Screening for dementia by telephone using the memory impairment screen

OBJECTIVES: : To develop and assess telephone-based screening tests for dementia, especially Alzheimer's disease (AD). DESIGN: : A cross-sectional validation study nested within a longitudinal study of aging and dementia. SETTING: : The Einstein Aging Study of the Albert Einstein College of Medicine, Bronx, New York. PARTICIPANTS: : Three hundred elderly community volunteers living in Bronx County, 27 of whom were diagnosed with dementia based on in-person clinical evaluation. Of the 27 individuals with dementia, 18 had AD. MEASUREMENTS: : A telephone battery was administered that included the Memory Impairment Screen by telephone (MIS-T, a test of semantic memory), the Category Fluency Test (CF-T), and the Telephone Instrument for Cognitive Status (TICS). An in-person evaluation then followed that included a neurological examination, a neuropsychological battery, demographics, and medical history. RESULTS: : The telephone battery was well accepted. The MIS-T required 4 minutes; the CF-T, 3 minutes; and the TICS, 10 minutes. The MIS-T had excellent sensitivity and specificity when compared with the CF-T and the TICS. Using cutscores on all three tests that provide a sensitivity of 78%, specificity was significantly higher for the MIS-T (93%) than for the CF-T (78%, P<.05) or the TICS (80%, P<.05). Combining the MIS-T and CF-T improved discriminative validity but increased screening time and the complexity of scoring. Normative data for the MIS-T, the CF-T, and the TICS for use in settings with different base rates (prevalence) of dementia are presented in this study. CONCLUSION: : The MIS-T outperforms the CF-T and the TICS as a valid and time-efficient telephone screen for dementia. For applications that require optimal efficiency and accuracy, the MIS-T is recommended.     

The delayed word recall task using ADAS-Jcog word booklet effectively divides patients with mild cognitive impairment from normal elderly people

AIM: A new screening test for detecting mild cognitive impairment (MCI) with higher sensitivity that can easily be administered at the bedside is necessary. In this study, we proposed the delayed recall task using the word booklet of Alzheimer's Disease Assessment Scale-cognitive component-Japanese version (ADAS-Jcog) and compared the score of the task in patients with MCI with that of cognitive normal elderly (NE) and patients with AD. METHODS: Thirty six patients with MCI, 13 very mild AD, 104 mild AD, 13 moderate AD, and age- and education-matched 19 NE, recruited from the memory clinic of Nagoya University Hospital, were evaluated by the ADAS-Jcog word recall task which consisted of immediate recall (IR), a classical method on ADAS-Jcog, and delayed recall (DR) that has been newly introduced. RESULTS: Compared with controls, patients with MCI were significantly impaired on both IR and DR. On the other hand, DR is more sensitive than IR for distinguishing MCI from NE. The highest sensitivity (94.4%) and specificity (68.4%) were achieved when the results of IR were combined with those of DR. CONCLUSION: The result suggests that the delayed word recall task using the word booklet of ADAS-Jcog may be a useful tool as a screening method for the detection of MCI.     

序列位置效应联合延迟回忆识别不同认知障碍水平患者的研究

目的 探索序列位置效应联合延迟回忆在区分不同认知障碍水平人群的诊断价值.方法 共纳入310例受试,其中认知正常(NC)组128例,轻度认知功能障碍(MCI)组133例,轻度阿尔茨海默病(AD)组49例.3组性别、年龄、受教育程度无显著性差异.所有受试进行成套神经心理学测验,使用听觉词语学习测验量表华山版(AVLT-H)...     

瑞金简易记忆测试量表对阿尔茨海默病患者筛查效用的初步研究

目的:为研发适合中国人群的记忆力筛查量表,采用瑞金简易记忆测试(RISMET)量表对阿尔茨海默病(AD)患者进行检测,评价其效用。方法:分别对57例AD患者和46名正常对照者行RISMET量表和简易智能状态检查(MMSE)量表测评,比较2组得分情况;以内部相关系数(ICC)计算重测信度,Cronbach’sα系数评价内部一致性;以受试者工作特征(ROC)曲线评价RISMET量表对于筛查AD患者的敏感性和特异性。结果:①MMSE、RISMET量表及其分项得分(包括定向力、瞬间记忆、逆行性记忆、相似性、画钟测验、计算力、语言流畅性和回忆8项)均AD组0.7;③Spearman相关分析显示RISMET量表与MMSE量表呈正相关(P=0.726,P=0.000),每一分项与总分的相关性均大于2个分项的相关性,具有统计学差异(P     

词语记忆量表在老年人认知功能损害中的应用

目的评估词语记忆量表在区分正常老年人、轻度认知功能损害(MCI)及轻度阿尔茨海默病(AD)患者中的应用。方法选择认知功能正常者108例(对照组),MCI患者105例(MCI组)及轻度AD患者57例(轻度AD组),进行简易智能状态检查量表及词语记忆量表检查,量表内容包括词语即刻回忆、延迟回忆、原词再认和新词再认,并分析各组的词语记忆得分及组间比较。结果与对照组比较,MCI组及轻度AD组的词语记忆量表各项得分均降低,且延迟回忆得分降低显著,差异有统计学意义(P=0.000);3组间各项得分比较,差异有统计学意义(P=0.000),MCI组与轻度AD组比较,延迟回忆、原词再认和新词再认差异有统计学意义(P<0.05);多因素分析对年龄和教育程度进行调整后,年龄影响第1次即刻回忆、第2次即刻回忆、延迟回忆;临床诊断影响词语记忆量表的各项得分,差异有统计学意义(P=0.000)。结论词语记忆量表中的延迟回忆及延迟再认有助于MCI的早期识别以及MCI与轻度AD的鉴别。     

The effects of acute hypoglycaemia on memory acquisition and recall and prospective memory in type 1 diabetes

Aims/hypothesis Global memory performance is impaired during acute hypoglycaemia. This study assessed whether moderate hypoglycaemia disrupts learning and recall in isolation, and utilised a novel test of prospective memory which may better reflect the role of memory in daily life than conventional tests. Subjects and methods Thirty-six subjects with type 1 diabetes participated, 20 with normal hypoglycaemia awareness (NHA) and 16 with impaired hypoglycaemia awareness (IHA). Each underwent a hypoglycaemic clamp with target blood glucose 2.5 mmol/l. Prior to hypoglycaemia, subjects attempted to memorise instructions for a prospective memory task, and recall was assessed during hypoglycaemia. Subjects then completed the learning and immediate recall stages of three conventional memory tasks (word recall, story recall, visual recall) during hypoglycaemia. Euglycaemia was restored and delayed memory for the conventional tasks was tested. The same procedures were completed in euglycaemic control studies (blood glucose 4.5 mmol/l). Results Hypoglycaemia impaired performance significantly on the prospective memory task (p = 0.004). Hypoglycaemia also significantly impaired both immediate and delayed recall for the word and story recall tasks (p < 0.01 in each case). There was no significant deterioration of performance on the visual memory task. The effect of hypoglycaemia did not differ significantly between subjects with NHA and IHA. Conclusions/interpretation Impaired performance on the prospective memory task during hypoglycaemia demonstrates that recall is disrupted by hypoglycaemia. Impaired performance on the conventional memory tasks demonstrates that learning is also disrupted by hypoglycaemia. Results of the prospective memory task support the relevance of these findings to the everyday lives of people with diabetes.     

Recall and recognition as diagnostic indices of Malignant Memory loss in senile dementia: A bayesian analysis

The Benign Senescent Forgetfulness of normal aging and the Malignant Memory Loss of Senile Dementia of the Alzheimer Type (SDAT) each have a distinct symptomatology, course, and prognosis. The purpose of this study was to evaluate the discriminative validity and relative predictive values of recall and recognition as diagnostic screening tests for the Malignant Memory Loss of SDAT. Thirty-six patients with mild to moderate SDAT and 40 normal aged controls were studied. Both recall and recognition showed good discriminative validity. However, analysis of recall and recognition by Bayes's Theorem revealed the relative predictive values as diagnostic screening instruments were 11% and 100% respectively. Thus, it was concluded that while both recall and recognition have discriminative validity under experimental conditions, a test of recognition is the preferred diagnostic instrument when screening for the Malignant Memory Loss of SDAT.     

阿尔茨海默病各种临床记忆检测方法的评价

目的评价各种临床记忆检测方法对阿尔茨海默病(Alzheimer’s disease,AD)诊断的临床效度,从而组合出最适宜AD患者的一套记忆力检测量表。方法以北京市十五攻关项目中研究的患者为背景,对正常老年人1 584例(常模组),AD患者351例(AD组),应用各种记忆力检测量表进行临床分析。结果各种记忆力检测量表对AD的记忆力检测均有较好的临床效度。结合记忆力检测量表的敏感性、特异性、临床可行性及不同的记忆模式,以常模组记忆总得分的第5百分位为分界值,联合各量表的记忆检测,轻度AD患者敏感性为82.57%,特异性为93.29%;检测中度AD患者的敏感性为85.46%,特异性为91.63%。结论联合各量表的记忆检查对AD患者的记忆力检测,敏感性及特异性高,对AD的轻、中度分界有辅助作用。     

Memory and metamemory performance in Alzheimer's disease and healthy elderly: the Contextual Memory Test (CMT).

The purpose of the present study was to examine the ability of the Contextual Memory Test (CMT) to differentiate between elderly people suffering from Alzheimer's disease (AD) in comparison to healthy elderly people. Specifically, the objectives were to compare for differences between and within the groups on components of memory, including immediate and delayed recall as well as recognition. In addition, parameters of metamemory skills, such as general awareness, self-prediction of memory capacity, self-estimation, strategy use and use of contextual information, as well as the correlation between self-awareness and actual performance in both groups, were investigated. The sample consisted of 60 elderly participants, including 30 people diagnosed with AD who were assigned to the research group and 30 people matched for age, gender and educational level who were assigned to the control group. The results provide support for the hypothesis positing differences in memory performance between healthy elderly participants and those suffering from AD, particularly in immediate and delayed recall as well as in recognition. Moreover, findings indicate an improvement in memory performance under the cued condition (contextual), whereas improvement in the AD group proved to be significant only for immediate recall. The findings point to a distinct overestimation of memory ability predicted by both the AD and control groups. Following the memory task, however, the participants accurately estimated the number of items they remembered. In addition, significant correlations between the use of contextual and association strategies and the number of items remembered by both groups were obtained, in immediate as well as in delayed recall. Therefore, these findings support the CMT as a valuable memory and metamemory assessment tool for use with the AD population.     

Refining memory assessment of elderly people with cognitive impairment: Insights from the short-term memory binding test

Alzheimer's disease (AD) affects temporary memory for bound features more remarkably than for individual features. Such selective impairments manifest from presymptomatic through dementia stages via titration procedures. A recent study suggested that without titration and with high memory load the binding selectivity may disappear in people at risk of AD such as those with Mild Cognitive Impairment (MCI). We compared data from two studies on temporary binding which assessed people with MCI and controls using different memory loads (2 or 3 items). Selective binding impairments were found in MCI, but relative to controls, such selectivity was contingent upon memory load (i.e., present with 2 items). Further analysis with MCI people who tested positive to neuroimaging biomarkers (i.e., hippocampal atrophy) confirmed that this specific binding impairments are a feature of prodromal AD. The temporary binding task has been recently suggested by consensus papers as a potential screening tool for AD. The results presented here inform on task properties that can maximize the reliability of this new assessment tool for the detection of memory impairments in prodromal cases of AD.     

Validation study of the three-objects-three-places test: a screening test for Alzheimer's disease

The aim of the present study was to validate a short, ecological test of episodic memory for the screening of Alzheimer's disease (AD). The validation was performed by computing intrarater reliability, homogeneity, internal coherence, convergent, discriminant and known group validities in the performance of normal subjects (N = 65), mild cognitive impairment (MCI) patients (N = 114), and AD (N = 44) and non-AD demented (N = 39) patients. Intrarater reliability was 0.88, homogeneity ranged from 0.81 to 0.97, and internal coherence was 0.87. With respect to convergent and discriminant validities, the test loaded strongly on memory factor (value = 0.64) and weakly on other nonmemory factors. The known group validity showed a specificity between 87% and 91% and a sensitivity between 92% and 100% in correctly identifying AD in age classes ranging from 50 to 65 and 66 to 80 years. The test is a valid instrument for the screening of AD.     

The misplaced-objects task: a brief test for memory dysfunction in the aged.

A brief, simple test for memory dysfunction in the aged is presented. Materials for the test consist of: 1) a board on which the cross-section of a seven-room house is imprinted, and 2) representations of 10 objects frequently misplaced in the home (e.g., keys). The task of the subject is to place the objects in rooms on the board and, after an interval of 5--30 minutes, to recall the location of each object. The measure is appropriate for a broad range of aged subjects, since performance requirements are minimal and readily apparent. The task has obvious face validity, which is essential for maintaining appropriate motivation in many aged subjects. Discriminate validity was demonstrated in a study in which significantly fewer objects were recalled by 60 aged persons with memory impairment (-x = 6.0) than by 44 unimpaired aged persons (-x = 8.9) or 63 young normal persons (-x = 9.9). Satisfactory test-retest reliability was demonstrated by a correlation of .84 between performances on two consecutive days in a subgroup of 20 impaired patients. Subjects appeared to enjoy the game-like structure of the test and clearly were not threatened by the test procedures. Suggestions are offered for further development of the measure.     

Acquistion and retention of categorized material in normal aging and senile dementia

The “shopping list task” is a new verbal learning task with a high degree of face validity for elderly subjects. Learning and delayed recall performance were examined for three groups of subjects: young normals (n=63, median age=21), elderly normals (n=44, median age=69) and mild to moderately impaired senile dementia patients (n=60, median age=70). The young normal subjects performed best of the three groups in both initial learning and delayed recall measures. The elderly normals showed significant decrements in learning and recalling the list items (p<.01). The impaired elderly showed much greater performance decrements in both learning and recall. None of the subjects showed a deficit in delayed recognition. These results suggest that both storage and retrieval difficulties occur in normal aging and dementia. The recognition test results suggest that recall deficits evidenced by both elderly groups are in large part due to faulty retrieval mechanisms. Since the shopping list task discriminated well among the three groups, it has potential for memory assessment in clinical settings.     

Spatial versus verbal memory impairments in patients with fibromyalgia

Mounting evidence suggests that individuals with fibromyalgia (FM) have impairments in general cognitive functions. However, few studies have explored the possibility of dissociation between verbal and visuospatial memory impairments in FM. Therefore, the purpose of this study was to investigate the asymmetrical impairment of cognitive functions between verbal and visuospatial memory and between short-term and long-term memory. Neuropsychological assessments were carried out on 23 female patients with FM and 24 healthy female controls. Verbal memory abilities were assessed using the Korean version of the Rey auditory verbal learning test (KAVLT) and digit span task, and visuospatial memory abilities were assessed using the Korean version of the Rey complex figure test (KCFT) and spatial span task. The analysis of covariance was used to assess group differences in performance on cognitive tests after controlling for depression. The two groups did not significantly differ in terms of age, years of education, or in their estimated verbal and performance IQ, but FM patients reported more severe depressive symptoms than did controls on the Beck depression inventory. Significant group differences were found in immediate and delayed recall on the KCFT (F _1,44 = 6.49, p = 0.014 and F _1,44 = 6.96, p = 0.011, respectively), whereas no difference was found in immediate and delayed recall on the KAVLT. In terms of short-term memory, neither the digit span task nor spatial span task showed any difference between groups, regardless of whether repetition was forward or backward. These findings suggest that spatial memory abilities may be more impaired than verbal memory abilities in patients with FM.     

Working memory impairments in alcohol-dependent participants without clinical amnesia

BACKGROUND: The delayed alternation (DA) task is highly sensitive to the deficits of nonhuman animals with alcohol-related brain damage. DA is thought to measure working memory which serves as a temporary store for processing of information. However, performance on this type of task has only been investigated in alcohol-dependent humans with severe cognitive deficits. The aim of the current study was to explore the validity of DA as a test sensitive to alcohol-related brain damage by manipulating storage and processing components in three versions of the task. It was hypothesized that alcohol-dependent people would perform worse than control participants and that their deficits would be more pronounced in DA versions with maximal working memory demands. METHODS: A sample of 12 alcohol-dependent participants without Wernicke-Korsakoff syndrome was compared with a sample of 12 nonalcohol-dependent controls on three versions of DA. These versions, in order of increasing working memory demand, were single alternation (LR), double alternation (LLRR), and asymmetric alternation (LRRR). DA was administered on a personal computer and performance measured by the number of trials taken to reach criterion. RESULTS: Alcohol-dependent participants, compared with the control participants, took more trials to reach learning criterion on DA on all versions when analyzed together (p = 0.002). Performance on DA was also found to deteriorate with increased working memory demands in both groups of participants (p < 0.001). However, the deficits of alcohol-dependent participants were most pronounced on the DA task with moderate (LLRR) as opposed to extreme (LRRR) working memory demands. CONCLUSIONS: The results indicate that both storage and processing demands are necessary for task performance and demonstrate sensitivity of DA to alcohol-related brain injury.     

A clinical profile of memory impairment in humans due to endogenous glucocorticoid excess

Objective  Glucocorticoid excess is commonly related to neuropsychiatric and neurological disorders, with memory impairment typically found among these disorders. The objective of this study is to offer a clinical profile of memory deficits resulting from exposure to chronic stress-level elevations of endogenous glucocorticoids in patients with Cushing's Syndrome (CS).
Study subjects  Thirty female participants of matching age and education level were studied: 15 had untreated CS (mean age 38 ± 14) and 15 were healthy. In all patients, CS was confirmed by histology of the lesion after surgery.
Design  Different learning and memory processes were assessed using an adapted version of Luria's Memory Words-Revised task (LMW-R). Participants' performances were measured in an immediate condition and, 30 min later, in a delayed condition. Attentional and executive functions were also evaluated.
Results  Our data show that chronic exposure to elevated levels of cortisol is clinically associated with significant working memory deficits, which included less shot-term memory volume, slow learning rate, memory contamination and no accurate perception of own performance. Patients also show impairment in the delayed recall task. No relation was detected between learning and delayed conditions. CS group did not differ significantly from control group in basic attentional and executive functioning.
Conclusions  Our clinical profile of memory deficits related to CS relates chronic exposure to hypercortisolemia to impaired attentional-dependent working memory and delayed recall process, suggesting that cortisol levels play a critical role in the modulation of learning and memory. Possible damage to hippocampus and extrahippocampal areas is discussed.     

A direct comparison of popular models of normal memory loss and Alzheimer's disease in samples of African Americans, Mexican Americans, and refugees and immigrants from the former Soviet Union

OBJECTIVES: To understand how people differentiate normal memory loss from Alzheimer's disease (AD) by investigating cultural models of these conditions. DESIGN: Ethnographic interviews followed by a survey. Cultural consensus analysis was used to test for the presence of group models, derive the “culturally correct” set of beliefs, and compare models of normal memory loss and AD. SETTING: Chicago, Illinois. PARTICIPANTS: One hundred eight individuals from local neighborhoods: African Americans, Mexican Americans, and refugees and immigrants from the former Soviet Union. MEASUREMENTS: Participants responded to yes‐or‐no questions about the nature and causes of normal memory loss and AD and provided information on ethnicity, age, sex, acculturation, and experience with AD. RESULTS: Groups held a common model of AD as a brain‐based disease reflecting irreversible cognitive decline. Higher levels of acculturation predicted greater knowledge of AD. Russian speakers favored biological over psychological models of the disease. Groups also held a common model of normal memory loss, including the important belief that “normal” forgetting involves eventual recall of the forgotten material. CONCLUSION: Popular models of memory loss and AD confirm that patients and clinicians are speaking the same “language” in their discussions of memory loss and AD. Nevertheless, the presence of coherent models of memory loss and AD, and the unequal distribution of that knowledge across groups, suggests that clinicians should include wider circles of patients' families and friends in their consultations. These results frame knowledge as distributed across social groups rather than simply the possession of individual minds.     

The effects of age, glucose ingestion and gluco-regulatory control on episodic memory

BACKGROUND: Previous research has been inconclusive regarding the impact of glucose ingestion and gluco-regulatory control on cognitive performance in healthy older adults. The aim of this research was to determine whether glucose specifically enhanced episodic memory in an older population. In addition, the link between individual differences in glucose regulation and the magnitude of the enhancement effect was examined. DESIGN AND SUBJECTS: A within subjects, counterbalanced, crossover design was used with 20 participants (60-80 year olds), each serving as his/her control. METHODS: Episodic memory was tested by presenting unrelated paired associates followed by immediate and delayed cued recall, and delayed recognition, under single and dual task conditions. In addition, a battery of cognitive tests was administered, including tests of semantic memory, working memory and speed of processing. RESULTS: Glucose ingestion was found to largely facilitate performance of episodic memory. Furthermore, subsidiary analyses found that gluco-regulatory efficiency predicted episodic memory performance in both control and glucose conditions. CONCLUSIONS: A boost in performance after glucose ingestion was particularly seen in the episodic memory domain. Notably, strong evidence was provided for the utility of gluco-regulatory control measures as indicators of cognitive decline in the elderly.     

The Validation of a Mailed Health Survey for Screening of Dementia of the Alzheimer''s Type

OBJECTIVE: To test the efficacy of a mailed health survey, which included the Clock Completion Test (CCT), to screen previously undiagnosed older adults for dementia of the Alzheimer's type (DAT) in a community-dwelling population, and to determine whether the addition of selected risk factors for Alzheimer's disease (AD) would enhance the screening instrument's operating characteristics. DESIGN: Comparison of the results of a self-administered screen for DAT with the diagnosis of DAT by clinician evaluation or telephone interviews. SETTING: A geriatric assessment clinic. PARTICIPANTS: Three hundred and five women age 65 and older from St. Louis, Missouri. MEASUREMENTS: The sensitivity and specificity of the CCT and the CCT plus risk factors for AD were evaluated using two standards: The Short Blessed Test (SBT) and the physician diagnosis of probable AD using National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria. RESULTS: Sensitivity and specificity for the CCT by SBT criteria were 63% and 79%, respectively. Using the physician's assessment as a criterion, the CCT had better sensitivity (67%) but poorer specificity (69%). Adding two or more risk factors for AD improved sensitivity and specificity to 71% and 89% and, in the physician assessment subgroup, to 75% and 87%, primarily by halving the false-positive rate. CONCLUSION: The combination of the simple, self-administered CCT and two or more AD risk factors is a more effective screening instrument for DAT and potentially preclinical DAT than the CCT alone. However, the instrument may be better suited for use in an office setting because of a poor response rate by subjects with dementia.     

Influence of losartan and atenolol on memory function in very elderly hypertensive patients

The aim of this study was to compare the effect of the beta-adrenergic blocker atenolol and the Angiotensin II type 1 (AT1) receptor antagonist losartan on cognitive function in very elderly hypertensive patients. A total of 120 mild to moderate essential hypertensive (DBP >90 and <105 mmHg) patients, aged 75-89 years, were studied. After a 4-week wash-out period on placebo, they were randomized to receive atenolol 50 mg or losartan 50 mg for 24 weeks according to a parallel arm design. At the end of the placebo period and of each active treatment period, BP was measured (by mercury sphygmomanometer, Korotkoff I and V) and cognitive function was evaluated through three different tests (word list memory, word list recall and word list fluency). Both atenolol and losartan were equally effective in reducing SBP (-22.1 and -23.1 mmHg, respectively, P< 0.01 vs baseline) and DBP (-10.3 and -11.2 mmHg, respectively, P< 0.01 vs baseline). Atenolol treatment did not induce significant changes in any test score, whereas losartan significantly increased the score of both the word list memory (+2.2, P<0.05 vs baseline) and the word list recall test (+2.1, P<0.05 vs baseline). The comparison between losartan and atenolol was significant (P<0.05) for both memory tests. These data suggest that in very elderly hypertensive patients, chronic AT1 receptor blockade by losartan could improve cognitive function, in particular immediate and delayed memory.