Clinical Dementia Rating Scale Detects White Matter Changes in Older Adults at Risk for Alzheimer’s Disease

Alzheimer’s disease (AD) is traditionally thought of as a neurodegenerative disease. Recent evidence shows that beta amyloid-independent vascular changes and beta amyloid-dependent neuronal dysfunction both equally influence the disease, leading to loss of structural and functional connectivity. White matter changes (WMCs) in the brain are commonly observed in dementia patients. The effect of vascular factors on WMCs and the relationship between WMCs and severity of AD in patients remain to be clarified. We recruited 501 clinically diagnosed probable AD patients with a series of comprehensive neuropsychological tests and brain imaging. The WMCs in cerebral CT or MRI were rated using both the modified Fazekas scale and the combined CT-MRI age related WMC (ARWMC) rating scale. Periventricular WMCs were observed in 79.4% of the patients and deep WMCs were also seen in 48.7% of the patients. WMC scores were significantly higher in the advanced dementia stage in periventricular WMCs (p = 0.001) and total ARWMCs (p < 0.001). Age and disease severity were both independently associated with WMCs score, particularly in the total, frontal and parieto-occipital areas. Vascular factors including hypertension, diabetes mellitus, and gender were not significantly associated with WMCs. In conclusion, both age and severity of dementia were significantly associated with WMCs in AD patients. These associations highlight future research targets.

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Evaluation of Alzheimer’s disease progression based on clinical dementia rating scale with missing responses and covariates

Journal of Biopharmaceutical Statistics ◽

10.1080/10543406.2017.1402780 ◽

2017 ◽

Vol 28 (5) ◽

pp. 893-908 ◽

Cited By ~ 1

Author(s):

Kalyan Das ◽

Subrata Rana ◽

Surupa Roy

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Disease Progression ◽

Rating Scale ◽

Clinical Dementia Rating ◽

Missing Responses ◽

Dementia Rating Scale

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Validity of the Clinical Dementia Rating Scale Sum of Boxes in Staging and Detection of Cognitive Impairment in Mexican Americans

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/0891988720973755 ◽

2020 ◽

pp. 089198872097375

Author(s):

Parunyou Julayanont ◽

John C. DeToledo

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Mexican Americans ◽

Rating Scale ◽

Amnestic Mild Cognitive Impairment ◽

Clinical Dementia Rating ◽

Education Levels ◽

Dementia Rating Scale

Objective: We evaluated the utility of the Clinical Dementia Rating Sum of Boxes score (CDR-SB) in staging and detecting amnestic-mild cognitive impairment (a-MCI) and Alzheimer’s disease (AD) among Mexican Americans. Methods: Receiver operator curves were generated to evaluate the validity of the CDR-SB in staging and detecting a-MCI and AD in 1,073 Mexican Americans (758 controls, 163 a-MCI, and 152 AD). Results: Optimal ranges of the CDR-SB were 0, 0.5-4, 4.5-8.0, 8.5-13 and 13.5-18 for staging the global CDR score of 0, 0.5, 1, 2, and 3, respectively. The CDR-SB ≥ 0.5 differentiated the a-MCI patients from the controls (sensitivity 100% and specificity 99.5%) and ≥ 2.0 distinguished the AD from a-MCI patients (sensitivity 83.6% and specificity 87.1%). These cutoffs were also appropriate for patients with ≤6 years of education. Conclusion: The CDR-SB is useful to detect and stage a-MCI and AD in Mexican Americans with diverse education levels.

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Patterns of Gray and White Matter Changes in Individuals at Risk for Alzheimer’s Disease

Current Alzheimer Research ◽

10.2174/156720512803568993 ◽

2012 ◽

Vol 9 (9) ◽

pp. 1097-1105 ◽

Cited By ~ 1

Author(s):

Heidi I.L. Jacobs ◽

Martin P.J. van Boxtel ◽

Ed H.B.M. Gronenschild ◽

Victoria J. Williams ◽

Saartje Burgmans ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

At Risk ◽

White Matter ◽

White Matter Changes

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Effect of the Interaction Between Hypertension and Cerebral White Matter Changes on the Progression of Alzheimer Disease

Current Alzheimer Research ◽

10.2174/1567205015666181002141013 ◽

2018 ◽

Vol 15 (14) ◽

pp. 1354-1360 ◽

Cited By ~ 4

Author(s):

Ping-Song Chou ◽

Yi-Hui Kao ◽

Meng-Ni Wu ◽

Mei-Chuan Chou ◽

Chun-Hung Chen ◽

...

Keyword(s):

White Matter ◽

Alzheimer Disease ◽

Rating Scale ◽

Vital Role ◽

Independent Effect ◽

Cerebral White Matter ◽

Clinical Dementia Rating ◽

White Matter Changes ◽

Age Related ◽

The Mean

Background: Cerebrovascular pathologies and hypertension could play a vital role in Alzheimer disease (AD) progression. However, whether cerebrovascular pathologies and hypertension accelerate the AD progression through an independent or interaction effect is unknown. Objective: To investigate the effect of the interactions of cerebrovascular pathologies and hypertension on AD progression. Method: A retrospective longitudinal study was conducted to compare AD courses in patients with different severities of cerebral White Matter Changes (WMCs) in relation to hypertension. Annual comprehensive psychometrics were performed. WMCs were rated using a rating scale for Age-related WMCs (ARWMC). Results: In total, 278 patients with sporadic AD were enrolled in this study. The mean age of the patients was 76.6 ± 7.4 years, and 166 patients had hypertension. Among AD patients with hypertension, those with deterioration in clinical dementia rating-sum of box (CDR-SB) and CDR had significantly severe baseline ARWMC scales in total (CDR-SB: 5.8 vs. 3.6, adjusted P = 0.04; CDR: 6.4 vs. 4.4, adjusted P = 0.04) and frontal area (CDR-SB: 2.4 vs. 1.2, adjusted P = 0.01; CDR: 2.4 vs. 1.7, adjusted P < 0.01) compared with those with no deterioration in psychometrics after adjustment for confounders. By contrast, among AD patients without hypertension, no significant differences in ARWMC scales were observed between patients with and without deterioration. Conclusion: The effect of cerebrovascular pathologies on AD progression between those with and without hypertension might differ. An interaction but not independent effect of hypertension and WMCs on the progression of AD is possible.

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