The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) was developed to assess cognitive and behavioural changes common in Amyotrophic Lateral Sclerosis and other diseases affecting motor functions. It focuses on domains typically affected by the frontotemporal syndrome (executive and language functions, fluency and behaviour), but assesses also memory and visuospatial functions. Objectives:A. To investigate the relationship between the ECAS and the Addenbrooke's Cognitive Examination (ACE-III).B. To investigate the effects of age, education, and IQ on the ECAS and create appropriate cutoff scores to determine abnormality. Methods:A: 57 healthy participants (aged 35-80) were assessed with the ECAS, the Wechsler Abbreviated Scale of Intelligence (WASI-II), and the ACE-III. B: 80 healthy participants (aged 51-80) were divided into four groups according to age and education and were tested with the ECAS and the WASI-II. Results:The ECAS and the ACE-III have a good convergent validity with a significant correlation.Regression analysis revealed that IQ, followed by age, were the strongest predictors of the total ECAS score. IQ predicted 24% of the ECAS and 46% of the ACE-III variance. Education was not a significant predictor over and above IQ for both the ECAS and the ACE-III. Abnormality cut-off scores adjusted for age and education are presented. Conclusions:The ECAS shows good convergent validity with the ACE-III, but is less influenced by intelligence and presents less ceiling effects. The inclusion of an executive function assessment and behavioural interview in the ECAS makes it particularly useful for the assessment of frontal lobe disorders.
The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) was developed to assess cognitive and behavioural changes in an anterior frontotemporal syndrome (executive functions, language, fluency and behaviour), common in Amyotrophic Lateral Sclerosis (ALS) and also assesses posterior cerebral dysfunction (memory and visuospatial abilities). Objectives To validate the ECAS in behavioural variant Frontotemporal Dementia (bvFTD) without ALS, as compared with Alzheimer’s disease (AD), against comprehensive neuropsychological assessment. Compare its sensitivity to that of the Addenbrooke’s Cognitive Examination (ACE‐III) and investigate behavioural changes in both types of dementia. Methods Retrospective study of 16 people with bvFTD (without ALS), 32 with AD, and 48 healthy controls completed the ECAS, ACE‐III and extensive neuropsychological assessment. Results The ECAS showed higher sensitivity (94%) and marginally lower specificity (96%) than the ACE‐III for both the bvFTD and AD groups. The anterior composite subscore was sensitive for bvFTD (94%), and slightly less so for AD (84%), while the posterior composite subscore was sensitive for AD (97%), and less so for bvFTD (75%). All people with bvFTD that were impaired on the ECAS total and anterior composite scores were also impaired on the anterior function’s tests of the neuropsychological assessment. A cut‐off of four or more behavioural domains affected differentiated well between the bvFTD and AD groups, while a qualitative analysis of the behavioural interview found different themes between groups. Conclusions The ECAS is a valid and sensitive assessment for bvFTD without ALS and for AD. The carer behavioural interview makes it particularly suitable to detect behavioural abnormalities related to frontal lobe disorders
Differences in potentially modifiable factors, such as education, occupation, and late-life social engagement have been associated with cognitive decline and dementia in late life. Whether there is a collective effect of these variables on cognitionecognitive reservedis unclear. This talk will break reserve into its individual components and compare the importance of each factor in models of cognitive change.Data came from 13 004 participants of the Medical Research Council Cognitive Function and Ageing Study who were aged 65 years and over. Cognition was assessed at multiple waves over 16 years using the Mini-Mental State Examination. Cognitive change was assessed using a multi-state model that incorporated deaths, right censoring, state misclassification, and cognitive recovery. Cognition was treated as a discrete variable with three possible states: no impairment, slight impairment, and moderate to severe impairment.Results suggest independent effects for education, occupation, and social engagement. A higher level of education and a more complex occupation were associated with a decreased risk of cognitive decline to a slightly impaired state but they accelerated the transition to death from a severely impaired cognitive state; increased social engagement protected from transitions to severe impairment.These findings support the possibility that contributions to cognitive reserve or cognitive lifestyle can be made across the life-course. Factors such as education have been associated with both late-life cognitive ability and cognitive decline. How education relates to decline in the final stages of life is not clear. We examined the association between education and the onset of terminal decline in a population-based longitudinal study of ageing. Participants came from the Cambridge City over 75 Cohort Study (n¼2166). They were at least 75 years old at baseline (1985e1987) and registered at any of six selected primary care practices in the Cambridge City (UK) area. Participants were followed-up over a 21-year period. Global cognitive function was assessed using the Mini Mental State Examination 2, 7, 9, 13, 17 and 21 years after baseline. O3-4.3 EDUCATION IS ASSOCIATED WITH THE DELAYED ONSET OF TERMINAL DECLINEPeople with higher education had a slightly delayed onset of terminal decline. Cognitive performance 2 years before death and its rate of change before the onset of terminal decline varied across individuals. However, in the terminal phase, we did not find evidence of variability across individuals in rate of decline nor its change. Thus, more educated individuals experience a slightly shorter period of accelerated cognitive decline before death.Two findings emerge from this cohort in which almost all individuals have died. The first is that education does appear to have a slight delay on the onset of terminal decline. The second is that once initiated, terminal decline is a relatively uniform process in those aged 75 and over. Such findings have implications in early life enhancement of cognitive func...
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