Speaking More than One Language may Delay Onset of Dementia

Elderly FriendsA recent study of 648 older adults in India suggests that those who were bilingual developed dementia more than four years later, on average, than those who spoke only one language—regardless of educational level.

Published recently in Neurology, the medical journal of the American Academy of Neurology (AAN), the study found that speaking two languages seems to have a protective effect against three types of dementia: Alzheimer’s disease, frontotemporal dementia, and vascular dementia.

“Speaking more than one language is thought to lead to better development of the areas of the brain that handle executive functions and attention tasks, which may help protect from the onset of dementia,” said study author Suvarna Alladi, DM, with Nizam’s Institute of Medical Sciences in Hyderabad, India, in a press release from the AAN.

The study subjects, all of whom were diagnosed with dementia, had an average age of 66. Approximately half spoke two or more languages; 14 percent were illiterate.

“These results offer strong evidence for the protective effect of bilingualism against dementia in a population very different from those studied so far in terms of its ethnicity, culture and patterns of language use,” Alladi said.

To learn more or to read the full article online, visit the Neurology Web site.

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Music “Reawakens” Alzheimer’s Patients

A remarkable transformation is taking place in nursing homes around the country as elderly patients are reconnecting with life through music. The brainchild of social worker Dan Cohen, a program called Music & Memory has created personalized iPod playlists for residents of elder care facilities, many of whom have Alzheimer’s type dementia. The results have been truly life changing for patients as they are “reawakened” by the music of their youth.

Cohen is now working with renowned neuropsychologist Oliver Sacks (author of Musicophilia: Tales of Music and the Brain) on a documentary about Cohen’s program and the elderly patients who are responding so positively. In a clip from this documentary, a man reacts to hearing music from his past:

 

 

“Our approach is simple, elegant and effective,” says Cohen on his Music & Memory Web site. “We train elder care professionals how to set up personalized music playlists, delivered on iPods and other digital devices, for those in their care. These musical favorites tap deep memories not lost to dementia and can bring residents and clients back to life, enabling them to feel like themselves again, to converse, socialize and stay present.”

What do you think? Has music helped your clients with dementia to access memories and engage more positively in daily life? PAR wants to hear from you, so leave a comment and join the conversation!

The MMSE®/MMSE®-2™ Cognitive Impairment Screener Goes Mobile in New App

One of the world’s most popular and trusted assessments of cognitive impairment is now available as a convenient app for smartphones and tablets. Like the paper-and-pencil version, the app can be used to screen for cognitive impairment, to select patients for clinical trials research in dementia treatment, or to track patients’ progress over time.

The MMSE/MMSE-2 app includes a brief instructional video that walks users through the features of the app. In addition to the original MMSE, both standard and brief versions of the MMSE-2 are available, enabling health care providers to choose the version that will suit each client. Scoring is done automatically, and patient records can be uploaded directly to an electronic medical records (EMR) system or e-mailed to appropriate personnel. Equivalent, alternate forms of the MMSE-2 decrease the possibility of practice effects that can occur over serial examinations. The app also includes norms for the MMSE and the MMSE-2, by age and education level.

The MMSE/MMSE-2 app is available to qualified health care professionals from the Apple® App StoreSM (for the iPhone® or iPad®) and from Google Play (for Android™ devices). The app is free—users pay only for administrations, which start at $1.25 each.

 

Alzheimer’s Diagnostic Guidelines Updated

Broader Definition of the Disease Could Help Doctors with Early Diagnosis and Intervention

In April of this year, the National Institutes of Health and the Alzheimer’s Association announced significant changes in the clinical diagnostic criteria for Alzheimer’s disease dementia. These revisions—the first in 27 years—are intended to help diagnose patients in the very early stages of the disease, allowing doctors to prescribe medication when it is most effective; that is, before a patient’s memory becomes compromised.

The new guidelines recognize two early stages of the disease: preclinical Alzheimer’s, in which biochemical and physiological changes caused by the disease have begun; and mild cognitive impairment, a stage marked by memory problems severe enough to be noticed and measured, but not severe enough to compromise a person’s independence. The new guidelines also reflect the increased knowledge scientists have about Alzheimer’s, including a better understanding of the biological changes that occur and the development of new tools that allow early diagnosis.

William H. Thies, chief scientific and medical officer of the Alzheimer’s Association, explains, “If we start 10 years earlier and could push off the appearance of dementia by, say, five years … that could cut the number of demented people in the U.S. by half” (Los Angeles Times, April 25, 2011).

For more information about the updated guidelines, as well as a list of journal articles and answers to frequently asked questions for clinicians, visit the National Institute on Aging Web site at http://www.nia.nih.gov/Alzheimers/Resources/diagnosticguidelines.htm.

Meet the MMSE & MMSE-2 Authors: Marshal F. Folstein, MD & Susan E. Folstein, MD

What made you decide initially to develop the Mini-Mental® State Examination (MMSE)?

We developed the MMSE to solve a clinical problem on a geriatric psychiatric inpatient service. The diagnoses of patients on our unit included depression, dementia, delirium, and occasional late-life schizophrenia. We needed a practical quantitative cognitive exam in order to aide clinicians in determining the severity of cognitive impairment ranging from mild to severe and to document improvement or decline.

At the time, Susan was a psychiatry resident rotating on the geriatric psychiatric unit where I (Marshal) was a junior attending. Always a perfectionist, she was not happy when I repeatedly asked for cognitive information that she had not asked about. So she asked me to write down all the items that I wanted her to include.

What made you decide to update it and create the Mini-Mental® State Examination, Second Edition™ (MMSE®-2™)?

Over the years, students and other users made many suggestions about how to improve the MMSE. There was a need to clarify the instructions so that certain tasks were administered; there was a need for phrases that were more easily translated into other languages; and users requested multiple forms in order to minimize practice effects with serial administration. In addition, we had long wanted to develop a shorter version that could be given very quickly in busy clinical settings, and also a longer version that would eliminate ceiling effects. We wanted this longer version to be more sensitive than the original MMSE to disorders of executive function and to the kinds of memory impairment found in mild cognitive impairment.

What would you like to tell people about the MMSE-2 that they may not know?

The MMSE-2 Standard Version scores are equivalent to the original MMSE scores. We took care that subjects tested during development scored the same, regardless of whether they were given the original MMSE or the MMSE-2 Standard Version. Longitudinal studies currently underway can switch to the new version without any adjustment to scores. The original, unrevised MMSE is still available if users do not want to change to the revised versions.

How do you spend your free time?

Marshal takes flute lessons and is trying to improve his photography. Susan enjoys gardening and reading spy novels, biographies, Jane Austen, and Patrick O’Brian. She has a new job at the University of Miami School of Medicine with a joint appointment in psychiatry and in the Hussman Institute for Human Genomics. We both like to write and watch old movies.

Screen for cognitive impairment with a revised version of the most widely used cognitive status exam...