Natalia Ciesielska

Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis.

OBJECTIVES Screening tests play a crucial role in dementia diagnostics, thus they should be very sensitive for mild cognitive impairment (MCI) assessment. Nowadays, the MiniMental State Examination (MMSE) is the most commonly used scale in cognitive function evaluation, albeit it is claimed to be imprecise for MCI detection. The Montreal Cognitive Assessment (MoCA), was created as an alternative method for MMSE. Aim. MoCA vs. MMSE credibility assessment in detecting MCI, while taking into consideration the sensitivity and specificity by cut-off points. METHODS A systematic literature search was carried out by the authors using EBSCO host Web, Wiley Online Library, Springer Link, Science Direct and Medline databases. The following medical subject headings were used in the search: mild cognitive impairment, mini-mental state examination, Montreal cognitive assessment, diagnostics value. Papers which met inclusion and exclusion criteria were chosen to be included in this review. At the end, for the evaluation of MoCA 20, and MMSE 13 studies were qualified. Research credibility was established by computing weighted arithmetic mean, where weight is defined as population for which the result of sensitivity and specificity for the cut-off point was achieved. The cut-offs are shown as ROC curve and accuracy of diagnosis for MoCA and MMSE was calculated as the area under the curve (AUC). RESULTS ROC curve analysis for MoCA demonstrated that MCI best detection can be achieved with a cut-off point of 24/25 (n = 9350, the sensitivity of 80.48% and specificity of 81.19%). AUC was 0.846 (95% CI 0.823-0.868). For MMSE, it turned out that more important cut-off was of 27/28 (n = 882, 66.34% sensitivity and specificity of 72.94%). AUC was 0.736 (95% CI 0.718-0.767). CONCLUSIONS MoCA test better meets the criteria for screening tests for the detection of MCI among patients over 60 years of age than MMSE.

Cognitive tests used in examining effects of physical training in elderly people

Introduction. Cognitive tests are a valuable, sensitive and useful tool for examining the effectiveness of physical training. Purpose. To show which studies are sensitive in examining cognitive changes induced by physical training. We explored meta-analysis with healthy participants and patients with MCI. Materials and methods. Analysis of meta-analysis in the EBSCO database using keywords: meta-analysis, cognitive tests, physical training, elderly. Results. 4 meta-analysis have 10 researches in common; however, diverse of inclusion and exclusion criteria led to inability in obtaining reliable results. Discussion and conclusion. Some cognitive tests seems to be more sensitive in examining results of physical training. Diversity of research methodology induces much difficulties in comparing of studies.

Falls in the elderly – risk assessment and procedding

The aging of society was an incentive to the development of many fields of medicine including geriatric physiotherapy. Rehabilitation in geriatrics involves a range of issues connected with the involutional and/or disease related changes in the organism of an elderly person. To highlight the most important ones, so called ‘great geriatric problems’ were distinguished. One of them are falls. The risk of falls rises significantly after the age of 65. Among people older than 65 the chances of falls are 40% higher than among younger people. The article aims at showing the issues connected with the role of physiotherapy in falls prophylaxis in the elderly. The problem of falls in the elderly is mainly connected with the consequences of falls. Falls may lead to injuries, disability and even death. Falls prophylaxis should start with complex geriatric assessment. To assess the risk of falls a physiotherapist may use special scales: the stand up and go and the Tinetti test. After thorough analysis of the state of health of the elderly person appropriate prophylaxis measures may be chosen: removal of the environmental threats, appropriate selection of shoes as well as the assisting equipment, acute and chronic diseases treatment, pharmacotherapy modification, physiotherapy. Anti-fall rehabilitation usually focuses on balance training, expanding the range of motion, gait re-education and analgesic measures. In some medical centres special anti-fall programs are being developed, where physical activities and appropriate assisting equipment play the most important role. Modern physiotherapy methods enable individual anti-fall prophylaxis adjustment to the elderly person’s needs. The use of rehabilitation to diminish the risk of falls in the elderly is more and more common.

Urination disorders occurring in the elderly – point of view of a physiotherapist

International Continence Society defines urinary incontinence as involuntary urine leakage in subjective assessment. It is essential that urinary incontinence is regarded to as a symptom not as a separate disease. Until recently, majority of the elderly society considered disorders connected with urinary continence a taboo topic. Higher awareness level and easier access to knowledge enable even the elderly patients to start therapy in the area of these afflictions more willingly. According to the world standards of urination disorders, in the first stage of treatment noninvasive treatment should be used and when it fails, surgical treatment is to be applied. It is especially crucial in geriatrics patients whose polymorbidity poses contraindications or higher risk to general anesthesia procedures. The following article presents the point of view of a physiotherapist and possibilities of using a wide range of noninvasive methods in the therapy of urination disorders. Classification of urination disorders is presented, as well as possible comorbidities relevant during urological physiotherapy