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Changes in cognition in Huntington’s disease and its relationship to future cognition
Abstracts: Clinical Assessment / 1 (Suppl 1) (2005) P-026
CHANGES IN COGNITION IN HUNTINGTON’S DISEASE AND ITS RELATIONSHIP TO FUTURE COGNITION
Kevin Duff, Leigh J. Beglinger, David J. Moser, Douglas R. Langbehn, Jane S. Paulsen; University of Iowa, Iowa City, IA, USA Background: Newman et al. (2001) noted that subtle changes in cognition of patients undergoing CABG surgery were predictive of cognition 5-years later. To our knowledge, similar comparisons have not been made in patients with neurodegenerative disorders, like Huntington’s disease (HD). Objective(s): The current study examined the relationship between shortterm changes in cognition and future cognitive functioning. Methods: One hundred seventy adults, who had been previously diagnosed with HD, were followed clinically on an “as needed” basis. The clinical visit included three cognitive tasks: 1) Digit Symbol, 2) verbal fluency, and 3) Stroop Color Word Test. The amount of time between Time 1 and Time 2 averaged 7 months, and the amount of time between Time 2 and the follow-up point, Time 3, averaged 29 months. Partial correlations were used to assess the relationship between short-term changes in cognition (Time 2 - Time 1) and cognitive outcome (Time 3), while controlling for baseline functioning (Time 1). Results: Digit Symbol practice effects were significantly related to Time 3 Digit Symbol scores (pr[158] ⫽ .56, p⬍.01) after controlling for Time 1 Digit Symbol scores. Digit Symbol practice effects were also related to other cognitive scores, but to a lesser degree (verbal fluency: pr[158] ⫽ .29, p⬍.01; Stroop Interference: pr[154] ⫽ .37, p⬍.01). The other cognitive tasks showed similar, but weaker, relationships. Conclusions: Changes in test performance on repeated assessments were related to long-term cognitive performance in this large sample of patients with manifest HD. Digit Symbol showed the strongest relationship between short-term change and 29 month follow-up, possibly because of its more prominent motor component than the other cognitive tests and the underlying neuropathology of HD. This short-term change variable might offer a simple, convenient, and non-invasive marker for monitoring longterm changes in an individual patient’s cognitive status. This value might also serve as an outcome variable in clinical trials. P-027
THE FUTURE OF P-300 BRAINWAVE TECHNOLOGY FOR ALZHEIMER’S DIAGNOSIS AND CARE MANAGEMENT
Lawrence A. Farwell1, Alarik T. Arenander2; 1Brainwave Science, Seattle, WA, USA; 2Brain Research Institute, Fairfield, IA, USA Background: This poster will provide an overview of brainwave technology and Alzheimer’s disease, with special attention to the P-300 electroencephalic waveform. Currently, most healthcare providers rely on standardized, but subjective cognitive impairment test protocols with limited utility. Until recently, there was no objective means of diagnosing the early prodromal stages of dementia short of a neuropathological investigation at autopsy. Recently, neuroimaging techniques and biomarkers have been used to diagnose AD, but these also have inherent limitations including cost and invasion. Objective: Present an understanding of the current developments in utilizing the P300 response to various stimuli as a tool for diagnosis and care management. Method: We will briefly describe the definitive study of the use of the P300 and cognitive correlations to diagnose Alzheimer’s in over 1500 patients (Braverman and Blum, 2003). We will describe Brainwave Science’s technology which offers a significant improvement over the standard P300 protocol and analysis, due to the use of the field tested, inexpensive and easy to administer brainwave response that is called the MERMER. (Memory and Encoding Related Multifaceted Electrographic Response). Brainwave Science is developing an accurate and cost-effective technology for early stage diagnosis of Alzheimer’s disease (AD) and ongoing care management. Conclusion: This unique, patented technology will allow implementation of a brainwave system by primary care physicians as well as in medical centers and greatly improve patient care and reduce the overall cost of treatment.
P-028
S17
ON THE USABILITY OF COMPUTERIZED COGNITIVE TESTS FOR DEMENTIA SCREENING
Aharonson Vered1, Amos D. Korczyn2; 1Afeka, Tel-Aviv Academic College of Engineering, Tel Aviv, Israel; 2Sackler School of Medicine Tel-Aviv University, Tel Aviv, Israel Background: Computerized cognitive assessment raises usability issues when screening of dementia. Difficulties in computer interaction are often hard to separate from cognitive problems, particularly in computer naı¨ve elderly. Objective: We studied 2 usability issues induced by computer interaction in cognitive assessment: the effect of fatigue and of keyboard interaction complexity. Methods: We adapted to computer several known cognitive tests. Our paradigm defined SRP, a basic unit in interaction, and each test as a series of SRP. The required responses were pressing a single key (“K”) or typing a series of keys (“T(n)”, n⫽number of keys in series). An un-computerized version of a “K” test a “T(n)” test were also administered. 98 subjects participated in the study. All were over years old and 53 were computer naı¨ve. 50 were memory clinic subjects and 48 were controls. All subjects performed at least two computerized tests which involved “K” responses and at least one which involved “T(n)” response, n⫽2 to 6 keys. The fatigue effect was studied by correlating the number of subjects who quit, expressed wish to quit, complained of fatigue or had a significant drop in performance, and the duration from test start to that event. Results: 1) a 43⫾9 minutes were the mean and SD of time lapse before fatigue overruled subjects’ performance and/or wish to continue the computerized tests. 2) A significant difference in time till fatigue dominance between computer naive and computer skilled subjects, but not between controls and memory clinic subjects. 3) 16% of the controls and 34% in memory clinic subjects were not able to proceed in the “T(n)” test beyond n⫽3. 4) A significant difference in “T(n)” test performance between computer naive and computer skilled controls, but not within the memory clinic subjects. 5) Difference (preliminary) in T(n) test performance between computerized and traditional administration. Conclusions: Computerized cognitive assessment for the elderly should be shortened to 40 min or less to avoid fatigue dominance in performance and their interpretation when keyboard typing is required might fail to differentiate cognitive decline from computer usability problem. P-029
A REVIEW OF DEMENTIA-SPECIFIC SCREENING TOOLS UTILIZED IN AFRICAN AMERICAN POPULATIONS
Adah Carter, Travonia Hughes, Deborah Danner, Charles Smith; University of Kentucky, Lexington, GA, USA Background: Demographers have predicted that the number of African Americans over the age of 65 will double by 2030 (Dilworth-Anderson, Williams, & Gibson, 2002). Studies have shown that African Americans develop Alzheimer’s disease and vascular dementia at rates almost two times greater than whites (Froehlich, Bogardus, & Inouye, 2001; Demirovic et al., 2003). However, prevalence rates of Alzheimer’s disease among African Americans are confounded by factors such as inadequate screening mechanisms, inequitable access to healthcare and cultural differences in their perception of the disease. Consequently there is considerable variance (14-100%) among studies that have examined the prevalence of Alzheimer’s disease and vascular dementia in black and white populations (Ripich, Carpenter, & Ziol, 1997; Froehlich, Bogardus, & Inouye, 2001). The Sanders-Brown Center on Aging at the University of Kentucky and the Kentucky Division of Aging Services, with funding from the Administration on Aging, instituted the African American Dementia Outreach Partnership (AADOP). Objectives: To analyze and critic screening mechanisms that have been used in African American populations To examine the specificity and sensitivity rates of prior neuropsychological assessment tests that had been administered to minority populations. To identify and administer neuropsychological tests (Fuld Objective Memory Test and the Modified MMSE) with high sensitivity and specificity rates to older African Americans in Kentucky. Methods: A comprehensive review
CHANGES IN COGNITION IN HUNTINGTON’S DISEASE AND ITS RELATIONSHIP TO FUTURE COGNITION
Kevin Duff, Leigh J. Beglinger, David J. Moser, Douglas R. Langbehn, Jane S. Paulsen; University of Iowa, Iowa City, IA, USA Background: Newman et al. (2001) noted that subtle changes in cognition of patients undergoing CABG surgery were predictive of cognition 5-years later. To our knowledge, similar comparisons have not been made in patients with neurodegenerative disorders, like Huntington’s disease (HD). Objective(s): The current study examined the relationship between shortterm changes in cognition and future cognitive functioning. Methods: One hundred seventy adults, who had been previously diagnosed with HD, were followed clinically on an “as needed” basis. The clinical visit included three cognitive tasks: 1) Digit Symbol, 2) verbal fluency, and 3) Stroop Color Word Test. The amount of time between Time 1 and Time 2 averaged 7 months, and the amount of time between Time 2 and the follow-up point, Time 3, averaged 29 months. Partial correlations were used to assess the relationship between short-term changes in cognition (Time 2 - Time 1) and cognitive outcome (Time 3), while controlling for baseline functioning (Time 1). Results: Digit Symbol practice effects were significantly related to Time 3 Digit Symbol scores (pr[158] ⫽ .56, p⬍.01) after controlling for Time 1 Digit Symbol scores. Digit Symbol practice effects were also related to other cognitive scores, but to a lesser degree (verbal fluency: pr[158] ⫽ .29, p⬍.01; Stroop Interference: pr[154] ⫽ .37, p⬍.01). The other cognitive tasks showed similar, but weaker, relationships. Conclusions: Changes in test performance on repeated assessments were related to long-term cognitive performance in this large sample of patients with manifest HD. Digit Symbol showed the strongest relationship between short-term change and 29 month follow-up, possibly because of its more prominent motor component than the other cognitive tests and the underlying neuropathology of HD. This short-term change variable might offer a simple, convenient, and non-invasive marker for monitoring longterm changes in an individual patient’s cognitive status. This value might also serve as an outcome variable in clinical trials. P-027
THE FUTURE OF P-300 BRAINWAVE TECHNOLOGY FOR ALZHEIMER’S DIAGNOSIS AND CARE MANAGEMENT
Lawrence A. Farwell1, Alarik T. Arenander2; 1Brainwave Science, Seattle, WA, USA; 2Brain Research Institute, Fairfield, IA, USA Background: This poster will provide an overview of brainwave technology and Alzheimer’s disease, with special attention to the P-300 electroencephalic waveform. Currently, most healthcare providers rely on standardized, but subjective cognitive impairment test protocols with limited utility. Until recently, there was no objective means of diagnosing the early prodromal stages of dementia short of a neuropathological investigation at autopsy. Recently, neuroimaging techniques and biomarkers have been used to diagnose AD, but these also have inherent limitations including cost and invasion. Objective: Present an understanding of the current developments in utilizing the P300 response to various stimuli as a tool for diagnosis and care management. Method: We will briefly describe the definitive study of the use of the P300 and cognitive correlations to diagnose Alzheimer’s in over 1500 patients (Braverman and Blum, 2003). We will describe Brainwave Science’s technology which offers a significant improvement over the standard P300 protocol and analysis, due to the use of the field tested, inexpensive and easy to administer brainwave response that is called the MERMER. (Memory and Encoding Related Multifaceted Electrographic Response). Brainwave Science is developing an accurate and cost-effective technology for early stage diagnosis of Alzheimer’s disease (AD) and ongoing care management. Conclusion: This unique, patented technology will allow implementation of a brainwave system by primary care physicians as well as in medical centers and greatly improve patient care and reduce the overall cost of treatment.
P-028
S17
ON THE USABILITY OF COMPUTERIZED COGNITIVE TESTS FOR DEMENTIA SCREENING
Aharonson Vered1, Amos D. Korczyn2; 1Afeka, Tel-Aviv Academic College of Engineering, Tel Aviv, Israel; 2Sackler School of Medicine Tel-Aviv University, Tel Aviv, Israel Background: Computerized cognitive assessment raises usability issues when screening of dementia. Difficulties in computer interaction are often hard to separate from cognitive problems, particularly in computer naı¨ve elderly. Objective: We studied 2 usability issues induced by computer interaction in cognitive assessment: the effect of fatigue and of keyboard interaction complexity. Methods: We adapted to computer several known cognitive tests. Our paradigm defined SRP, a basic unit in interaction, and each test as a series of SRP. The required responses were pressing a single key (“K”) or typing a series of keys (“T(n)”, n⫽number of keys in series). An un-computerized version of a “K” test a “T(n)” test were also administered. 98 subjects participated in the study. All were over years old and 53 were computer naı¨ve. 50 were memory clinic subjects and 48 were controls. All subjects performed at least two computerized tests which involved “K” responses and at least one which involved “T(n)” response, n⫽2 to 6 keys. The fatigue effect was studied by correlating the number of subjects who quit, expressed wish to quit, complained of fatigue or had a significant drop in performance, and the duration from test start to that event. Results: 1) a 43⫾9 minutes were the mean and SD of time lapse before fatigue overruled subjects’ performance and/or wish to continue the computerized tests. 2) A significant difference in time till fatigue dominance between computer naive and computer skilled subjects, but not between controls and memory clinic subjects. 3) 16% of the controls and 34% in memory clinic subjects were not able to proceed in the “T(n)” test beyond n⫽3. 4) A significant difference in “T(n)” test performance between computer naive and computer skilled controls, but not within the memory clinic subjects. 5) Difference (preliminary) in T(n) test performance between computerized and traditional administration. Conclusions: Computerized cognitive assessment for the elderly should be shortened to 40 min or less to avoid fatigue dominance in performance and their interpretation when keyboard typing is required might fail to differentiate cognitive decline from computer usability problem. P-029
A REVIEW OF DEMENTIA-SPECIFIC SCREENING TOOLS UTILIZED IN AFRICAN AMERICAN POPULATIONS
Adah Carter, Travonia Hughes, Deborah Danner, Charles Smith; University of Kentucky, Lexington, GA, USA Background: Demographers have predicted that the number of African Americans over the age of 65 will double by 2030 (Dilworth-Anderson, Williams, & Gibson, 2002). Studies have shown that African Americans develop Alzheimer’s disease and vascular dementia at rates almost two times greater than whites (Froehlich, Bogardus, & Inouye, 2001; Demirovic et al., 2003). However, prevalence rates of Alzheimer’s disease among African Americans are confounded by factors such as inadequate screening mechanisms, inequitable access to healthcare and cultural differences in their perception of the disease. Consequently there is considerable variance (14-100%) among studies that have examined the prevalence of Alzheimer’s disease and vascular dementia in black and white populations (Ripich, Carpenter, & Ziol, 1997; Froehlich, Bogardus, & Inouye, 2001). The Sanders-Brown Center on Aging at the University of Kentucky and the Kentucky Division of Aging Services, with funding from the Administration on Aging, instituted the African American Dementia Outreach Partnership (AADOP). Objectives: To analyze and critic screening mechanisms that have been used in African American populations To examine the specificity and sensitivity rates of prior neuropsychological assessment tests that had been administered to minority populations. To identify and administer neuropsychological tests (Fuld Objective Memory Test and the Modified MMSE) with high sensitivity and specificity rates to older African Americans in Kentucky. Methods: A comprehensive review