Associations of Status and Change Measures of Neuropsychological Function With Pathologic Changes in Elderly, Originally Nondemented Subjects

Abstract

Among elderly, initially nondemented subjects who were followed up until death, subjects with pathologically confirmed Alzheimer's disease or vascular dementia had lower neuropsychological scores at initial evaluation than normal subjects or subjects with pathologic aging. Subjects with Alzheimer's disease had a more rapid rate of decline than normal subjects or subjects with pathologic aging.

Longitudinal Modeling of Age-Related Memory Decline and theAPOEε4 Effect

“…More recently, we have shown that PIB-PET studies of asymptomatic APOE e4/4 HMZ at this age reveal early amyloid deposition in AD salient regions (32). Finally, AD-like neuropathology in thirty and forty year olds (33,34) and in nondemented elderly (35-37) is more prevalent and severe in APOE e4 carriers than NC.…”

Longitudinal Modeling of Age-Related Memory Decline and theAPOEε4 Effect

“…More recently, we have shown that PIB-PET studies of asymptomatic APOE e4/4 HMZ at this age reveal early amyloid deposition in AD salient regions (32). Finally, AD-like neuropathology in thirty and forty year olds (33,34) and in nondemented elderly (35-37) is more prevalent and severe in APOE e4 carriers than NC.…”

Usefulness of repeated presentation of Mini-Mental State Examination as a diagnostic procedure - a population-based study

“…Status scores from a single test session have often been used to predict a diagnosis of dementia. However, changes in these scores have even better predicted pathological brain changes in ageing and dementia than status scores alone (32). This is in keeping with our results suggesting that a repeat MMSE within a short interval improved the usefulness of MMSE for detection of early dementia.…”

“…Lower sensitivities have also been found when MMSE has been applied to individuals with higher educational levels (8, 14). Consequently, several authors have suggested cut‐off point of MMSE stratified for education, screening and dementia (32, 35–42). As education is regarded by some researchers to be potentially involved in the aetiology of dementia, Fratiglioni and co‐workers (43) concluded that differential MMSE cut‐off points according to educational level are not universally applicable.…”

“…Correction for age and education in the MMSE score results in missing mildest demented patients and thus it heavily reduces the sensitivity of the test, while a moderate improvement in the specificity is observed (37). Crystal and co‐authors (32) found that the status scores were associated with level of education, but the change scores were not. We found that the improvement in the repeat MMSE scores were greater in better educated non‐demented subjects but not in demented subjects.…”

TOP CITED PAPERS IN INTERNATIONAL PSYCHOGERIATRICS: 6c. TRACKING COGNITIVE DECLINE IN ALZHEIMER'S DISEASE USING THE MINI-MENTAL STATE EXAMINATION: A META-ANALYSIS (“MINI” IS NOT NECESSARILY TRIVIAL!)

“…As demonstrated in several more recent studies, gender (Mendiondo et al ., 2000; Backman et al ., 2003; Suh et al ., 2004) and education (Backman et al ., 2003; Suh et al ., 2004) are not independently associated with the rate of cognitive decline in AD patients, though cross-sectionally both factors may affect a person's MMSE performance and deserve specific consideration when establishing the population norm. One possible explanation for this conflicting finding is that such fixed risk factors mainly affect the intercept or start point rather than the slope of the cognitive deterioration in AD (Crystal et al ., 1996; Backman et al ., 2003). Because we adjusted for baseline MMSE score in the random effect regression model, the residual effect of these fixed risk factors on cognitive decline would be removed.…”

Longitudinal Modeling of Age-Related Memory Decline and theAPOEε4 Effect

“…More recently, we have shown that PIB-PET studies of asymptomatic APOE e4/4 HMZ at this age reveal early amyloid deposition in AD salient regions (32). Finally, AD-like neuropathology in thirty and forty year olds (33,34) and in nondemented elderly (35-37) is more prevalent and severe in APOE e4 carriers than NC.…”

Usefulness of repeated presentation of Mini-Mental State Examination as a diagnostic procedure - a population-based study

“…Status scores from a single test session have often been used to predict a diagnosis of dementia. However, changes in these scores have even better predicted pathological brain changes in ageing and dementia than status scores alone (32). This is in keeping with our results suggesting that a repeat MMSE within a short interval improved the usefulness of MMSE for detection of early dementia.…”

“…Lower sensitivities have also been found when MMSE has been applied to individuals with higher educational levels (8, 14). Consequently, several authors have suggested cut‐off point of MMSE stratified for education, screening and dementia (32, 35–42). As education is regarded by some researchers to be potentially involved in the aetiology of dementia, Fratiglioni and co‐workers (43) concluded that differential MMSE cut‐off points according to educational level are not universally applicable.…”

“…Correction for age and education in the MMSE score results in missing mildest demented patients and thus it heavily reduces the sensitivity of the test, while a moderate improvement in the specificity is observed (37). Crystal and co‐authors (32) found that the status scores were associated with level of education, but the change scores were not. We found that the improvement in the repeat MMSE scores were greater in better educated non‐demented subjects but not in demented subjects.…”

TOP CITED PAPERS IN INTERNATIONAL PSYCHOGERIATRICS: 6c. TRACKING COGNITIVE DECLINE IN ALZHEIMER'S DISEASE USING THE MINI-MENTAL STATE EXAMINATION: A META-ANALYSIS (“MINI” IS NOT NECESSARILY TRIVIAL!)

“…As demonstrated in several more recent studies, gender (Mendiondo et al ., 2000; Backman et al ., 2003; Suh et al ., 2004) and education (Backman et al ., 2003; Suh et al ., 2004) are not independently associated with the rate of cognitive decline in AD patients, though cross-sectionally both factors may affect a person's MMSE performance and deserve specific consideration when establishing the population norm. One possible explanation for this conflicting finding is that such fixed risk factors mainly affect the intercept or start point rather than the slope of the cognitive deterioration in AD (Crystal et al ., 1996; Backman et al ., 2003). Because we adjusted for baseline MMSE score in the random effect regression model, the residual effect of these fixed risk factors on cognitive decline would be removed.…”

Longitudinal Modeling of Age-Related Memory Decline and theAPOEε4 Effect

“…More recently, we have shown that PIB-PET studies of asymptomatic APOE e4/4 HMZ at this age reveal early amyloid deposition in AD salient regions (32). Finally, AD-like neuropathology in thirty and forty year olds (33,34) and in nondemented elderly (35-37) is more prevalent and severe in APOE e4 carriers than NC.…”

Usefulness of repeated presentation of Mini-Mental State Examination as a diagnostic procedure - a population-based study

“…Status scores from a single test session have often been used to predict a diagnosis of dementia. However, changes in these scores have even better predicted pathological brain changes in ageing and dementia than status scores alone (32). This is in keeping with our results suggesting that a repeat MMSE within a short interval improved the usefulness of MMSE for detection of early dementia.…”

“…Lower sensitivities have also been found when MMSE has been applied to individuals with higher educational levels (8, 14). Consequently, several authors have suggested cut‐off point of MMSE stratified for education, screening and dementia (32, 35–42). As education is regarded by some researchers to be potentially involved in the aetiology of dementia, Fratiglioni and co‐workers (43) concluded that differential MMSE cut‐off points according to educational level are not universally applicable.…”

“…Correction for age and education in the MMSE score results in missing mildest demented patients and thus it heavily reduces the sensitivity of the test, while a moderate improvement in the specificity is observed (37). Crystal and co‐authors (32) found that the status scores were associated with level of education, but the change scores were not. We found that the improvement in the repeat MMSE scores were greater in better educated non‐demented subjects but not in demented subjects.…”

TOP CITED PAPERS IN INTERNATIONAL PSYCHOGERIATRICS: 6c. TRACKING COGNITIVE DECLINE IN ALZHEIMER'S DISEASE USING THE MINI-MENTAL STATE EXAMINATION: A META-ANALYSIS (“MINI” IS NOT NECESSARILY TRIVIAL!)

“…As demonstrated in several more recent studies, gender (Mendiondo et al ., 2000; Backman et al ., 2003; Suh et al ., 2004) and education (Backman et al ., 2003; Suh et al ., 2004) are not independently associated with the rate of cognitive decline in AD patients, though cross-sectionally both factors may affect a person's MMSE performance and deserve specific consideration when establishing the population norm. One possible explanation for this conflicting finding is that such fixed risk factors mainly affect the intercept or start point rather than the slope of the cognitive deterioration in AD (Crystal et al ., 1996; Backman et al ., 2003). Because we adjusted for baseline MMSE score in the random effect regression model, the residual effect of these fixed risk factors on cognitive decline would be removed.…”