado et al, 2009; Freitas et al, 2015). Este teste tem um tempo de aplicação de cerca de 10 a 15 minutos, o que, ainda assim, é considerado demorado para aplicação em consulta, particularmente em consultas de Medicina Geral e Familiar (MGF). Perante estas limitações, consideramos importante dispormos de um instrumento de aplicação muito rápida, com valores satisfatórios de sensibilidade e especificidade na população portuguesa, para a deteção de defeito cognitivo. O objetivo deste estudo é, com base na versão portuguesa do MMSE (Guerreiro et al., 1994), construir uma versão curta deste teste, com um tempo de aplicação que não exceda os 5 minutos e que apresente valores de sensibilidade e especificidade semelhantes, ou superiores, aos da versão original na discriminação entre sujeitos com DCL e sujeitos normais (sem queixas de memória e sem défices cognitivos objetivos).

Exame público realizado em 24 de Julho de 2012 pelas 11h00.
O presente trabalho teve por objectivo avaliar as relações entre o estado mental e a qualidade de vida em idosos institucionalizados versus não institucionalizados e verificar se os idosos institucionalizados têm ou não mais qualidade de vida e por conseguinte melhor estado mental. Todos os sujeitos foram submetidos ao protocolo constituído por o questionário sociodemográfico, o WHOQOL-Bref e o MMSE, individualmente e numa única sessão para cada sujeito. A amostra foi constituída por 100 sujeitos de ambos os sexos, idosos, dos quais 51 estão institucionalizados em centro de dia e 49 não estão agregados a qualquer instituição. Conclui-se com este estudo que existem diferenças no estado mental em função da situação dos sujeitos institucionalizado/ não institucïonalizado, foram realizados testes de U de Mann Whitney, obtiveram-se diferenças estatisticamente significativas nas dimensões atenção e cálculo e linguagem, sendo que os sujeitos não institucionalizados (atenção e cálculo 56,58 e linguagem 58,62) apresentam médias significativamente superiores aos sujeitos de centro de dia (atenção e cálculo 44.66 e linguagem 42.70); no que diz respeito á presença de diferenças na qualidade de vida em função da situação dos sujeitos face à institucionalização foram realizados testes de U de Mann Whitney, nos quais se obtiveram diferenças estatisticamente significativas nos domínios psicológico e meio ambiente, sendo que os sujeitos não institucionalizados Domínio psicológico - 59.47 e no domínio maio ambiente - 59.35) apresentam médias significativamente superiores aos sujeitos de centro de dia (domínio psicológico - 41.88 e no domínio meio ambiente — 42.00). No que diz respeito a relação entre o estado mental e a qualidade de vida, através da correlação de Pearson, verificou-se que de facto sujeitos com qualidade de vida mais elevada têm associados com melhores níveis de estado mental.

碩士
慈濟大學
醫學資訊學系碩士班
107
While the aged population is increasing, Taiwan has truly entered an aging society. The risk of developing dementia increases with age.Via using assessment tools, early observations, and diagnosis to alleviate the progression of disease, is one of the main goals of the Dementia Medical Team. In fact, nowadays clinical evaluation forms are still paper-based, which is not only difficult to store, but also unable to instantly access. Therefore, the researcher used the Excel VBA macro functions to build a simple electronic evaluation interface for clinical and community using as a screening tool for Dementia. However, one of the significant factors for the system or interface to work is related to the willingness to use. System quality, easy to operate, easy to adapt and simplify the examining processes that make the users feel their problems are solved. If the system can also give suggestions based on the examination results automatically, it will certainly help the busy medical professionals to increase work efficiency. In order to understand whether the built-in interface meets the needs of medical professionals, the researchers used questionnaires to collect and analyze data. A total of 80 questionnaires were distributed and 72 were collected, all of which were valid questionnaires. The results of the questionnaire showed that the Perceive Usefulness to the interface has a stronger and significant effect than the Perceive Ease of Use. The current hospital supervisors, medical professionals who can use computer proficiently and long-term care workers have a strong positive response to the satisfaction of use.

A cross-sectional, retrospective study, using data from the Victoria Longitudinal Study, was conducted to investigate the impact of impending death on test performance on the Mini-Mental State Examination (MMSE), a measure of general cognitive functioning. Test score on the MMSE of individuals collected between one to five years before death was compared to the MMSE test score of individuals who are still alive. Results revealed a significant difference between the MMSE total score of individuals who died within three years post-measurement and survivors, and those who died between three to five years after measurement. When the individual items were analyzed, only the "WORLD" and "copy pentagon" items obtained results similar to the total score, providing support for the specificity of impending death effect on fluid abilities. The cause of death (CardioKerebro-vascular disease and non-CardioICerebro-vascular disease), however, did not differentiate the groups, suggesting that the mechanism of impending death may not be disease-related. Our results revealed that the influence of impending death on cognitive functioning could be observed on the MMSE; the source of the influence is still unknown, however. Despite the statistical significance, our findings did not appear to be clinically meaningful. As a result, our findings suggest that it may not be necessary to collect new normative data that are removed of the effects of impending death.

碩士
元智大學
資訊傳播學系
98
The Mini-Mental Status Examination, which is a brief test used to screen for cognitive impairment, assesses orientation, memory, concentration, language, and motor skills for elder adults. It’s an important clinical tool to realize how the elder people live independently, and is the main basis to approve Alzheimer''s medication by Bureau of National Health Insurance in Taiwan at the present time. In this study, I compare the assessment method of digital platform with the old one. With the integra-tion of multimedia techniques into the assessment, not only it can record the process effectively, but also track and review the cognitive status of elders conveniently in the future, moreover, the system offers some useful auxiliary functions like multilanguage pronunciation, time record of examination and all of the cognitive examination items tagged with tips which can help elders answer the questions easily. In addtion, the platform especially has the features such as it can create electronic medical records, and it’s possible to advance the remote assessment function like telemedicine.

碩士
國立臺灣大學
職能治療研究所
101
Background and purposes: Cognitive impairments, one of the common sequelae in patients with stroke, often have huge impact on patients’ functional recovery in multiple domains. Mini-Mental State Examination (MMSE) is a widely-used and simple evaluation tool for assessing patients’ general cognitive function. Thus far, however, in the context of cognitive evaluation for stroke patients, MMSE has not been examined for its score distribution, floor and ceiling effects, predictive validity, and responsiveness, which limits its practicability. The current study therefore aims to examine the score distribution, floor and ceiling effects, predictive validity, and responsiveness of MMSE in inpatients with stroke to validate its discriminative, predictive and evaluative functions. Methods: We took a retrospective study approach in the current research. All data were acquired from the database of “Establishment of a databank for inpatients receiving stroke rehabilitation”. Eligible participants were recruited from consecutive admissions with stroke to the rehabilitation wards at National Taiwan University Hospital. Participants included adults aged over 18 y/o with an ischemic or hemorrhagic stroke. We excluded patients who has history of neurological or psychiatric diseases, such as dementia, schizophrenia, unable to follow commands, and who stayed in the rehabilitation wards for less than 7 days. Both MMSE and Barthel Index (BI) were administered to each participant within 3 days after admission, before discharge from the rehabilitation ward, and one year after stroke onset. We examined the score distribution, ceiling and floor effects of MMSE. BI was used as an external criterion for examining the predictive validity, and external responsiveness of MMSE. Moreover, the responsiveness of MMSE was measured by the effect size (ES) and the Standardized response mean (SRM). Results: Our data analysis included 168 patients, and 124 of them completed the 1-year-after-onset follow-up. The results showed that the MMSE displayed a notable ceiling effect at discharge, while the ceiling effect was not observed at admission. The predictive validity of MMSE was between acceptable to good (Spearman’s ρ=0.40-0.57). Using BI score as external criterion, the external validity of the MMSE was poor (ρ=0.26). The changes in scores of MMSE between admission and discharge were between small to medium (ES=0.33; SRM=0.66), indicating that the MMSE had small to medium internal responsiveness. Discussion and Conclusion: This study is the first to examine the three practical functions of MMSE in the clinical context with stroke inpatient. Our findings suggest that MMSE has sufficient discriminability while administrated at admission, good predictive function while using the MMSE score at discharge to predict the BADL function 1-year after the patients’ onset. Furthermore, MMSE has small to medium internal responsiveness, indicating that MMSE is appropriate for prognosis evaluation. The evidence supports that MMSE is a proper assessment tool with discriminability, predictability and evaluative function for assessing cognitive function of stroke inpatients.

碩士
臺北醫學大學
醫學資訊研究所
98
With the advancement of medical technology, the older population aged 65 or more of Taiwan has already reached 7% threshold defined by United Nations to become an aging nation. In recent years, the population of Taiwan is aging rapidly, according to the latest statistics by the Ministry of Interior at the end of 2008, the older population has reached 2.4 million, accounting for 10.4% of the total population. A Taiwanese Dementia Society survey revealed that the prevalence of dementia in old age is about 5-6%. However, Alzheimer''s Dementia is ranked the first, whereas Vascular Dementia is the second. Increased prevalence of multiple variables with increase age is presented. In this study, Mini-Mental State Examination (MMSE) is the major research tools and using DSM-IV as an assist to classifity Alzheimer''s Dementia and Vascular Dementia. Using logistic regression, classification and regression tree and support vector machine to analysis the different between Alzheimer''s Dementia and Vascular Dementia. The results were shown that, Logistic regression using the difference between the five variables and no difference by adding the four variables to construct the model accuracy were 0.6991 and 0.6372; classification and regression tree (CART) for the 0.6903 and 0.7168; support vector machines (SVM) for the 0.7345 and 0.9027 . From the results, revealed that support vector machine model performed the best accuracy all three models.

碩士
靜宜大學
資訊傳播工程學系
105
In order to monitoring the cognitive status of the elderly people at an early stage and to take measures as soon as possible, the elderly care centers usually use the paper-based questionnaires to measure elders’ cognitive abilities at regular intervals. However, this approach is not only time consuming and laborious, but accuracy may depend on social worker’s questioning skills. Therefore, this study refers to the most widely used scale-MMSE (Mini-Mental State Examination), which is based on its six major aspects: Orientation, Attention, Recall, Language, Stage Command and Visuospatial construction, and integrate with somatosensory to develop a Game-based Cognitive Detection System. The system has two major functions: a game-based cognitive detection system and a web-based data management and analysis system, which allows participants to carry out cognitive measuring through the game playing, and let caregiver observe the status of subjects through the data collection and process records. The research object is a conservation center in Taichung City. Ten participants who have completed the paper-based cognitive measuring were invited to participate the research project. The comparison between the physical scale scores and the measured results of this system is made. The results are limited by the body movements of the participants who may not meet the system requirements, and may result in detection errors. However, according to the system measuring results, a significant distinction between normal or mild cognitive impairment of participants can be identify. From the experimental results and observed records, it shows that the developed game-based measures system enhanced participants’ motivation effectively and the professional social workers also give positive recognition of the system.

Trabalho final de mestrado integrado em Medicina área científica de Neurologia, apresentado á Faculdade de Medicina da Universidade de Coimbra
Introdução: A Atrofia de Sistemas Múltiplos é predominantemente uma doença do movimento, também com envolvimento cognitivo. O “Mini Mental Status Examination” é um teste de rastreio cognitivo, universal, que falha na identificação de défices precoces. Existem outros instrumentos, como o “Montreal Cognitive Assessment”, que podem demonstrar maior sensibilidade na identificação destes casos. Métodos: Foram aplicados o Mini Mental Status Examination” e o “Montreal Cognitive Assessment” em nove doentes com Atrofia de Sistemas Múltiplos e os respetivos “scores” comparados. Estes foram posteriormente relacionados com os resultados de uma avaliação neuropsicológica detalhada e da “Disability Assessment for Dementia”. Foram emparelhados dezoito controlos. Todos os participantes foram submetidos a avaliação clínica e rastreados para a presença de depressão pela “Geriatric Depression Scale”. Resultados: Após o ajuste da literacia nos doentes, foi identificado défice cognitivo em 22% através do “Mini Mental Status Examination” e em 78% usando o “Montreal Cognitive Assessment”. Os doentes pontuaram em média significativamente mais baixo nos dois testes em comparação com os controlos, com variação e desvio padrão dos “scores” maior no “Montreal Cognitive Assessment” (9-29; 6,67) do que no “Mini Mental Status Examination” (21-30; 2,79), sendo o coeficiente de correlação significativo (0,543). Conclusão: Este estudo corrobora a superioridade do “Montreal Cognitive Assessment” sobre o “Mini Mental Status Examination” na identificação precoce de qualquer grau de défice cognitivo em doentes com Atrofia de Sistemas Múltiplo
Introduction: Multiple System Atrophy is predominantly a disease of the movement, also with cognitive involvement. The Mini Mental Status Examination is a universal cognitive test, although not very effective in detecting early cognitive deficit. There are other instruments such as the "Montreal Cognitive Assessment," which may show greater sensitivity in identifying these cases. Methods: The scores of the Mini Mental Status Examination and Montreal Cognitive Assessment were compared in nine subjects with Multiple System Atrophy. These were related to the results of Disability Assessment for Dementia and detailed neuropsychological assessment. Eighteen matched controls were included. All participants underwent clinical evaluation and were screened to the presence of depression through the Geriatric Depression Scale. Results: After adjustment literacy, cognitive deficit was identified in 22% of the patients through the Mini Mental Status Examination and 78% using the scale Montreal Cognitive Assessment. They scored on average significantly lower in both scales compared with the controls. The variation and standard deviation score was higher with Montreal Cognitive Assessment (9-29, 6.67) than with the Mini Mental Status Examination (21-30, 2.79) and the correlation coefficient was 0.543. Conclusion: This study confirms the superiority of the Montreal Cognitive Assessment compared with Mini Mental Status Examination in the early identification of any degree of cognitive impairment in patients with Multiple System Atrophy

碩士
國立成功大學
行為醫學研究所
104
Patients with cerebrovascular accident (CVA) often experience neurocognitive impairment; thus, an effective screening test should be developed. The Mini-Mental Status Examination-Chinese (MMSE-C) and the Luria-Nebraska Neuropsychological Battery-Screening test (LNNB-S) are two commonly used tests for assessing cognitive impairment. In the present study, we examined the assessment effectiveness of the MMSE-C and LNNB-S and compared them regarding their assessment effectiveness for impairment in various CVA brain regions. This study was a retrospective study. Medical records from the 2005–2014 period for patients with CVA at the rehabilitation division at a medical center in Southern Taiwan were used. A total of 158 patients diagnosed with CVA and who had completed the MMSE-C and LNNB-S tests were enrolled in this study. When cutoff points 23/24 were used to screen patients with CVA, the detection rate of the MMSE-C test was low particularly for patients with right-brain impairment. The reason may be that the test involves verbal function. Because of the ceiling effect, the MMSE-C test was not a challenge for patients with CVA; thus, the MMSE-C test should not be used alone to diagnose patients’ condition for CVA. The cutoff point for the LNNB-S test can be used to test for abnormalities in patients with CVA. Therefore, we suggest that after using the MMSE-C test, medical professionals should use the LNNB-S test to enhance accuracy in the test for impaired neurocognitive function.

Dissertação de mestrado realizada no âmbito do Mestrado em Psicologia Clínica.
Exame público realizado em 14 de Fevereiro de 2013.
Com o aumento da esperança de vida e com o panorama de envelhecimento populacional que se assiste nas sociedades industrializadas, as investigações que se debruçam sobre os idosos tornam-se extremamente pertinentes. Também devido a este fenómeno, se torna cada vez mais urgente a criação de respostas sociais que se pautem pelos princípios de um envelhecimento activo e bem sucedido, de modo a assegurar a dimensão avaliativa do valor enquanto pessoa e da integridade do idoso. O objectivo deste estudo consistiu em averiguar as relações entre o estado mental e a auto-estima em idosos em duas condições distintas face à institucionalização: não institucionalizados versus institucionalizados (valência de centro de dia). Para esse efeito, recorreu-se a uma amostra constituída por 100 sujeitos de ambos os sexos, idosos, dos quais 51 estão institucionalizados em centro de dia e 49, aos quais foi administrado um questionário sociodemográfico, o MMSE e a escala de auto-estima de Rosenberg, individualmente e numa única sessão para cada sujeito. Os resultados apontam para a existência de diferenças estatisticamente significativas no estado mental em função da situação dos sujeitos face à institucionalização, sendo que nos testes de U de Mann Whitney se obtiveram diferenças estatisticamente significativas nas dimensões atenção e cálculo e linguagem e na auto-estima, sendo que os sujeitos não institucionalizados apresentam médias significativamente superiores aos sujeitos de centro de dia. No que diz respeito a relação entre o estado mental e a auto-estima, através da correlação de Pearson, verificou-se que de facto sujeitos com melhor auto-estima possuem níveis melhores de estado mental nas dimensões de atenção e cálculo e linguagem. Obteve-se ainda uma associação positiva e significativa entre o número de actividades desempenhadas nos tempos livres e o estado mental e a auto-estima, salientando-se a importância do envelhecimento activo.
Abstract: With increasing life expectancy and the aging population panorama that we assist in industrialized societies, investigations that focus on the elderly become extremely relevant. Also due to this phenomenon, it becomes increasingly urgent to create social responses that are guided by the principles of active and successful aging, to ensure the evaluative dirnension of value as a person of integrity of the elderly. The aim of this study was to investigate the relationship between mental state and self-esteem in the elderly in two different conditions face to the institutionalization: institutionalized versus non-institutionalized (valence of day center). With this purpose, we used a sample of 100 subjects of both sexes, aged, of which 51 are institutionalized in day care and 49 non institucionalized, who were administered a sociodemographic questionnaire, the MMSE scale and self-esteem Rosenberg, individuality and in a single session for each subject. The results point to the existence of statistically significant differences in mental status according to the situation of the subjects face institutionalization, and tests of Mann Whitney U were obtained statistically significant differences in the dimensions of attention and calculation, language and self-esteem, and the subjects did not have institutionalized means significantly higher than the subject of Day Care. Regarding the relationship between mental state and self-esteem through the Pearson correlation, it was found that in fact subjects with higher self-esteem levels have better mental status in the dimensions of attention and calculation and language. Obtained still a positive and significant association between the number of activities perforrned during free time and mental state and self-esteem, emphasizing the importance of active aging.

The main goal of the thesis entitled "The selected methods of social work with clients self-non sufficient in health care facilities" was to describe and to analyze methods used in activation of the elderly suffering from dementia. It draws a comparison of different settings and explores workers's attitude to the methods of activation. The text of the thesis was mapped out into five chapters. The first chapter was set into the context of old age and ageing. The second chapter is concerned with the issues of self-sufficiency and dependency of old age and other related issues. The topic of the third chapter is old age in relation with memory. It defines memory and memory disorders in the elderly suffering from dementia. The fourth chapter is crucial and gives an idea of non-pharmacological and other possible activities which are eligible for application in practice and are intended to reduce cognitive disorders of cognitive functions and behavior disorders. The theoretical part enters into research carried out in four facilities which care for clients with dementia. The research section is represented by a qualitative research where methods of a half structured interview and observation were opted for. The interviews were realized with eight practicing experts. The outcomes gathered from the...

O défice cognitivo ligeiro (DCL) é descrito como uma fase de transição entre oenvelhecimento normal e a demência. Tem sido estudada a relação entre perturbações domovimento e o DCL, em particular com a doença de Parkinson (DP), nomeadamente aonível da especificidade dos défices frequentemente de natureza executiva. Recentemente,tem havido evidências crescentes da presença de défices cognitivos ligeiros no tremoressencial (TE), colocando novos desafios ao estudo destes quadros pré-demenciais. Nopresente estudo explorou-se o estado cognitivo global, ao nível do rastreio inicial, com oMini Mental State Examination (MMSE; Guerreiro et al., 1994) e o Montreal CognitiveAssessment (MoCA; Simões et al., 2008) em doentes com DCL associado ou não a doençasdo movimento (DP e TE) e em doentes com queixas subjetivas de memória (QSM), quadroque tem sido sugerido como pré DCL. Dado que o MoCA inclui itens de avaliação dasfunções executivas, averiguaram-se eventuais diferenças no desempenho entre os grupos nossubdomínios do teste. Procurou-se perceber se estes testes diferenciam pessoas com DCL depessoas com QSM. Avaliou-se o valor preditivo das variáveis escolaridade, idade sexo, egrupo clínico de pertença nas pontuações totais obtidas nos dois testes. Não foramencontradas diferenças na cognição global entre os doentes com DCL com e semperturbações do movimento. O desempenho no MMSE e no MoCA apenas diferenciousignificativamente os doentes com DCL de pessoas com QSM. Nas análises por subdomíniosno MoCA, os resultados sugerem que os subdomínios visuoespacial/executivo, atenção eevocação diferida parecem ser os mais discriminativos de DCL, o que é consistente com aliteratura (Nasreddine et al., 2005). A escolaridade foi o preditor mais forte do desempenhono MoCA, seguido do grupo clínico, sexo e idade. No MMSE o único preditor significativodo desempenho foi o grupo clínico. Discute-se a vantagem de utilização do MoCArelativamente ao MMSE na avaliação da cognição global no DCL, associado ou não aperturbações do movimento e a necessidade de recorrer a outros instrumentos de rastreio dasfunções executivas para diagnósticos diferenciais mais detalhados.

O défice cognitivo ligeiro (DCL) é descrito como uma fase de transição entre oenvelhecimento normal e a demência. Tem sido estudada a relação entre perturbações domovimento e o DCL, em particular com a doença de Parkinson (DP), nomeadamente aonível da especificidade dos défices frequentemente de natureza executiva. Recentemente,tem havido evidências crescentes da presença de défices cognitivos ligeiros no tremoressencial (TE), colocando novos desafios ao estudo destes quadros pré-demenciais. Nopresente estudo explorou-se o estado cognitivo global, ao nível do rastreio inicial, com oMini Mental State Examination (MMSE; Guerreiro et al., 1994) e o Montreal CognitiveAssessment (MoCA; Simões et al., 2008) em doentes com DCL associado ou não a doençasdo movimento (DP e TE) e em doentes com queixas subjetivas de memória (QSM), quadroque tem sido sugerido como pré DCL. Dado que o MoCA inclui itens de avaliação dasfunções executivas, averiguaram-se eventuais diferenças no desempenho entre os grupos nossubdomínios do teste. Procurou-se perceber se estes testes diferenciam pessoas com DCL depessoas com QSM. Avaliou-se o valor preditivo das variáveis escolaridade, idade sexo, egrupo clínico de pertença nas pontuações totais obtidas nos dois testes. Não foramencontradas diferenças na cognição global entre os doentes com DCL com e semperturbações do movimento. O desempenho no MMSE e no MoCA apenas diferenciousignificativamente os doentes com DCL de pessoas com QSM. Nas análises por subdomíniosno MoCA, os resultados sugerem que os subdomínios visuoespacial/executivo, atenção eevocação diferida parecem ser os mais discriminativos de DCL, o que é consistente com aliteratura (Nasreddine et al., 2005). A escolaridade foi o preditor mais forte do desempenhono MoCA, seguido do grupo clínico, sexo e idade. No MMSE o único preditor significativodo desempenho foi o grupo clínico. Discute-se a vantagem de utilização do MoCArelativamente ao MMSE na avaliação da cognição global no DCL, associado ou não aperturbações do movimento e a necessidade de recorrer a outros instrumentos de rastreio dasfunções executivas para diagnósticos diferenciais mais detalhados.

The chapter titled Present state focuses on the problem of gerontology and geriatrics. Other chapters include description of the most outstanding neuropsychical and somatic changes in the old-age. Next chapters deal with functional examine and geriatric rehabilitation problem.The objective of the thesis was assessing the extent of self-reliance and psychical changes affecting all the occupants of using Crichton Geriatric Rating Scale.146 seniors were tested according to the Crichton Geriatric Rating Scale.Three hypotheses were stated. It was expected that the results of the Crichton tests would correlate with the results of MiniMental Test. Another hypothesis was that there would be better results of the test done to the people whose family care for them actively. The last hypothesis expected worse results of the people who have been in the retirement home for more than three years.The research has confirmed that the results of the Chrichton test and MiniMental test correlate. Correlation of the Crichton test with the active care and interest of the family for the senior and the length of their stay was not proved.

This thesis deals with the neuropsychological diagnosis of Alzheimer's disease. The aim is to evaluate the psychometric characteristics ofthe new Czech translation of the Montreal Cognitive Assessment (MoCA) by comparison with the Mini-Mental State Examination (MMSE), a method widely used by doctors inscreening diagnostics of Alzheimer's disease. The theoretical part deals with the diagnostics of Alzheimer's disease and mild cognitive impairment. We describe international diagnostic criteria of cognitive disorders and provide an overview of the screening neuropsychological methods most commonly used by Czech specialists. We summarize the current psychometric and psychodiagnostic findings on these methods and focuse on description of MMSE and MoCA. In the empirical part we compare Czech version of MMSE and MoCA-CZ (the new Czech translation of the test). We examined 38 patients with Alzheimer's disease and 70 cognitively healthy seniors. The results show that MoCA-CZ is sufficiently valid and reliable screening method that accurately distinguishbetween healthy subjects and patiens with Alzheimer's disease. We believe that it can enrich screening tools that are available to Czech experts. Key words: Montreal Cognitive Assessment, Mini-Mental State Examination, Alzheimer's disease, psychodiagnostics,...

Relatório de estágio realizado no âmbito de mestrado de Psicologia Clínica.
Exame público realizado em 15 de Março de 2013.
O presente relatório visa descrever actividades desenvolvidas no âmbito do estágio curricular do Mestrado em Psicologia Clínica que decorreu no Serviço de Psicologia do Lar Nossa Senhora da Misericórdia sediado no Porto. O envelhecimento faz parte do ciclo de vida de um indivíduo. A população está cada vez mais envelhecida devido ao aumento da esperança média de vida e da diminuição da taxa de natalidade. Esta realidade provoca a reflexão sobre as infra-estruturas; apoios; políticas; que rodeiam a população idosa. Na realidade, devido às grandes mudanças estruturais que tem ocorrido no seio das famílias, tendem a existir cada vez mais idosos que são institucionalizados, uns por vontade própria, outros mesmo, porque a família não tem capacidade de resposta para os seus emergentes cuidados. Como o referido extensamente pela literatura, o processo de envelhecimento acarreta um conjunto de alterações fisiológicas, psicológicas, e sociais. Torna-se cada vez mais emergente, que as instituições pensem em medidas, que para além de satisfazerem as necessidades básicas de vida diária do idoso, devem estimular e reabilitar as suas funções cognitivas, atingindo assim, um máximo de qualidade de vida possível nesta etapa de vida. No contexto de estágio foram desenvolvidas várias intervenções e actividades com os idosos institucionalizados, quer a nível grupal, quer a nível individual. No âmbito da Psicologia Clínica, a avaliação cognitiva esteve sempre presente através da aplicação de testes neuropsicológicos: 1) Mini-Mental State (MMSE); o Dementia-Railing Scale (DRS-2); o Teste do Desenho do Relógio (TR); e a Escala de Depressão Geriátrica (GDS). Estes serviram de instrumentos utilizados no programa que foi criado de Estimulação e Reabilitação Cognitiva, bem como, serviram de complemento ao diagnóstico dos casos clínicos acompanhados. De um modo geral, tendencialmente, verificou-se que a aplicação do programa surtiu efeitos positivos na melhoria de funções cognitivas dos idosos avaliados. A realização deste estágio permitiu desenvolver e treinar competências de atendimento clínico, elaboração de diagnósticos clínicos, e rigor na aplicação de baterias de testes. Por outro lado, permitiu ainda, uma análise aprofundada dos resultados obtidos, possibilitando delinear intervenções realistas e eficazes.

Relatório de estágio realizado no âmbito do mestrado em Psicologia Clínica.
Exame público realizado em 5 de Março de 2013 pelas 10h00.
O presente relatório é o resultado de um estágio realizado no âmbito do Mestrado cm Psicologia Clínica da Universidade Lusíada do Porto, ao longo do ano letivo de 2011/2012. O estágio surge num contexto comunitário, no “O Abrigo” Centro de Solidariedade Social de São João de Ver”, instituição particular de solidariedade social (IPSS). O local escolhido para realizar o estágio deveu-se ao interesse pela intervenção comunitária e pela expectativa de contactar com diferentes populações que permitiram mobilizar para a intervenção os conhecimentos teóricos adquiridos ao longo da minha formação bem como as minhas características pessoais. O propósito da realização deste relatório ultrapassa a simples descrição mais ou menos, fragmentada, das atividades desenvolvidas e ambiciona veicular o tão pessoal da experiência de estágio. Assim, colocar em palavras a experiência de todo um ano letivo repleto de crescimento, aprendizagem e suas reflexões num domínio tão objetivo e complexo como é a Psicologia, não é de todo tarefa fácil. No entanto, a variedade de experiências, as diversas faixas etárias com que me deparei, as problemáticas e as diferentes modalidades de intervenção, sempre cm colaboração com as diferentes populações e profissionais com quem tive o privilégio de trabalhar em cooperação, fizeram com que vivenciasse no terreno a necessidade do trabalho cm parceria (ou não seria este um local de intervenção comunitária se assim não ocorresse). Assim, é no âmbito desta variedade de populações e modalidades de intervenção que a intencionalidade da ação do psicólogo não poderia fazer perder de vista o objetivo último do empowerment. Foi ainda, sob esta riqueza que me foi dada a possibilidade de construir, a partir dos primeiros alicerces científicos e teóricos adquiridos ao longo da Licenciatura e do Mestrado, os diversos andaimes da minha identidade profissional que continuará a crescer durante todo o meu percurso enquanto profissional e pessoal. O presente trabalho divide-se cm cinco capítulos: no primeiro capitulo procede-se ao enquadramento teórico da Psicologia Comunitária, no segundo à caracterização da instituição onde foi realizado o estágio, no terceiro capitulo apresenta-se uma síntese de todas as atividades realizadas e passa-se a incidir concretamente sobre cada uma delas, no quarto capitulo apresentam-se os casos clínicos. O quinto é uma reflexão pessoal sobre o estágio, olhando para as funções desempenhadas, as atividades desenvolvidas, mas sobretudo as aprendizagens conseguidas e o contributo destas para o desenvolvimento estagiária de psicologia.