Annals of Long Term Care

Using the Mini-Mental State Examination for Tracking Cognition in the Older Population Based on Longitudinal Data

Mark Chatfield, MSc, Fiona E. Matthews, PhD, and Carol Brayne, MD, and the Medical Research Council Cognitive Function and Ageing Study

OBJECTIVES: To estimate population norms for use in assessment of individuals in relation to their age-matched peers using true longitudinal patterns of decline.

DESIGN: Longitudinal study of 10 years of follow-up data from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) on the most commonly used cognitive test across clinical and research settings.

SETTING: England and Wales.
PARTICIPANTS: Thirteen thousand four people were seen in five sites at baseline, with follow up at 2, 5, and 10 years.

MEASUREMENTS: Mini-Mental State Examination (MMSE) score at three interviews over 10 years. A total of 42,777 MMSE scores were used in the analysis.

RESULTS: MMSE norms are presented according to age and split according to sex using longitudinal data. Potential cohort effects and dropout of individuals with low MMSE scores have been accounted for.

CONCLUSION: It is likely that the cognitive MMSE scale will continue to be used in many settings and across the age range. The figures presented here can be used to plot individual performance and chart where there is change in the relative position of one individual compared with others. J Am Geriatr Soc 2007;55(7):1066-1071.

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CLINICAL INVESTIGATIONS

Maintenance Treatment for Old-Age Depression Preserves Health-Related Quality of Life:
A Randomized, Controlled Trial of Paroxetine and Interpersonal Psychotherapy

Alexandre Y. Dombrovski, MD, Eric J. Lenze, MD, Mary Amanda Dew, PhD, Benoit H. Mulsant, MD, Bruce G. Pollock, MD, PhD, Patricia R. Houck, MS, and Charles F. Reynolds III, MD

OBJECTIVES: To determine whether maintenance antidepressant pharmacotherapy and interpersonal psychotherapy sustain gains in health-related quality of life (HR-QOL) achieved during short-term treatment in older patients with depression.

DESIGN: After open combined treatment with paroxetine and interpersonal psychotherapy, responders were randomly assigned to a two (paroxetine vs placebo) by two (monthly interpersonal psychotherapy vs clinical management) double-blind, placebo-controlled maintenance trial. HR-QOL outcomes were assessed over 1 year.

SETTING: University-based clinic.

PATIENTS: Of the referred sample of 363 persons aged 70 and older with major depression, 210 gave consent, and 195 started acute treatment; 116 met criteria for recovery, entered maintenance treatment, and were included in this analysis.

INTERVENTIONS: Paroxetine; monthly manual-based interpersonal psychotherapy.

MEASUREMENTS: Overall HR-QOL as measured using the Quality of Well-Being Scale (QWB) and six specific HR-QOL domains derived from the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) subscales.

RESULTS: All domains of HR-QOL except physical functioning improved with successful acute and continuation treatment. After controlling for any effects of psychotherapy, pharmacotherapy was superior to placebo in preserving overall well-being (P=.04, effect size (r)=0.23), social functioning (P=.02, r=0.27), and role limitations due to emotional problems (P=.007, r=0.30). Interpersonal psychotherapy (controlling for the effects of pharmacotherapy) did not preserve HR-QOL better than supportive clinical management.

CONCLUSION: Maintenance antidepressant pharmacotherapy is superior to placebo in preserving improvements in overall well-being achieved with treatment response in late-life depression. No such benefit was seen with interpersonal psychotherapy.