Neuropsychological strategies for detecting early dementia

Abstract

As new and more effective treatments for Alzheimer's disease (AD) emerge, the development of efficient screening strategies in educationally and racially diverse primary care settings has increased in importance. A set of candidate screening tests and an independent diagnostic assessment were administered to a sample of 318 patients treated at a geriatric primary care center. Fifty-six subjects met criteria for dementia. Exploratory analysis led to the development of three two-stage screening strategies that differed in the composition of the first stage or Rapid Dementia Screen, which is applied to all patients over the age of 65. The second stage, applied to those patients who screen positively for dementia, is accomplished with the Free and Cued Selective Reminding Test to detect memory impairment. Using clinical diagnosis as a gold standard, the strategies had high sensitivity and specificity for identifying dementia and performed better for identifying AD than non-AD dementias. Sensitivity and specificity did not differ by race or education. The strategies provide an efficient approach to screening for early dementia.

Memory impairment, executive dysfunction, and intellectual decline in preclinical Alzheimer's disease

“…FCSR is also used in the Alzheimer's Disease Cooperative Study Instrumentation Protocol to identify persons with prevalent dementia and trigger clinical evaluations for incident dementia (Ferris et al, 2006). Performance has been highly associated with early dementia and preclinical dementia in several cohorts (Grober et al, 1988(Grober et al, , 2000(Grober et al, , 2008Grober & Kawas, 1997;Lindenberger & Reischies, 1999;Petersen et al, 1994Petersen et al, , 1995Tounsi et al, 1999;Tuokko & Crockett, 1989) and is not associated with education (Ivnik et al, 1997) or race (Grober et al, 1998(Grober et al, , 2008. The test takes 10 to 15 min to administer, depending upon the mental status of the patient.…”

“…There is 20 seconds of interference between trials. The FCSR procedure is described in greater detail elsewhere (Grober & Buschke, 1987;Grober et al, 2008). The measure of learning used here was the sum of free recall over the 3 test trials.…”

“…FCSR differs from Selective Reminding, used in the BAS, in that category cues are used both in the study and test phases, controlling attention and cognitive processing. This test has excellent discriminative validity for dementia at cross-section and excellent predictive validity for incident dementia (Grober et al, 1988(Grober et al, , 2000(Grober et al, , 2008. We used learning as our measure of memory instead of delayed recall or retention because of prior data suggesting that learning defined as the sum of free recall across three test trials was sensitive to preclinical disease, whereas retention tested 30 min later was not (Grober & Kawas, 1997).…”

Prevalence of Mild Cognitive Impairment and Its Subtypes in the Mexican Population

“…The MIS score is calculated as follows: [2 × (free recall)] + (obtained) cued recall. Furthermore, adding cued recall to free recall increases the range of scores (0-8) and improves the ability of the test to detect amnestic impairments of the AD type [17].…”

Relevance between Alzheimer’s Disease Patients and Normal Subjects Using Go/No-Go Tasks and Alzheimer Assessment Scores

“…Early detection will be even more important if new early treatments with long-term effectiveness are confirmed. However, early detection is not always easy because of the lack of good methods to identify the early stages of AD, and research identifying changeable risk factors of AD is scarce [7]. Therefore, many people with AD often stay undiagnosed until symptoms are moderate or severe and, in turn, lose the opportunity to receive early effective treatment.…”