Table 4. Vision Impairment & Diet Characteristics Eye Diseases (n=100 ) Patients Diet Risk (N) (N) Cataracts 55 38 Glaucoma 12 8 Optic Neuropathy 6 2
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Eye Diseases (n=100)
Patients Diet Risk
A Comparative Study of Mini-Mental State Exam and the Saint Louis University Mental Status for Detecting Mild Cognitive ImpairmentAmong Eye Care Patients
Patricia C. Heyn, Ph.D.1, Tammie Nakamura, M.S.1, Rosa Tang, M.D., M.P.H.2, Mukaila Raji, M.D.,MSc.2, Young-Fang Kuo, Ph.D.2
1Division of Geriatric Medicine • The University of Colorado Health Sciences Center • Denver, Colorado
2 School of Medicine • The University of Texas Medical Branch • Galveston, Texas
Aging is one of the major factors for cognitive dysfunction. The combination of an aging population and the promise of disease-modifying therapies for Alzheimer’s Disease (AD), inspire the dementia research field to seek screening approaches to identify the early stages of AD. Although screening instruments for cognitive impairment (CI) are frequently used in the elderly, the concept of mild cognitive impairment (MCI) is aimed to capture patients in the transition from normality to dementia. If MCI is identified patients could be informed about options for intervention and treatment that could delay the progression of this syndrome.
The World Health Organization identifies visual impairment (VI) as one of the major reasons for disability in the elderly. VI directly and indirectly affects the health of the elderly. It was reported that 1.668 million British adults were disabled by defective vision in 19881. Cataract was the most common cause of disability and blindness.
Recent studies are supporting a cause-and-effect association between type of severity of visual loss and the major causes of dementia 2-3. A key public health strategy to reduce disease burden and slow down disability processes in the elderly is early screening for potentially treatable health factors at specific target sites, such as the Eye Clinic. Older adults visit the ophthalmology clinic more often than other health-care specialties (Table 1).
To examine the Saint Louis University Mental Status (SLUMS) examination as a screen for MCI; and to test if the SLUMS is more sensitive than the Mini-Mental State Exam (MMSE) in mild cognitive screening. The SLUMS like the MMSE is a11-item scale with scores ranging from 0-30, with lower scores indicating increasing severity of CI in the domains of orientation,memory, attention, language & executive function.
100 patients age 60 and older attending the University of Texas Medical Branch (UTMB) Eye Clinic were consented to participate. Study was approved by the UTMB IRB. After educational adjustments4, 60% of the sample scored in the CI range of the SLUMS but not on the MMSE. African American and Hispanics presented more CI compared to white patients as defined by the SLUMS (OR, 2.80; 95% CI,1.05-7.44), independent of age, years of education and chronic diseases.
Table 2.Sample Characteristics (N= 100) Value
Age, mean +SD 68.4+8.1
Men % 42.0
White % 61.0
African American,% 22.0
Hispanic, % 16.0
Income (>$20,000 )% 33.3
Education (>high school) 36.0
Living Alone % 35.0
Currently Married % 60.0
Currently Taking Medications % 89.0
Chronic Disease History % 92.0
(Diabetes, Hypertension, Stroke, CAD, Cancer, etc)
Eye Disease % 87.0
BMI > 25 % 74.7
Systolic Blood Pressure >135mmHG % 68.4
MMSE, mean +SD 27.5+3.7
SLUMS, mean +SD 21.8+ 5.5
Table 1. The National Ambulatory Medical Survey: ophthalmology ranked as the second most visited specialty by patients 65 yrs and older.
Figure 3. MMSE & SLUMS Domains & Demographic Comparisons
Figure 1. Frequency of cognitive impairment using the
St. Louis University Mental Status Examination Scale (SLUMS), N=100 (adjusted by education levels).
these findings do support the need to further determine the association between cognitive function and disease development in visually impaired elders.
Figure 2. Canonical Discriminate Function (X2=48.6,18df,p<0.0001; 74% variance explained by scale, 26% with significant loadings for SLUMS domains - Registration & Recall, Attention, Calculation, Executive Function, Language
1. Congdon NG, Friedman DS, Lietman TL. (2003). Important causes of visual impairment in the world today. JAMA(290):2057-60
2. Duffy C.J. (1999). Visual loss in Alzheimer’s disease. Neurology; 52:10-11.
3. Giannakopoulos P. et al (1999). Neuroanatomic correlates of visual agnosia in Alzheimer’s disease: a clinicopathologic study. Neurology; 52:71-77.
4.Crum RM, Anthony JC, Bassett SS, Folstein MF.. Population-based norms for the Mini-Mental State Examination by age and educational level .JAMA. 1993 May 12; 269(18):2386-91.
Acknowledgments: Dr.Heyn is supported by the National Institute on Aging, Trainee Grant in Geriatric Research NIH/NIA# ST 60877. Ms. Nakamura is supported by the NIH R01 AG0193398. This study was also supported by the Galveston Jamail Foundation. The authors thank the developers of the Saint Louis University Mental Status Examination (SLUMS) instrument for allowing the use of their instrument.