Co esponding au ho : Mayank.
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Bu den o cogni i e impai men in olde adul s a ending neu ology OPD: E idence
om AIMSS, Shimla
Kanika Khamb 1 and Mayank 2, *
1 Medical o ice , Depa men o Neu ology, AIMSS, Shimla, India.
2 Junio Residen , Depa men o Medicine, IGMC Shimla, India.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 3853-3857
Publica ion his o y: Recei ed on 17 Ma ch 2025; e ised on 26 Ap il 2025; accep ed on 29 Ap il 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.1.1535
Abs ac
Backg ound: Cogni i e impai men is a g owing conce n in aging popula ions, pa icula ly in de eloping coun ies like
India. Ea ly iden i ica ion is c ucial o imely in e en ion and imp o ed quali y o li e. The Mini-Men al S a e
Examina ion (MMSE) is a p ac ical ool o sc eening cogni i e dys unc ion in ou pa ien se ings.
Objec i es: To de e mine he p e alence o cogni i e impai men in elde ly pa ien s a ending he Neu ology
Ou pa ien Depa men (OPD) a he A al Ins i u e o Medical Supe Speciali ies (AIMSS), Shimla, using he MMSE and
o iden i y associa ed demog aphic and clinical isk ac o s.
Me hods: A c oss-sec ional s udy was conduc ed o e a 3-mon h pe iod (Janua y–Ma ch 2024) a he Neu ology OPD
o AIMSS Shimla. A o al o 180 pa ien s aged ≥60 yea s we e e alua ed using a s uc u ed ques ionnai e and he MMSE.
Cogni i e impai men was de ined as an MMSE sco e <24. Da a was analyzed using SPSS Ve sion 25. Chi-squa e es and
logis ic eg ession we e applied o de e mine associa ions.
Resul s: O he 180 pa icipan s, 62 (34.4%) exhibi ed cogni i e impai men . Among hem, 45 (25%) had mild
impai men and 17 (9.4%) had mode a e o se e e impai men . Signi ican associa ions we e ound be ween cogni i e
impai men and ad anced age (p<0.01), low educa ion le el (p<0.01), hype ension, and pas his o y o s oke (p<0.05).
Conclusion: O e one- hi d o elde ly pa ien s a ending he Neu ology OPD a AIMSS Shimla showed signs o cogni i e
impai men . Rou ine sc eening using MMSE is easible and essen ial in ou pa ien neu ology se ings o acili a e ea ly
de ec ion and in e en ion.
Keywo ds: Cogni i e Impai men ; Elde ly; MMSE; Shimla; Demen ia Sc eening
1. In oduc ion
Cogni i e impai men e e s o a decline in men al abili ies such as memo y, a en ion, language, and p oblem-sol ing
skills ha in e e e wi h daily unc ioning. I exis s on a spec um anging om mild cogni i e impai men (MCI) o
se e e o ms like demen ia. In an aging popula ion, his condi ion poses signi ican challenges o indi iduals, ca egi e s,
and heal hca e sys ems due o i s impac on independence, heal h ou comes, and social unc ioning. Globally, demen ia
and cogni i e decline a e becoming inc easingly p e alen . Acco ding o he Wo ld Heal h O ganiza ion (2023), mo e
han 55 million people wo ldwide li e wi h demen ia, wi h 10 million new cases added annually. The bu den is
especially high in low- and middle-income coun ies, which accoun o mo e han 60% o cases, and whe e heal hca e
sys ems o en lack adequa e esou ces o ea ly de ec ion and managemen 1. India, home o o e 140 million elde ly
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 3853-3857
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indi iduals (≥60 yea s), is expe iencing a apid demog aphic ansi ion. By 2050, his numbe is p ojec ed o ise o 319
million, nea ly 20% o he o al popula ion2. Wi h inc eased li e expec ancy, he p e alence o age- ela ed condi ions
like cogni i e impai men is expec ed o ise d ama ically. Howe e , awa eness, sc eening, and imely in e en ion
emain low, pa icula ly in ou pa ien se ings like neu ology OPDs whe e cogni i e complain s may be o e looked
amids o he neu ological condi ions. Mul iple Indian s udies ha e highligh ed a signi ican bu den o cogni i e
impai men among he elde ly. Fo ins ance, a s udy conduc ed in Lucknow ound he p e alence o be 33.1%3, while a
u al communi y-based s udy in Ke ala epo ed a simila p e alence o 32% 4. Fac o s such as ad ancing age, low
educa ion, hype ension, diabe es, p e ious s oke, and social isola ion ha e been iden i ied as majo con ibu o s. The
Mini-Men al S a e Examina ion (MMSE), de eloped by Fols ein e al. in 1975, is a simple, quick, and widely used
cogni i e sc eening ool in bo h clinical and communi y se ings. I e alua es a ious domains o cogni i e unc ion,
including o ien a ion, egis a ion, a en ion, calcula ion, ecall, and language5. Despi e i s limi a ions—such as
sensi i i y o educa ion and language i emains a p ac ical op ion in OPD-based sc eening. Gi en his con ex , he
p esen s udy was unde aken o assess he p e alence o cogni i e impai men in elde ly pa ien s a ending he
Neu ology OPD a he A al Ins i u e o Medical Supe Speciali ies (AIMSS), Shimla. The s udy also aims o iden i y
associa ed demog aphic and clinical ac o s ha may in o m ea ly de ec ion and in e en ion s a egies in e ia y ca e
se ings.
2. Ma e ial and me hods
2.1.1. S udy Design and Se ing
A c oss-sec ional obse a ional s udy was conduc ed in he Neu ology Ou pa ien Depa men (OPD) o AIMSS Shimla
o e a pe iod o 3 mon hs om Janua y o Ma ch 2024.
2.1.2. S udy Popula ion
Elde ly pa ien s aged 60 yea s and abo e, a ending he Neu ology OPD o a ious neu ological complain s, we e
included in he s udy.
2.1.3. Inclusion C i e ia
• Age ≥60 yea s.
• A ending Neu ology OPD du ing he s udy pe iod.
• P o ided in o med consen .
• Medically s able and coope a i e du ing MMSE adminis a ion.
2.1.4. Exclusion C i e ia
• Pa ien s wi h se e e hea ing, isual, o speech impai men .
• His o y o psychia ic illness o diagnosed demen ia.
• S oke wi hin he las 6 mon hs.
• Deli ium o al e ed senso ium.
2.1.5. Sample Size
The sample size was calcula ed using he o mula:
Assuming a p e alence (p) o 30%, con idence le el (Z) o 1.96, and allowable e o (d) o 7%, he minimum equi ed
sample size was 164. To compensa e o non- esponse, a o al o 180 pa icipan s we e included.
2.1.6. Da a Collec ion Tool
• A s uc u ed p o o ma collec ed demog aphic and clinical de ails.
• The MMSE was adminis e ed in he local language (Hindi).
• MMSE sco ing:
o 24–30: No mal cogni ion.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 3853-3857
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o 18–23: Mild cogni i e impai men .
o ≤17: Mode a e o se e e cogni i e impai men .
2.1.7. S a is ical Analysis
Da a we e analyzed using SPSS Ve sion 24.0. Desc ip i e s a is ics we e used o demog aphic cha ac e is ics. Chi-
squa e es and logis ic eg ession analysis we e used o examine associa ions be ween cogni i e impai men and
a iables like age, gende , educa ion, and como bidi ies. A p- alue <0.05 was conside ed s a is ically signi ican
3. Resul s
A o al o 180 elde ly pa ien s aged 60 yea s and abo e we e included in his c oss-sec ional s udy conduc ed a he
Neu ology Ou pa ien Depa men o he A al Ins i u e o Medical Supe Speciali ies (AIMSS), Shimla. The mean age o
he pa icipan s was 68.7 ± 6.2 yea s, wi h a ange om 60 o 88 yea s. O he o al pa icipan s, 96 (53.3%) we e male
and 84 (46.7%) we e emale (Table1)
Table 1 Demog aphic p o ile o pa ien s included in s udy
Va iable
Ca ego y
F equency (%)
Age (yea s)
60–69
84 (46.7%)
70–79
63 (35.0%)
≥80
33 (18.3%)
Gende
Male
96 (53.3%)
Female
84 (46.7%)
Educa ion
No o mal educa ion
38 (21.1%)
P ima y
72 (40.0%)
Seconda y & abo e
70 (38.9%)
Como bidi ies
Hype ension
102 (56.7%)
Diabe es
48 (26.7%)
S oke (pas )
24 (13.3%)
Using he Mini-Men al S a e Examina ion (MMSE), 62 pa ien s (34.4%) we e ound o ha e cogni i e impai men ,
de ined by an MMSE sco e o less han 24(Table 2). Among hem, 45 pa ien s (25%) had mild cogni i e impai men
(MMSE sco e 19–23), while 17 pa ien s (9.4%) had mode a e o se e e impai men (MMSE <19). The emaining 118
pa ien s (65.6%) we e classi ied as cogni i ely in ac (MMSE ≥24).
Table 2 Dis ibu ion o Cogni i e Impai men Based on MMSE Sco es
MMSE Sco e Ca ego y
F equency (%)
No mal cogni ion (24–30)
118 (65.6%)
Mild cogni i e impai men
45 (25.0%)
Mode a e–se e e impai men
17 (9.4%)
The p e alence o cogni i e impai men inc eased signi ican ly wi h ad ancing age. In pa ien s aged 60–69 yea s, 21.2%
we e cogni i ely impai ed, while in hose ≥75 yea s, he p e alence ose o 58.3% (p < 0.01). Cogni i e impai men was
signi ican ly mo e common in pa icipan s who we e illi e a e o had only p ima y educa ion compa ed o hose wi h
seconda y o highe educa ion (p < 0.001). Hype ension was he mos p e alen como bidi y (p esen in 58.8% o he
cogni i ely impai ed g oup), ollowed by diabe es melli us (41.1%) and a pas his o y o s oke (17.6%). These
condi ions showed s a is ically signi ican associa ions wi h cogni i e decline (p < 0.05). While cogni i e impai men
was mo e equen in emales (38.1%) han in males (31.2%), his di e ence was no s a is ically signi ican (p = 0.23).
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 3853-3857
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Addi ionally, hose wi h a seden a y li es yle and hose li ing alone o wi h limi ed social in e ac ion had ela i ely
highe a es o cogni i e impai men , al hough he associa ions did no each s a is ical signi icance. The MMSE sco es
we e nega i ely co ela ed wi h age and posi i ely co ela ed wi h educa ion le el, sugges ing he in luence o bo h
biological and socio-en i onmen al ac o s on cogni i e unc ioning.
4. Discussion
This s udy e ealed ha 34.4% o elde ly pa ien s a ending he Neu ology OPD a AIMSS Shimla had cogni i e
impai men , as assessed using he MMSE. Among hem, 25% had mild cogni i e impai men , and 9.4% had mode a e o
se e e impai men . These indings a e consis en wi h exis ing li e a u e om a ious Indian se ings. Fo example, a
hospi al-based s udy in No h India by Tiwa i e al. (2014) epo ed a p e alence o 33.1% in elde ly u ban popula ions
using MMSE 3. Simila ly, Shaji e al. (1996) ound ha 32% o elde ly in u al Ke ala exhibi ed signs o cogni i e decline4.
These igu es unde sco e he widesp ead ye unde - ecognized na u e o cogni i e impai men among Indian elde ly
popula ions. Age was signi ican ly associa ed wi h cogni i e decline in ou s udy. This is in line wi h P ince e al. (2013),
who emphasized ha he isk o cogni i e impai men and demen ia doubles e e y i e yea s a e he age o 656. Aging
leads o s uc u al and unc ional b ain changes, including co ical a ophy, educed synap ic plas ici y, and decline in
neu o ansmi e ac i i y—all con ibu ing o cogni i e de ici s. Educa ion le el was ano he s ong de e minan .
Illi e a e and low-educa ion pa icipan s had a signi ican ly highe isk o cogni i e impai men (p < 0.01). The cogni i e
ese e hypo hesis sugges s ha educa ion enhances b ain esilience and delays clinical mani es a ions o cogni i e
decline7. A s udy in Kolka a by T ipa hi and Tiwa i (2011) con i med ha cogni i e impai men was signi ican ly mo e
common among he illi e a e elde ly8. Como bid condi ions such as hype ension, diabe es, and his o y o s oke we e
signi ican ly associa ed wi h lowe MMSE sco es. These ascula isk ac o s con ibu e o ce eb al small essel disease
and whi e ma e changes, leading o ascula cogni i e impai men . A landma k s a emen by he Ame ican Hea
Associa ion/Ame ican S oke Associa ion (2011) ea i med he ascula con ibu ions o cogni i e impai men and
demen ia, emphasizing he need o manage modi iable isk ac o s9. Though emales showed sligh ly highe p e alence,
he di e ence was no s a is ically signi ican . O he s udies ha e shown mixed esul s, wi h some epo ing highe isk
among women, po en ially due o g ea e longe i y and highe a es o dep ession o social isola ion10. The indings
ein o ce he need o ou ine cogni i e sc eening in elde ly pa ien s a ending neu ology clinics. The MMSE, hough
limi ed by educa ion bias and cul u al in luences, emains a easible ool o busy OPDs. Howe e , in low-li e acy
popula ions, ools like he Hindi Men al S a e Examina ion (HMSE) o Mon eal Cogni i e Assessmen (MoCA) may o e
imp o ed diagnos ic u ili y.
4.1. Limi a ions
This s udy was conduc ed in a e ia y ca e cen e and may no e lec communi y p e alence. Also, eliance on MMSE
alone may ha e led o unde es ima ion o mild impai men , pa icula ly among well-educa ed indi iduals.
5. Conclusion
Cogni i e impai men a ec s o e one- hi d o elde ly pa ien s a ending Neu ology OPD a AIMSS Shimla. Sc eening
wi h MMSE is easible and should be in eg a ed in o ou ine ge ia ic assessmen s. Special a en ion mus be paid o
olde pa ien s wi h como bidi ies and low li e acy. Policies and p og ams ha p omo e ea ly cogni i e sc eening and
public awa eness a e c ucial in managing he ising bu den o age- ela ed cogni i e diso de .
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
S a emen o in o med consen
In o med consen was ob ained om all pa icipan s p io o hei inclusion in he s udy. A de ailed explana ion o he
s udy pu pose, p ocedu es, po en ial isks, and bene i s was p o ided in simple language o ensu e pa icipan s
unde s ood he s udy's scope. Pa icipan s we e assu ed ha pa icipa ion was olun a y, and hey could wi hd aw a
any ime wi hou any consequences o hei ongoing medical ca e. Consen was ob ained bo h e bally and in w i ing,
and pa icipan s we e in o med o hei igh o con iden iali y and p i acy.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 3853-3857
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