Issues in the Assessment of Cognitive Function in Dementia (original) (raw)
Related papers
The evaluation of cognitive function in the dementias: methodological and regulatory considerations.
Dialogues in Clinical Neuroscience, 2003
Impairment of cognitive function is the central feature of dementia. Although, clinically, the cognitive deficit most often manifests itself as memory problems, a number of other areas of cognition are affected, and memory is but one of the cognitive skills compromised in dementia. Dementia with Lewy bodies, for example, accounts for 15% to 25% of all dementias and does not have memory deficits as a core feature. Our cognitive facilities underlie our abilities to engage successfully in the activities of daily living (ADL) and it follows thai enhancement of cognitive function will facilitate performance of ADL The assessment and understanding of these impairments are crucial to any treatment of the disorder. Unfortunately, the principal instrument used to assess cognitive function in most of the major clinical trials of Alzheimer's disease in recent years, the Alzheimer's Disease Assessment Scale-Cognitive Subsection (ADAS-COG), primarily assesses aspects of memory, which has resulted in other important cognitive deficits in dementia being overlooked. Automated cognitive tests are now available that can identify an earlier onset of improvements in dementia in smaller samples than the ADAS, Regulatory authorities should encourage - or even require - the use of automated procedures alongside the ADAS in pivotal trials to help determine the relative utility of the instruments in the fairest way possible. Whatever the outcome, this will be of long-term benefit to patients, carers, drug developers, clinicians, and regulators in this important area.
Comparison between neuropsychological evaluation instruments for severe dementia
Arquivos de Neuro-Psiquiatria, 2006
Objective: To study the correlation between two tools for cognitive evaluation, Mini-Mental State Examination-severe (MMSE-s) and Severe Impairment Battery (SIB), and the Bristol Daily Activities Functional Scale. Method: 50 patients from the Behavioral Neurology Section -EPM-UNIFESP -were evaluated. Mean age was 76.8±7.9 (range 57 to 95); 32% were males; mean education was 5.0±2.3 years (range 4 to 15); mean disease duration was 3.9±1.5 years (range 2 to 10). Results: Preliminary results in a small sample drawn from the study group do indicate a difference between the three cognitive scales. SIB and MMSE-s had a better correlation with functional score than MMSE, and MMSE-s had a correlation slightly better than SIB. Conclusion: These data indicate that it is possible to follow dementia patients up to severe stage as long as adequate instruments are used, and that there may be differences between scales with regard to sensitivity.
Assessment of cognition in early dementia
Alzheimers & Dementia, 2011
Better tools for assessing cognitive impairment in the early stages of Alzheimer’s disease (AD) are required to enable diagnosis of the disease before substantial neurodegeneration has taken place and to allow for detection of subtle changes in the early stages of progression of the disease. The National Institute on Aging and the Alzheimer’s Association convened a meeting to discuss state-of-the
Neuropsychological testing and assessment for dementia
Alzheimer's & Dementia, 2007
This evidence-based review examines the utility of brief cognitive tests and neuropsychological testing (NPT) in the detection and diagnosis of mild cognitive impairment (MCI) and dementia. All patients presenting with cognitive complaints are recommended to have a brief screening test administered to document the presence and severity of memory/cognitive deficits. There is fair evidence to support the use of a range of new screening tests that can detect MCI and mild dementia with higher sensitivity (Ն80%) than the Mini-Mental State Exam (MMSE). NPT should be part of a clinically integrative approach to the diagnosis and differential diagnosis of dementia. It should be applied selectively to address specific clinical and diagnostic issues including: 1) The distinction between normal cognitive functioning in the aged, MCI and early dementia: there is fair evidence that NPT can document the presence of specific diagnostic criteria and provide additional useful information on the pattern of memory/cognitive impairment. 2) The evaluation of risk for Alzheimer disease (AD) or other types of dementia in persons with MCI: there is fair evidence that NPT measures or profiles can predict progression to dementia (predictive accuracy ranges from ϳ80 to 100%, sensitivities from 53 to 80%, and specificities from 67 to 99%). 3) Differential diagnosis: There is fair evidence that NPT can complement clinical history and neuroimaging in determining the dementia etiology. Different dementia types have distinguishable NPT profiles though these may be stage-dependent, and increased sensitivity may be at the expense of specificity. 4) When NPT is part of a comprehensive assessment, which also entails clinical interviews and consideration of other clinical data, there is good evidence that it can contribute to management decisions in MCI and dementia, including the determination of retained and impaired cognitive abilities, their functional and vocational impact, and opportunities for cognitive rehabilitation.
Current Alzheimer Research, 2005
Early detection of cognitive decline may lead to more effective treatment. Clinical cognitive assessment is essential for early detection, but must be brief with easily interpretable results. The present study defines and evaluates a 30minute cognitive battery consisting of a subset of tests that comprise a longer computerized battery recently validated in detecting mild cognitive impairment (MCI). Participants were from three tertiary care memory clinics and an assisted living facility (final group: N=161) with consensus diagnoses of cognitively healthy, MCI, or mild dementia. A comprehensive NeuroTrax battery evaluated memory, executive function, visual spatial perception, verbal function, information processing speed, and motor skills. Validity of a single summary measure ('MCI Score') designed for dementia detection and built exclusively from tests of memory, executive function, and visual spatial perception was evaluated with receiver operating characteristic (ROC) analysis. Discriminant validity (area under the curve: AUC) was at least as large for the 6parameter MCI Score as for a 20-parameter score necessitating administration of the entire battery. Further, the MCI Score had a larger AUC with reduced variance relative to its constituent parameters. AUC for distinguishing dementia was 0.886; AUC for distinguishing cognitively healthy was 0.823. Finally, the MCI Score discriminated among all three diagnostic groups (ANOVA; F[2,150]=52.54, p<0.001). Hence a reduced NeuroTrax battery (30 minutes) with MCI Score is a useful clinical tool for summarizing cognitive data relevant to early dementia detection.
A Brief Dementia Test with Subjective and Objective Measures
Dementia and Geriatric Cognitive Disorders Extra, 2015
Background: The development of an effective brief dementia test will help in the early identification of dementia. Aim: This study investigates the diagnostic utility of a brief cognitive test for dementia which combines a short subjective informant-rated questionnaire (AD8) with an objective cognitive measure (Mini-Mental State Examination, MMSE) or its subcomponents. Methods: Subjects with mild dementia (Clinical Dementia Rating Scale score ≤ 1) were matched with community-dwelling, cognitively intact controls. MMSE and Clinical Dementia Rating Scale were administered to all subjects, while AD8 was completed by a reliable informant. Receiver operating characteristics analysis determined the diagnostic accuracies of AD8, MMSE, and AD8 combined with MMSE (AD8+MMSE). Stepwise logistic regression identified the subcomponents of MMSE which, combined with AD8, best discriminated dementia patients from controls. Results: The AD8 (area under the curve [AUC] = 0.92, 95% confidence interval [CI] 0.89-0.95) was superior to the MMSE (AUC = 0.87, 95% CI 0.83-0.92) in discriminating mild dementia patients from controls, and AD8+MMSE (AUC = 0.95, 0.92-0.98) increased its superior discrimination over MMSE alone. AD8 combined with three-item recall and intersecting pentagon copy (AUC = 0.95, 95% CI 0.92-0.97) performed as well as AD8 combined with full MMSE. Conclusion: AD8 combined with the MMSE subcomponents threeitem recall and intersecting pentagon copy has excellent diagnostic utility and is a promising brief cognitive test for early dementia.
2022
BACKGROUND Early detection of dementia is critical for intervention and care planning but remains difficult. Computerized cognitive testing provides an accessible and promising solution to address these current challenges. This study evaluated a computerized cognitive testing battery (BrainCheck) for its diagnostic accuracy and ability to distinguish the severity of cognitive impairment. OBJECTIVE This study evaluated a computerized cognitive testing battery (BrainCheck) for its diagnostic accuracy and ability to distinguish the severity of cognitive impairment. METHODS 99 participants diagnosed with Dementia, Mild Cognitive Impairment (MCI), or Normal Cognition (NC) completed the BrainCheck battery. Statistical analyses compared participant performances on BrainCheck based on their diagnostic group. RESULTS BrainCheck battery performance showed significant differences between the NC, MCI, and Dementia groups, achieving >88% sensitivity/specificity (true positive/true negative ra...
Practicality of a computerized system for cognitive assessment in the elderly
Biochemical Pharmacology, 2008
Early detection and diagnosis are critical to dementia care. However, many early cases remain undiagnosed as a result of the impracticality of neuropsychological testing, particularly in primary care. Mindstreams is an office-based computerized system for measuring cognitive function in multiple domains, with demonstrated validity, test-retest reliability, and sensitivity to treatment effects. This study evaluated its feasibility for assessment of the elderly.Usability data were collected after each of 2,888 consecutive initial-visit testing sessions at the first 11 clinical centers to use Mindstreams. The χ2 goodness-of-fit test was employed to determine whether patients and supervisors more often rated tests easy versus hard to use. Separate analyses were run for non–computer users, patients older than 75 years, and poor performers (≤1 standard deviation on overall battery performance).For all patients (n = 2,888; age, 64.7 ± 18.2 years), 83% rated the tests easy to use (P < .001). Seventy-three percent of non–computer users, 70% of patients older than 75, and 69% of poor performers rated them easy to use (Ps < .001). Supervisor ratings and ease of understandability ratings were similar. For all patients, 76% of supervisor ratings indicated no patient frustration (P < .001). Seventy-eight percent of ratings for non–computer users, 76% for patients older than 75, and 74% for poor performers indicated no frustration (Ps < .001).Mindstreams was easily employed, including in patients with considerable cognitive impairment, supporting its practicality for in-office cognitive assessment of the elderly. The availability of such valid and practical assessment suggests the feasibility of integrating the technology within a clinical algorithm for improved detection of cognitive decline.