OBJECTIVES: To compare the Clock Drawing Test (CDT) performance of Filipino patients with schizophrenia and normal subjects in detecting cognitive impairment and to determine the correlation of symptom severity using Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale (PANSS) with the CDT performance among schizophrenic subjects.
METHODOLOGY: A descriptive cross-sectional study using convenient sampling. Stable and compliant schizophrenic subjects were recruited at the psychiatry OPD of our institution from July to November 2004. Normal subjects were recruited from the community who were age,sex, and education matched. CDT and MMSE were administered to all the subjects and the scores of the two groups were compared using the two-tailed Student t-test. Symptom severity using BPRS and PANSS were correlated with CDT and Mini Mental Status Exam (MMSE) in schizophrenic subjects using the Pearson;s correlation coefficient.
RESULTS: A total of 66 subjects, 33 schizophrenic and 33 normal subjects were included in the study. Schizophrenic subjects performed poorly on CDT and MMSE compared to the normal subjects. The difference between the mean scores was statistically significant. The examination errors on the clock drawing test was more apparent among schizophrenic subjects. There were positive correlations between CDT and MMSE, and BPRS and PANSS. Negative correlations were observed between the cognitive performance and the symptom severity of schizophrenia.
CONCLUSION: Schizophrenic subjects performed poorly on CDT compared to the normal subjects, thus it is useful in detecting cognitive impairment. Likewise, CDT performance correlates well with symptom severity. Its availability and simplicity makes it very useful in detecting cognitive impairment in our clinical practice.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Brief Psychiatric Rating Scale ; Cognition ; Cognition Disorders ; Cognitive Dysfunction ; Cross-sectional Studies ; Neuropsychological Tests ; Psychiatry ; Schizophrenia

OBJECTIVE: This paper aims to correlate the white matter changes seen in cranial Magnetic Resonance Imaging (MRI) the severity of cognitive impairment in patients diagnose Alzheimer Disease by using the conventional Cranial MRI weighted and Fluid-attenuated inversion recovery (FLAIR) images.

METHODS: All patients diagnosed with Probable Alzheimer's disease at the Memory Assessment Center in a tertiary hospital in Manila from January 2007 to September 2008 were included in the study who underwent cranial MRI (T2 weighted and FLAIR images), with ages varying from 65-87 years old using the following tests: Alzheimer's Disease Assessment Scale-Cognitive (ADASCOG), Mini-Mental Status Examination (MMSE), Boston Naming, Verbal Fluency, Word List Memory Task, Recall and Recognition, Trail making A and B and Clinical Dementia Rating (CDR). The Cranial MRI images were rated using the Age-Related White Matter Changes (ARWMC) rating scale for MRI. Analyses were done using the Statistical Package for the Social Sciences (SPSS version 14.) Correlation between continuous data was done using the Pearson correlation test while the correlation between ranked data utilized the Spearman test.

RESULT: Four patients with no white matter changes had mild AD while another two had made an AD. Among those with focal lesions, two were categorized as mild AD, another two cases as moderate and one case with severe AD. Among those with the beginning confluence of lesions, three had mild AD, two had moderate AD and one had severe AD. No case had severe age-related white matter changes. We found no significant relationship between the clinical dementia ratings (severity of AD) and the presence or absence of white matter lesions in the cranial MRI (T2 weighted and FLAIR images). 

CONCLUSION: Diffusion tensor imaging (DTI) captures neurodegenerative brain changes that traditional MRI may miss. Further studies using structural and functional imaging methodologies should be promoted to show cognitive performance and its correlation. In particular, compensatory networks in patients were shown to linearly correlate to cognitive performance. Thus, varied approaches to understanding networks could be valuable tools in developing new approaches for early diagnosis of AD and in the future, aid us in the effectivity of treatment strategies.

Human ; Diffusion Tensor Imaging ; Alzheimer Disease ; Cognitive Dysfunction ; Tertiary Care Centers ; White Matter ; Magnetic Resonance Imaging ; Brain ; Memory ; Cognition ; Early Diagnosis ; Social Sciences ; Mental Status And Dementia Tests

BACKGROUND: The Asian population is rapidly aging and a concomitant exponential rise in the number of elderly people with dementia is expected. Early diagnosis of dementia and recognition of concomitant psychiatric symptoms have profound implications for the patient. In our local setting, majority of elderly individuals live with their families due to cultural influence on family ties. However, institutionalization of elderly individuals is gradually being recognized due to the increasing demands of the society on caregivers who usually belong to the working class.

OBJECTIVE: This pilot study evaluates the cognitive status of Filipino elderly individuals residing at Hospicio De San Jose which aims to examine the prevalence of cognitive impairment and neuropsychiatric manifestations in an institutionalized environment and to determine the rate of progression of cognitive decline.

METHODOLOGY: This is a research study evaluating all Filipino elderly individuals residing at Hospicio de San Jose aged 60 years and above, with or without objective memory complaints. Only literate individuals are included. Exclusion criteria include the presence of acute confusional state or altered sensorium, severe expressive and receptive aphasia, vegetative state, blindness, deafness, and denise hemiplegia in the dominant upper limb. Cognitive status was assessed using the following tests: Mini Mental State Exam (MMSE), US Second Version of Isaac's Set Test of Verbal Fluency (IST), Zasso Cancellation Task, 4-item version of Instrumental Activities of Daily Living: Modified Lawton's Scale (I-ADL). Neuropsychiatric manifestations were evaluated with the use of the Neuropsychiatric Inventory (NPI) and Modified Geriatric Depression Scale (MGDS). Patients were assessed at baseline (BS) and after 6 months (MO). The patients were classified accordingly based on set criteria as follows: Not Cognitively Impaired (NCI), Cognitive Impairment Not Demented (CIND), and Dementia (DEM).

RESULT: There were eighty elderly individuals at Hospicio De San Jose. There were twelve male patients and sixty-eight female home dwellers in total. Twenty-five (25) were included in the study based on the set criteria. Majority were female (84%) and previously employed (70%). The mean age of the population was 70.92 years old and mean level of education (in years) was 10.52. Seventy-two percent (72%) of patients subjectively complained of progressive and insidious memory impairment with an onset ranging from 6 months to 17 years. This pilot study shows that the prevalence of CIND and dementia in an institutionalized care center in our local setting like Hospicio De San Jose is 52% and 8%, respectively.

CONCLUSION: The presentation of the patients is progressive cognitive decline so that careful clinical monitoring is essential. The rate of conversion to dementia within 6 months is negligible. Amongst the several domains evaluated, it is the verbal fluency and speed that is greatly affected which is more compatible with sub cortical white matter changes in an aging brain. The identification of  Filipino home care dwellers at potential risk of dementia is important to lessen caregiver burden, to address early intervention both pharmacologic and non-pharmacologic including improvement of facilities and in-house program to prevent neuropsychiatric complications

Human ; Male ; Female ; Cognitive Dysfunction ; Caregivers ; Activities Of Daily Living ; Persistent Vegetative State ; Prevalence ; Deaf-blind Disorders ; Early Intervention (education) ; Hemiplegia ; Pilot Projects ; Aphasia, Wernicke ; Depression ; White Matter ; Dementia ; Memory ; Memory Disorders ; Institutionalization ; Home Care Services ; Early Diagnosis ; Confusion ; Educational Status ; Cognition

BACKGROUND: CIND is a common condition among the elderly population that has acquired clinical significance with the prevalence in elderly people about twice that of all forums of dementia gathered The concept of cognitive impairment with no dementia CIND has emerged as an important clinical entity because of its possible progression to dementia. Compared to patients diagnosed with no cognitive impairment, CIND patients have a 47% chance of developing dementia in 5 years. OBJECTIVES: This study aims to depict the Filipino patient diagnosed with CIND based on a consensus. It is further our goal to ascertain the prevalence of CIND among patients referred to the Memory Clinic for screening and assessment and also aims to determine if there is a relationship between the patient's profile and certain neuropsychological tests. METHODOLOGY: This is a research study which included all the patients (n=86) referred to the Memory Assessment Clinic of a tertiary hospital. Patients diagnosed with CIND were further evaluated and characterized based on the patient's profile such as general data, history of present illness, past medical history, family history, laboratories and ancillary procedures and neuropsychological examination. Relationship of patient's profile with various neuropsychological test was examined through linear and logistic regression and Spearman's correlation test. RESULTS: Out of the 86 patients evaluated by the Memory Clinic of a tertiary hospital, 17 (19.76%) were diagnosed with CIND. The mean age of the patients with CIND is 70.06 years, majority of whom are females (64.7&) and had 10 years of education. All are married with most of them residing in Metro Manila. All presented with progressive cognitive decline. Years of formal education showed that majority of patients had more than or equal to 10 years. Majority had co-morbid medical conditions. and majority are non-smokers and non-alcoholic beverage drinkers. Average MMSE is 25.88 points; the memory domain is greaty affected. Among the various neuropsychological tests, Verbal fluency and Maze tests were frequently impaired. The rest of the neuropsychological test such as Boston naming, Frontal assessment battery, Clock drawing test were frequently unimpaired. The ADAS Cog mean value was 16.37. MMSE and ADAS Cog showed no significant relationship with the patients profile based on linear and logistic regression as well as Spearman correlation.CONCLUSION: The prevalence of CIND in the memory Clinic of a tertiary hospital is 19.76%. The presentation of these patients is progressive cognitive decline so that careful clinical monitoring is essential. Majority of CIND patients have co-morbid medical conditions (76%). The identification of people at potential risk of dementia with a view to early therapeutic intervention is important, because it may lessen distress for both patient and family, minimize the risk of accidents, prolong autonomy, and perhaps even ultimately prevent the onset of the dementing process itself.
Human ; Male ; Female ; Dementia ; Nervous System Diseases ; Central Nervous System Diseases ; Brain Diseases ; Mild Cognitive Impairment ; Mental Disorders ; Delirium, Dementia, Amnestic, Cognitive Disorders ; Cognition Disorders ; Diagnosis ; Neuropsychological Tests ; Behavioral Disciplines And Activities ; Psychological Tests