Richard F. Uhlmann

Involuntary weight loss in older outpatients: incidence and clinical significance.

OBJECTIVES: To describe the incidence, anthropometric parameters, and clinical significance of weight loss in older outpatients.

Effect of education on the mini-mental state examination as a screening test for dementia

We studied whether Mini‐Mental State Examination (MMSE) norms for detecting dementia in elderly outpatients vary according to educational attainment. Subjects were 109 elderly outpatients with Alzheimers dementia and 100 non‐demented outpatient controls. Receiver operating characteristics (ROC) of the MMSE were examined among three strata of educational attainment: middle school, high school, and college/graduate school. MMSE ROC curve areas were .95–.96 in the three educational strata. Assuming a dementia prevalence of 10%–30%, the most accurate lower limits of normal for MMSE scores and their attendent sensitivities and specificities were 21 for middle school (.82/.94), 23 for high school (.79/.97), and 24 for college/graduate school (83/1.00) attainment. These norms accurately classified over 90% of subjects in all three educational strata. We conclude that education‐specific norms optimize performance of the MMSE as a screening test for Alzheimers dementia in elderly outpatients.

Reliability of estimates of changes in mental status test performance in senile dementia of the alzheimer type

The concept of the reliability of a measure can also be applied to its change over time. In this study we consider the growth curve approach to estimating the reliability of change, in the context of cognitive status as measured by the Mini-Mental State Examination (MMSE) and the Blessed and Tomlinson Dementia Rating Scale (DRS) in patients with senile dementia of the Alzheimer type (SDAT). The reliability of the estimates of change is shown to depend primarily upon the length of time of observation, not the number of observations made. The estimated reliability coefficient for the change in MMSE (or DRS) at 6 months is 0.16 (or 0.08); at 2 years is 0.75 (or 0.57). The concept of signal-to-noise ratio is introduced to compare reliabilities in change scores.

Visual impairment and Alzheimer’s disease

detection of abdominal aortic aneurysms. Surg Clin North Am. 1989;69:713-20. 3. Lederle FA, WalkerJM, Reinke DB. Selective screening foralxtominal aortic aneurysms with physical examination and ultrasound. Arch Intern Med. 1988;148:1753-6. It would be helpful if the authors could cite earlier work or their own experience on the validity of these vision tests in d e m e n t i a . CATHY A. ALESSI, MD, Department o f Medicine, University of California, Los Angeles, Sepulveda VA Medical Center, Sepulveda, CA 91343

Reply to Weinstein and Amsel

To the Editor:-Hardy et al.’ stated that the wide variation in arm muscle mass among the healthy elderly makes arm muscle mass ”unsuitable to diagnose malnutrition in the aged population.” Three prospective trials (two published2e3 and the third submitted for publication) contradict their conclusion. In fact, corrected arm muscle area below 17 cm2 consistently identified severely wasted sick old men with a median survival of two weeks and a maximum survival (without nutritional recovery) of 3.5 months. Of 24 such men seen by me since November 1983, the only two surviving beyond four months were men who gained weight and restored arm muscle area to at least 20 cm2; all the others died from this lethal wasting syndrome. Therefore, arm muscle area should be measured on all wasted elderly men in preference to weight,