Nanaka Mogi

The Clock Drawing Test as a Valid Screening Method for Mild Cognitive Impairment

To validate the Clock Drawing Test (CDT) as a screening method for detecting mild cognitive impairment (MCI) and to find the appropriate scoring protocol and its cutoff point, we compared the sensitivity and specificity of three CDT protocols. Subjects included 219 outpatients with memory complaints, who were attending the geriatric memory clinic. Cahn’s protocol, with a cutoff point of 7, was more successful at differentiating clinically diagnosed MCI subjects from normal elderly individuals, with higher sensitivity (74.7%) and specificity (75.6%), than were the other protocols. The CDT, as a handy screening method, may be useful for clinicians to reliably identify subjects with MCI, and it may contribute to early detection of dementia.

Cognitive function in Japanese elderly with type 2 diabetes mellitus

The current study was conducted to investigate the cognitive function in Japanese elderly with type 2 diabetes mellitus (DM). Participants included 69 diabetic and 27 nondiabetic subjects (60 to 85 years old). The cognitive functional tests conducted were the Mini-Mental State Examination (MMSE), Word Lists Recall (immediate, delayed), Digit Symbol Test (Wechsler Adult Intelligence Scale-Revised [WAIS-R]), and the Stroop Color Word Test. Hemoglobin A1c (HbA1c) was measured as the index of glycemic control, and information about recent hypoglycemic episodes was gathered by using questionnaires. Students t test showed that DM subjects had significantly lower scores in the MMSE (P<.01) and Digit Symbol Test (P<.05) than non-DM subjects. The scores of the Digit Symbol Test in diabetes subjects had a significant negative relationship with HbA1c (r=-.433; P<.001), and insulin-use had a significant relationship with the scores of the MMSE and Digit Symbol Test. Subjects in the DM group were further divided by insulin use. Comparison of insulin-treated DM subjects, non-insulin-treated DM subjects, and nondiabetic subjects by analysis of variance followed by Bonferronis post hoc test showed that insulin-treated DM subjects had significantly lower scores in the MMSE and Digit Symbol Tests than both non-insulin-treated DM subjects (P<.05) and nondiabetic subjects (P<.01). Our study suggests that Japanese elderly DM subjects, especially those with insulin treatment, have poor cognitive function.

Glucose control levels, ischaemic brain lesions, and hyperinsulinaemia were associated with cognitive dysfunction in diabetic elderly

14. UnitedHealth Europe. Assessment of the Evercare Programme in England, 2003–2004. Final Report , 2005; www.unitedhealtheurope.co.uk/our-activities/evercare.html. 15. Dr Foster Intelligence. Keeping People Out of Hospital. The challenge of reducing emergency admission, 2006; http://www. drfoster.co.uk/library/localDocuments/Reducing EmergencyAdmissions February 2006. 16. WHO. International Classification of Diseases and Related Health Problems, 10th Revision. Geneva: WHO. 17. WHO. International Classification of Diseases and Related Health Problems. 9th Revision. Geneva: WHO, 1978. 18. Walsh B, Roberts HC, Hopkinson J. Emergency hospital admissions for ill-defined conditions amongst older people: a review of the literature. Int J Older People Nurs 2007; 2: 270–7. 19. Walsh B, Roberts H. Older people’s use of Accident and Emergency services. Age Ageing 2005; 34: 535. 20. Fried LP, Store DJ, King DE et al. Diagnosis of illness presentation in the elderly. J Am Geriatr Soc 1991; 39: 117–23. 21. Berman P, Hogan DB, Fox RA. The atypical presentation of infection in old age. Age Ageing 1987; 16: 201–7. 22. HES Online. Hospital Episodes Statistics http://www. hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937 &categoryID=537. 23. DH. NHS Reference Costs 2005, 2006; http://www.dh.gov. uk/en/Publicationsandstatistics/Publications/Publications PolicyAndGuidance/DH 4133221. 24. Elmstahl S, Wahlfrid C. Increased medical attention needed for frail elderly admitted to the Emergency Department for lack of community support. Aging Clin Exp Res 1999; 11: 56–60. 25. Office of National Statistics Population Estimates. http://www.statistics.gov.uk/ statbase/ssdataset.asp?vlnk=8606&More=Y. 26. Aylin P, Bottle A, Majeed A. 2007 Use of administrative data or clinical databases as predictors of risk of death in hospital: comparison of models. BMJ 2007; 334: 1044. 27. Mohammed MA, Stevens A. The value of administrative databases. BMJ 2007; 334: 1014–5.

Factors associated with cognitive impairment in elderly patients with diabetes mellitus.

ruary 12, 2005. 2. Evans JG, Wilcock G, Birks J. Evidence-based pharmacotherapy of Alzheimer’s disease. Int J Neuropsychopharmacol 2004;7:351–369. 3. Doody RS, Stevens JC, Beck C et al. Practice parameter: Management of dementia (an evidence-based review). Neurology 2001;56:1154–1166. 4. Nordic Medico-Statistical committee. Medicines Consumption in the Nordic Countries 1999–2003 [on-line]. Available at www.nom-nos.dk Accessed April 20, 2005. 5. Rahkonen T, Eloniemi-Sulkava U, Rissanen S et al. Dementia with Lewy bodies according to the consensus criteria in a general population aged 75 years or older. J Neurol Neurosurg Psychiatry 2003;74:720–724. 6. Sales Statistics of National Agency for Medicines [on-line]. Available at www.nam.fi Accessed April 20, 2005.

Association between insulin resistance and cognitive function in elderly diabetic patients

Background:  Recently, cognitive impairment in elder diabetic subjects has sparked considerable interest. Insulin resistance (IR) is one of the central pathologies in diabetes mellitus, and several studies have shown that IR is associated with cognitive impairment in non‐diabetic elderly subjects. However, the involvement of IR in cognitive dysfunction in the diabetic elderly has remained to be elucidated.

Effect of death education on self-determination in medical treatment in university students

Background:  Young people have little opportunity to acquire knowledge about or to determine in advance their medical preferences regarding their own end‐of‐life situation, including diagnosis disclosure and/or organ donation. Therefore a 90 min university‐level death education lecture was presented, which was designed to allow students to examine their attitudes regarding medical autonomy and to prepare themselves to make realistic decisions.

Assessment of brain atrophy in elderly subjects with diabetes mellitus by computed tomography

Several studies have shown cognitive functional impairment in elderly subjects with diabetic mellitus (DM). However, there have been few studies on the image of the brain in DM subjects.