MMSE

FIGURE 32-2. Treatment algorithm for Alzheimer s disease. A. Cognitive treatment. B. Treatment of psychiatric or behavioral symptoms. AD, Alzheimer s disease MMSE, Mini Mental Status Examination NINCDS-ADRDA National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer s Disease and Related Disorders Association. (From Faulkner JD, Bartlett J, Hicks P. Alzheimer s disease. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 1164, with permission.)... 

The success of therapy is measured by the degree to which the care plan decreases the pretreatment deterioration rate, preserves the patients functioning, and treats psychiatric and behavioral symptoms. The primary outcome measure is thus subjective information from the patient and the caregiver, although the MMSE can be a helpful tool for monitoring changes in the severity of illness. There are no physical examination or laboratory parameters that are used to evaluate the success of therapy. 

The Folstein Mini-Mental State Examination (MMSE) can help to establish a history of deficits in two or more areas of cognition and establish a baseline against which to evaluate change in severity. The average expected decline in an untreated patient is 2 to 4 points per year. 

Successful treatment reflects a decline of less than 2 points each year on the MMSE score. 

If the decline in MMSE score is more than 2 to 4 points after treatment for 1 year with the initial agent, it is reasonable to change to a different cholinesterase inhibitor. Otherwise, treatment should be continued with the initial medication throughout the course of the illness. 

Objective assessments, such as the MMSE for cognition and the Functional Activities Questionnaire for activities of daily living, should be used to quantify changes in symptoms and functioning. 

Engelhart et al., 1999). This instrument assesses many more areas of cognitive function than does the MMSE. I Iowever, as a screening tool, it too has limits to what it can tell you. My recommendation is that if a client of yours screens positive for a cognitive problem on one of these measures, you refer that client for a comprehensive neuropsychological workup as part of the treatment plan. Note that sometimes a person will screen positive during detoxification, but will clear cognitively after that period is finished. You should probably retest after detox has been completed if the client screens positive while in detox. 

Elderly patients after admission to a hospital often first show mental signs and symptoms, then show behavioural disturbances (Saravay et al. 2004). Thus if early mental signs and symptoms are identified and acted on, behavioural disturbances and subsequent extended length of hospital stay may be prevented. For cognitive testing many screening instruments are available. The most widely used is probably Mini Mental State Examination (MMSE). 

Ganzer, S., Ard, S., Schoder, V., et al. (2003) CSF-tau, CSF-Abetal-42, APOE-genotype and clinical parameters in the diagnosis of Alzheimer s disease combination of CSF-tau and MMSE yields highest sensitivity and specificity. J. Neural Transm., 110, 1149-1160. 

In addition, you should perform some objective measure of the patient s intellectual functioning. The most commonly used measure is the Folstein Mini-Mental Status Examination (MMSE). The 30 point MMSE assesses many of the intellectual functions that might be impacted by dementia orientation to surroundings, registration of new information into memory, recall of that same information, concentration, word-finding, following directions, and visuospatial tasks. A score of 25 or lower should raise concern but early dementia is not ruled out even with higher scores. 

Patients who continue on the drug should be reviewed every 6 months by MMSE score and global, functional and behavioural assessment. Carers s views on the patient s condition at follow-up should be sought. 

Cognitive function (e.g., ADAS, Mini-Mental Status Exam [MMSE ), activities of daily living, global functioning, blood chemistry, complete blood counts, heart rate, blood pressure... 

The Mini-Mental State Evaluation (MMSE) is a very popular instrument and includes components of orientation, calculation, registration, memory and praxis. It required active participation by patients who have to perform a number of simple tasks. The MMSE provides a rough estimate of cognitive decline it is useful for screening purposes because it takes a very short time to perform (Folstein et al., 1975). 

The MMSE showed some improvement on sertraline and some minor decline on nortriptyline the difference between treatments was statistically significant (P<0.01). 

Assessment methods that determine mental functioning (attention, orientation, memory, speech, understanding of speech, psychomotor functions) in a simple, practical way are recommended for a rough estimation of the severity of dementia. The best-known instrument is the Mini-Mental State Examination (MMSE. Folstein et al.. 1975), which allows the grading of dementia on a 30-point scale on the basis of a simple 5 10-min examination. Other, rather more involved procedures include the Dementia Rating Scale (DRS) of Mattis (1976) and the Alzheimer Disease Assessment Scale (ADAS) of Rosen et al. (1984). The... 

As t—>oo, the ratio goes to one. This would follow from the result that the biased estimator and the unbiased estimator are converging to the same thing, either as a2 goes to zero, in which case the MMSE estimator is the same as OLS, or as x x grows, in which case both estimators are consistent. 

FIGURE 2 Determination of analytes contributing significantly to separation between AD patients and healthy controls by OPLS-DA of the CSF data set. (A) OPLS-DA score plot for light AD patients (MMSE.22) versus controls. (B) OPLS-DA coefficient plot for light AD patients (MMSE.22) versus controls. Cysteine and uridine are the most relevant analytes for separating light AD patients (MMSE.22) from healthy subjects. Reproduced from Ref. (84). 

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