The principal aim of our study was to present norms for old and very old Czech adults on the Czech version of the Montreal Cognitive Assessment (MoCA) and investigate the influence of social and demographic factors on MoCA performance. We analyzed 540 adults aged ≥ 60 years (5-year age categories; nationally representative sample in terms of sex and educational level), who met strict inclusion criteria for the absence of neurodegenerative disorders and performed within normal range in neuropsychological assessment. Using multiple regression model, we found that MoCA performance was affected by age and education (both p < .001) but not sex. The study provides normed percentile estimates for MoCA performance stratified by age (60-74 years; ≥ 75 years) and education lower versus higher. We also present percentile equivalents for the MoCA and Mini-Mental State Examination (MMSE) for use in clinical practice. We found age- and education-related effects on MoCA performance which support the use of culturally adapted normative data.
The long-term visual sequelae were clearly underestimated on discharge, suggesting a significantly higher amount of patients with long-term sequelae than earlier reported. Thorough examinations before discharge and during follow-up will likely uncover a higher morbidity also after methanol poisonings in general.
BackgroundFalls are a common complication of advancing Parkinson's disease (PD). Although numerous risk factors are known, reliable predictors of future falls are still lacking. The objective of this prospective study was to investigate clinical and instrumented tests of balance and gait in both OFF and ON medication states and to verify their utility in the prediction of future falls in PD patients.MethodsForty-five patients with idiopathic PD were examined in defined OFF and ON medication states within one examination day including PD-specific clinical tests, instrumented Timed Up and Go test (iTUG) and computerized dynamic posturography. The same gait and balance tests were performed in 22 control subjects of comparable age and sex. Participants were then followed-up for 6 months using monthly fall diaries and phone calls.ResultsDuring the follow-up period, 27/45 PD patients and 4/22 control subjects fell one or more times. Previous falls, fear of falling, more severe motor impairment in the OFF state, higher PD stage, more pronounced depressive symptoms, higher daily levodopa dose and stride time variability in the OFF state were significant risk factors for future falls in PD patients. Increased stride time variability in the OFF state in combination with faster walking cadence appears to be the most significant predictor of future falls, superior to clinical predictors.ConclusionIncorporating instrumented gait measures into the baseline assessment battery as well as accounting for both OFF and ON medication states might improve future fall prediction in PD patients. However, instrumented testing in the OFF state is not routinely performed in clinical practice and has not been used in the development of fall prevention programs in PD. New assessment methods for daylong monitoring of gait, balance and falls are thus required to more effectively address the risk of falling in PD patients.
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