- Email: [email protected]
P-114
Posters: P-113 P-113
4 POINT CLOCK DRAWING TASK IS SUPERIOR TO THE MINI MENTAL STATUS EXAM FOR DETECTION OF COGNITIVE IMPAIRMENT IN COMMUNITY MEMORY SCREENINGS
Neala J. Lane1,2, Tracy Ohrt3, David Baker1,2, Naoko Yura Yasui4, Sanjay Asthana1,2, Carey Gleason1,2, 1University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA; 2Geriatric Research, Education, and Clinical Center - Wm S. Middleton Memorial VA Hospital, Madison, WI, USA; 3University of Wisconsin-Madison, Graduate School, Madison, WI, USA; 4University of Wisconsin-Madison, School of Education, Madison, WI, USA. Contact e-mail: [email protected] Background: The rate of undiagnosed dementia has been reported between 50% to 90%. Primary care settings also traditionally rely on the Mini Mental Status Exam (MMSE) as the predominant screening tool for detection of cognitive impairment. Use of the MMSE as a sole screener has been criticized; yet efficient and reliable screening tools have not been identified. Objective: The Midwest Initiative for Dementia Screening (MINDS) Project, funded by The Extendicare Foundation, provided community based memory screenings to 260 older adults in southern Wisconsin. Screenings were not intended to provide diagnoses, but rather to identify individuals in need of clinical evaluation, and to determine effectiveness of several screening tools. Methods: 260 individuals were screened with a cognitive battery including the Mini Mental Status Exam (MMSE), Geriatric Depression Scale, Cognistat, Animal Fluency, Clock Drawing Task (CDT), Stroop Color Word Interference Test, Trailmaking Test A & B, and the CERAD Word Learning and Memory Test. Performance was considered in relation to age and education normative data, and information regarding medical history and concomitant medication use, collected from participants prior to neuropsychological testing. Results: Of the 260 participants, 107 individuals (41%) demonstrated varying degrees of presumably undetected cognitive impairment on the MINDS battery (Table 1). Performance on the MMSE and CDT were also compared to performance on the full screening battery. Only 4 of these 107 participants scored below the standard cutoff of ⬍24/30 points on the MMSE. On CDT, however, 43 participants missed at least one point on this simple measure of cognition (Table 2). Conclusions: It is not uncommon for primary care providers to rely upon the MMSE to quickly gauge patients’ cognitive functioning. In the MINDS Project, however, 96% of project participants who demonstrated cognitive impairment on extensive neuropsychological testing, scored within the normal range by standard MMSE scoring criteria (ⱖ24/30). The 4 point CDT, however, identified impairment in 43% of these individuals. Compared to the MMSE, the 4 point CDT is a quickly and easily administered screening test that may be more likely to detect underlying cognitive impairment.
Table 1 Participant Performance
N (%)
No Impairment Previously Diagnosed with Memory Impairment Suspected MCI Suspected AD Impaired - Other Reasons Suspected
129 24 30 35 42
(50%) (9%) (12%) (13%) (16%)
Table 2 Participant Group
Impaired MMSE Performance (<24/30)
Impaired CDT Performance (< 3)
Suspected MCI Suspected AD Impaired due to other reasons
0 4 (11%) 0
9 (30%) 20 (57%) 14 (33%)
P-114
S135 VIRTUAL REALITY VISUOSPATIAL AND WAYFINDING ASSESSMENT FOR MILD DEMENTIA OF THE ALZHEIMER’S TYPE
Belinda S. Lange1, Albert Rizzo1, Robert Astur2, Thomas Parsons1, 1 University of Southern California, Marina Del Rey, CA, USA; 2Yale University, New Haven, CT, USA. Contact e-mail: [email protected] Background: An early observable sign of mild Dementia of the Alzheimer’s Type (mDAT) is difficulty finding and navigating around familiar/ unfamiliar environments (wayfinding). Decline in the ability to process visuospatial (VS) information is thought to contribute to wayfinding difficulties, increased disorientation and loss of functional independence. Traditional measures assessing VS processing rely on paper-and-pencil tests using 2D representations of 3D objects that must be visually rotated/ transformed. In rodents, navigation/wayfinding and place learning performance is tested using the Morris Water Maze (MWM), which requires the animals to find their way to a submerged platform in a round pool of “milky” water. Traditional neuropsychological testing has been criticized as limited in ecological validity. Virtual Reality (VR) is an immersive and interactive system that allows users to interact with virtual environments on a PC using a joystick or input device. Objective(s): The objective of this study was to validate two VR environments that were modeled after standardized neuropsychological batteries (VRVS and VRMWM tasks) for use with persons with mDAT. Methods: A total of 30 Healthy adults (HAs) and 30 adults with mDAT (CDR⫽1) will be recruited. Two VR environments will be used to assess processing of VS information (VRVS task) and wayfinding/navigation (VRMWM task) in HAs and adults with mDAT. Each subject will complete the VRVS and VRMWM tasks, nine paper-and-pencil tests and two “real-world” wayfinding/navigation tasks. The VRVS task delivers 3D stimuli (in monoscopic/stereoscopic and passive/interactive formats), viewed on a PC using stereoscopic shutter glasses and allows manipulation of virtual objects using a tracking/input device. The VRMWM, allows the user to navigate through a virtual water pool on a PC screen to find a hidden platform using a joystick. Precise measurements of time and distance traveled are recorded. The “real-world” wayfinding tasks involve finding an unmarked chair in an auditorium from different starting points. Results: Usability issues and preliminary data analyses validating the psychometrics of the VRVS and VRMWM to assess cognitive decline in mDAT will be presented for the sample collected from January to May 2007. Conclusions: Findings will be used to determine if these VR environments are useful assessment tools. P-115
EFFECT OF FAMILY HISTORY OF ALZHEIMER’S DISEASE ON SERIAL POSITION PROFILES
Asenath LaRue1, Bruce Hermann1, Jana Jones1, Tina Boncyk2, Mark A. Sager1, 1University of Wisconsin-Madison, Madison, WI, USA; 2 Northern Michigan University, Marquette, MI, USA. Contact e-mail: [email protected] Background: In rote list learning, the serial position curve (SPC) provides information regarding relative dependence on primary memory (recency effect) versus secondary memory (primacy and middle regions). Alterations of the SPC are seen in Alzheimer’s disease (AD), namely, an exaggerated recency effect. Objective(s): The purpose of this investigation was to determine if there are alterations in the SPC among asymptomatic persons at increased risk for AD. Methods: Subjects included 623 asymptomatic middle-aged children of patients with AD (median ⫽ 53 years) enrolled in the Wisconsin Registry for Alzheimer’s Prevention (WRAP), a prospective longitudinal study of risk and protective factors for AD. AD was confirmed in parents by autopsy, diagnostic assessment, or review of medical records. Also included were 157 control participants whose parents survived to at least age 70 without AD or other memory disorders. All
4 POINT CLOCK DRAWING TASK IS SUPERIOR TO THE MINI MENTAL STATUS EXAM FOR DETECTION OF COGNITIVE IMPAIRMENT IN COMMUNITY MEMORY SCREENINGS
Neala J. Lane1,2, Tracy Ohrt3, David Baker1,2, Naoko Yura Yasui4, Sanjay Asthana1,2, Carey Gleason1,2, 1University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA; 2Geriatric Research, Education, and Clinical Center - Wm S. Middleton Memorial VA Hospital, Madison, WI, USA; 3University of Wisconsin-Madison, Graduate School, Madison, WI, USA; 4University of Wisconsin-Madison, School of Education, Madison, WI, USA. Contact e-mail: [email protected] Background: The rate of undiagnosed dementia has been reported between 50% to 90%. Primary care settings also traditionally rely on the Mini Mental Status Exam (MMSE) as the predominant screening tool for detection of cognitive impairment. Use of the MMSE as a sole screener has been criticized; yet efficient and reliable screening tools have not been identified. Objective: The Midwest Initiative for Dementia Screening (MINDS) Project, funded by The Extendicare Foundation, provided community based memory screenings to 260 older adults in southern Wisconsin. Screenings were not intended to provide diagnoses, but rather to identify individuals in need of clinical evaluation, and to determine effectiveness of several screening tools. Methods: 260 individuals were screened with a cognitive battery including the Mini Mental Status Exam (MMSE), Geriatric Depression Scale, Cognistat, Animal Fluency, Clock Drawing Task (CDT), Stroop Color Word Interference Test, Trailmaking Test A & B, and the CERAD Word Learning and Memory Test. Performance was considered in relation to age and education normative data, and information regarding medical history and concomitant medication use, collected from participants prior to neuropsychological testing. Results: Of the 260 participants, 107 individuals (41%) demonstrated varying degrees of presumably undetected cognitive impairment on the MINDS battery (Table 1). Performance on the MMSE and CDT were also compared to performance on the full screening battery. Only 4 of these 107 participants scored below the standard cutoff of ⬍24/30 points on the MMSE. On CDT, however, 43 participants missed at least one point on this simple measure of cognition (Table 2). Conclusions: It is not uncommon for primary care providers to rely upon the MMSE to quickly gauge patients’ cognitive functioning. In the MINDS Project, however, 96% of project participants who demonstrated cognitive impairment on extensive neuropsychological testing, scored within the normal range by standard MMSE scoring criteria (ⱖ24/30). The 4 point CDT, however, identified impairment in 43% of these individuals. Compared to the MMSE, the 4 point CDT is a quickly and easily administered screening test that may be more likely to detect underlying cognitive impairment.
Table 1 Participant Performance
N (%)
No Impairment Previously Diagnosed with Memory Impairment Suspected MCI Suspected AD Impaired - Other Reasons Suspected
129 24 30 35 42
(50%) (9%) (12%) (13%) (16%)
Table 2 Participant Group
Impaired MMSE Performance (<24/30)
Impaired CDT Performance (< 3)
Suspected MCI Suspected AD Impaired due to other reasons
0 4 (11%) 0
9 (30%) 20 (57%) 14 (33%)
P-114
S135 VIRTUAL REALITY VISUOSPATIAL AND WAYFINDING ASSESSMENT FOR MILD DEMENTIA OF THE ALZHEIMER’S TYPE
Belinda S. Lange1, Albert Rizzo1, Robert Astur2, Thomas Parsons1, 1 University of Southern California, Marina Del Rey, CA, USA; 2Yale University, New Haven, CT, USA. Contact e-mail: [email protected] Background: An early observable sign of mild Dementia of the Alzheimer’s Type (mDAT) is difficulty finding and navigating around familiar/ unfamiliar environments (wayfinding). Decline in the ability to process visuospatial (VS) information is thought to contribute to wayfinding difficulties, increased disorientation and loss of functional independence. Traditional measures assessing VS processing rely on paper-and-pencil tests using 2D representations of 3D objects that must be visually rotated/ transformed. In rodents, navigation/wayfinding and place learning performance is tested using the Morris Water Maze (MWM), which requires the animals to find their way to a submerged platform in a round pool of “milky” water. Traditional neuropsychological testing has been criticized as limited in ecological validity. Virtual Reality (VR) is an immersive and interactive system that allows users to interact with virtual environments on a PC using a joystick or input device. Objective(s): The objective of this study was to validate two VR environments that were modeled after standardized neuropsychological batteries (VRVS and VRMWM tasks) for use with persons with mDAT. Methods: A total of 30 Healthy adults (HAs) and 30 adults with mDAT (CDR⫽1) will be recruited. Two VR environments will be used to assess processing of VS information (VRVS task) and wayfinding/navigation (VRMWM task) in HAs and adults with mDAT. Each subject will complete the VRVS and VRMWM tasks, nine paper-and-pencil tests and two “real-world” wayfinding/navigation tasks. The VRVS task delivers 3D stimuli (in monoscopic/stereoscopic and passive/interactive formats), viewed on a PC using stereoscopic shutter glasses and allows manipulation of virtual objects using a tracking/input device. The VRMWM, allows the user to navigate through a virtual water pool on a PC screen to find a hidden platform using a joystick. Precise measurements of time and distance traveled are recorded. The “real-world” wayfinding tasks involve finding an unmarked chair in an auditorium from different starting points. Results: Usability issues and preliminary data analyses validating the psychometrics of the VRVS and VRMWM to assess cognitive decline in mDAT will be presented for the sample collected from January to May 2007. Conclusions: Findings will be used to determine if these VR environments are useful assessment tools. P-115
EFFECT OF FAMILY HISTORY OF ALZHEIMER’S DISEASE ON SERIAL POSITION PROFILES
Asenath LaRue1, Bruce Hermann1, Jana Jones1, Tina Boncyk2, Mark A. Sager1, 1University of Wisconsin-Madison, Madison, WI, USA; 2 Northern Michigan University, Marquette, MI, USA. Contact e-mail: [email protected] Background: In rote list learning, the serial position curve (SPC) provides information regarding relative dependence on primary memory (recency effect) versus secondary memory (primacy and middle regions). Alterations of the SPC are seen in Alzheimer’s disease (AD), namely, an exaggerated recency effect. Objective(s): The purpose of this investigation was to determine if there are alterations in the SPC among asymptomatic persons at increased risk for AD. Methods: Subjects included 623 asymptomatic middle-aged children of patients with AD (median ⫽ 53 years) enrolled in the Wisconsin Registry for Alzheimer’s Prevention (WRAP), a prospective longitudinal study of risk and protective factors for AD. AD was confirmed in parents by autopsy, diagnostic assessment, or review of medical records. Also included were 157 control participants whose parents survived to at least age 70 without AD or other memory disorders. All