The use of neuropsychological tests across Europe: the need for a consensus in the use of assessment tools for dementia (original) (raw)
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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.
Alzheimer's research & therapy, 2017
Cognitive, behavioural, and functional assessment is crucial in longitudinal studies of neurodegenerative dementias (NDD). Central issues, such as the definition of the study population (asymptomatic, at risk, or individuals with dementia), the detection of change/decline, and the assessment of relevant outcomes depend on quantitative measures of cognitive, behavioural, and functional status.Currently, we are far from having available reliable protocols and tools for the assessment of dementias in Europe. The main problems are the heterogeneity of the tools used across different European countries, the lack of standardisation of administration and scoring methods across centres, and the limited information available about the psychometric properties of many tests currently in widespread use. This situation makes it hard to compare results across studies carried out in different centres, thus hampering research progress, in particular towards the contribution to a "big data"...
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.
2015
The aim of this project was to provide guidelines for harmonization and innovation of assessment tools to be applied to research in neurodegenerative dementias (NDD), with a special focus on longitudinal cohort studies. A consensus was achieved on the general recommendations to be followed in developing procedures and tools for neuropsychological assessment. The context, the target population, the cognitive/behavioural variable to evaluate and the exact clinical questions to be answered, should be considered as the main preliminary aspects to address. Validity and reliability are two main psychometric properties that must be known before using a test. Sensitivity, specificity and predictive value are particularly important in the context of NDD, to define normal vs. abnormal conditions and for the purpose of differential diagnosis. The working group particularly focused on unmet needs and provided specific recommendations on how to design studies that can provide empirical evidence for selecting between methods for diagnosis and monitoring of NDD. These issues refer to the assessment of global functions, memory, language, visual-spatial abilities, executive function, functional abilities, motor and behavioural symptoms. A central issue is represented by the lack of standardized norms for the tests to be used in the different European countries. Another important aspect is the need to improve knowledge about the sensitivity, specificity and predictive value of the currently used tools. For each single domain a consensus was also achieved on the practical recommendations of the assessment tools.
Alzheimers & Dementia, 2006
Current clinical practice and research request for precise and accessible instruments to detect early cognitive impairment (CI). Folstein's Mini Mental State Examination (MMSE) 1 is widely used in screening studies. Unfortunately, its specificity is hampered by being affected by age, education level and cultural environment. It is also very sensitive to moderate to severe-, but not to mild cognitive impairment (MCI). Teng y Chang Chui developed a more extensive version (3MS) 2 which may overcome such limitations. Objectives: Since the 3MS has not been validated in Venezuela, we correlated both instruments' scores and evaluated their sensitivity and specificity compared to the clinical diagnosis. Methods: The scales were administered in a random sequence to 93 outpatients aged 50 or more years who were assessed in the neurology or psychiatry departments. Cutoff scores for CI were 23 for the MMSE and Ͻ 79 for the 3MS. Results: We evaluated 36 healthy subjects (89% women; age (years: average Ϯ SD): 65.4 Ϯ 7.7); 25 with MCI (72% women; age: 69.4 Ϯ 10.1) and 32 demented patients (78% women; age: 73.7 Ϯ 7.3). A significant positive correlation was found between the MMSE and the 3MS: whole sample [r (93) ϭ 0.876, p ϭ 0.0001]; healthy subjects [r (36) ϭ 0.466, p ϭ 0.004]; MCI [r (25) ϭ 0.644, p ϭ 0.001] and dementia [r (32) ϭ 0.854, p ϭ 0.0001]. The MMSE specificity reached 100%, but its sensitivity was of 12% for MCI and 44 % for dementia. The 3MS specificity was of 83.3%, and the sensitivity reached 44% for MCI and 69% for dementia. Conclusions: In spite of an excellent numeric correlation between both instruments, the MMSE displayed a very low sensitivity for the MCI in our population. Since sensitivity was better for the 3MS, additional validation studies for this instrument are warranted in Venezuela. References: (1) Folstein, M., Folstein, S., McHugh P. (1975) Mini-Mental State Examination: a practical method for grading the cognitive sate of patients for the clinician.
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.
The neuropsychiatry of dementia : psychometrics, clinical implications and outcome
2009
Behavioural and psychological symptoms are highly prevalent in dementia. The Neuropsychiatric Inventory was constructed to measure these symptoms. Data from three studies are presented, concerning psychometric aspects of the NPI Dutch version. The NPI was compared to the Revised Memory and Behavioral Problems Checklist (RMBPC) and the Mini Mental State Examination (MMSE) (n=24). In the three selected patient samples prevalence of behavioural or psychological symptoms was as high as 90%. Interrater agreement (n=19) was very high (kappa > .90). Factor analysis (n=199) supports NPI construct validity. The NPI correlated reasonably close (R = .42-.63) with the relevant RMBPC subscales, but not with a cognitive measure (MMSE). The NPI Dutch version can be scored objectively and it is a valid rating scale for measuring a wide range of behavioural and psychological symptoms of dementia.
Neuropsychological assessment in preclinical and prodromal Alzheimer disease: a global perspective
Journal of Global Health, 2019
A lzheimer disease (AD), the most prevalent form of dementia, refers to a syndrome in which cognitive ability declines to such a degree that functioning in daily and/or social activities is compromised. In 2015, there were approximately 47 million people living with dementia globally, a figure expected to rise to 131 million by 2050. By as soon as 2030, the worldwide prevalence of dementia is estimated to reach 75 million with the majority of cases concentrated in low-and middle-income countries (LMiCs) [1-3]. Ageing worldwide populations beget greater numbers of older individuals living with chronic health conditions, such as dementia, which might pose significant social and economic challenges, most notably, for LMiCs [4]. In high income countries (HiCs), the focus of dementia detection is evolving to further encompass earlier stages of disease with the view to promote future approaches in secondary prevention. It is now accepted that AD-related pathology, such as amyloid and/or tau deposition, occurs decades before the onset of dementia symptoms [5]. The earliest sites of amyloidosis and tauopathy are the medial temporal lobe (MTL) structures, namely the hippocampus and sub-hippocampal areas, followed by neuronal lesions to the neocortical areas [6,7]. Current research nomenclature for AD includes preclinical AD, the earliest stage of AD in which biomarkers, such as amyloid and tau, are detectable through imaging data or cerebrospinal fluid (CSF), but no overt cognitive symptoms are indicated. Preclinical AD precedes another stage, termed prodromal AD where obvious cognitive symptoms emerge alongside aggregating neuropathological change. Finally, continuous neuropathological and cognitive changes culminate in clinical dementia towards the end of the AD continuum (see Figure 1 and [8]). Different research frameworks for AD have been proposed [9,10] (and references s11 and s12 in Online Supplementary Document),
Issues in the Assessment of Cognitive Function in Dementia
Brain and Cognition, 1996
The increasing prevalence of elderly patients presenting with disorders of cognitive functioning suggestive of dementia, coupled with limits in resources available to address these problems, is going to necessitate the development of new technologies to be used for assessment. These measures should be efficient, designed to reflect both the current knowledge of brain function and the developmental characteristics of older patients. Though few current measures of cognitive function meet these goals, neuropsychological ''microbatteries'' such as the DRS and NCSE may serve as models for a new generation of cognitively specific assessment instruments.