Examining the reliability and validity of the Hebrew version of the Mini Mental State Examination

The Mini Mental State Examination is used worldwide for the screening and diagnosis of dementia. The aim of the present study was to examine the reliability and validity of the Hebrew version of the Mini Mental State Examination. The Hebrew version of the Mini Mental State Examination was administered to 36 demented and 19 non-demented elderly persons. Test-retest reliability scores were calculated as exact agreement rates, and ranged from good to excellent for all the items. Strong convergent validity, as measured by the correlation between the MMSE and the CAM-COG (r = 0.94), was found. Good predictive value was observed as over three-quarters of the participants were correctly classified as demented or non-demented. The Hebrew version of the MMSE was found to be a useful and valid instrument for the determination of dementia in the elderly population.     

Validation study of the three-objects-three-places test: a screening test for Alzheimer's disease

The aim of the present study was to validate a short, ecological test of episodic memory for the screening of Alzheimer's disease (AD). The validation was performed by computing intrarater reliability, homogeneity, internal coherence, convergent, discriminant and known group validities in the performance of normal subjects (N = 65), mild cognitive impairment (MCI) patients (N = 114), and AD (N = 44) and non-AD demented (N = 39) patients. Intrarater reliability was 0.88, homogeneity ranged from 0.81 to 0.97, and internal coherence was 0.87. With respect to convergent and discriminant validities, the test loaded strongly on memory factor (value = 0.64) and weakly on other nonmemory factors. The known group validity showed a specificity between 87% and 91% and a sensitivity between 92% and 100% in correctly identifying AD in age classes ranging from 50 to 65 and 66 to 80 years. The test is a valid instrument for the screening of AD.     

The short human figure drawing scale for evaluation of suspect cognitive dysfunction in old age

Human figure drawings have been widely used to assess cognitive development in children. In the present study, free-hand human figure drawings were examined for 62 demented patients, and 60 normal elderly subjects. The drawings were scored for 53 body details using a method derived from work with children. A short scale of 15 details was developed by selecting body details with high item-total correlations which are simple to score even for untrained staff. This short scale had excellent interscorer and test-retest reliability and excellent concurrent validity as well. It correlated highly with the Mini-Mental State Examination, a commonly used screening test for dementia. The short scale discriminated demented and non-demented subjects and different levels of dementia severity as graded by the Clinical Dementia Rating Scale. However, no differences were observed between Alzheimer patients and patients with vascular dementia concerning presence of details in human figure drawings.     

A simple screening test for hearing impairment in elderly patients

This study investigated the reliability of simple bedside free-field voice testing in the detection of hearing impairment in patients admitted to a geriatric unit. Sixty-two consecutive admissions were assessed at four graduated levels of loudness by geriatrician and otolaryngologist independently. Pure tone audiometry was then performed blind. Voice testing by both observers was concordant in 88% of all ears and in 100% of ears able to hear a whispered voice (WV) at 2 ft (approximately 0.6 m). The WV at 2 ft was the most discriminant test with a sensitivity of 100%, a specificity of 84% and a predictive value of 92% for hearing impairment likely to benefit from provision of a hearing aid. Free-field voice testing appears a simple, reliable and reproducible test for detecting hearing impairment in elderly patients.     

瑞金简易记忆测试量表对阿尔茨海默病患者筛查效用的初步研究

目的:为研发适合中国人群的记忆力筛查量表,采用瑞金简易记忆测试(RISMET)量表对阿尔茨海默病(AD)患者进行检测,评价其效用。方法:分别对57例AD患者和46名正常对照者行RISMET量表和简易智能状态检查(MMSE)量表测评,比较2组得分情况;以内部相关系数(ICC)计算重测信度,Cronbach’sα系数评价内部一致性;以受试者工作特征(ROC)曲线评价RISMET量表对于筛查AD患者的敏感性和特异性。结果:①MMSE、RISMET量表及其分项得分(包括定向力、瞬间记忆、逆行性记忆、相似性、画钟测验、计算力、语言流畅性和回忆8项)均AD组0.7;③Spearman相关分析显示RISMET量表与MMSE量表呈正相关(P=0.726,P=0.000),每一分项与总分的相关性均大于2个分项的相关性,具有统计学差异(P     

阿尔茨海默病各种临床记忆检测方法的评价

目的评价各种临床记忆检测方法对阿尔茨海默病(Alzheimer’s disease,AD)诊断的临床效度,从而组合出最适宜AD患者的一套记忆力检测量表。方法以北京市十五攻关项目中研究的患者为背景,对正常老年人1 584例(常模组),AD患者351例(AD组),应用各种记忆力检测量表进行临床分析。结果各种记忆力检测量表对AD的记忆力检测均有较好的临床效度。结合记忆力检测量表的敏感性、特异性、临床可行性及不同的记忆模式,以常模组记忆总得分的第5百分位为分界值,联合各量表的记忆检测,轻度AD患者敏感性为82.57%,特异性为93.29%;检测中度AD患者的敏感性为85.46%,特异性为91.63%。结论联合各量表的记忆检查对AD患者的记忆力检测,敏感性及特异性高,对AD的轻、中度分界有辅助作用。     

40 Hz听性稳态反应在脑干卒中患者中的近期预后价值

目的 探讨40 Hz听性稳态反应(40 Hz auditory steady state response,40-Hz ASSR)在脑干卒中患者近期预后评价中的价值.方法 分别对神经重症监护病房(Neurological Intensive Care Unit,NICU)收治的36例脑干卒中患者进行40-Hz ASSR和脑干听觉诱发电位(brainstem auditory evoked potential,BAEP)检查,并对两者进行分级.以转出NICU时为近期预后评价终点,将脑干卒中患者分为生存组(n=21)和死亡组(包括脑死亡,n=15),分析40-Hz ASSR和BAEP分级与近期预后的相关性.结果 40-Hz ASSR(r=0.571,P=0.000)、BAEP(r=0.441,P=0.001)分级与脑干卒中患者近期预后显著相关.40-Hz ASSR的敏感性、特异性和准确性分别为60.00%、100%和83.33%,而BAEP分级则分别为66.67%、7.43%和69.44%.结论 40-Hz ASSR对脑干卒中患者的近期预后有一定的预测价值;级别越高提示病情越严重,预后也越差.     

A visual recognition memory test for the assessment of cognitive function in aging and dementia

Young, non-demented elderly, and elderly demented subjects were administered a computerized visual recognition memory task. In the task, subjects were instructed to point out the new object from a group of objects whose number was progressively incremented. The test was subject-paced and made use of face-valid stimulus materials; it is closely comparable to tests developed for memory assessment in non-human primates that are sensitive to the effects of hippocampal ablation. The present task was found to elicit significant differences in performance between young and non-demented aged subjects, between the non-demented and demented elderly, and between demented subjects in the early and more advanced stages of senile dementia of the Alzheimer type (SDAT). In a discriminant analysis, the visual recognition memory test scores correctly classified 72.6% of the aged subjects and early SDAT patients. No significant difference in task performance was found between SDAT patients and demented patients with a significant cerebrovascular etiological component. Thus, although the task does not appear to be suitable for diagnostic purposes it would be useful for the assessment of treatment effects upon age-related cognitive dysfunction.     

The Human Figure Drawing test as a screen for dementia in the elderly: a community-based study

The Human Figure Drawing (HFD) test is a non-verbal test, mainly based on visuo-spatial and constructional abilities. In screening for dementia, the HFD test can be hypothesised as a good complement to Mini-Mental State Examination (MMSE), which is inherently limited by its verbal nature. In order to test this hypothesis, both MMSE and HFD tests were administered to 461 individuals recruited from a community-based study of the elderly (the Kungsholmen project). According to the Third Revised Diagnostic and Statistical Manual of Mental Disorders, 95 subjects were affected by dementia and 366 were non-demented. We calculated the sensitivity and specificity of MMSE, the HFD test, and the combination of the two. Results showed that MMSE mean scores were significantly reduced between the non-demented group and groups with different severities of dementia. The mean scores of a short version of 29 HFD body details (HFD29) and seven HFD essential body details (HFDess) showed similar, but weaker trends than MMSE. However, the sensitivity increased by 4.2% when HFD29 and HFDess were added to MMSE, compared to the MMSE test alone. This increase partially derived from the portion of questionable and mild demented subjects. Unfortunately, a high drop-out rate was present in the HFD test. We conclude that the use of HFD test has limitations in this well-educated population, due to a high number of refusals and only a small improvement in detecting mild demented cases. The application of this test in lower educated populations requires further investigation.     

Computer-automated dementia screening using a touch-tone telephone.

BACKGROUND: This study investigated the sensitivity and specificity of a computer-automated telephone system to evaluate cognitive impairment in elderly callers to identify signs of early dementia. METHODS: The Clinical Dementia Rating Scale was used to assess 155 subjects aged 56 to 93 years (n = 74, 27, 42, and 12, with a Clinical Dementia Rating Scale score of 0, 0.5, 1, and 2, respectively). These subjects performed a battery of tests administered by an interactive voice response system using standard Touch-Tone telephones. Seventy-four collateral informants also completed an interactive voice response version of the Symptoms of Dementia Screener. RESULTS: Sixteen cognitively impaired subjects were unable to complete the telephone call. Performances on 6 of 8 tasks were significantly influenced by Clinical Dementia Rating Scale status. The mean (SD) call length was 12 minutes 27 seconds (2 minutes 32 seconds). A subsample (n = 116) was analyzed using machine-learning methods, producing a scoring algorithm that combined performances across 4 tasks. Results indicated a potential sensitivity of 82.0% and specificity of 85.5%. The scoring model generalized to a validation subsample (n = 39), producing 85.0% sensitivity and 78.9% specificity. The kappa agreement between predicted and actual group membership was 0.64 (P<.001). Of the 16 subjects unable to complete the call, 11 provided sufficient information to permit us to classify them as impaired. Standard scoring of the interactive voice response-administered Symptoms of Dementia Screener (completed by informants) produced a screening sensitivity of 63.5% and 100% specificity. A lower criterion found a 90.4% sensitivity, without lowering specificity. CONCLUSIONS: Computer-automated telephone screening for early dementia using either informant or direct assessment is feasible. Such systems could provide wide-scale, cost-effective screening, education, and referral services to patients and caregivers.     

Central auditory processing in elderly with mild cognitive impairment

Aim: The aim of the present study was to assess if central auditory processing affected patients with mild cognitive impairment (MCI) or not and to assess sensitivity and specificity of central auditory processing tests in detection of MCI. Methods: This was a case–control study conducted at the Geriatrics Department and Audiology Unit, Ain Shams University Hospital. Participants were 150 elderly diagnosed as MCI compared with 150 normal subjects, based on a neuropsychological diagnostic test battery, the Cambridge Cognitive Examination (CAMCOG), and who were matched for age, sex and average threshold of hearing. Both cases and control groups were subjected to otological examination, immittancemetry, pure tone audiometry, speech audiometry and central auditory processing assessment by the use of a selective auditory attention test, dichotic digits test, auditory fusion test, pitch pattern sequences test and auditory memory battery of Goldman–Fristoe–Woodcock. Results: The MCI group scored significantly lower than the control group in central auditory processing tests (P < 0.05). Sensitivity of dichotic digit test, pitch pattern sequence test and recognition memory test were 76.6%, 71.7% and 70.4%, respectively, while specificity were 56.2%, 81.2% and 92.2%, respectively. When the previous three tests were used together the sensitivity and specificity were 82.8% and 93.2%, respectively. Conclusion: Central auditory processing was affected in MCI patients. The dichotic digit test, pitch pattern sequence test and recognition memory test can be used in detection of MCI with high sensitivity and specificity. Geriatr Gerontol Int 2011; 11: 304–308 .     

Sensitivity and specificity of rapid HIV testing of pregnant women in India

OBJECTIVE: Efforts to prevent HIV transmission from mother to infants in settings like India may benefit from the availability of reliable methods for rapid and simple HIV screening. Data from India on the reliability of rapid HIV test kits are limited and there are no data on the use of rapid HIV tests for screening of pregnant women. METHODS: Pregnant women attending an antenatal clinic and delivery room in Pune agreed to participate in an evaluation of five rapid HIV tests, including (a) a saliva brush test (Oraquick HIV-1/2, Orasure Technologies Inc.), (b) a rapid plasma test (Oraquick HIV-1/2) and (c) three rapid finger prick tests (Oraquick HIV-1/2; HIV-1/2 Determine, Abbott; NEVA HIV-1/2 Cadila). Results of the rapid tests were compared with three commercial plasma enzyme immunoassay (EIA) tests (Innotest HIV AB EIA, Lab systems/ELISCAN HIV AB EIA, UBI HIV Ab EIA). RESULTS: Between September 2000 and October 1, 2001, 1258 pregnant women were screened for HIV using these rapid tests. Forty-four (3.49%) of the specimens were HIV-antibody-positive by at least two plasma EIA tests. All of the rapid HIV tests demonstrated excellent specificity (96-100%). The sensitivity of the rapid tests ranged from 75-94%. The combined sensitivity and specificity of a two-step algorithm for rapid HIV testing was excellent for a number of combinations of the five rapid finger stick tests. CONCLUSION: In this relatively low HIV prevalence population of pregnant women in India, the sensitivity of the rapid HIV tests varied, when compared to a dual EIA algorithm. In general, the specificity of all the rapid tests was excellent, with very few false positive HIV tests. Based upon these data, two different rapid HIV tests for screening pregnant women in India would be highly sensitive, with excellent specificity to reliably prevent inappropriate use of antiretroviral therapy for prevention of vertical HIV transmission.     

Clinical study of watershed infarct dementia

This clinical study of watershed infarct was carried out in two hospitals for elderly patients. The purpose of this study was an investigation of the clinical specificity of this type of infarct as compared with other types of infarcts. The most important point was to determine which patients with this type of infarct usually become demented. The items of investigation were brain CT findings, measurements of the width of the ventricles and the extent of sylvian fissures from CT images, blood pressure, past history of hypertension, diabetes mellitus, alcohol use and smoking, blood analysis of total cholesterol, HDL-cholesterol, hematocrit, hemoglobin A1 and uric acid and the incidence of patients in whom dementia had improved from the previous state. From CT findings, we classified all patients with brain infarcts into 4 groups; 173 patients with central infarcts, 56 patients with watershed infarcts, 20 patients with subcortical lesions of the Binswanger type and 11 patients with occlusion of main brain arteries. Among all investigated patients, there were 56 non-demented and 162 demented (74.3%) patients. Among the patients with watershed infarcts, there were 10 non-demented and 45 (81.8%) demented patients. In the group of demented patients with watershed infarcts, females were four times as many as males. Demented patients with watershed infarcts in the right hemisphere were twice as frequent as those with infarcts in the left hemisphere, while the number of non-demented patients with this type of infarct in right hemisphere was the same as that in the left hemisphere.(ABSTRACT TRUNCATED AT 250 WORDS)     

The GPcog for detecting a population with a high risk of dementia

GPcog is a screening tool for dementia in the aged. It consists of nine cognitive items and six items assessing the daily living instrumental activities by an informal carer. This study was aimed to assess the reliability of the French version of the GPcog in a psychogeriatric population. Two hundred and eighty inpatients from a short-term psychogeriatric ward, with or without dementia, were examined. Scores on GPcog, MMSE and on a five-word memory test for screening dementia were compared to the final diagnosis of dementia. The mean age of subjects was 77.8+/-7.0 years for males (n=116), and of 80.3+/-6.6 years for females (n=164). One hundred eighty two patients had dementia, mainly of Alzheimer's type, and 98 had psychiatric disorders but were non demented. GPcog sensitivity for the diagnosis of dementia was 96%, specificity 62%, positive predictive value 83% and negative predictive value 90%. GPcog is an accurate and well-accepted instrument for dementia screening in primary care. French results were similar to those obtained with the English version. It can be easily used by non-specialized carers.     

Field evaluation of enzyme-linked immunosorbent assay for the serodiagnosis of tuberculosis

An enzyme-linked immunosorbent assay (ELISA) was evaluated as a serodiagnostic test for active tuberculosis in La Paz, Bolivia. ELISA was compared with sputum smear in 277 persons presenting to the Instituto de Torax and was used for screening in 1,458 military personnel. The test was performed under field conditions on 4-microliter samples of capillary blood obtained by finger prick. ELISA was found to have a sensitivity of 69% and a specificity of 88%. Sputum smear had a sensitivity of 79% and a specificity of 100%. ELISA was found to have undiminished sensitivity and specificity in patients who were sputum-negative, and the two tests could be combined to achieve a sensitivity of 92% and specificity of 88%. Positive and negative predictive values were highest for populations with tuberculosis prevalences in the range of that seen among patients presenting to the Instituto de Torax in Bolivia, but ELISA also led to the diagnosis of tuberculosis in 5 of 1,458 soldiers tested in the screening program.     

The value of the Rydel-Seiffer tuning fork as a predictor of diabetic polyneuropathy compared with a neurothesiometer.

AIMS: The aim of the study was to investigate the predictive value of the Rydel-Seiffer tuning fork for detecting diabetic neuropathy and to compare it with an electronic neurothesiometer. METHODS: In 2022 consecutive diabetic subjects, peripheral polyneuropathy was diagnosed by vibration perception threshold (VPT) at the tip of both great toes using a 128-Hz tuning fork and a neurothesiometer, by simple bedside tests and by the presence of neuropathic symptoms. These evaluations were further combined to diagnose peripheral nerve dysfunction (abnormal bedside tests) and symptomatic neuropathy. VPT was also measured in 175 non-diabetic control subjects to define normal values. RESULTS: VPT was normal in 1917 subjects and abnormal in 105 (5.2%) patients when measured by the tuning fork. Patients with an abnormal vibration test were significantly (P < 0.0001) older than subjects with a normal vibration sense, while diabetes duration and HbA(1c) of the former were also significantly elevated. The same was true for the percentages of an abnormal 10-g monofilament test (66.7% vs. 7.2%, P < 0.0001) and a missing Achilles' tendon reflex (68.6% vs. 24.8%, P < 0.0001). Finally, the VPT measured by the neurothesiometer was 2.5 times higher in patients with an abnormal tuning fork test (32.0 +/- 9.8 vs. 12.5 +/- 6.4 V, P < 0.0001). The plot of the difference of both methods against their mean yielded a good agreement of the two VPT measurements, and the tuning fork had a high sensitivity and positive predictive value for the diagnosis of abnormal bedside tests and for symptomatic neuropathy. CONCLUSION: The tuning fork reliably detected peripheral neuropathy in comparison with the neurothesiometer. A tuning fork is a useful screening test for diabetic neuropathy.     

The Clock Drawing Test: utility for dementia detection in multiethnic elders

BACKGROUND: Disproportionate increases in dementia morbidity in ethnic minorities challenge established screening methodologies because of language and culture barriers, varying access to health services, and a relative paucity of cross-cultural data validating their use. Simple screening techniques adapted to a range of health and social service settings would accelerate dementia detection and social and health services planning for demented minority elders. METHODS: The effectiveness of the Clock Drawing Test (CDT) for dementia detection was compared with that of the Mini-Mental State Examination (MMSE) and the Cognitive Abilities Screening Instrument (CASI) in community-dwelling elders of diverse linguistic, ethnic, and educational backgrounds. Subjects (N = 295) were tested at home in their native languages (English, n = 141; another language, n = 154). An informant-based clinical dementia history and functional severity index derived from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) protocols were used to classify subjects as probably demented (n = 170), and probably not demented (n = 125). RESULTS: All tests were significantly affected by education (p < .001) but not by primary language (p > .05). Sensitivities and specificities for probable dementia were 82% and 92%, respectively, for the CDT; 92% and 92% for the MMSE; and 93% and 97% for the CASI for subjects completing each test. However, in poorly educated non-English speakers, the CDT detected demented subjects with higher sensitivity than the two longer instruments (sensitivity and specificity 85% and 94% for the CDT, 46% and 100% for the MMSE, and 75% and 95% for the CASI). Moreover less information was lost due to noncompletion of the CDT than the MMSE or CASI (severe dementia or refusal: CDT 8%, MMSE 12%, and CASI 16%). CONCLUSIONS: Overall, the CDT may be as effective as the MMSE or CASI as a first-level dementia screen for clinical use in multiethnic, multilingual samples of older adults. Its brevity (1-5 minutes), minimal language requirements, high acceptability, and lack of dependence on specialized testing materials are well adapted for screening of non-English-speaking elderly persons in settings where bilingual interpreters are not readily available and screening time is at a premium.     

Validation of the language component of the Addenbrooke's Cognitive Examination – Revised (ACE‐R) as a screening tool for aphasia in stroke patients

Aim: Several tests are available for aphasia screening following stroke. However, some of them have shortcomings such as need of specialist knowledge, low sensitivity and/or specificity and lengthy administration time. Our study aims to evaluate the language component of the Addenbrooke's Cognitive Examination – Revised (ACE‐R) as a screening tool for aphasia in stroke patients. Methods: The language component of ACE‐R was administered to consecutive patients admitted to a post‐acute stroke unit. Patients who were medically unstable or had a significant history of sensory impairment or mental health issues were excluded. The test was administered by two junior doctors with basic training in ACE‐R administration. Patients recruited were also assessed by an experienced speech and language therapist (SLT). The results of the two assessments were documented by a different member of the team and the SLT results were used as the benchmark to calculate the ACE‐R language component sensitivity and specificity. Results: Fifty‐nine participants were recruited and 27 of them were women. The mean age was 72 (SD 11.9). Thirty‐four participants had left and 11 right hemisphere stroke. Fourteen had bilateral affection. Six participants were left handed. A cut‐off value of 22/26 of ACE‐R language component showed 100% specificity and 83.1% sensitivity, while a cut‐off value of 16/26 had 88.2% specificity and 100% sensitivity. Conclusion: Our results suggest that the language component of ACE‐R has a satisfactory sensitivity and specificity compared with other screening tests used in strokes. It is easy to administer and free to use.     

Wet Voice as a Sign of Penetration/Aspiration in Parkinson’s Disease: Does Testing Material Matter?

Wet voice is a perceptual vocal quality that is commonly used as an indicator of penetration and/or aspiration in clinical swallowing assessments and bedside screening tests. Our aim was to describe the clinimetric characteristics of this clinical sign using various fluid materials and one solid food in the Parkinson’s disease (PD) population. Consecutive PD individuals were submitted for simultaneous fiberoptic endoscopic evaluation of swallowing (FEES) and voice recording. Speech therapists rated the presence or absence of wetness and other voice abnormalities. Two binary endpoints of FEES were selected for comparison with an index test: low penetration (LP) and low penetration and/or aspiration (LP/ASP). The accuracy of wet voice changed according to the testing material in PD patients. Overall, the specificity of this indicator was better than its sensitivity, and the wafer cookie and yogurt drink yielded the best indices. Our data show that wet voice is clearly indicative of LP or LP/ASP in PD patients in case of positive test. However, in the case of a negative result, the wet voice test should be repeated or combined with other clinical tests to include or exclude the risk of LP or LP/ASP.     

Speech pathology for chronic cough: A new approach

Chronic cough may persist despite systematic evaluation and medical treatment of known associated diseases such as asthma, rhinitis, and gastro-esophageal reflux. These patients have refractory chronic cough and many exhibit laryngeal hypersensitivity that is manifest at both a sensory and motor level. Examples of this are heightened sensitivity of the cough reflex to capsaicin, and laryngeal motor dysfunction with hoarse vocal quality and paradoxical vocal cord movement. Chronic cough that persists despite medical treatment may respond to speech pathology intervention. A multidimensional speech pathology treatment programme was designed based upon methods used to treat hyperfunctional voice disorders and paradoxical vocal fold movement. This included education, vocal hygiene training, cough suppression strategies and psychoeducational counseling. When tested in a single-blind, randomized, placebo-controlled trial involving 87 patients, participants in the treatment group demonstrated a significant reduction in cough, breathing, voice and upper airway symptoms following intervention, as well as improvements in auditory perceptual ratings of voice quality (breathy, rough, strain and glottal fry) and significant improvement in voice acoustic parameters (maximum phonation time, jitter and harmonic-to-noise ratio). Speech pathology intervention can be an effective way to treat refractory chronic cough.