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.

No description available.

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

Bakgrund: Andelen äldre över 60 år ökar och förväntas öka ytterligare framöver. Kognitiv svikt är en av de vanligaste åkommorna samt ett hälsoproblem över hela världen. En viktig riskfaktor för kognitiv svikt är åldrande. Ett annat tillstånd hos äldre som lätt förbises är ortostatisk hypotension (OH). Det finns studier som påvisar samband mellan OH och kognitiv svikt, likväl studier som inte påvisar något samband, vilket gör att det råder delade meningar. Ytterligare kunskap behövs för att stärka det vetenskapliga underlaget till distriktssköterskans hälsofrämjande arbete när det gäller patientutbildning och egenvårdsråd. Syfte: Syftet med studien var att undersöka om ortostatisk hypotension har ett samband med kognitiv svikt hos yngre äldre för att bidra med vetenskapligt underlag till distriktssköterskans hälsofrämjande arbete. Metod: Designen var en kvantitativ studie i samarbete med Swedish National Study on Aging and Care – Blekinge. Urvalet inkluderade yngre äldre (60-78år). Variabler som kön, ålder, utbildning, blodtrycksvärden samt resultat på Mini-Mental State Examination (MMSE) valdes ut. Analysen gjordes i statistikprogrammet SPSS och började med deskriptiv statistik. För att se signifikant skillnad genomfördes Mann-Whitney U-test och Chi-2. Till sist utfördes en logistisk regression för att undersöka vad som påverkade den kognitiva förmågan mest. Resultat: Hos yngre äldre påvisades ingen statistisk signifikans när det gäller sambandet mellan OH och kognitiv svikt. Däremot sågs en tendens som pekade på att av de som har kognitiv svikt så var det fler som hade OH. 72-åringarna hade lägst medelvärde på MMSE. Kvinnor hade i högre utsträckning både kognitiv svikt och låg utbildning än män. Lågutbildning var en riskfaktor för kognitiv svikt. Det sågs en markant ökning av OH där 14% av 60-åringarna hade OH och 36,7% av 72-åringarna. Generellt hade män i högre utsträckning OH än kvinnor.  Slutsats: Inget samband påvisades mellan OH och kognitiv svikt, däremot sågs en visuellt synlig skillnad i alla grupper utom 60 år. Prevalensen av OH ökade efter 60 år. Låg utbildningsnivå var en riskfaktor för kognitiv svikt. Genom ökad kunskap kan distriktssköterskan ge egenvårdsråd och säker hälsovägledning till patienter och närstående för att främja hälsan hos äldre individer

No description available.

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.

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 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.

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.

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,...