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Detection and Staging of Dementia in Alzheimer's Disease: Use of the Neuropsychological Measures Developed for the Consortium to Establish a Registry for Alzheimer's Disease

Detection and Staging of Dementia in Alzheimer's Disease: Use of the Neuropsychological Measures... Abstract • Our earlier studies using the Consortium to Establish a Registry of Alzheimer's Disease neuropsychological battery showed that delayed recall was a highly sensitive indicator of early Alzheimer's disease. None of the learning and memory measures in the battery were found to be useful in staging the severity of this form of dementia. This study explores the nonmemory functions (fluency, naming, and praxis) of the Consortium to Establish a Registry of Alzheimer's Disease battery and asks whether performance on any of these measures adds to the detection of early Alzheimer's disease or is sensitive to the later progression of the illness. We stratified patients with this disease according to severity (mild, moderate, severe), and compared them with age-, education-, and gender-matched control subjects (group N =49 each). Multivariate procedures and cutting scores were used to determine the efficacy of the various measures in distinguishing between the cases and control subjects. Impairment of delayed recall was again found to be the best discriminator for detecting mild cases of Alzheimer's disease. Confrontation naming was the only nonmemory factor that assisted in this discrimination. For staging the illness, a combination of measures including fluency, praxis, and recognition memory best differentiated cases with mild dementia from those with either moderate or severe stages of disease. Measures of delayed recall quickly "bottomed out" in the patients with Alzheimer's disease and proved of little value in staging the disorder. These findings are consistent with the reported pathologic progression of the illness and suggest that whereas delayed recall memory is a highly sensitive indicator of Alzheimer's disease, lexical-semantic processing and visuospatial functions are better determinants of the progressive course of this illness. References 1. Moss MB, Albert MS. Alzheimer's disease and other dementing disorders . In: Albert MS, Moss MB, eds. Geriatric Neuropsychology . New York, NY: Guilford Press; 1988. 2. Storandt M, Botwinick RJ, Danziger WL, Berg L, Hughes CP. Psychometric differentiation of mild senile dementia of the Alzheimer type . Arch Neurol . 1984;41:497-499.Crossref 3. Eslinger PJ, Damasio AR, Benton AL, Van Allen M. Neuropsychological detection of abnormal mental decline in older persons . JAMA . 1985;253:670-674.Crossref 4. Welsh KA, Butters N, Hughes J, Mohs R, Heyman A. Detection of abnormal memory decline in mild cases of Alzheimer's disease using CERAD neuropsychological measures . Arch Neurol . 1991;48:278-281.Crossref 5. Knopman DS, Ryberg S. A verbal memory test with high predictive accuracy for dementia of the Alzheimer type . Arch Neurol . 1989;46:141-145.Crossref 6. Masur DM, Fuld PA, Blau AD, Crystal H, Aronson MK. Predicting development of dementia in the elderly with the selective reminding test . J Clin Exp Neuropsychol . 1990;12:529-538.Crossref 7. Fuld PA, Masur DM, Blau AD, Crystal H, Aronson MK. Objectmemory evaluation for prospective detection of dementia in normal functioning elderly: predictive and normative data . J Clin Exp Neuropsychol . 1990;12:539-548.Crossref 8. Katzman R, Aronson M, Fuld P, et al. Development of dementing illness in an 80 year old volunteer cohort . Ann Neurol . 1989;25:317-324.Crossref 9. Morris JC, Heyman A, Mohs RC, et al. The Consortium to Establish a Registry for Alzheimer's disease (CERAD) . Neurology . 1989;39:1159-1165.Crossref 10. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease . Neurology . 1984;34:939-944.Crossref 11. Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician . J Psychiatric Res . 1975;12:189-198.Crossref 12. Kaplan E, Goodglass H, Weintraub S. Boston Naming Test . Philadelphia, Pa: Lea & Febiger; 1983. 13. Winer BJ. Statistical Principles in Experimental Design . 2nd ed. New York, NY: McGraw-Hill International Book Co; 1971. 14. Crapper McLachlan DR, Dalton AJ, Galin H, Schlotterer G, Daicar E. Alzheimer's disease: clinical course and cognitive disturbances . Acta Neurol Scand . 1984;99:83-89.Crossref 15. Grady CL, Haxby JV, Horwitz B, et al. Longitudinal study of the early neuropsychological and cerebral metabolic changes in dementia of the Alzheimer type . J Clin Exp Neuropsychol . 1988;10:579-596.Crossref 16. Haxby JV, Grady CL, Koss E, et al. Longitudinal study of cerebral metabolic asymmetries and associated neuropsychological patterns in early dementia of the Alzheimer type . Arch Neurol . 1990;47:753-760.Crossref 17. Rosen WG, Mohs RC. Evolution of cognitive decline in dementia . In: Corkin S, Davis KL, Growden JH, Usdin E, Wurtman RJ, eds. Aging: Alzheimer's Disease: A Report of Progress . New York, NY: Raven Press; 1982;19:183-188. 18. Rebok G, Brandt J, Folstein M. Longitudinal cognitive decline in patients with Alzheimer's disease . J Geriatr Psychiatry Neurol . 1990;3:91-97.Crossref 19. Hyman BT, Van Hoesen GW, Damasio AR, Barnes CL. Alzheimer's disease: cell-specific pathology isolates the hippocampal formation . Science . 1984;225:1168-1170.Crossref 20. Pearson RCA, Esiri MM, Hjorns RW, Wilcock GK, Powell TPS. Anatomical correlates of the distribution of pathological changes in the neocortex in Alzheimer's disease . Proc Natl Acad Sci U S A . 1985;82:4531-4534.Crossref 21. Arnold SE, Hyman BT, Flory J, Damasio AR, Van Hoesen GW. The topographical and neuroanatomical distribution of neurofibrillary tangles and neuritic plaques in the cerebral cortex of patients with Alzheimer's disease . Cereb Cortex . 1991;1:103-116.Crossref 22. Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia . Br J Psychiatry . 1982:140:566-572.Crossref 23. Welsh KA, Butters N, Hughes J, Mohs RC, Heyman A. Memory impairments of Alzheimer's disease characterized by the CERAD psychometric battery. Proceedings from the 15th Annual Meeting for the Society for Neurosciences; October 29-November 3, 1989; Phoenix, Ariz. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Detection and Staging of Dementia in Alzheimer's Disease: Use of the Neuropsychological Measures Developed for the Consortium to Establish a Registry for Alzheimer's Disease

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Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1992.00530290030008
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Abstract

Abstract • Our earlier studies using the Consortium to Establish a Registry of Alzheimer's Disease neuropsychological battery showed that delayed recall was a highly sensitive indicator of early Alzheimer's disease. None of the learning and memory measures in the battery were found to be useful in staging the severity of this form of dementia. This study explores the nonmemory functions (fluency, naming, and praxis) of the Consortium to Establish a Registry of Alzheimer's Disease battery and asks whether performance on any of these measures adds to the detection of early Alzheimer's disease or is sensitive to the later progression of the illness. We stratified patients with this disease according to severity (mild, moderate, severe), and compared them with age-, education-, and gender-matched control subjects (group N =49 each). Multivariate procedures and cutting scores were used to determine the efficacy of the various measures in distinguishing between the cases and control subjects. Impairment of delayed recall was again found to be the best discriminator for detecting mild cases of Alzheimer's disease. Confrontation naming was the only nonmemory factor that assisted in this discrimination. For staging the illness, a combination of measures including fluency, praxis, and recognition memory best differentiated cases with mild dementia from those with either moderate or severe stages of disease. Measures of delayed recall quickly "bottomed out" in the patients with Alzheimer's disease and proved of little value in staging the disorder. These findings are consistent with the reported pathologic progression of the illness and suggest that whereas delayed recall memory is a highly sensitive indicator of Alzheimer's disease, lexical-semantic processing and visuospatial functions are better determinants of the progressive course of this illness. References 1. Moss MB, Albert MS. Alzheimer's disease and other dementing disorders . In: Albert MS, Moss MB, eds. Geriatric Neuropsychology . New York, NY: Guilford Press; 1988. 2. Storandt M, Botwinick RJ, Danziger WL, Berg L, Hughes CP. Psychometric differentiation of mild senile dementia of the Alzheimer type . Arch Neurol . 1984;41:497-499.Crossref 3. Eslinger PJ, Damasio AR, Benton AL, Van Allen M. Neuropsychological detection of abnormal mental decline in older persons . JAMA . 1985;253:670-674.Crossref 4. Welsh KA, Butters N, Hughes J, Mohs R, Heyman A. Detection of abnormal memory decline in mild cases of Alzheimer's disease using CERAD neuropsychological measures . Arch Neurol . 1991;48:278-281.Crossref 5. Knopman DS, Ryberg S. A verbal memory test with high predictive accuracy for dementia of the Alzheimer type . Arch Neurol . 1989;46:141-145.Crossref 6. Masur DM, Fuld PA, Blau AD, Crystal H, Aronson MK. Predicting development of dementia in the elderly with the selective reminding test . J Clin Exp Neuropsychol . 1990;12:529-538.Crossref 7. Fuld PA, Masur DM, Blau AD, Crystal H, Aronson MK. Objectmemory evaluation for prospective detection of dementia in normal functioning elderly: predictive and normative data . J Clin Exp Neuropsychol . 1990;12:539-548.Crossref 8. Katzman R, Aronson M, Fuld P, et al. Development of dementing illness in an 80 year old volunteer cohort . Ann Neurol . 1989;25:317-324.Crossref 9. Morris JC, Heyman A, Mohs RC, et al. The Consortium to Establish a Registry for Alzheimer's disease (CERAD) . Neurology . 1989;39:1159-1165.Crossref 10. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease . Neurology . 1984;34:939-944.Crossref 11. Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician . J Psychiatric Res . 1975;12:189-198.Crossref 12. Kaplan E, Goodglass H, Weintraub S. Boston Naming Test . Philadelphia, Pa: Lea & Febiger; 1983. 13. Winer BJ. Statistical Principles in Experimental Design . 2nd ed. New York, NY: McGraw-Hill International Book Co; 1971. 14. Crapper McLachlan DR, Dalton AJ, Galin H, Schlotterer G, Daicar E. Alzheimer's disease: clinical course and cognitive disturbances . Acta Neurol Scand . 1984;99:83-89.Crossref 15. Grady CL, Haxby JV, Horwitz B, et al. Longitudinal study of the early neuropsychological and cerebral metabolic changes in dementia of the Alzheimer type . J Clin Exp Neuropsychol . 1988;10:579-596.Crossref 16. Haxby JV, Grady CL, Koss E, et al. Longitudinal study of cerebral metabolic asymmetries and associated neuropsychological patterns in early dementia of the Alzheimer type . Arch Neurol . 1990;47:753-760.Crossref 17. Rosen WG, Mohs RC. Evolution of cognitive decline in dementia . In: Corkin S, Davis KL, Growden JH, Usdin E, Wurtman RJ, eds. Aging: Alzheimer's Disease: A Report of Progress . New York, NY: Raven Press; 1982;19:183-188. 18. Rebok G, Brandt J, Folstein M. Longitudinal cognitive decline in patients with Alzheimer's disease . J Geriatr Psychiatry Neurol . 1990;3:91-97.Crossref 19. Hyman BT, Van Hoesen GW, Damasio AR, Barnes CL. Alzheimer's disease: cell-specific pathology isolates the hippocampal formation . Science . 1984;225:1168-1170.Crossref 20. Pearson RCA, Esiri MM, Hjorns RW, Wilcock GK, Powell TPS. Anatomical correlates of the distribution of pathological changes in the neocortex in Alzheimer's disease . Proc Natl Acad Sci U S A . 1985;82:4531-4534.Crossref 21. Arnold SE, Hyman BT, Flory J, Damasio AR, Van Hoesen GW. The topographical and neuroanatomical distribution of neurofibrillary tangles and neuritic plaques in the cerebral cortex of patients with Alzheimer's disease . Cereb Cortex . 1991;1:103-116.Crossref 22. Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia . Br J Psychiatry . 1982:140:566-572.Crossref 23. Welsh KA, Butters N, Hughes J, Mohs RC, Heyman A. Memory impairments of Alzheimer's disease characterized by the CERAD psychometric battery. Proceedings from the 15th Annual Meeting for the Society for Neurosciences; October 29-November 3, 1989; Phoenix, Ariz.

Journal

Archives of NeurologyAmerican Medical Association

Published: May 1, 1992

References