We examined the effects of selected health conditions and sensory functions, socioeconomic status, age, and education on cognitive functioning in 3,974 community-dwelling individuals aged 65-84 years. Logistic regression analysis was used to examine the independent and joint effects of these variables on borderline (Mini-Mental State Exam [MMSE] of 22-25) and poor (MMSE of < or = 21) functioning relative to adequate functioning (MMSE of 26-30). The effect of age and of education on MMSE performance was relatively stable, even after adjusting for age- and education-related health conditions and sensory impairments that also influenced level of cognitive functioning. These conditions included poor vision, Parkinson's disease, diabetes, depression, stroke (in 65-74-year-olds), and low socioeconomic status (in 75-84-year-olds). Education did not modify the effect of these variables on MMSE performance. Additional studies elucidating further the mechanisms that relate these sociodemographic factors to cognitive performance are warranted, as are studies of the relationship between these factors and the incidence of cognitive impairment.

SynopsisThe CAMCOG, the cognitive section of the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX), was administered twice to 53 patients with a clinical diagnosis ranging from no dementia to severe dementia. The stability of the total CAMCOG score was high (0·97). Patients with less than moderate dementia were differentiated well by the total score and by subscales with a range of more than 8 points, except when education was low or age was higher than 78. Because performance on most (sub)scales is modified by age and education level, stratified norms are desirable. Only the Praxis subscale, and specifically performance on drawing tasks, appeared to be influenced by depression.

SUMMARYThe distribution of change scores of the Mini-Mental State Examination (MMSE) was assessed in healthy aged subjects after an interval of 1 year. As part of the Amsterdam Study of the Elderly, which is a community survey on ageing and cognitive decline (N = 4051; age range 65-84), a subsample of subjects ( N = 247) was studied twice.Participants with dementia, other psychiatric disorders or physical disease which might interfere with cognitive testing were excluded. Test-retest reliability was 0.55 in this group. The distribution of change scores ranged from -9 to +5. From this result the following clinical rule-of-thumb was derived. In an individual patient, and in the absence of other indications of a dementing process, a deterioration in MMSE score must be greater than five points after 1 year to be suspect for a genuine cognitive decline. KEY WoRDs-Mini-Mental State Examination; dementia; healthy ageingWhen diagnosing a possible early dementia, one is mainly interested in changes with respect to premorbid cognitive functioning. Dementia screening tests are useful instruments for this purpose. These tests perform well when the impairment is large enough. However, in cases of a possible early dementia it is often necessary to examine the patient twice with a considerable interval before one can decide on the diagnosis. In such cases, where it comes to the detection of changes over time, the test-retest reliability of the screening test (Rtt; ie the correlation between two measurements after an interval) and its distribution of change scores are of utmost importance.The most popular dementia screening test is the Mini-Mental State Examination (MMSE;Folstein et al., 1975). Many studies have reported on the Rtt

The coexistence of many screening tests for senile dementia raises the question of their potential differences. In an elderly community sample (n = 358), four different tests were applied in parallel. All tests were able to identify similar samples of subjects regarding sample size, age, education or depression. We failed to prove one test to be superior in predicting CAMDEX or AGECAT diagnoses of dementia. Yet, the individuals identified by different tests, and especially the cases of minimal dementia, were only partly identical and partly unique for each of the tests. There is a clear need for greater consensus about the use of screening tests for dementia.

Few evidence-based methods for case management in child protection and child welfare are available. That is why Youth Protection Amsterdam Area developed a new method, by integrating their best practices: Intensive Family Case Management (IFCM). Because IFCM was developed in practice, clarity about its core elements and behavior acts was lacking. The purpose of this study was to establish a valid operationalization of IFCM used for implementation purposes such as training, clinical supervision and monitoring. A 74-item draft was developed to describe the behavioral acts of IFCM, based on a literature study and analysis of internal documents and training. To ensure content validity, a Delphi study was conducted. Over two rounds, professionals (1) rated the behavioral acts needed in the application of IFCM on a five-point Likert scale and (2) provided their preferred terminology. Items with consensus ratings of 80 % or more were included in the final description. Selected IFCM experts rated the behavior acts over two rounds. The initial list with 74 behavior acts was reduced to 55 acts with a consensus of 80 % or more.Certain behavior acts were combined, others did not lead to consensus. Based on experts' feedback, the initial terminology of 46 behavior acts was modified. The final 55 acts were categorized in ten core elements. This study explicates the core elements of IFCM and describes the 55 necessary behavior acts in preferred and recognizable terminology. The study describes implications of these findings for the practice and gives recommendations for future research.