To examine long-term speech and cognition outcomes in older adult cochlear implant (CI) recipients. First, by evaluating if CI performance was maintained over an extended follow-up period regardless of preoperative cognitive status. Secondly, by evaluating if there was a difference in the rate of cognitive decline between preoperative mild and normal cognition following CI over an extended period of time.
Retrospective cohort study.
CI recipients ≥65 years of age implanted between 2009 and 2014 with 4+ years follow up. Pre- and postoperative audiometric and speech outcome assessments were collected. Cognitive status was measured using the mini mental status examination (MMSE) at numerous time points.
Fifty-three patients met inclusion. Patients were divided into two groups based on preoperative MMSE with scores considered normal (28-30) and those with mildly impaired cognition (MIC, scores 25-27). Audiometric and speech performance improved significantly at one-year post implantation and this was maintained without significant change at 4+ years, regardless of cognitive status. Mixed modeling analysis controlling for age demonstrated no significant difference in the rate of cognitive decline at 4+ years post implantation between the normal cognition cohort (1.74; 95%CI 0.89-2.6) and MIC (2.9; 95%1.91-3.88).
Speech performance was significantly improved and sustained after CI in both normal cognition and MIC patients. The rate of cognitive decline in older adult CI patients appears to be similar regardless of preoperative cognitive status. Although results demonstrate rates of cognitive decline following CI did not differ between cognition groups over 4+ years, future studies will need to further investigate this over extended time periods with a more comprehensive cognitive testing battery.
4 Laryngoscope, 133:2379-2387, 2023.

BACKGROUND: Mini-Mental State Examination (MMSE) is one of the most widely used patient-rated assessment tools but may not be applicable among an overwhelming majority of Nigerians older adults. This is because MMSE was designed and adapted for English speakers, and some of its items are challenging to understand for those with low literacy levels.
OBJECTIVE: This study aimed at translating and adapting MMSE into the Hausa language and also evaluates the psychometric properties of the modified Hausa version of MMSE.
METHODS: The MMSE was translated and adapted into Hausa language by an Hausa language expert and focus group of experts and the validity of the adapted Hausa MMSE was evaluated against a gold standard (Diagnostic and Statistical Manual of Mental Disorder V criteria for neurocognitive disorders), among older adults participants (N=100). Descriptive statistics and inferential statistics (Receiver Operating Curve analysis and Cronbach alpha coefficient approach) were employed for data analysis and the alpha level was set at 0.05.
RESULTS: The adapted Hausa MMSE has item content validity index of 0.97 and the mean expert proportion relevant rating, across all the experts was 0.99. The adapted Hausa version of MMSE shows 66.7% sensitivity and 84.7% specificity, when the original MMSE cut off point of 24 was used. With ROC analysis, optimal cut-offs derived were 25 and 26 with Area Under Curve of 0.886 (95% CI: 0.816-0.956; Std.Err: 0.036; P=0.000). However, at the optimal cut off of 26, derived using ROC analysis, the modified Hausa MMSE had sensitivity of 93.3% and specificity of 71.8% and the tool internal consistency reliability had alpha value of 0.64.
CONCLUSIONS: Hausa adapted versions of MMSE is a valid cognitive screening tool for Hausa older adult patients although its use for Screening and for monitoring changes warrant considerations for two separate cut- off points.
BACKGROUND: Le mini-examen de l’état mental (MMSE) est l’un des outils d’évaluation évalués par le patient les plus utilisés, mais il n’est peut-être pas applicable chez une écrasante majorité de Nigérians âgés. Cela est dû au fait que le MMSE a été conçu et adapté pour les anglophones et que certains de ses éléments sont difficiles à comprendre pour les personnes ayant un faible niveau d’alphabétisation.
OBJECTIVE: Cette étude vise à traduire et à adapter le MMSE en langue haoussa et à évaluer les propriétés psychométriques de la version haoussa modifiée du MMSE.
UNASSIGNED: Le MMSE a été traduit et adapté en langue haoussa par un expert en langue haoussa et un groupe de discussion d’experts, et la validité du MMSE adapté en haoussa a été évaluée par rapport à un étalon-or (critères du Manuel diagnostique et statistique des troubles mentaux V pour les troubles neurocognitifs), parmi des adultes âgés participants (N=100). Des statistiques descriptives et inférentielles (analyse de la courbe d’exploitation du récepteur et approche du coefficient alpha de Cronbach) ont été utilisées pour l’analyse des données et le niveau alpha a été fixé à 0,05.
UNASSIGNED: Le MMSE Hausa adapté a un indice de validité de contenu de 0,97 et la note moyenne de pertinence de la proportion d’experts, parmi tous les experts, était de 0,99. La version Hausa adaptée du MMSE présente une sensibilité de 66,7% et une spécificité de 84,7%, lorsque le seuil original du MMSE de 24 est utilisé. Avec l’analyse ROC, les seuils optimaux 25 et 26 avec une aire sous la courbe de 0,886 (IC 95 % : 0,816-0,956 ; Erreur type : 0,036 ; P=0,000). Cependant, au seuil optimal de 26, déterminé à l’aide de l’analyse ROC, le Hausa MMSE modifié avait une sensibilité de 93,3 % et une spécificité de 71,8 %, et la fiabilité de la cohérence interne de l’outil avait une valeur alpha de 0,64.
CONCLUSIONS: La version Hausa adaptée du MMSE est un outil de dépistage cognitif valide pour les patients adultes âgés Hausa bien que son utilisation pour le dépistage et le suivi des changements justifie la prise en compte de deux seuils distincts.
UNASSIGNED: Mini examen de l’état mental, évaluation cognitive, adultes âgés, langue Hausa.

BACKGROUND: Vitamin B12 deficiency is an easily treatable cause of reversible dementia. It is likely to be more common in Indian population due to traditionally vegetarian culture. This study was conducted to estimate the prevalence of Vitamin B12 deficiency in elderly patients (>60 years) with dementia attending outpatient department.
METHODS: This study was conducted in two phases. The first phase was a cross sectional observational study to estimate the prevalence of Vitamin B12 deficiency in the elderly population with dementia. The second phase was a pilot study done in subjects with Vitamin B12 deficiency to assess the change in cognition following Vitamin B12 supplementation.
RESULTS: Out of 2920 study eligible subjects, 200 were diagnosed as dementia with Mini Mental Status Examination (MMSE) score of ≤ 24. Vitamin B12 deficiency was seen in 7.5% of patients. Vitamin B12 deficiency was associated with shorter and more severe dementia. Macrocytosis was more common in Vitamin B12 deficiency (p value < 0.001) where as vegetarian diet did not show significant correlation (p value 0.69). There was significant improvement in the median MMSE score in the intervention group with increase in MMSE by 2 points at 6-8 weeks and 3 points at 12 weeks (p value 0.009 and 0.003 by Mann Whitney test).
CONCLUSIONS: Prevalence of Vitamin B12 deficiency in dementia was 7.5%. It was associated with macrocytosis, shorter duration and more severe dementia. There was a significant improvement in median MMSE score at 6 weeks and 12 weeks following Vitamin B12 supplementation.

BACKGROUND: Neurocysticercosis is a common cerebral parasitic infestation, caused due to pork tapeworm infection the infestations risks parallels the socio-economic status, personal hygiene and education. The effect of NCC was assessed in neurocognition.
OBJECTIVE: To study demographic characteristics and neurocognitive domains of patients with Neurocysticercosis.
METHODS: Neurocysticercosis diagnosed patients by CT, MRI and LAMP tests. MMSE score was measured for assessment.
RESULTS: MMSE score were reduced in majority of the patients. In attention was the most common deficit found. Repeat MMSE assessment done in 6 patients showed an improvement of scores post therapy.
CONCLUSIONS: Cognitive involvement is common in NCC and is a major cause of morbidity.

With rising elderly populations, age-related health problems such as cognitive impairment and dementia are major public health concerns. We sought to assess the prevalence of cognitive impairment and associated factors in rural elderly Cameroonians.
The Mini Mental State Examination was used to assess the cognitive function of participants randomly recruited during a house-to-house survey of the Batibo Health District.
The prevalence of cognitive impairment in our study was 33.3%. Increasing age, female gender, being single, a lack of formal education, and higher systolic blood pressure values were significantly and independently associated with cognitive impairment.
The identification of modifiable factors would inform evidence-based policy to decrease the health and social burdens of cognitive impairment and dementia in the elderly in rural Cameroon.

OBJECTIVE: Cognitive impairments are now widely recognized and emerging as an important therapeutic target in a patient with a major depressive disorder (MDD). It associated with a more deteriorating course of illness among MDD patients. Therefore, understanding the level of cognitive impairment and associated factors is crucial to provide optimal care for MDD patients.
RESULTS: The proportion of cognitive impairment among MDD patients was found to be 54.4% (95%, CI (49.6, 59.3). Factors significantly associated with having cognitive impairment were age adjusted odds ratio (AOR) = 3.00, 95%, confidence interval (CI): (1.49, 6.03), educational status, (AOR = 5.36, 95% CI 2.16, 13.26), employment status (AOR = 3.63, 95 CI 1.99, 6.62), duration of the illness (AOR = 3.16, 95% CI 1.31, 7.64), having co-morbid psychiatric illnesses (AOR = 2.16, 95% CI 1.26, 3.71), and illness relapse (AOR = 2.97, 95% CI 1.54, 5.73).

BACKGROUND: Folstein\'s Mini Mental Status Examination (MMSE) often fails to identify executive dysfunction even if quite severe. Detailed neuropsychological tests and extensive bedside tests are available to evaluate executive function, but most of them are time consuming. This study was done to determine the value of a Clock Drawing Test (CDT) as a simple tool to identify cognitive dysfunction in various neurological disorders and to assess its utility as an adjunct to MMSE in identifying executive dysfunction in a a busy out patient department (OPD).
METHODS: A total of 81 patients suffering from neurological disorders and 81 controls were studied. All subjects received the MMSE and the CDT. The CDT is divided into an unprompted task that is sensitive to executive control (CDT 1) and a copying task which is not (CDT 2).
RESULTS: All the three tests (CDT 1, CDT 2 and MMSE) could recognize cognitive and executive function deficits, when compared with age and sex matched controls (p < 0. 001). CDT scores correlated strongly with the level of executive function deficits. CDT+MMSE detected 95% cases as abnormal as compared to 47% detected by MMSE alone.
CONCLUSIONS: CDT along with MMSE can detect executive control deficits and cognitive deficits. The CDT 1 tests executive control performance, while CDT 2 tests posterior cortical deficits.

BACKGROUND: Caregivers of patients with intracranial tumors handle physical, cognitive, and behavioral impairments of patients. The purpose of this study was to assess the magnitude of burden experienced by primary caregivers of patients operated for intracranial tumors and evaluate factors influencing it.
METHODS: Descriptive cross-sectional design was used to assess home-care burden experienced by primary caregivers of patients operated for intracranial tumors. Using purposive sampling, 70 patient-caregiver pairs were enrolled. Modified caregiver strain index (MCSI) was used to assess the caregiver burden. Mini mental status examination (MMSE), Katz index of independence in activities of daily living (ADL), and neuropsychiatric inventory questionnaire (NPI-Q) were used to assess the status of patients.
RESULTS: Of 70 caregivers, 45 had mild, and 22 had moderate MCSI burden. A number of behavioral changes in NPI-Q had a significant correlation with MCSI burden (P < 0.001), whereas MMSE and Katz-ADL of patients did not show significant relation with caregiver burden. In NPI-Q, irritability, agitation, anxiety, depression, and sleep disturbances had a significant impact on MCSI. Among caregiver factors, unemployment, low per capita income, time spent, inability to meet household needs, quitting the job, and health problems had a significant impact on MCSI. In separate multivariate analyses, irritability component (P = 0.004) among behavioral changes of patients and caregivers\' inability to meet household needs (P < 0.001) had a significant association with caregiver burden independent of other factors.
CONCLUSIONS: Behavioral changes in patients (especially irritability) and financial constraints had a significant independent impact on the burden experienced by primary caregivers of patients operated for intracranial tumors. Identifying and managing, these are essential for reducing caregiver burden.

Validation study of the Mini-Mental State Examination in Urdu language for Pakistani population.
OBJECTIVE: This study was conducted primarily to validate and determine the optimal cutoff score in the diagnosis of dementia among Pakistani\'s and study the effects of gender and education on the MMSE performance in our population.
METHODS: Four hundred participants took part in the study. Patient with dementia recruited from five major hospitals from Pakistan. The MMSE was translated into Urdu.
RESULTS: There were 61 men and 39 women in dementia group and 225 men and 75 women in the control group. The mean score of Urdu MMSE were lower in patients with dementia 18.5 ± 5.6 (range 0-30) as compared to the controls 26.8 ± 2.6 (range 7-30). This difference between groups was statistically significant (p<0.001). Educational based MMSE score below 15 yielded perfect sensitivity and specificity for the diagnosis of dementia.
CONCLUSIONS: These finding confirm the influence of level of education on MMSE score and education stratified cutoff scores should be used while screening for cognitive impairment in this population.

BACKGROUND: To test the hypothesis that cognitive impairment in older adults is associated with all-cause mortality risk and the risk increases when the degree of cognitive impairment augments; and then, if this association is confirmed, to report the population-attributable fraction (PAF) of mortality due to cognitive impairment.
METHODS: A representative random community sample of individuals aged over 55 was interviewed, and 4557 subjects remaining alive at the end of the first year of follow-up were included in the analysis. Instruments used in the assessment included the Mini-Mental Status Examination (MMSE), the History and Aetiology Schedule (HAS) and the Geriatric Mental State (GMS)-AGECAT. For the standardised degree of cognitive impairment Perneczky et al\'s MMSE criteria were applied. Mortality information was obtained from the official population registry. Multivariate Cox proportional hazard models were used to test the association between MMSE degrees of cognitive impairment and mortality risk. We also estimated the PAF of mortality due to specific MMSE stages.
RESULTS: Cognitive impairment was associated with mortality risk, the risk increasing in parallel with the degree of cognitive impairment (Hazard ratio, HR: 1.18 in the \'mild\' degree of impairment; HR: 1.29 in the \'moderate\' degree; and HR: 2.08 in the \'severe\' degree). The PAF of mortality due to severe cognitive impairment was 3.49%.
CONCLUSIONS: A gradient of increased mortality-risk associated with severity of cognitive impairment was observed. The results support the claim that routine assessment of cognitive function in older adults should be considered in clinical practice.