mini mental state examination

Dementia involves a neuronal loss in the primary somatosensory cortex of the parietal lobe, causing dementia patients to perceive pain stimuli hardly. The function of temperature sensation declines. Studies measuring brain blood volume using near-infrared light have reported that patients suffering from dementia have less activation than healthy elderly people. However, the majority of these studies used tests related to cognitive function and the frontal lobe, and few have examined thermal sensation.
The present study aimed to investigate the effect of cold and warm stimulation on cerebral blood volume in elderly and young subjects.
This observational study measured changes in oxygenated hemoglobin concentrations in the frontal cortex during cold and warm stimulation in elderly and young subjects using a near-infrared light device. The mean and standard deviation of the change in oxygenated hemoglobin concentration before and after cold and warm stimulation, as well as the center-of-gravity values, were compared between the young and the elderly.
During warm stimulation, the younger subjects showed an increase in blood oxygenated hemoglobin levels; however, the difference was not significant. For the elderly, no change was observed during the task. The center of gravity values was lower in the young compared to the elderly which was similar to the reaction threshold. No significant changes were observed during cold stimulation. 
Thermal sensation thresholds were impaired in the elderly compared to the young; however, cerebral blood volume changes were unclear.

This study aimed to compare the diagnostic value of four questionnaires for the diagnosis of neurocognitive disorders (NCDs) in the elderly.

 In this project, people older than 60 years who lived in Tehran were investigated. A total of 99 literate cases were enrolled in the study, and four questionnaires, including functional assessment staging tool (FAST), abbreviated mental test score (AMTS), mini-mental state examination (MMSE), and modified Persian test of elderly for assessment of cognition and executive function (PEACE) were completed for them. They were then referred to a neuropsychiatrist, and the status of their cognition and neurobehavior was determined. The specialists were blinded to the results of the tests.

Of the 99 participants studied, 39 cases were healthy, eight cases had mild Alzheimer’s disease, 38 had amnesic MCI, five cases had secondary dementia, and nine cases had mixed vascular dementia and Alzheimer’s disease. The area under the ROC curve for distinguishing the healthy group from the rest of the population was 0.692, 0.629, 0.734, and 0.751 for the FAST, AMTS, MMSE, and NBCSS questionnaires, respectively.

MMSE and NBCSS tests had better diagnostic power than the other two tests to distinguish the healthy group from the rest of the population.

Post-traumatic epilepsy is one of the most common and disabling sequels of traumatic brain injury and is defined as repeated unprovoked seizures seven days after traumatic brain injury. The present study aimed to determine the late consequences of epilepsy in veterans with traumatic brain injury during the imposed Iran-Iraq war.
Instruments &

This study was observational cohort research in 2022. The sample of the study included all living veterans with a history of Post-traumatic epilepsy who were covered by the services of the "Veterans Affairs Foundation" of Isfahan, Iran. 218 veterans with epilepsy, who were available, were identified, 100 of them had a traumatic brain injury, and 118 did not have any traumatic brain injury. Data were collected using the Mini Mental State Examination (MMSE) and Instrumental Activities of Daily Living and Physical Self-Maintenance Scale (IADL-PSMS).

There was a significant difference between veterans with and without traumatic brain injuries in the age at post-traumatic epilepsy debut (p<0.05). Epilepsy characteristics were not significantly different between the two groups (p>0.05). The mean score of MMSE in veterans with and without traumatic brain injuries was significantly different (p<0.05). The Recall and Registration subscales were significantly different in veterans with/without traumatic brain injuries (p<0.05).

The ability to perform daily activities and cognitive function are lower in veterans with epilepsy with traumatic brain injuries compared to veterans with epilepsy without traumatic brain injuries.

The purpose of this study is to use linear and non-linear features extracted from Electroencephalography (EEG) signal to predict the Mini-Mental State Examination (MMSE) test score by machine learning algorithms.

First, the MMSE test was taken from 20 subjects that were referred with the initial diagnosis of dementia. Then, the brain activity of subjects was recorded via EEG signal. After preprocessing this signal, various linear and non-linear features are extracted from it that are used as input to machine learning algorithms to predict MMSE test scores in three levels.

Based on the experiments, the best classification result is related to the Long Short-Term Memory (LSTM) network with 68% accuracy.

Findings show that by using machine learning algorithms and features extracted from EEG signal the MMSE scores are predicted in three levels. Although deep neural networks require a lot of data for training, the LSTM network has been able to achieve the best performance. By increasing the number of subjects, it is expected that the classification results will also increase.

The majority of the TBI patients are those with mild traumatic brain injury (mTBI). However, due to the absence of symptoms in brain imaging until long after the injury, the manifestations of cognitive impairments remain undiagnosed. Therefore, cognitive screening is considered a key measure in these patients. One of the common screening tools for evaluating cognitive impairments is the MMSE test. The present study aimed to determine the cut-off point, sensitivity, and specificity of the MMSE test in mTBI patients.

Methods and Materials/Patients:

In this observational and cross-sectional-analytical study, the statistical population was all patients with mTBI who were injured in the first half of 2022. The case group included 79 mTBI patients admitted to the trauma, neurosurgery, and ICU departments of Poursina Hospital in Rasht in the first half of 2022, who had been referred to the same hospital as well as the Velayat specialized clinic for rehabilitation and re-visit, and the control group included 79 normal healthy individuals. Both groups were cognitively evaluated by the MMSE test on two occasions with an average time interval of 2-3 weeks.

The results of the Discriminant analysis showed a cut-off point of 27/28 as the probable point of cognitive impairment. Also, for identifying the cognitive impairment in mTBI patients, this test reported low sensitivity of 0.43-0.58 and a moderate specificity of 0.69-0.80 in two tests.

 In screening for possible mild cognitive impairment in mTBI patients, the MMSE is relatively useful and should not be used solely to replace a comprehensive neuropsychological evaluation with diagnostic purposes.

Recent studies have shown that Polyunsaturated Fatty Acids (PUFAs), including Eicosapentaenoic Acid (EPA), and Arachidonic Acid (AA), are associated with cognitive functions in patients with Coronary Artery Disease (CAD). Nevertheless, controversial results have been reported, too. The current study aimed to clarify the association of serum EPA and AA levels with cognitive decline in an Iranian sample with CAD.

We evaluated cognitive function with the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), in relation to serum levels of EPA and AA, in 179 CAD patients. The associations between the MMSE and MoCA scores and the other demographic parameters were evaluated.

Patients with CAD generally had mild cognitive impairment. But we could not find any significant correlation between PUFAs and cognitive function. However, BMI was associated with EPA/MoCA; age was associated with MMSE/MoCA and BMI. Finally, the correlation between sex and MMSE/MoCA was significant. 

Subjects generally had mild cognitive impairment, but we could not find any significant correlation between serum EPA and AA levels with cognitive function.

 Mild cognitive impairment (MCI) is a transient state between normal condition and dementia. Available data indicates that coronary artery diseases (CAD) may increase the risk of MCI. Hence, the early detection of MCI can prevent the progression of cognitive decline.  A sample of 65 subjects with degrees of CAD was enrolled to the study. For cognitive assessment, Mini Mental State Examination and Montreal Cognitive Assessment were used. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of MoCA were assessed in the cut-off points of 26 and 25. The SPSS 22 was used for data analysis. The statistical significance was set at P-value<0.05. The prevalence of cognitive impairment was calculated 41.5% and between 47.7% and 60% by MMSE and MoCA, respectively. At the cut-off point of 25 for MoCA test, the sensitivity and specificity were 92.6% and 84.2%, and PPV and NPV were 80.6% and 94.1%, respectively, and the efficacy of MoCA test for the detection of MCI was 87.69%. At the cut-off point of 26 for MoCA test, the sensitivity and specificity were 96.3% and 65.8%, and PPV and NPV were 66.7% and 96.2%, respectively, and the efficacy of MoCA test was 78.46%. The prevalence of MCI in patients with CAD was higher than what was previously reported. The MoCA was more sensitive for recognizing the MCI in these patients. We suggested the cut-off point of 25 for the higher accuracy of the MoCA in detecting MCI in CAD patients.

Mini-mental state examination, a nonspecific measure of global cognitive function, and the clock drawing test, a very concise and specific measure of cognitive function, are among the most widely used screening tests for cognitive dysfunction. The present research aimed to examine the correspondence between MMSE and CDT scores.
A total of 70 older adults (mean(SD) age=69.70(6.41) y) were selected by convenience sampling method from two local health centers from the same civil servant area in Mashhad City, Iran. They completed MMSE and CDT tests. Mann–Whitney U test and Spearman correlation were used for analyzing the data.
Results showed a significant correlation between CDT and MMSE total score. Also the older adults’ performance on MMSE and CDT were significantly related to their level of education and gender, but not age.
The correlation between the MMSE and CDT test scores was high. Although one test cannot be replaced for the other, the CDT is a simple test that can be used for fast initial screening of cognitive performance among the elderly.

Sulfur Mustard (SM) is an alkylating agent that has been used as a chemical warfare gas during World War II and by Iraqi army in the Iran-Iraq conflict between 1983 and 1988. SM can cause serious organ damages especially ocular, neurologic, coetaneous, bone marrow and pulmonary complications. On the other hand dexmedetomidine is a α2 agonist with sedative and analgesic effect with a short duration half-life. Considering these benefits, usage of dexmedetomidine would be a good choice in ophthalmic outpatient’s surgeries to keep the cognition state in an acceptable condition comparing with other available drugs especially in patients with concurrent chemical burn injury.
After informed consent, patients with inclusion criteria were randomly divided in to two groups: dexmedetomidine (group D, n=50) and Remifentanil (group R, n=50). Cardiovascular signs, Mini Mental State Examination (MMSE) score were recorded as baseline. Patients received respectively dexmedetomidine by infusion with a loading dose of 0.5µg/kg (during 10 minutes) in group D. The maintenance dose of 0.2µg/kg/hr was then started. Loading dose of remifentanil was given by 0.1µg/kg (during 10 minutes); 5 minutes before local anesthesia in group R and maintenance dose of 0.05µg/kg/min was then started. In Post Anesthesia Care Unit (PACU) after 120 minutes of stopping drug infusions n-back and MMSE tests were performed.
The MMSE score had no statistically difference between two groups before surgery (in subgroup age>=65 P= 0.5, and in subgroup age=65 and age=65 P The result of n-back and MMSE revealed that the cognition state improves better in patients receiving dexmedetomidine comparing with those of remifentanil. Dexmedetomidine is safe for protecting the cognition state especially in patients with borderline respiratory reserve due to chemical burn injury.

The aim of the study is to compare the effects of remifentanil/dexmedetomidine and remifentanil/midazolam combinations in monitored anesthesia care (MAC) during cystoscopies. Forty patients who received remifentanil infusion of 0.05 mg kg-1 min-1 for cytoscopy procedure were randomized into two groups: Either dexmedetomidine 1 mg kg-1 (Group D) or midazolam 0.2 mg kg-1 h-1 (Group M) was administered intravenously for the first 10 min. Subsequently, anesthesia was maintained by using the bispectral index as a continuous infusion of dexmedetomidine (0.2-0.7 mg kg-1 h-1) or midazolam (0.05-0.15 mg kg-1 h-1). Heart rate, mean arterial pressure, mini-mental state examination findings, levels of sedation andanalgesia, and the patient’s and surgeon’s satisfaction were recorded. Successful sedation and analgesia were achieved in all the patients. We were able to reach the target sedation level faster in Group D (P<0.0001). In Group D, the cognitive functions were less affected than in Group M (P<0.0001). Patient’s and surgeon’s satisfaction were significantly higher in Group D. The targeted sedation levels were achieved in a shorter period with dexmedetomidine-remifentanil compared to midazolam-remifentanil. The dexmedetomidine-remifentanil combination was observed to affect the cognitive functions less than midazolam-remifentanil did with shorter recovery times. Besides, patient’s and surgeon’s satisfaction rates were superior with dexmedetomidine-remifentanil. It was concluded that dexmedetomidine-remifentanil may be a combination of choice for monitored anesthesia care applications in outpatient surgical procedures of short duration.