Indian Journal of Sleep Medicine

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VOLUME 16 , ISSUE 3 ( July-September, 2021 ) > List of Articles

ORIGINAL RESEARCH ARTICLE

Assessing Cognitive Impairment in Patients with Sleep-disordered Breathing Using Mini-mental State Score and Addenbrooke\'s Cognitive Examination—Revised

Priya Ramachandran, Kimberley D Souza, Uma Devaraj, Uma Maheshwari, George D Souza

Keywords : Addenbrooke\'s cognitive examination—revised, Mild cognitive impairment, Mini-mental state score, Obstructive sleep apnea

Citation Information : Ramachandran P, Souza KD, Devaraj U, Maheshwari U, Souza GD. Assessing Cognitive Impairment in Patients with Sleep-disordered Breathing Using Mini-mental State Score and Addenbrooke\'s Cognitive Examination—Revised. Indian Sleep Med 2021; 16 (3):65-68.

DOI: 10.5005/jp-journals-10069-0082

License: CC BY-NC 4.0

Published Online: 13-10-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aims and objectives: Obstructive sleep apnea (OSA), which is by far the most common form of sleep-disordered breathing, is associated with many other adverse health consequences including cognitive impairment. The screening methods for cognitive impairment in subjects with OSA are not well recognized. Mini-mental state score (MMSE) is the most widely used screening tool. This study was done to evaluate the utility of Addenbrooke\'s cognitive examination—revised (ACE-R) in comparison to MMSE. Methodology and results: Thirty-six cases and controls [Epworth sleepiness score (ESS<10)] were recruited. They were administered using MMSE and ACE-R along with the online simulation test. The average age of both cases and controls was 49.2. Fourteen (58%) subjects had an MMSE score of less than 24, and 30 (81%) subjects had an ACE-R score of less than 82 thus qualifying for mild cognitive impairment (MCI). None of the controls had MCI. All subjects had severe OSA. The sleep parameters like apnea–hypopnea index (AHI), oxygen desaturation index (ODI), lowest saturation, and ESS had a negative correlation though not significant. Reaction time on the online simulator was increased in OSA as compared to controls. Conclusion: The ACE-R can be used for screening for the presence of MCI in subjects with OSA and is a better screening tool than MMSE.


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  1. Al Lawati NM, Patel SR, Ayas NT. Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Prog Cardiovasc Dis 2009;51(4):285–293. DOI: 10.1016/j.pcad.2008.08.001.
  2. Bedard MA, Montplaisir J, Richer F, et al. Obstructive sleep apnea syndrome: pathogenesis of neuropsychological deficits. J Clin Exp Neuropsychol 1991;13(6):950–964. DOI: 10.1080/01688639108405110.
  3. Gagnon K, et al. Cognitive impairment in obstructive sleep apnea. Pathol Biol (Paris) 2014. Available from: http://dx.DOI.org/10.1016/j.patbio.2014.05.015.
  4. Mioshi E, Dawson K, Mitchell J, et al. The Addenbrooke's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry 2006;21(11):1078–1085. DOI: 10.1002/gps.1610.
  5. Mungas D. In-office mental status testing: a practical guide. Geriatrics 1991;46(7):54–58,63,66.
  6. Laumbach RJ, Kipen HM. Respiratory health effects of air pollution: update on biomass smoke and traffic pollution. J Allergy Clin Immunol 2012;129(1):3. DOI: 10.1016/j.jaci.2011.11.021.
  7. Johns MW. Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the epworth sleepiness scale: failure of the MSLT as a gold standard. J Sleep Res 2000;9(1):5–11. DOI: 10.1046/j.1365-2869.2000.00177.x.
  8. Iber C, Ancoli-Israel S, Chesson AL, Jr, Quan SF, for American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events, rules, terminology and technical specifications 1st ed. Westchester, IL American Academy of Sleep Medicine 2007.
  9. Choraghe RP, Pillai C. Assessment of cognitive deficits in obstructive sleep apnea with paper-based tests and choice reaction time in Indian population. Curr Sci 2016;111(11):1825–1831. DOI: 10.18520/cs/v111/i11/1825-1831.
  10. Sharma H, Sharma SK, Kadhiravan T, et al. Pattern and correlates of neurocognitive dysfunction in Asian Indian adults with severe obstructive sleep apnoea. Indian J Med Res 2010;132:409–414. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20966519.
  11. Chen X, Zhang R, Xiao Y, et al. Reliability and validity of the Beijing version of the montreal cognitive assessment in the evaluation of cognitive function of adult patients with OSAHS. PLoS One 2015;10(7):1–12. DOI: 10.1371/journal.pone.0132361.
  12. Quan SF, Chan CS, Dement WC, et al. The association between obstructive sleep apnea and neurocognitive performance—the Apnea Positive Pressure Long-term Efficacy Study (APPLES). Sleep 2011;34(3):303–314B. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041706/. DOI: 10.1093/sleep/34.3.303.
  13. Demirdöğen Çetinoğlu E, Görek Dilektaşlı A, Demir NA, et al. The relationship between driving simulation performance and obstructive sleep apnoea risk, daytime sleepiness, obesity and road traffic accident history of commercial drivers in Turkey. Sleep Breath 2015;19(3):865–872. DOI: 10.1007/s11325-014-1114-6.
  14. Juniper M, Hack M, George CF, et al. Steering simulation performance in patients with obstructive sleep apnoea and matched control subjects. Eur Respir J 2000;15(3):590–595. DOI: 10.1034/j.1399-3003.2000.15.27.x. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10759458.
  15. Turkington PM. Relationship between obstructive sleep apnoea, driving simulator performance, and risk of road traffic accidents. Thorax 2001;56(10):800–805. DOI: 10.1136/thorax.56.10.800. Available from: http://thorax.bmj.com/content/56/10/800.abstract.
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