Exploring Time of Day Effects on Mini-Mental State Examination Performance in Alzheimer's Disease and Age-Associated Cognitive Decline

Abstract

N europsychological assessment plays a prominent role in the diagnosis of Alzheimer's disease (AD) and other cognitive impairments. Increasingly, neuropsychological test results are also used to guide clinicians in the prescription of anti-dementia medication. There is evidence to suggest that the cognitive ability of an individual with AD may vary over the course of a day. If time of day can influence an individual's performance on cognitive tests, then it could potentially affect his or her diagnosis and eligibility for treatment. This study set out to explore the effect of time of day on Mini-Mental State Examination (MMSE) performance in individuals with AD and Age-Associated Cognitive Decline (AACD). No significant effect of time of day (TOD) on Folstein MMSE performance was found. However, some interesting results were highlighted and future research suggested. Overall, the study does not provide evidence that time of day needs to be considered when interpreting the result of a short cognitive screening test.

Cognitive Status Changes Based on Time of Day in Nursing Home Patients With and Without Dementia

“…Time of day may be a factor in the performance of visual copying in persons with AD. 18,24 Our results did not support any changes in cognitive functioning based on TOD as tested. We tested in the AM (9:30-11:30) and PM (2:30-4:30).…”

“…Published studies on the effect of TOD on cognitive efficiency in patients with Alzheimer's dementia are very limited and results are conflicting. 18,20 In a study measuring crystallized and fluid abilities in healthy adults ranging in age from 20 to 78 (mean age 44.77 years), Brown et al found that age was a significant predictor for 2 of the tasks whereas TOD did not predict performance for any of the 3 types of tasks (vocabulary, verbal fluency, and trail making test). They concluded that TOD influences may be limited to specific types of cognitive abilities.…”

“…Very few studies have been conducted in this regard in patients with dementia, and there are conflicting results probably because of methodological issues. Brown et al 18 did a retrospective study of 40 patients with AD and 20 with ageassociated memory decline from a memory disorders clinic in the United Kingdom using AM and PM Mini-Mental State Examination (MMSE) assessments. 19 No significant effect of TOD was found.…”

For Whom (and When) the Time Bell Tolls: Chronotypes and the Synchrony Effect

“…This reduced sensitivity to synchrony for neutral-type individuals may account for some of the discrepant findings regarding the influence of synchrony on cognitive performance, as a number of studies demonstrating small or absent synchrony effects have either intentionally included neutral-type individuals in their sample or failed to assess chronotype altogether (e.g., Barbosa & Albuquerque, 2008; Breslin, 2019; Brown et al, 2005; Bugg et al, 2006; Knight & Mather, 2013; B. Martin et al, 2008; Roeser et al, 2015; Root Kustritz et al, 2022; Rothen & Meier, 2017; Tandoc et al, 2021).…”

“…This reduced sensitivity to synchrony for neutral-type individuals may account for some of the discrepant findings regarding the influence of synchrony on cognitive performance, as a number of studies demonstrating small or absent synchrony effects have either intentionally included neutral-type individuals in their sample or failed to assess chronotype altogether (e.g., Barbosa & Albuquerque, 2008;Breslin, 2019;Brown et al, 2005;Bugg et al, 2006;Knight & Mather, 2013;Martin et al, 2008;Roeser et al, 2015;Root Kustritz, Bakke, & Rendahl, 2022;Rothen & Meier, 2017;Tandoc et al, 2021). Given that up to 50% of young adults and 25% of older adults do not show strong morning or evening preferences, it is likely that samples drawn from the general population will include significant proportions of neutral-types, thus diluting the synchrony effects experienced by those with strong chronotypes.…”