Global measures: utility in defining and measuring treatment response in dementia

2007 ◽  
Vol 19 (3) ◽  
pp. 421-456 ◽  
Author(s):  
Barry Reisberg
Keyword(s):  
Cognitive Impairment ◽  
Global Change ◽  
Therapeutic Efficacy ◽  
Clinical Dementia Rating ◽  
Global Deterioration Scale ◽  
Treatment Trials ◽  
Therapeutic Trials ◽  
Prevention Trials ◽  
Fast Procedure ◽  
State Examination

Global measures used in treatment trials in dementia encompass two distinct categories: (1) clinician's interview-based global severity scales, and (2) clinician's interview-based global change scales.The global severity scales that have been used include: the Clinical Dementia Rating (CDR) and the related CDR-sum of boxes (CDR-SB), the Global Deterioration Scale (GDS), and the Functional Assessment Staging (FAST) procedure. The global severity scales are clearly useful in subject categorization in treatment trials, in part because they are relatively free of many of the sociocultural biases inherent in mental status and psychometric descriptors. Global severity scales can also be used to demonstrate therapeutic efficacy in terms of the general progression of the dementia process. These measures have also proven to be useful in sensitively assessing pharmacotherapeutic effects in Alzheimer's disease (AD) treatment trials. For example, in pivotal trials: (1) in Mild to Moderate AD, the GDS has shown significant change in response to medication, whereas the results on the Mini-mental State Examination (MMSE) were not significant, and (2) in Moderate to Severe AD, the FAST has shown significant pharmacotherapeutic efficacy, whereas the results using the MMSE were not significant.The global change scales employed in dementia trials differ widely in assessment methodology. Clinical Global Impressions of Change (CGIC) scales do not have defined methodologies, whereas Clinician's Interview-Based Impression of Change Plus Caregiver Input (CIBIC-Plus) scales are much more elaborate. The CIBIC-Plus procedures require an independent clinician assessment and can provide independent, comprehensive evidence of therapeutic efficacy. The CIBIC-Plus procedure may also be useful in sensitively assessing efficacy in future prevention trials, for example in subjects with Subjective Cognitive Impairment. For Mild Cognitive Impairment (MCI), global severity scales already appear to be one modality for the sensitive assessment of change. The CIBIC-Plus procedures might also productively be applied in future MCI therapeutic trials.

scholarly journals Kanji and Kana agraphia in mild cognitive impairment and dementia: A trans-cultural comparison of elderly Japanese subjects living in Japan and Brazil

2010 ◽  
Vol 4 (4) ◽  
pp. 300-305 ◽  
Author(s):  
Kyoko Akanuma ◽  
Kenichi Meguro ◽  
Mitsue Meguro ◽  
Rosa Yuka Sato Chubaci ◽  
Paulo Caramelli ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Abilities ◽  
Prevalence Study ◽  
Clinical Dementia Rating ◽  
Spontaneous Writing ◽  
Elderly Japanese ◽  
Questionable Dementia ◽  
State Examination ◽  
Japanese Subjects

Abstract This study verifies the environmental effects on agraphia in mild cognitive impairment and dementia. We compared elderly Japanese subjects living in Japan and Brazil. Methods: We retrospectively analyzed the database of the Prevalence Study 1998 in Tajiri (n=497, Miyagi, Japan) and the Prevalence Study 1997 of elderly Japanese immigrants living in Brazil (n=166, migrated from Japan and living in the São Paulo Metropolitan Area). In three Clinical Dementia Rating (CDR) groups, i.e., CDR 0 (healthy), CDR 0.5 (questionable dementia), and CDR 1+ (dementia) , the Mini-Mental State Examination (MMSE) item of spontaneous writing and the Cognitive Abilities Screening Instrument (CASI) domain of dictation were analyzed with regard to the number of Kanji and Kana characters. Formal errors in characters and pragmatic errors were also analyzed. Results: The immigrants in Brazil wrote similar numbers of Kanji or Kana characters compared to the residents of Japan. In spontaneous writing, the formal Kanji errors were greater in the CDR 1+ group of immigrants. In writing from dictation, all the immigrant CDR groups made more formal errors in Kana than the Japan residents. No significant differences in pragmatic errors were detected between the two groups. Conclusions: Subjects living in Japan use Kanji frequently, and thus the form of written characters was simplified, which might be assessed as mild formal errors. In immigrants, the deterioration in Kanji and Kana writing was partly due to decreased daily usage of the characters. Lower levels of education of immigrants might also be related to the number of Kanji errors.

Mild cognitive impairment (MCI): a historical perspective

2008 ◽  
Vol 20 (1) ◽  
pp. 18-31 ◽  
Author(s):  
Barry Reisberg ◽  
Steven H. Ferris ◽  
Alan Kluger ◽  
Emile Franssen ◽  
Jerzy Wegiel ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Clinical Dementia Rating ◽  
Global Deterioration Scale ◽  
Mild Dementia ◽  
Functional Deficits ◽  
Early Dementia ◽  
Questionable Dementia ◽  
Definition Of ◽  
Executive Level

ABSTRACTDescriptions of dementia can be traced to antiquity. Prichard (1837) described four dementia stages and Kral (1962) described a “benign senescent forgetfulness” condition. The American Psychiatric Association's DSM-III (1980) identified an early dementia stage.In 1982, the Clinical Dementia Rating (CDR) and the Global Deterioration Scale (GDS) were published, which identified dementia antecedents. The CDR 0.5 “questionable dementia” stage encompasses both mild dementia and earlier antecedents. GDS stage 3 described a predementia condition termed “mild cognitive decline” or, alternatively, beginning in 1988, “mild cognitive impairment” (MCI). This GDS stage 3 MCI condition is differentiated from both a preceding GDS stage 2, “subjective cognitive impairment” (SCI) stage and a subsequent GDS 4 stage of mild dementia.GDS stage 3 MCI has been well characterized. For example, specific clinical concomitants, mental status and psychological assessment score ranges, behavioral and emotional changes, neuroimaging concomitants, neurological reflex changes, electrophysiological changes, motor and coordination changes, and changes in activities, accompanying GDS stage 3 MCI have been described.Petersen and associates proposed a definition of MCI in 2001 which has been widely used (hereafter referred to as “Petersen's MCI”). Important differences between GDS stage 3 MCI and Petersen's MCI are that, because of denial, GDS stage 3 MCI does not require memory complaints. Also, GDS stage 3 MCI recognizes the occurrence of executive level functional deficits, which Petersen's MCI did not. Nevertheless, longitudinal and other studies indicate essential compatibility between GDS stage 3 MCI and Petersen's MCI duration and outcomes.

scholarly journals Apathy in Alzheimer's disease: Contribution to a clinical view on progression of dementia

2010 ◽  
Vol 4 (3) ◽  
pp. 188-193 ◽  
Author(s):  
Florindo Stella ◽  
Larissa Pires de Andrade ◽  
Thays Martins Vital ◽  
Flávia Gomes de Melo Coelho ◽  
Carla Manuela Crispim Nascimento ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Mini Mental State Examination ◽  
Cognitive Status ◽  
Clinical Dementia Rating ◽  
Global Deterioration Scale ◽  
Severe Dementia ◽  
Coefficient Corrélation ◽  
The Relationship ◽  
State Examination

Abstract In addition to cognitive impairment, apathy is increasingly recognized as an important neuropsychiatric syndrome in Alzheimer's disease (AD). Aims: To identify the relationship between dementia severity and apathy levels, and to discuss the association of this condition with other psychopathological manifestations in AD patients. Methods: This study involved 15 AD patients (mean age: 77 years; schooling: 4.9 years), with mild, moderate and severe dementia, living in Rio Claro SP, Brazil. Procedures included evaluation of cognitive status by the Mini-Mental State Examination, Clinical Dementia Rating, and Global Deterioration Scale. Apathy syndrome was assessed by the Apathy Evaluation Scale and Neuropsychiatric Inventory (NPI-apathy domain). Other psychopathological manifestations such as depression were also considered. Results: Patients with more severe dementia presented higher levels of apathy, reinforcing the hypothesis that apathy severity aggravates as the disease progresses. Using the Spearman coefficient correlation an association was identified between the MMSE and Apathy Evaluation Scale (r=0.63; p=0.01), and also between the MMSE and NPI-apathy domain (r=0.81; p=0.01). Associations were also found between the Global Deterioration Scale and Apathy Evaluation Scale (r=0.58; p=0.02), and between the Global Deterioration Scale and NPI-apathy domain (r=0.81; p=0.01). Conclusions: Apathy is a distinct syndrome among patients with AD and increases with global deterioration.

scholarly journals Comparing measures of decline to dementia in amnestic MCI subjects in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set

2012 ◽  
Vol 24 (10) ◽  
pp. 1553-1560 ◽  
Author(s):  
Sarah E. Monsell ◽  
Danping Liu ◽  
Sandra Weintraub ◽  
Walter A. Kukull
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Neuropsychological Tests ◽  
Mini Mental State Examination ◽  
Clinical Dementia Rating ◽  
Data Set ◽  
Global Test ◽  
Allele Status ◽  
Rate Of Decline ◽  
State Examination

ABSTRACTBackground: Many studies have investigated factors associated with the rate of decline and evolution from mild cognitive impairment (MCI) to Alzheimer's disease (AD) dementia in elderly patients. In this analysis, we compared the rates of decline to dementia estimated from three common global measures of cognition: Mini-Mental State Examination (MMSE) score, Clinical Dementia Rating sum of boxes (CDR-SB) score, and a neuropsychological tests composite score (CS).Methods: A total of 2,899 subjects in the National Alzheimer's Coordinating Center Uniform Data Set aged 65+ years diagnosed with amnestic mild cognitive impairment (aMCI) were included in this analysis. Population-averaged decline to dementia rates was estimated and compared for standardized MMSE, CDR-SB, and CS using Generalized Estimating Equations (GEE). Associations between rate of decline and several potential correlates of decline were also calculated and compared across measures.Results: The CDR-SB had the steepest estimated slope, with a decline of 0.49 standard deviations (SD) per year, followed by the MMSE with 0.22 SD per year, and finally the CS with 0.07 SD per year. The rate of decline of the three measures differed significantly in a global test for differences (p < 0.0001). Age at visit, body mass index (BMI) at visit, Apolipoprotein E (APOE) ɛ4 allele status, and race (black vs. white) had significantly different relationships with rate of decline in a global test for difference among the three measures.Conclusions: These results suggest that both the rate of decline and the effects of AD risk factors on decline to dementia can vary depending on the evaluative measure used.

Diagnosis of Preclinical Alzheimer's Disease in a Clinical Setting

2001 ◽  
Vol 13 (4) ◽  
pp. 411-423 ◽  
Author(s):  
Pieter Jelle Visser ◽  
Frans R. J. Verhey ◽  
Rudolf W. H. M. Ponds ◽  
Jellemer Jolles
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Clinical Setting ◽  
Global Deterioration Scale ◽  
Delayed Recall ◽  
Clinical Criteria ◽  
Preclinical Ad ◽  
State Examination

Introduction. The aim of the study was to investigate whether the preclinical stage of Alzheimer's disease (AD) can be diagnosed in a clinical setting. To this end we investigated whether subjects with preclinical AD could be differentiated from subjects with nonprogressive mild cognitive impairment and from subjects with very mild AD-type dementia. Methods. Twenty-three subjects with preclinical AD, 44 subjects with nonprogressive mild cognitive impairment, and 25 subjects with very mild AD-type dementia were selected from a memory clinic population. Variables that were used to differentiate the groups were demographic variables, the Mini-Mental State Examination score, performance on cognitive tests, measures of functional impairment, and measures of noncognitive symptomatology. Results. Age and the scores for the delayed recall task could best discriminate between subjects with preclinical AD and subjects with nonprogressive mild cognitive impairment. The overall accuracy was 87% The score on the Global Deterioration Scale and a measure of intelligence could best discriminate between subjects with preclinical AD and subjects with very mild AD-type dementia. The overall accuracy was 85% Conclusions. Subjects with preclinical AD can be distinguished from subjects with nonprogressive mild cognitive impairment and from subjects with very mild AD-type dementia. This means that preclinical AD is a diagnostic entity for which clinical criteria should be developed.

scholarly journals Rapid Screening for Cognitive Impairment in Parkinson’s Disease: A Pilot Study

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
YanHong Dong ◽  
Way Inn Koay ◽  
Leonard Leong Litt Yeo ◽  
Christopher Li-Hsian Chen ◽  
Jing Xu ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Discriminant Validity ◽  
Operating Characteristic ◽  
Mini Mental State Examination ◽  
Characteristic Curve ◽  
Rapid Screening ◽  
Cognitive Screening ◽  
Clinical Dementia Rating ◽  
Cognitive Screen ◽  
State Examination

Aim. This study sought to establish the discriminant validity of a rapid cognitive screen, that is, the National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) 5-minute protocol, and compare its discriminant validity to the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE) in detecting cognitive impairment (CI) in PD patients.Methods. One hundred and one PD patients were recruited from a movement disorders clinic in Singapore and they received the NINDS-CSN 5-minute protocol, MoCA, and MMSE. No cognitive impairment (NCI) was defined as Clinical Dementia Rating (CDR) = 0 and CI was defined as CDR ≥ 0.5.Results. Area under the receiver operating characteristic curve of NINDS-CSN 5-minute protocol was statistically equivalent to MoCA and larger than MMSE (0.86 versus 0.90,P=0.07; 0.86 versus 0.76,P=0.03). The sensitivity of NINDS-CSN 5-minute protocol (<9) was statistically equivalent to MoCA (<22) (0.77 versus 0.85,P=0.13) and superior to MMSE (<24) (0.77 versus 0.52,P<0.01) in detecting CI, while the specificity of NINDS-CSN 5-minute protocol (<9) was statistically equivalent to MoCA (<22) and MMSE (<24) (0.78 versus 0.88,P=0.34).Conclusion. The NINDS-CSN 5-minute protocol is time expeditious while remaining statistically equivalent to MoCA and superior to MMSE and therefore is suitable for rapid cognitive screening of CI in PD patients.

scholarly journals 403 - Verbal fluency and spontaneous conversation in institutionalized older adults with and without cognitive impairment

2020 ◽  
Vol 32 (S1) ◽  
pp. 119-119
Author(s):  
Cristina G. Dumitrache ◽  
Laura Rubio ◽  
Nuria Calet ◽  
José Andrés González ◽  
Ian C. Simpson
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Language Impairment ◽  
Verbal Fluency ◽  
Mini Mental State Examination ◽  
Short Form ◽  
Boston Naming Test ◽  
Global Deterioration Scale ◽  
State Examination ◽  
Naming Test

Background:Several neurodegenerative conditions negatively impact linguistics skills. Despite this, many studies carried out with these kinds of patients either only include participants with initial stages of cognitive impairment either do not contemplate linguistic skills, or they do assess language in clinical or experimental settings. Due to it this study aims at investigating verbal fluency and spontaneous conversation abilities in a group of institutionalized Spanish older adults with and without cognitive impairment.Method:The sample comprised 50 older adults who were residing in care homes from the province of Granada and with ages between 52 and 92 years old (M= 83.40, SD= 7.18). The Mini Mental State Examination (MMSE), the Global Deterioration Scale, and the Short Form of the Boston Naming Test for Individuals with Aphasia were used to collect data. In order to analyze the differences in verbal fluency and in spontaneous conversation between participants ANOVA analysis were performed.Results:Results showed that people without cognitive impairment or with initial stages of Parkinson’s’ disease showed a higher complexity in their spontaneous conversation and obtained higher scores in verbal fluency when compared with patients with Alzheimer’s disease, and with people with cognitive impairment but without a clinical diagnose. No significant differences were found between participants in word or sentence repetitions tasks.Conclusions:Language impairment in people with cognitive impairment has dramatic consequences, affecting people’s communication and social interaction, their identity and autonomy thus language skills should be assessed in institutionalized older adults with cognitive impairment and interventions should be designed to maintain their linguistic abilities.

Buying time: management of mild cognitive impairment and early dementia

2006 ◽  
Vol 18 (s1) ◽  
pp. S17-S23 ◽  
Author(s):  
Stephen Salloway
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Time Management ◽  
Diagnostic Category ◽  
Early Initiation ◽  
Disease Assessment ◽  
New York University ◽  
Clinical Dementia Rating ◽  
Global Deterioration Scale ◽  
Amnestic Mci

Early initiation of Alzheimer's disease (AD) treatment is advantageous because it can potentially keep patients in milder stages of the disease longer than delayed treatment. Early initiation of cholinesterase inhibitor therapy is an effective intervention for mild AD. Therefore, it is critical to identify and monitor patients who are at risk for AD and to initiate treatment once AD is diagnosed. A new diagnostic category, mild cognitive impairment (MCI), has been evolving to identify patients who demonstrate objective memory impairment but have essentially intact function or only limited functional impairment and do not meet diagnostic criteria for dementia. The amnestic subtype of this condition is associated with a high risk of AD – 16% of amnestic MCI patients convert to AD each year compared with 1% to 3% of normal elders. A recent three-year study found that patients with amnestic MCI who were treated with donepezil had a significantly reduced likelihood of progression to dementia in the first 12 months of treatment. The effect of donepezil in delaying onset of dementia was supported by significant differences favoring donepezil in the Mini-mental State Examination, the Clinical Dementia Rating-Sum of the Boxes, the Global Deterioration Scale, and the modified Alzheimer Disease Assessment Scale-cognitive subscale (ADAS-Cog) over the first 18 months of treatment. A previous study evaluated the effects of donepezil on memory and cognition in patients with MCI. Although donepezil had no significant effect on memory as measured by the New York University Paragraph Recall Test, it significantly improved scores on the modified ADAS-Cog. Donepezil therefore shows promise in this patient population and warrants further investigation using extended study durations and refined outcome measures.

scholarly journals Mental and Physical Self-Awareness of Alzheimer Patients: Decreased Awareness of Amnesia and Increased Fear of Falling Compared to Views of Families: The Tajiri and Wakuya Projects

2021 ◽  
pp. 1-6
Author(s):  
Keiichi Kumai ◽  
Nobuko Kawabata ◽  
Kenichi Meguro ◽  
Junko Takada ◽  
Kei Nakamura ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Memory Impairment ◽  
Fear Of Falling ◽  
Family Members ◽  
Emotional Awareness ◽  
Self Awareness ◽  
Clinical Dementia Rating ◽  
Psychological Understanding ◽  
Community Residents ◽  
State Examination

<b><i>Introduction:</i></b> The purpose of this study is to examine self-awareness of patients with Alzheimer disease (AD) regarding forgetfulness and physical status, with the goal of further psychological understanding of these patients. <b><i>Methods:</i></b> The 255 subjects included 33 healthy volunteers and 48 patients with mild cognitive impairment who were elderly community residents selected from the 2017 Wakuya Project and 174 consecutive outpatients with AD at the Tajiri Clinic. Test data were selected from a pooled database. Results from the Mini-Mental State Examination, Clinical Dementia Rating (CDR), Short Falls Efficacy Scale International (FES), and Everyday Memory Checklist (EMC) were used in the study. FES and EMC data were also obtained from family members for comparison. <b><i>Results:</i></b> EMC scores in the AD groups (mild to moderate and moderate to severe) were significantly higher (more complaining memory impairment) than those in the CDR 0 (healthy) group and significantly lower (less self-awareness for memory impairment) than the corresponding EMC scores of families of the subjects. In contrast, FES scores of the AD groups did not differ significantly from those of the CDR 0 group, and these scores were higher (more fear of falling) than those of family members. Additionally, family-FES scores of the AD groups were higher than those of the CDR 0 and 0.5 groups. <b><i>Conclusion:</i></b> The results showed an evidence of the heterogeneity of awareness, an emotional response (concern or fear, FES), and a cognitive appraisal of function (EMC). These may be explained whereby awareness of/fear of falling increases with AD due to a preserved emotional awareness, whereas awareness of cognitive impairment is impaired due to memory deficits.

scholarly journals A Case Report of a Patient with Mild Cognitive Impairment Treated with Gugijihwang-tang

2021 ◽  
Vol 42 (5) ◽  
pp. 1082-1093
Author(s):  
Mi-so Park ◽  
Seock-man Kang ◽  
Dai-won Yoo ◽  
In-cheol Chae ◽  
Gyeong-soon Kim ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Mini Mental State Examination ◽  
Treatment Method ◽  
Clinical Dementia Rating ◽  
Irreversible Brain Damage ◽  
State Examination ◽  
With Memory

Objective: Alzheimer's disease is characterized by progressive, irreversible brain damage and cognitive decline. Although the diagnosis and treatment of the prodromal symptoms of dementia are important, no treatment for mild cognitive impairment has been currently established. Herein, we report the case of an 80-year-old female patient with memory complaints treated with Gugijihwang-tang, a traditional Korean medicine herbal formula, as an add-on medication.Case Presentation: The patient was diagnosed with mild cognitive impairment based on clinical examinations using the Mini-Mental State Examination (MMSE), the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Activities of Daily Living (ADL) Scale, Global Deterioration (GDR) Scale, and Clinical Dementia Rating (CDR) Scale. She was treated with Gugijihwang-tang bis in die for 12 months while continuing her original medications, including 5-mg donepezil and 590-mg acetyl-l-carnitine. The MMSE score in the Korean Version of the CERAD Assessment Packet increased from 21 to 27 during the 12-month treatment period, and the CERAD 2 score increased from 33 to 62. The instrumental ADL scale score improved from 11 to 5. Other clinical examination results also showed improvement. The patient was satisfied and experienced no significant adverse events related to the Gugijihwang-tang treatment.Conclusion: This case suggests that Gugijihwang-tang could be considered as a treatment method for patients with mild cognitive impairment.

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