Tracking Cognitive Decline in Amnestic Mild Cognitive Impairment and Early-Stage Alzheimer Dementia: Mini-Mental State Examination versus Neuropsychological Battery

Abstract

Background/Aims: Although the Mini-Mental State Examination (MMSE), Clinical Dementia Rating-Sum of Boxes (CDR-SOB), and neuropsychological batteries are widely used for evaluating cognitive function, it remains elusive which instrument best reflects the longitudinal disease progression in amnestic mild cognitive impairment (aMCI) and probable Alzheimer disease (AD). We investigated whether changes in these three instruments over time correlate with loss of cortical gray matter volume (cGMV). Methods: We retrospectively investigated 204 patients (aMCI, n = 114; AD, n = 90) who had undergone MMSE, CDR-SOB, the dementia version of the Seoul Neuropsychological Screening Battery (SNSB-D), and 3-dimensional T1-weighted magnetic resonance images at least twice. We investigated the partial correlation between annual decline in test scores and percent change of cGMV. Results: In aMCI patients, changes in the SNSB-D total score (r = 0.340, p < 0.001) and CDR-SOB (r = 0.222, p = 0.020), but not MMSE, showed a correlation with cGMV loss, with the SNSB-D total score showing the strongest correlation. In AD patients, decline in all three test scores correlated significantly with cGMV loss, with MMSE exhibiting the strongest correlation (r = 0.464, p < 0.001). Conclusion: In aMCI patients, neuropsychological battery, though time-consuming, was the most adequate tool in tracking disease progression. In AD patients, however, MMSE may be the most effective longitudinal monitoring tool when considering cost-effectiveness.

Identification of a Cascade of Changes in Activities of Daily Living Preceding Short-Term Clinical Deterioration in Mild Alzheimer’s Disease Dementia via Lead-Lag Analysis

“…In the present study, the MMSE score was observed to change early in short-term, marked disease progression. Considering its cost-effectiveness and sensitivity, this global cognitive functioning measure serves as one of the most effective instruments for monitoring patients with AD over time [1,9,10]. Our results also support previous reports that changes in the WMS-R delayed logical memory [31], visuospatial construction [39] and semantic fluency [40] scores are suggestive of disease progression in mild AD.…”

“…Timely implementation of such measures might compensate, maintain, or enhance neuropsychological abilities, improve the quality of life of both patients and caregivers by reducing distress, depression, and psychological morbidity, facilitate planning of subsequent care, personal, financial and health-related decision-making, and delay nursing home admission of patients [4][5][6]. Although most studies monitoring longitudinal changes focused on the Mini-Mental State Examination (MMSE) [3,[7][8][9][10][11], the Clinical Dementia Rating-Sum of Boxes (CDR-SOB) [3,9,12], and the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog) [3,8,9,11,13,14], the most optimal instrument reflecting longitudinal disease progression in mild dementia of Alzheimer-type remains elusive [9]. In this framework, the hierarchy of functional loss measured by changes in ADL has been generally relegated to the background.…”

The effectiveness and safety of Kami Guibi-tang for mild cognitive impairment: study protocol of a pilot, randomized, placebo-controlled, double-blind trial

“…Instruments, such as the K-MMSE and the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog), have been mainly used in previous studies for measuring cognitive decline. However, they lack sensitivity in detecting mild degrees of cognitive dysfunction, which demonstrate ceiling effects in MCI [18]. We will use the full neuropsychological battery, the SNSB, which contains comprehensive and diverse tests with varying difficulties, to sensitively and accurately monitor changes in cognitive function [11].…”

<p>Short-term adverse effects of the apolipoprotein E ϵ4 allele over language function and executive function in healthy older adults</p>

“…So NTB is able to quantitatively evaluate 5 cognitive domains, including attention, working memory, language, visuospatial function, visual memory and executive function.31 And it has been considered as the most valid instrument for monitoring cognitive decline in aMCI and dementia associated with AD.32…”