Neuropsychological strategies for detecting early dementia.

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.     

THE CLOCK DRAWING TEST FOR DEMENTIA OF THE ALZHEIMER'S TYPE: A COMPARISON OF THREE SCORING METHODS IN A MEMORY DISORDERS CLINIC

Objectives. To examine the reliability and validity of the Clock Drawing Test when used as a cognitive screening instrument for mild to moderate dementia, and to compare different scoring mechanisms. Design. Retrospective analysis of clock drawing performance using three published scoring methods (Shulman, Sunderland and Wolf-Klein). Setting. Hospital-based memory disorders clinic. Participants. A sample of 28 consecutive patients attending the memory clinic for assessment who were given a diagnosis of Alzheimer's disease (mild or moderate) and 28 age- and sex-matched control subjects comprising 17 memory clinic attenders found to be normal and 11 community volunteers. Measurements. Sensitivity and specificity of the three clock rating scales against memory clinic diagnoses of dementia using DSM-III-R; their respective interrater reliabilities; and comparisons of each with measures of cognitive impairment (the Mini-Mental State Examination and the Blessed Orientation–Information–Memory–Concentration Test), daily performance of basic and instrumental activities (the Blessed Dementia Scale) and depression (the Hamilton Rating Scale for Depression). Results. All methods of scoring the Clock Drawing Test correlated well with measures of cognitive impairment (r=0.57–0.73) and daily performance (r=0.38–0.48), were independent of mild depression and demonstrated high sensitivity, specificity and interrater reliability. While all clock scales identified mild to moderate dementia reasonably well, the Shulman method performed best. In screening for dementia, clock drawing proved superior to the MMSE: 24/28 vs 20/28 cases identified. When compared with the MMSE, clock drawing provided additional diagnostic discrimination, identifying 7/8 AD patients with MMSE scores ≥24. Conclusions. In a clinic population, clock drawing, especially if scored according to the Shulman scale and combined with the MMSE, is an extremely efficient test screening measure for mild to moderate dementia of the Alzheimer's type with low false negative and false positive rates. This may have implications for screening elderly populations.     

Validation of the Test Your Memory (F-TYM Test) in a French Memory Clinic Population

The Test Your Memory (TYM) test has been proposed for screening dementia. We present a French version and its validation in memory clinics. F-TYM was administered to 201 patients with memory complaints visiting five secondary referral hospital centers. Final diagnosis was dementia in 34%, amnestic mild cognitive impairment (MCI) in 32%, non-amnestic MCI in 11%, absence of cognitive disorder in 23% and F-TYM scores were respectively (M ± SD) 30.9 ± 7.6, 40.5 ± 6.3, 44.3 ± 4.5 and 43.5 ± 6.6 (p < .0001). F-TYM showed high correlation with MMSE (r = .78), excellent internal consistency, no effect of educational level, sex, or mood but a significant effect of age (p = .004). A F-TYM score ≤ 39 had 0.90 sensitivity and 0.70 specificity for diagnosis of dementia. F-TYM was unable to discriminate MCI and patients without cognitive disorders. F-TYM could be proposed for screening of dementia in patients with memory complaints.     

Prevalence of major depression in preschool children

The prevalence of preschool major depressive disorder (MDD) was studied in the community. The whole population of children between 3 and 6 years attending preschool nurseries in three areas (one urban, one rural and one suburban) in Spain (n = 1,427) were contacted. Selection was by a two-stage procedure. At stage I, the ESDM 3-6, a screening measure for preschool depression, was used to identify a sample for more intensive interviewing. Sensitivity and specificity of the cut-off point of the ESDM 3–6 had been previously tested in a pilot study (n = 229). During the first stage, 222 preschool children (15.6%) were found to be probable depressives, because they scored 27 or more, the cut-off used. At stage II, the children were interviewed and diagnosed by the consensus of two clinicians, blind to the ESDM 3-6 results. DSM-IV diagnostic criteria were used to define caseness. A total of 16 children (1.12%) met the MDD criteria. The prevalence by areas was urban 0.87%, rural 0.88%, suburban 1.43%. Sex distribution prevalence was 1:1. This study is a contribution to the scarce epidemiology of preschool depression in the community.     

Psychometric properties of Clock Drawing Test and MMSE or Short Performance Test (SKT) in dementia screening in a memory clinic population

OBJECTIVE: To evaluate five different scoring methods of the Clock Drawing Test (CDT) and to examine whether a combination of Mini Mental State Examination (MMSE) or Short Performance Test (Syndrom Kurz Test, SKT), respectively, with CDT can be used for cognitive screening. METHODS: Retrospective blinded analysis of clock drawing performance using five scoring methods (Shulman et al. (1986), Sunderland et al. (1989), Wolf-Klein et al. (1989), Watson et al. (1997), Manos (1997)). A Memory Clinic at an academic psychiatric hospital (University of Frankfurt am Main, Germany). 123 consecutive patients (79 dementia patients, 44 controls). Inter-rater reliability and correlation of five different scoring methods of the CDT with established psychometric tests. Sensitivity and specificity of all five CDT's using the original and modified cut-off scores. Sensitivity, specificity and positive and negative predictive value of a combination of the CDT with MMSE and SKT, respectively. RESULTS: All scoring methods of the CDT showed a highly significant interrater reliability (0.82 to 0.94). Correlation with the MMSE and the SKT was also significant (p < 0.01) for all five CDTs. Highest sensitivity was achieved by the Shulman scoring method (81% sensitivity, specificity 79%). Sensitivity of all scoring methods could be improved up to 89% by modifying the originally proposed cut-off scores at the cost of lower specificity. By combining the CDT with the MMSE or the SKT, respectively, the sensitivity of each of the tests could be improved to 92% (SKT and Shulman scale). In patients with mild dementia (GDS 3), a combination of the Shulman Scale with the SKT (92%) and the MMSE (75%) achieved the highest sensitivity. CONCLUSIONS: The CDT in combination with the MMSE or SKT is an easily administered, non threatening and highly sensitive screening test for dementia in the setting of a memory clinic.     

Suitability of the 6CIT as a screening test for dementia in primary care patients

Objectives: To map the suitability of the Six Item Cognitive Impairment Test's (6CIT) as a screening instrument for dementia in primary care and to assess its feasibility, reliability, and validity in a real-world setting.Method: The present study was part of a population-based prospective trial aimed at reducing the incidence of stroke and dementia. The 6CIT was administered by general practitioners (GPs) at routine examinations every two years. Incidence of dementia was obtained from health insurance records. Psychometric qualities of the 6CIT were evaluated for two different cut-offs.Results: At baseline, 72 GPs examined 3908 patients. In total, 528 patients were diagnosed with new dementia. Less than 1% of the tests were not completed. Internal consistency (Cronbach's alpha), stability over time (Pearson's r), and the agreement between successive tests (Cohen's kappa) reached values of 0.58, 0.62, and 0.45, respectively. Sensitivity and specificity reached values of 0.49 and 0.92 at the 7/8 cut-off and of 0.32 and 0.98 at the 10/11 cut-off, respectively. Patients with dementia had significantly higher mean error scores than patients without dementia. High scores at baseline posed a more than fourfold risk of being diagnosed with dementia.Conclusion: The 6CIT's psychometric properties in a real-world setting suggest that the test is not suited as a routine screening instrument. Factors inherent to screening in primary care likely contributed to its low reliability and validity. This highlights the need for training GPs in the conduct of cognitive screening before such procedures can be implemented on a routine basis.     

THE PREDICTIVE VALUE OF DEMENTIA SCREENING INSTRUMENTS IN CLINICAL POPULATIONS

Objective. To determine the positive predictive value of the Mini-Mental Status Examination (MMSE), the Abbreviated Mental Test (AMT) and the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) for dementia in different clinical settings. Design. Sensitivity and specificity of tests were compared against the criterion standard of clinical diagnosis made by a geriatrician or psychogeriatrician. Setting. Two groups of patients were studied, a referred group of outpatients to a memory clinic (MC) and a random selection of patients referred to an aged care assessment team (ACAT) Patients. Of 437 eligible MC patients, 299 were used in analyses of whom 216 subjects had dementia. Of 100 randomly selected ACAT patients, 78 agreed to be studied, and 32 subjects had dementia. Results. The correlation between the MMSE and AMT was 0.87 for the ACAT sample and 0.86 for the MC sample. The correlation between the MMSE and IQCODE was −0.65 for the ACAT sample and −0.56 for the MC sample. The correlation between the DMT and IQCODE was −0.62 for the ACAT sample and −0.54 for the MC sample. The AMT and MMSE had lower sensitivity and specificity in the MC sample compared with the ACAT sample. Using a sensitivity of 78% and a specificity of 88%, chosen on the basis of findings, the positive predictive value in clinical situations varied from 70% for patients over the age of 75 admitted to acute teaching hospitals to 84% for patients seen by ACATs, inpatient geriatric liaison patients or acute geriatric units. The positive predictive value for the general population aged 80–84 years was 45%. Conclusions. The use of these tests is appropriate for the clinical situations described above. Their use in an unselected elderly population is not recommended as the tests are likely to produce more false positives than true cases of dementia. © 1997 John Wiley & Sons, Ltd.     

Adaptation of Addenbrooke’s Cognitive Examination‐Revised for the Greek population

Background/Purpose: Addenbrooke’s Cognitive Examination‐Revised [ 1 ] is a highly sensitive and specific bedside test for the diagnosis of dementia. The aim of this study was to validate a Greek version of this simple, bedside instrument and to investigate its psychometric properties. Method: We translated and administered the Greek version of the ACE‐R to 95 individuals comprising two groups: a dementia group (n = 35) and an age‐matched and education‐matched healthy control group (n = 60). Results: Our results suggest high internal consistency and very good sensitivity, specificity and negative predictive value, but only adequate positive predictive value for the ACE‐R, with excellent diagnostic accuracy. In our sample, the ratio of verbal fluency plus language scores to orientation plus memory (VLOM) subscore failed to discriminate patients in the target dementia group. Conclusion: The present findings support the usefulness of the ACE‐R as a brief dementia screening tool in clinical practice. Further neuropsychologic evaluation is required for the differential diagnosis of dementia.     

The Cross-Cultural Dementia Screening (CCD): A new neuropsychological screening instrument for dementia in elderly immigrants

Objective: Currently, approximately 3.9% of the European population are non-EU citizens, and a large part of these people are from “non-Western” societies, such as Turkey and Morocco. For various reasons, the incidence of dementia in this group is expected to increase. However, cognitive testing is challenging due to language barriers and low education and/or illiteracy. The newly developed Cross-Cultural Dementia Screening (CCD) can be administered without an interpreter. It contains three subtests that assess memory, mental speed, and executive function. We hypothesized the CCD to be a culture-fair test that could discriminate between demented patients and cognitively healthy controls. Method: To test this hypothesis, 54 patients who had probable dementia were recruited via memory clinics. Controls (N = 1625) were recruited via their general practitioners. All patients and controls were aged 55 years and older and of six different self-defined ethnicities (Dutch, Turkish, Moroccan-Arabic, Moroccan-Berber, Surinamese-Creole, and Surinamese-Hindustani). Exclusion criteria included current or previous conditions that affect cognitive functioning. Results: There were performance differences between the ethnic groups, but these disappeared after correcting for age and education differences between the groups, which supports our central hypothesis that the CCD is a culture-fair test. Receiver-operating characteristic (ROC) and logistic regression analyses showed that the CCD has high predictive validity for dementia (sensitivity: 85%; specificity: 89%). Discussion: The CCD is a sensitive and culture-fair neuropsychological instrument for dementia screening in low-educated immigrant populations.     

RELIABILITY AND VALIDITY OF THE SPANISH VERSION OF THEGMS–AGECAT PACKAGE FOR THE ASSESSMENT OF DEMENTIA AND COGNITIVE DISTURBANCES

This report confirms the reliability and validity of the Geriatric Mental State–Automated Geriatric Examination for Computer Assisted Taxonomy (GMS–AGECAT) package in a Spanish elderly population. No changes in the original English version are considered necessary. A representative sample (N=1080) of the elderly (65+ years) community in Zaragoza, Spain, stratified by age and sex was assessed. A two-phase screening was designed: phase I (lay interviewers): Spanish versions of GMS–AGECAT and Mini-Mental (MMSE); phase II (psychiatrists,N=324): the same instruments and History and Aetiology Schedule (HAS). Diagnosis: DSM-III-R criteria. Stringent test–retest reliability coefficients were calculated by comparing lay interviewers’ (phase I) vs psychiatrists’ (phase II) ratings. DSM-III-R psychiatric diagnoses in phase II were the gold standards for the validity study. Test–retest reliability coefficients of the cognitive sections of GMS were: case/no case distinction, mean kappa=0.71; dementia/no dementia distinction, mean kappa=0.80. GMS validity coefficients: detection of cases, sensitivity=98.4%; specificity=76.5%. Test–retest reliability coefficients of AGECAT: case/no case distinction, mean kappa=0.59; organic syndrome, dementia, mean kappa=0.68. Validity coefficients of AGECAT (psychiatrists’ outputs): case/no case distinction, sensitivity=90.6%; specificity=89.3%; dementia/no dementia distinction, sensitivity=86.4%; specificity=94.3%.     

Validation of the Seven Minute Screen and Syndrom Kurztest among elderly Norwegian outpatients

BACKGROUND: Brief cognitive tests represent a first step in the assessment of elderly people referred to outpatient clinics because of cognitive impairment. The aim of this study is to determine sensitivity, specificity and likelihood ratio for a positive result (LR+) for the brief cognitive tests Seven Minute Screen (7MS) and Syndrom Kurztest (SKT) in an outpatient sample of elderly patients with no dementia or mild dementia. METHODS: Ninety-five patients aged 65 years or more from 10 Norwegian geriatric and psychogeriatric outpatient clinics were included in the study. All the subjects had a Mini-mental State Examination score of 22-30. A consensus diagnosis of dementia according to ICD-10 was established by an expert panel that considered data from a standardized assessment protocol blinded for 7MS and SKT results. RESULTS: Subjects were diagnosed with mild dementia (n = 69) or no dementia (n = 26). Sensitivity for 7MS was 71%, specificity 73% and LR+ was 2.6. Sensitivity for SKT was 65%, specificity 65% and LR+ was 1.9. CONCLUSION: Sensitivity, specificity and LR+ for 7MS and SKT were unacceptably low in this outpatient sample.     

Training compensatory memory strategies via the telephone for persons with TBI

Background: Spaced retrieval training has been used to teach individuals with dementia to use compensatory memory strategies. This training has been delivered over the telephone to some persons with dementia. Spaced retrieval applications for individuals with traumatic brain injury have not been reported to date.Aims: The purpose of this study was to investigate the efficacy of spaced retrieval for teaching individuals with traumatic brain injury strategies and facts via the telephone, with an emphasis on generalisation.Methods & Procedures: Seven participants with chronic everyday memory problems due to traumatic brain injury were trained to use memory aids for prospective and episodic memory tasks. Participants demonstrated borderline normal to mild global severity ratings. Functional memory problems were identified and external memory aids were provided if appropriate. Participants were trained using spaced retrieval via the telephone 30 minutes per day; each participant was trained on three memory goals. Participants and some caregivers reported strategy use and generalisation for most trained goals.Outcomes & Results: Results indicated that goal attainment and generalisation were achieved in an average of five 30-minute training sessions, resulting in 94.4% spaced-retrieval goal maintenance at 1 month. Strategy execution at 1 month was reported on 77.7% of goals trained.Conclusions: Spaced retrieval is a viable approach for training individuals with traumatic brain injury to use external memory aids and learn prospective memory tasks. Telephone intervention should be considered as an accessible service delivery alternative to promote generalisation with this population.     

The seven minute screen: a neurocognitive screening test highly sensitive to various types of dementia

Background: The seven minute screen (7MS) is a compilation of the temporal orientation test, enhanced cued recall, clock drawing, and verbal fluency. It has been shown to be useful for detecting Alzheimer's disease in a population of patients with memory complaints.

Objective: To assess the predictive validity of the 7MS for various types of dementia, and the influence of depression and other psychiatric conditions on 7MS scores.

Setting: Multicentre: secondary referral sites across the Netherlands.

Subjects: 542 patients with various types of dementia or depression, together with 45 healthy controls.

Results: Alzheimer's disease was diagnosed in 177 patients, other types of dementia in 164. The sensitivity of the 7MS for Alzheimer's disease was 92.9% with a specificity of 93.5%. For other types of dementia the sensitivity was 89.4% and the specificity 93.5%. Cognitive abnormalities were found in 71% of the patients with depression (n = 31). The mean (SD) duration of administration of the 7MS was 12.4 (4.6) minutes, range 8 to 22, depending on dementia severity.

Conclusions: The 7MS is a useful screening tool for discriminating patients with dementia from cognitively intact patients. This not only applies to Alzheimer's disease but also to other types of dementia. Specificity with respect to depression was lower for the 7MS than for the MMSE.

     

Mild cognitive impairment in Parkinson’s disease: Diagnosis and progression to dementia

Introduction: Mild cognitive impairment is common in nondemented Parkinson disease patients (PD-MCI) and is considered as a risk factor for dementia (PDD). Recently, the Movement Disorder Society (MDS) published guidelines for PD-MCI, although the studies available are still limited. The aim of this work was to characterize PD-MCI and its progression to dementia. Moreover, the study variables could be considered as predictors for the progression of cognitive impairment. Method: The study included 43 patients with idiopathic PD (mean age = 59.19 years, SD = 9.64) and 20 healthy and neurologically normal controls (mean age = 60.85 years, SD = 12.26). The criteria proposed by the MDS Task Force were applied for the PD-MCI diagnosis. Follow-up assessments were conducted within six to eight years after the diagnosis of PD-MCI. Results: The results showed that 60.5% of the patients were diagnosed with PD-MCI when a comprehensive assessment was performed (MDS criteria Level 2), while 23.3% of the patients met MCI criteria when a brief assessment was used (MDS criteria Level 1). Multiple domain impairment was the most frequent impairment (96.2%). A total of 42.3% of PD-MCI patients had dementia in the follow-up study. Logistic regression showed that the Hoehn and Yahr stage and education significantly contributed to the prediction of PD-MCI. Moreover, the Hoehn and Yahr stage and memory domain significantly contributed to the prediction of dementia. Conclusions: The results of the study: (a) provide relevant data about the process of validation of the MDS PD-MCI criteria, (b) reinforce the hypothesis that PD-MCI is more frequent than previous studies showed without applying MDS criteria, and (c) confirm that PD-MCI is a risk factor for the onset of dementia. Finally, the study shows that neurological impairment, educational level and memory impairment were predictors for the progression of cognitive impairment.     

Validation d’une batterie brève d’évaluation des praxies gestuelles pour consultation Mémoire. Évaluation chez 419 témoins, 127 patients atteints de troubles cognitifs légers et 320 patients atteints d’une démence

IntroductionThe aim of this study was to build a brief clinical scale evaluating praxic abilities of the upper limbs for use in memory clinics and to produce norms.Patients and methodsThe scale includes three subtests: symbolic gestures (five gestures), pantomimes (five gestures) and imitation of meaningless gestures (eight gestures). Data were collected in a sample of 419 normal subjects. Sensitivity and specificity were established from their comparison to data collected from 320 demented patients. A group of 127 patients with mild cognitive impairment was also studied.ResultsCut-off scores were proposed based on the fifth percentile observed in three classes of age and three levels of education. The specificity was high. Sensitivity was higher for imitation of meaningless gestures than for pantomimes and the least for symbolic gestures. The group of patients with mild cognitive impairment was half-way between demented patients and normal subjects.ConclusionThe proposed scale meets its initial aims of brevity and high specificity. It can easily be used in memory clinics and identifies apraxia in dementia patients. It therefore usefully contributes to clinical diagnosis.     

Validating the DemTect with 18-fluoro-2-deoxy-glucose positron emission tomography as a sensitive neuropsychological screening test for early alzheimer disease in patients of a memory clinic

OBJECTIVES: The first study to validate the diagnostic value of the DemTect, a short neuropsychological screening test for dementia (8-10 min), using 18-fluoro-2-deoxy-glucose positron emission tomography (FDG-PET) in patients of a memory clinic. METHODS: DemTect results were compared to the clinical diagnosis and to FDG-PET as a reference method for the early in vivo detection of Alzheimer's disease (AD). Results: 38 patients (age 65.2 +/- 9.8 years, 16 men, 22 women) were investigated using clinical standard examination, FDG-PET, and cranial magnetic resonance imaging. According to NINCDS-ADRDA and Petersen's criteria, 18 patients had dementia of the Alzheimer type (DAT) and 13 patients received the diagnosis of mild cognitive impairment (MCI). Compared to the clinical diagnosis, a DemTect cutoff score of < or =11 points demonstrated good sensitivity (83.3%) and specificity (70.0%) for the detection of DAT, whereas the best cutoff score for MCI was < or =13 points with comparable sensitivity (84.6%) and specificity (85.7%). With regard to FDG-PET, the DemTect demonstrated excellent sensitivity (93%) and low specificity (50%) for the detection of AD-typical patterns of cerebral glucose metabolism (cutoff < or =13 points). CONCLUSION: DemTect is a favorable neuropsychological screening instrument for detecting cognitive dysfunction even in predementia stages of AD. For definite cross-sectional diagnosis, further diagnostic evaluation with higher specificity, e.g. comprehensive neuropsychological examination, FDG-PET or other biomarkers, is necessary.     

Identifying dyslexia risk for sport-related concussion management: Sensitivity and specificity of self-report and rapid naming

Background: Dyslexia is the most common type of learning disability and studies have shown that student-athletes with learning disabilities sustain more concussions than their non-affected peers. However, current methods of dyslexia identification in college students are potentially invalid because they rely on students to self-report formal dyslexia diagnoses.

Methods: To test the accuracy of self-report against two alternative methods of dyslexia screening, 94 college students completed three dyslexia symptom inventories, two rapid naming (RAN) tasks, and a standard word reading measure.

Results: Reliability was acceptable for screening purposes on the inventories (α =.70, ?.72), and excellent for RAN (α = .91, ?.94). Specificity was acceptable (82.5%), but sensitivity was low (14.3%) when students self-reported suspected diagnoses of reading impairment. Sensitivity and specificity were higher for the digit RAN task (71 and 98%, respectively) compared to the letter RAN task (57 and 90%). Sensitivity (92.7%) and specificity (92.5%) were optimal when a cut-score of ≥27 seconds was used. A binary logistic regression showed digit RAN alone significantly predicted whether students were classified as typical or inefficient readers, p< .001, whereas the most reliable dyslexia inventory alone did not, p=.284. Including inventories along with RAN provided no additional predictive value.

Conclusion: Self-report inventories missed many cases of inefficient word reading. The digit RAN task classified 93.6% of the cases correctly compared to 72.3% for self-report inventory. Thus, we recommend that neuropsychologists working with college concussion management programs add to their baseline screening protocols the digit RAN task, which can be completed in less than one minute.     

Clinical utility of Patient Health Questionnaire-9 (PHQ-9) in memory clinics

Background. Both dementia and depression may produce complaints of memory impairment. Differential diagnosis may be difficult, but has practical implications regarding choice of appropriate treatment. Aim. To assess the clinical utility of the Patient Health Questionnaire-9 (PHQ-9), a validated instrument for measurement of depression severity, in differentiating patients with and without dementia, referred with complaints of memory impairment to dedicated memory clinics. Methods. Pragmatic prospective study of consecutive referrals (n=113) to two dementia clinics, diagnosed using standard clinical diagnostic criteria for dementia (DSM-IV) and also administered the PHQ-9. Results. PHQ-9 proved acceptable to patients, and was quick and easy to use. Using traditional parameters of diagnostic utility (sensitivity, specificity, positive predictive value, likelihood ratios), PHQ-9 performance was modest for the diagnosis of dementia. However, pragmatically PHQ-9 scores proved helpful in deciding which patients, both with and without dementia, required a trial of antidepressant medication. Conclusions. PHQ-9 proved useful as a brief screen for depression in patients attending dementia clinics with a complaint of memory impairment.     

Psychiatric morbidity among continuing care geriatric inpatients

This study examines the point prevalence of psychiatric morbidity among continuing care geriatric inpatients and the performance of screening questionnaires in detecting such morbidity. From a sample of 74 patients it was possible to carry out complete dementia ratings in 53 patients and depression ratings in 52 patients. Eighty-three per cent of the patients assessed had dementia and 48% had significant depressive symptoms. Screening for dementia with the Mini Mental State Examination (MMSE) had 100% sensitivity and 78% specificity. The Geriatric Depression Scale (GDS) had 80% sensitivity and 64% specificity at the conventional cutoff of 10/11. Receiver operating characteristics curve analysis suggested that a 12/13 cutoff gave the best sensitivity (75%) and specificity (73%) values for depressive symptoms. Among patients with dementia a cutoff score of 12/13 on the GDS also gave optimal sensitivity, specificity and positive predictive values. The GDS revealed good test–retest stability in the whole sample (tau = +0.55, p < 0.001) and the demented subgroup (tau = +0.52, p < 0.001).     

Diagnostic differentiation of mild cognitive impairment due to Alzheimer's disease using a hippocampus‐dependent test of spatial memory

The hippocampus is one of the earliest brain regions affected in Alzheimer's disease (AD) and tests of hippocampal function have the potential to detect AD in its earliest stages. Given that the hippocampus is critically involved in allocentric spatial memory, this study applied a short test of spatial memory, the 4 Mountains Test (4MT), to determine whether test performance can differentiate mild cognitive impairment (MCI) patients with and without CSF biomarker evidence of underlying AD and whether the test can distinguish patients with MCI and mild AD dementia when applied in different cultural settings. Healthy controls (HC), patients with MCI, and mild AD dementia were recruited from study sites in UK and Italy. Study numbers were: HC (UK 20, Italy 10), MCI (UK 21, Italy 14), and AD (UK 11, Italy 9). Nineteen UK MCI patients were grouped into CSF biomarker‐positive (MCI+, n = 10) and biomarker‐negative (MCI–, n = 9) subgroups. Behavioral data were correlated with hippocampal volume and cortical thickness of the precuneus and posterior cingulate gyrus. Spatial memory was impaired in both UK and Italy MCI and AD patients. Test performance additionally differentiated between MCI+ and MCI– subgroups (P = 0.001). A 4MT score of ≤8/15 was associated with 100% sensitivity and 90% specificity for detection of early AD (MCI+ and mild AD dementia) in the UK population, and with 100% sensitivity and 50% specificity for detection of MCI and AD in the Italy sample. 4MT performance correlated with hippocampal volume in the UK population and cortical thickness of the precuneus in both study populations. In conclusion, performance on a hippocampus‐sensitive test of spatial memory differentiates MCI due to AD with high diagnostic sensitivity and specificity. The observation that similar diagnostic sensitivity was obtained in two separate study populations, allied to the scalability and usability of the test in community memory clinics, supports future application of the 4MT in the diagnosis of pre‐dementia due to AD. © 2015 Wiley Periodicals, Inc.