Standardized
Mini-Mental state examination of Anaemic patients and its comparison with
control
Mohit Trivedi
Arivind
Chansoria
D. S. Kushwah
R. K. Dixit
* Junior Resident
Pharmacology E.L.M.C. Lucknow
**Professor Pharmacology
and Therapeutics K.G.M.U. Lucknow
Address
for Corresponding Author:-
Dr. Mohit Trivedi
B8 Sector A MahaNagar
Lucknow. 226006
Mobile- 09793624151
Present study
was done in 30 anaemia patients against 30 controls . The tools used was SMMSE.
Data were presented as mean and analyzed using students t test,
Anemic had
very highly significant cognitive dysfunction in the orientation, attention,
language and construction domains of
SMMSE and also on the total scores. Anaemic patients had significant
circumscribed areas of cognitive dysfunctions compared to the control group but
a clear relation between the severity of anaemia and the severity of cognitive
dysfunction could not be established
KEY WORDS
anaemia
,cognitive dysfunctions , hemoglobin,
SMMSE,
Anaemia is related to cognitive performance,
especially attention, in preschool and school children. Pollet et al (1989)
found significant differences in IQ between children iron deficiency anemia and
iron replete children. They also found that vocabulary scores differed
significantly among iron deficit anaemics and iron deficit replete groups. In a
study of iron deficient adolescent girls, Burner et al (1996) found improvement
in vocabulary performance after eight weeks of iron supplementation although
there was no change in attention measures. All the chronic medical conditions
with restored hemoglobin levels did not have much neurocognitive deficits.
Soemantri et al (1989) suggested that supplementation with 10mg ferrous sulfate
per kilogram body weight per day for 3 months in anaemic subjects resulted in
apparent improvement in hematological status and learning achievement scores.
Soewond S. et al (1989) from pre and post psychological test data showed that
iron deficient anemia produces alterations in cognitive process related to visual
attention and concept acquisition and these alterations are reversed with iron
treatment. Pollett E. et al (1989) found that there is evidence of a positive
association between iron status and IQ, language and school achievement test
but there is no support for the internal validity of the hypothesis that this
association is casual. A Driva et al (1985) states that 6-7 year old children
who had suffered from iron deficiency during the 6th-18th
months of life, showed less ability to concentrate, were more clumsy and more
hyperactive when compared to group of children who did not have iron deficiency
during the first 2 years of life. In the recent years attention has been focussed
on the behavior disturbances which accompany iron deficiency. Therefore
present study was done to know the impact of anemia on various cognitive
functions. The objectives of study were to determine the cognitive dysfunctions in anemia
patients. and its comparison with that
of controls .
Material and Methods:-
This was a single point non-invasive study of cases of
anemia involving administration of a battery of neuropsychological tests to
assess the cognitive function in the patient group and control group which has
been group matched for age, gender and education. All subjects gave informed
consent for the study. Purposive
random sampling technique was applied. The
sample consisted of first 30 patients diagnosed as anemia selected from the
various in patient wards.
Inclusion
Criteria (Anaemic Patients)
- Informed consent
- Age group 18-55 years
- Diagnosis of Anemia confirmed by haematological tests
Exclusion
Criteria: (Anaemic Patients)
- History suggestive
of other significant physical (such as HIV, Hepatitis etc.) or
neuropsychiatric disorder which can cause cognitive impairment such as;
seizures, cerebrovascular disorders, dementia, nerurodegenerative
disorders, systemic illness with known cerebral consequences, depression,
anxiety, psychotic illnesses either presently or in the past.
- Evidence of
psychoactive substance dependence or significant abuse.
- Those patients
receiving the medication associated with cognitive side effects like
tricyclic antidepresents, antipsychotics and lithium.
- Family history of
psychiatric illness in first degree relative.
The control group subjects consisted of subjects not
having anemia (Hb > 11.0g/dl). A written informed consent had been taken for
participation after explaining the purpose and design of study to each subject.
The psychiatric status was assessed by using a structured clinical interview to
know the psychiatric status. Standardised mini-mental status examination (SMMSE)
was used for the analysis of mental status. Data were presented as mean ± SEM and Students ‘t’ test used to find the significant
differences between the two groups
RESULTS
AND DISCUSSION
Table1. Shows
results obtained from standardized mini mental state examination.
The
study revealed that there is a significant cognitive impairment in anaemia
patients compared with controls which persisted even after correction for
confounding factors. The mean age in the present study was 28.3 years for
control group and 28.5 year for the cases. It is well established that
impairments in cognitive functions are often seen with anaemia but a number of
confounding factors are also known to play an important role. The confounding factors which occur in
association with anaemia could be malnutrition, poverty, low maternal IQ, poor
maternal education, low birth weight. The use of SMMSE has yielded conflicting
results. Most of the studies done in this context have been done in children
and SMMSE or MMSE has not been used in these studies. Even in recent studies on
pregnant females and on iron deficiency anaemia adolescents, more comprehensive
neuropsychological testing has been done and has revealed considerable
cognitive deficits. SMMSE is not the a
test of choice when one is interested in finding mild cognitive
impairment as it might miss these
subjects, which could have been the case in this study as well. Another fallacy
in the SMMSE is that it is biased towards verbal items and does not adequately
measure other cognitive functions such as ability to attend to relevant input,
ability to solve abstract problems, psychomotor speed, information processing speed,
which are more affected in anaemia patients. This means that SMMSE should be
used in conjuction with other more comprehensive neuropsychological assessments
of cognitive functions. Current study
was a cross-sectional one. Since cognition is a measure of change in an
individual over time, longitudinal studies are more reliable.
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