Effectiveness of the Takeda Three Colors Combination Test as a screening test for dementia

Background:  The aged population is increasing worldwide and it is expected that dementia, for which aging is a risk factor, will increase as well. A critical issue then becomes a community's capacity for the early detection of dementia among its senior citizens. In the present paper, we report on the development and potential use of a screening test for dementia that can be administered and assessed easily in a short period of time by non-specialist clinicians and represents no burden for those undergoing the screening.
Methods:  Three hundred and sixty senior citizens, over 60 years of age, participated in the study. Of these, 126 had Alzheimer's disease (AD), 60 had vascular dementia (VaD), 41 had mild cognitive impairment (MCI), and 133 were healthy volunteers (control group). A screening test for dementia, which consisted of a colored cards configuration memory task (the Takeda Three Colors Combination Test; TTCC) was examined for sensitivity, specificity, reliability and criterion-related validity.
Results:  Sufficient sensitivity and specificity were demonstrated for each clinical group (AD, VaD) and the control group. The sensitivity of the TTCC was 0.94, 0.82, and 0.71 for the AD, VaD, and MCI groups, respectively; specificity was 0.83. In addition, sufficient reliability and validity were established. Administration of the TTCCand assessment procedures required only 1 or 2 min.
Conclusion:  Satisfactory sensitivity and specificity were indicated for both the AD and VaD groups, with sufficient reliability and validity also indicated. Thus, the TTCC is an effective dementia screening test.     

Cognitive complaint and test performance in elderly patients suffering depression or dementia

Ten depressed elderly patients were compared with 20 age-matched normal controls on measures of memory, perceptual organization, and speed of letter cancellation. Only on the letter cancellation task were there significant differences between groups. In contrast, 10 elderly patients with primary degenerative dementia (Alzheimer's type) performed more poorly than 10 age-matched normal controls on all the cognitive tests employed. Depressed patients rated their level of dysfunction in performing everyday tasks as more severe than the controls; however, the demented patients rated their degree of deficit as significantly less severe than the normal controls. The relationship between patient's subjective ratings of their cognitive difficulties and their results on neuropsychological tests is discussed. The present data suggest that determining subjective complaint may be important when assessing geriatric patients.     

A New Screening Test for Dementia

Abstract: The purpose of this study is to develop a new screening test for detecting the demented elderly in the early stage in communities. The test is easy to apply for consultation, guidance and care and is capable of administering differential diagnoses. Based on the 9 dementia rating scales used in Japan, Europe and the US., a new test was completed after investigating and modifying the design 5 times. The test consists of 20 items. This test was given to 203 subjects (59 males and 144 females) including normal elderly as well as those suspected of suffering from dementia. The internal consistency, reliability and validity were studied using clinical diagnoses (diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) and Karasawa's Criteria for Judging Senility), Hasegawa's Dementia Rating Scale and Mental Status Questionnaire (MSQ) as external criteria. The present test was confirmed to have sufficient effectiveness as the screening test for dementia.     

PDD‐Short Screen: A brief cognitive test for screening dementia in Parkinson's disease

The diagnosis of Parkinson's disease with dementia (PDD) is currently based on clinical criteria (DSM‐IV, MDS–Task Force). In daily practice and research studies, these criteria still depend on the subjective impression of the examiner. Brief screening tests (BST) are helpful in identifying patients with PD with dementia, which can be difficult in patients with advanced PD. We aimed to develop a BST for PD, the PDD‐Short Screen (PDD‐SS), to accurately and quickly screen for PDD. In this prospective study, 70 patients with nondemented (age 73.8 ± 4.4) and 32 demented (age 73.8 ± 4.4) PD regularly attending a Movement Disorders Clinic were included. Diagnosis of dementia was based on DSM‐IV criteria, CDR score ≥1, and PD‐CRS total score ≤64. The PDD‐SS, Mattis Dementia Rating Scale (MDRS), and Mini‐Mental State Examination (MMSE) were administered to all participants. Validity, reliability, and discriminative power of the PDD‐SS were examined. The final version of the scale included the items immediate and delayed verbal memory, clock drawing, alternating verbal fluency, and a questionnaire covering cognitive and psychiatric (hallucinations, apathy) symptoms common in PDD. A cutoff score ≤11 on the PDD‐SS yielded high sensitivity (89.8%) and specificity (88.5%) for diagnosing PDD. The MDRS displayed similar accuracy, but the PDD‐SS administration time was significantly shorter (4.8–6.9 vs. 17.5–25.2 minutes). Diagnosis of dementia using the PDD‐SS was not influenced by age, education, or motor function. The PDD‐SS appears as the first BST for diagnosing PDD, displays an excellent diagnostic accuracy, and takes 5 to 7 minutes to be administered. © 2010 Movement Disorder Society     

老年期痴呆抑郁和焦虑障碍共病研究

目的：了解老年期痴呆患者抑郁和焦虑障碍共病率及其相关因素。方法：将100例老年期痴呆患者分为两组,阿尔茨海默病（AD）组和血管性痴呆（VD）组。用简明精神病评定量表（BPRS）、Hamilton抑郁量表（HAMD）、Hamilton焦虑量表（HAMA）进行评定。结果：AD组有焦虑20例,伴抑郁17例;VD组有焦虑17例,伴抑郁15例。共病28例,AD组与VD组各14例。AD组与VD组在HAMD因子分有明显差异（P〈0．05）。结论：老年期痴呆患者抑郁和焦虑共病率较高,应引起高度重视。     

A brief dementia screener suitable for use by non-specialists in resource poor settings--the cross-cultural derivation and validation of the brief Community Screening Instrument for Dementia

Objective

Brief screening tools for dementia for use by non‐specialists in primary care have yet to be validated in non‐western settings where cultural factors and limited education may complicate the task. We aimed to derive a brief version of cognitive and informant scales from the Community Screening Instrument for Dementia (CSI‐D) and to carry out initial assessments of their likely validity.

Methods

We applied Mokken analysis to CSI‐D cognitive and informant scale data from 15 022 participants in representative population‐based surveys in Latin America, India and China, to identify a subset of items from each that conformed optimally to item response theory scaling principles. The validity coefficients of the resulting brief scales (area under ROC curve, optimal cutpoint, sensitivity, specificity and Youden's index) were estimated from data collected in a previous cross‐cultural validation of the full CSI‐D.

Results

Seven cognitive items (Loevinger H coefficient 0.64) and six informant items (Loevinger H coefficient 0.69) were selected with excellent hierarchical scaling properties. For the brief cognitive scale, AUROC varied between 0.88 and 0.97, for the brief informant scale between 0.92 and 1.00, and for the combined algorithm between 0.94 and 1.00. Optimal cutpoints did not vary between regions. Youden's index for the combined algorithm varied between 0.78 and 1.00 by region.

Conclusion

A brief version of the full CSI‐D appears to share the favourable culture‐ and education‐fair screening properties of the full assessment, despite considerable abbreviation. The feasibility and validity of the brief version still needs to be established in routine primary care. Copyright © 2010 John Wiley & Sons, Ltd.     

Neuropsychological test performance and CSF levels of monoamine metabolites in healthy volunteers and patients with Alzheimer's dementia

Fifteen patients (51-78 yrs) with mild to moderately severe Alzheimer's dementia and 18 healthy subjects of the same age were examined by clinical rating scales and a battery of neuropsychological tests. Levels of the monoamine metabolites homovanillic acid (HVA), 3-methoxy-4-hydroxyphenyl glycol (MHPG) and 5-hydroxyindoleacetic acid (5-HIAA) were determined in the lumbar cerebrospinal fluid (CSF). Correlations between clinical, psychological and biochemical measures were calculated in order to elucidate whether monoaminergic mechanisms are of importance for the maintenance of cognitive abilities in normal and pathological aging. The patients' performance was severely impaired in all neuropsychological tests. The mean levels of monoamine metabolites, however, did not differ between patients and volunteers. The correlations between psychological test scores and CSF metabolite levels were generally low, but mostly negative, associating a poor performance to a high activity of brain monoaminergic neurons. Thus, among the volunteers high 5-HIAA and MHPG levels correlated with poor performance in the Picture completion and the Trail making tests--measures of visuo-perceptual and visuo-motor skills. In the demented patients poor performance in the memory tests was associated with high levels of HVA and 5-HIAA. The results indicate that monoamine neuron activity is not a primary determinant for cognitive abilities in healthy elderly subjects or in demented patients. The slight negative correlation between cognitive function and metabolite concentrations in the patients may reflect a disturbance in a dopaminergic-cholinergic balance due to degenerative changes of central cholinergic pathways.     

Neuropsychological differentiation of Alzheimer's disease from vascular dementia

The purpose of this study was to determine whether cognitive test performances alone could distinguish patients with probable Alzheimer's disease from those with probable vascular dementia. Sixty-eight outpatients with clinical diagnoses of either Alzheimer's disease or vascular dementia were administered a brief battery of neuropsychological tests. Scores from the Boston Naming Test and the Hopkins Verbal Learning Test were identified as most discriminating of the groups. Seventy-seven per cent of the sample was correctly classified by a stepwise discriminant function analysis. Results of this study indicate that selected neuropsychological tests have moderate concurrent utility in the differential diagnosis of dementia.     

The prevalence of dementia in elderly Chinese.

A stratified random sample of 612 Chinese aged 65 years and more and living in the community in Singapore was interviewed in 1985, using the Geriatric Mental State Schedule. The overall prevalence of dementia was 1.8%. The rate increased to 4.8% for those 80-84 years and 12.0% for those 85 years and more. An epidemiological survey of dementia in Beijing in 1986, also using the Geriatric Mental State Schedule, reported a similar rate of 1.8% for those 65 years and more. However, the prevalence of senile dementia was higher and multi-infarct dementia lower in Singapore than in Beijing.     

An investigation of dementia among elderly outpatients

A total of 110 unselected demented outpatients aged 60 and over (mean age: 76.2 years), 69 women and 41 men, were prospectively investigated. A potentially reversible cause of dementia was found in 26 patients (normal pressure hydrocephalus 2, cerebral tumor 1, hyperthyroidism 2, hypothyroidism 4, vitamin B12 deficiency 13, pseudodementia 4). Follow-up investigation showed that the only true reversible dementia in which improvement from abnormal to normal mental status occurred and was sustained for up to 2 years was 1 case of normal pressure hydrocephalus and 1 case of pseudodementia. In all cases of vitamin B12 deficiency, hypothyroidism and hyperthyroidism, despite proper treatment, mental status did not improve significantly and follow-up in most cases showed persistant cognitive deterioration. It can be concluded that although true reversible dementias do exist, they do not seem as prevalent as previously reported. Most elderly outpatients with reversible causes of dementia do not revert to normal and continue showing progressive decline.     

Seven minute screen performance in a normal elderly sample

BACKGROUND AND OBJECTIVE: The Seven Minute Screen (7MS) is a brief cognitive case-finding instrument for dementia. The test is composed of four subtests that assess performance with regard to orientation, memory, visuospatial ability and language. The objective of this study was to describe 7MS performance in a normal sample of people aged 65 years and older. METHOD: The subjects were 66 Norwegian community-dwellers who met selection criteria modified from the Mayo Older American Normative Studies standard. Mean age was 73.2 years, age range was 65-93 years, and mean Mini-Mental State Examination score was 29.06, range 26-30. RESULTS: Analysis of the 7MS subtests revealed relatively modest influence of age, education and gender on test performance. The composite 7MS performance scores were associated with education. Normal performance was expressed as means, standard deviations and percentile values for the age groups 65-74 years and 75 + years. CONCLUSION: 7MS performance is described for a normal sample. These data have the potential to increase the clinicians' ability to interpret 7MS test results.     

Visual cognitive function in dementia of Alzheimer's type: a comparison of visual event-related potentials and Stroop test

Background: Many published studies on dementia of Alzheimer’s type (DAT) have utilized event‐related potentials (ERP) and the Stroop test. However, most of this research has performed these analyses separately. Therefore, in the present research, these two examinations were carried out together following the same paradigm in order to clarify the characteristics of visual dysfunction in DAT patients. Methods: Subjects included 30 normal adults, 10 normal elderly and 10 DAT patients. A visual categorically deviant paradigm was utilized during ERP measurement. The target stimulus was red and non‐target stimuli were blue, yellow and green. The stimuli were displayed as square figures. During the Stroop test, the subjects read color names from word cards, named colors from color cards, and the text color of a printed color word. Reading times and differences in reading times were measured for each task. Results: Regarding ERP, the normal elderly and DAT groups displayed increased latencies and decreased amplitudes compared to the normal adult group. The normal elderly and DAT groups displayed no significant differences in N100 latencies and amplitudes. However, for P300, the DAT group displayed significantly decreased amplitudes in comparison to the normal elderly group. On the Stroop test, the normal elderly and DAT groups displayed significantly extended differences in reading times compared to the normal adult group. No significant differences were observed between the normal elderly and DAT groups. Conclusion: Age‐related changes were observed in the latency of ERP and the increase of the Stroop effect. Characteristic changes in DAT were indicated by latencies and amplitudes of P300, but were not indicated by the Stroop test. Characteristic abnormalities in the stimulation evaluation process were observed for DAT; however, changes other than those related to aging were not apparent in the selection process reaction.     

Cognitive deficits of mild dementia:A comparison between dementia of the Alzheimer's type and vascular dementia

Abstract This study was designed to examine the profiles of cognitive deficits in 11 mildly demented patients with dementia of Alzheimer's type (DAT), five with vascular dementia with multiple subcortical lacunar infarcts (VDS), and seven with vascular dementia with extensive white matter lesions (VDW) in comparison with 23 aged individuals without dementia. Memory, attention, abstract thinking, and visuospatial function were assessed using the Japanese translation of the Wechsler Memory Scale-Revised (WMS-R) and the Japanese version of the Wechsler Adult Intelligence Scale-Revised (WAIS-R). Compared with normal aged individuals, three dementia groups were significantly impaired in the memory and abstract thinking. However, the performances on several tests on attention (i.e. Mental Control and Visual Memory Span Backward from WMS-R) and visuospatial function (i.e. Object Assembly from WAIS-R) differed significantly between the DAT and VDS groups, with VDS being the worst in terms of performance than was DAT. This study suggests that, in the mildly demented stage, the patients with DAT have few problems in the attention and visuospatial function, but those with VDS have impairments in these cognitive abilities.     

The use of neuropsychological tests across Europe: the need for a consensus in the use of assessment tools for dementia

Background and purpose: The centres dedicated to dementia throughout Europe use different neuropsychological tests in clinical practice. The European Federation of Neurological Societies task force on neuropsychological tests produced this survey on neuropsychological tests currently being used in different European countries to gather knowledge on the practice of dementia centres and to promote the harmonization of such instruments and future multicentre collaborations. Methods: National representatives of 34 countries received a questionnaire and 25 (73.5%) sent it back. Results: A few instruments, Mini‐Mental State Examination (MMSE), Trail Making Test (TMT), Verbal Fluency and Clock Drawing Test, were available in all countries. Wechsler Adult Intelligence Scales and MMSE were reported to be valid, respectively, in 20 (80%) and 19 (76%) countries, whereas Verbal Fluency and Stroop Test are valid in 18 (72%) of them. Of the 25 countries, 17 have validation norms for Clock Drawing Test and TMT (68%), and Neuropsychiatric Inventory, Alzheimer’s Disease Assessment Scale – Cognitive Subscale, Rey Complex Figure Test, Digit Symbol and Beck Depression Inventory were standardized in 16 countries (64%). The remaining tests were validated, at most, in about half of them. Not all countries certificate neuropsychology. Conclusions: Despite the substantial differences in the tools used by the EFNS countries for most domains surveyed by the questionnaire, there is at least one neuropsychological instrument used by about 80% of the countries. There is clearly the need for a broader consensus in the use of neuropsychological tests for dementia diagnosis.     

Neuropsychological characteristics of mild vascular cognitive impairment and dementia after stroke

BACKGROUND: Post-stroke cognitive impairment is frequent, with characteristic impairments of attentional and executive performance. OBJECTIVE: The study aims to determine whether the profile and severity of impairment in vascular Cognitive Impairment No Dementia (vascular CIND) is intermediate between that seen in stroke patients without significant cognitive impairment and patients with post-stroke dementia and thus to establish if the potential value of vascular CIND is a useful concept for predicting further cognitive decline and dementia in stroke patients. METHODS: Stroke patients (n=381) > 75 were recruited from representative hospital-based stroke registers in Tyneside and Wearside, UK. Sixty six age matched controls were also recruited. A detailed battery of neuropsychological assessments was completed 3 months post stroke. RESULTS: Deficits of attention (z=5.7; p <0.0001) and executive function (z=5.9; p <0.0001) were seen even in stroke patients without vascular CIND, compared to controls. However, stroke patients with CIND were significantly more impaired again on tests of executive function (z=10.3; p <0.0001) compared to those not meeting CIND criteria; and also had greater impairments of memory (z=10.4; p <0.0001) and language expression (z=10.1; p <0.0001). A similar overall profile of deficits was evident in the CIND and the dementia group, but specific deficits were significantly more pronounced in those with dementia, particularly in orientation (z=7.2; p <0.0001) and memory (z=5.8; p <0.0001). CONCLUSIONS: The current study indicates that attentional and executive impairments are frequent in stroke patients, but deficits of memory, orientation and language are more indicative of CIND and dementia. Further longitudinal studies are required to clarify the relationship between specific lesions and the progression of specific cognitive deficits in post-stroke patients.     

北京地区人群中社会功能活动的调查及意义

目的研究社会功能活动在北京地区正常人群及老年性痴呆(AD)患者中的变化及意义,并探讨对痴呆早期诊断和预测的价值。方法应用社会功能活动调查量表(FAQ)对北京市不同城区及郊区常模人群(40岁以上各年龄组)1649人进行了测查,并按年龄、性别、受教育程度、城市与农村、总体健康状况比较各组间的差异。同时对AD患者292例(早期182例,中期110例)及其他易混淆疾病组(假性痴呆)144例进行了测查。结果(1)FAQ总分:常模组0.9933±2.2187,AD组7.4658±6.9119(早期4.8132±5.1053,中期11.8545±7.2885),易混淆疾病组3.3452±5.0222。(2)3组间两两比较结果显示差异具有显著性(P<0.0001)。(3)常模组受年龄、文化程度、居住条件、城乡等因素变化较为明显。(4)AD患者与其他两组变化规律明显不同。(5)量表各项目之间相关性较好,相关系数为0.457～0.795(P<0.0001)。结论FAQ作为神经心理检查中非认知功能测定的重要部分,主要反映社会活动能力,较为敏感,临床应用方便,对痴呆的早期诊断及人群筛查有一定意义。