- Email: [email protected]
P2-187
S290
Poster P2:: Monday Posters
observed between rates of brain volume change measured with MRI and both clinical conversion status as well as APOE genotype. These results validate the technical feasibility of using MRI as an outcome measure of disease progression in multi-center trials for amnestic MCI. Failure to detect a significant treatment effect in the MRI data could reflect the absence of a biologic effect of either vitamin E or donepezil on brain volume itself. Or it could simply represent inadequate sample size in the treatment groups: donepezil (n⫽ 36 - 40, number varies with different MRI measures), vitamin E (n ⫽ 34 -43). P2-187
COMPARISON BETWEEN THE STANDARD MINI MENTAL STATE EXAMINATION AND THE MODIFIED VERSION (3MS) IN HEALTHY SUBJECTS AND PATIENTS WITH MILD COGNITIVE IMPAIRMENT OR DEMENTIA. ME´RIDA-VENEZUELA, 2005-2006
Clara I. Ramirez1, Trino J. Baptista2, Ana Serrano3, Yinet Arape3, Evelyn Thonon4, 1Department of Neurology, Los Andes University Hospital, Merida, Venezuela; 2Department of Physiology, Los Andes University Medical School, Merida, Venezuela; 3Department of Psychiatry, Los Andes University Hospital, Merida, Venezuela; 4 Department of Neurology, El Vigia Hospital, Merida, Venezuela. Contact e-mail: [email protected] Introduction: Current clinical practice and research request for precise and accessible instruments to detect early cognitive impairment (CI). Folstein’s Mini Mental State Examination (MMSE)1 is widely used in screening studies. Unfortunately, its specificity is hampered by being affected by age, education level and cultural environment. It is also very sensitive to moderate to severe-, but not to mild cognitive impairment (MCI). Teng y Chang Chui developed a more extensive version (3MS)2 which may overcome such limitations. Objectives: Since the 3MS has not been validated in Venezuela, we correlated both instruments’ scores and evaluated their sensitivity and specificity compared to the clinical diagnosis. Methods: The scales were administered in a random sequence to 93 outpatients aged 50 or more years who were assessed in the neurology or psychiatry departments. Cut-off scores for CI were 23 for the MMSE and ⬍ 79 for the 3MS. Results: We evaluated 36 healthy subjects (89% women; age (years: average ⫾ SD): 65.4 ⫾ 7.7); 25 with MCI (72% women; age: 69.4 ⫾ 10.1) and 32 demented patients (78% women; age: 73.7 ⫾ 7.3). A significant positive correlation was found between the MMSE and the 3MS: whole sample [r (93) ⫽ 0.876, p ⫽ 0.0001]; healthy subjects [r (36) ⫽ 0.466, p ⫽ 0.004]; MCI [r (25) ⫽ 0.644, p ⫽ 0.001] and dementia [r (32) ⫽ 0.854, p ⫽ 0.0001]. The MMSE specificity reached 100%, but its sensitivity was of 12% for MCI and 44 % for dementia. The 3MS specificity was of 83.3%, and the sensitivity reached 44% for MCI and 69% for dementia. Conclusions: In spite of an excellent numeric correlation between both instruments, the MMSE displayed a very low sensitivity for the MCI in our population. Since sensitivity was better for the 3MS, additional validation studies for this instrument are warranted in Venezuela. References: (1) Folstein, M., Folstein, S., McHugh P. (1975) Mini-Mental State Examination: a practical method for grading the cognitive sate of patients for the clinician. J Psychiatr Res, 12: 189-198. (1) Teng, E., Chang, H. (1987) The Modified Mini-Mental State (3MS) Examination. J Clin Psychiatry, 48: 314-318. P2-188
PREDICTION OF COGNITIVE IMPAIRMENT AMONG ELDERLY PERSONS USING A BRIEF COGNITIVE SCREENING BATTERY
Anthony LoGalbo1, Laura Baker2, Suzanne Craft1,2, The ADAPT Research Group2, 1VA Puget Sound Health Care System, Seattle, WA, USA; 2University of Washington, Seattle, WA, USA. Contact e-mail: [email protected] Background: Early detection of cognitive impairment among the elderly is becoming increasingly important. There is a need for brief measures that
can reliably predict the presence of clinically significant cognitive impairment. Objective: To decipher which brief cognitive tests most reliably predict cognitive impairment, particularly amnestic Mild Cognitive Impairment (aMCI), among elderly persons. Methods: Participants aged 70⫹ with normal baseline cognitive functioning were subsequently administered yearly 30-35 minute cognitive screening batteries, including the Modified Mini Mental State Examination (3MSE), generative verbal fluency (supermarket items), Narratives from the Rivermead Behavioral Memory Test (RBMT), Brief Visuospatial Memory Test, Revised (BVMT-R), Hopkins Verbal Learning Test, Revised (HVLT-R), digit span (DS), and the Geriatric Depression Scale (GDS). When participants’ scores on these measures fell below pre-specified cut points, a more expansive dementia evaluation was triggered to assist in diagnosing the presence and extent of cognitive impairment. Results: Scores on the cognitive screening measures were entered into a stepwise logistic regression analysis to predict outcome of the dementia evaluation. The 3MSE, RBMT delay, HVLT-R delay, DS backward, and GDS were identified as significant predictors of normal versus impaired cognitive functioning. However, when participants with normal cognitive functioning were compared only to those with aMCI, the 3MSE and RBMT delay were the only significant predictors. Furthermore, only the 3MSE was identified as a significant predictor of aMCI versus Alzheimer’s disease (AD). Conclusions: Brief cognitive screening measures are capable of differentiating between normal and impaired cognitive functioning upon more in-depth cognitive evaluation. The fact that fewer and less diverse measures reliably predicted cognitive impairment when the outcome was narrowed to normal versus aMCI supports the notion that diverse cognitive impairment can result from a variety of factors among the elderly. This finding also highlights the benefit of using certain screening measures to assist in differentiating aMCI from other forms of cognitive impairment. Results of this study further suggest that some measures are not helpful in predicting dementia evaluation outcome. Thus, their utility in triggering a dementia evaluation should be further examined. Overall results of this study have implications for the effective early evaluation and diagnosis of aMCI. P2-189
A METHODOLOGICAL APPROACH FOR ASSESSING NEUROPSYCHOLOGICAL CHANGES IN THE PRECLINICAL STAGE OF ALZHEIMER’S DISEASE (AD)
Andreas U. Monsch1, Antoinette Zehnder1, Stefan Blaesi1, Manfred Berres2, Rene´ Spiegel1, Hannes B. Staehelin1, 1Memory Clinic, Basel, Switzerland; 2RheinAhrCampus, Remagen, Germany. Contact e-mail: [email protected] Background: The characterization of cognitive changes in healthy elderly individuals is a critical prerequisite for the detection of preclinical AD. Objective(s): To develop a methodological protocol to quantify neuropsychological practice/test sophistication effects of elderly individuals and to conduct a preliminary validation with longitudinal data of early AD patients. Methods: Three-hundred seventy-four cognitively normal elderly individuals (NC) (128 women, 246 men; age [baseline] ⫽ 68.3 ⫾ 7.5 years; education ⫽ 12.8 ⫾ 3.1 years) were administered the German version of the Consortium to Establish a Registry for Alzheimer’s DiseaseNeuropsychological Assessment Battery (CERAD-NAB) at baseline (T0) and 2.4 ⫾ 0.28 years later (T1). Practice effects were calculated as differences in demographically (age, gender, education) adjusted standard scores (T1-T0), and these values were again adjusted for demographic variables and baseline performance, yielding accurate normative change scores. These results were validated against those of 95 AD patients (57 women, 38 men; age [baseline] ⫽ 74.2 ⫾ 6.4 years; education ⫽ 11.8 ⫾ 2.9 years; MMSE [baseline] ⫽ 24.1 ⫾ 3.4) who had been tested at baseline (T0) and 1.1 ⫾ 0.24 years later (T1). The apolipoprotein E (ApoE) genotype was determined in all NC subjects in order to study differential patterns of cognitive change. Conclusions: Assessment of neuropsychological change will serve as a much better basis in our effort to diagnose dementia in its preclinical stages. Results: Within the NC subjects, individuals with one or
Poster P2:: Monday Posters
observed between rates of brain volume change measured with MRI and both clinical conversion status as well as APOE genotype. These results validate the technical feasibility of using MRI as an outcome measure of disease progression in multi-center trials for amnestic MCI. Failure to detect a significant treatment effect in the MRI data could reflect the absence of a biologic effect of either vitamin E or donepezil on brain volume itself. Or it could simply represent inadequate sample size in the treatment groups: donepezil (n⫽ 36 - 40, number varies with different MRI measures), vitamin E (n ⫽ 34 -43). P2-187
COMPARISON BETWEEN THE STANDARD MINI MENTAL STATE EXAMINATION AND THE MODIFIED VERSION (3MS) IN HEALTHY SUBJECTS AND PATIENTS WITH MILD COGNITIVE IMPAIRMENT OR DEMENTIA. ME´RIDA-VENEZUELA, 2005-2006
Clara I. Ramirez1, Trino J. Baptista2, Ana Serrano3, Yinet Arape3, Evelyn Thonon4, 1Department of Neurology, Los Andes University Hospital, Merida, Venezuela; 2Department of Physiology, Los Andes University Medical School, Merida, Venezuela; 3Department of Psychiatry, Los Andes University Hospital, Merida, Venezuela; 4 Department of Neurology, El Vigia Hospital, Merida, Venezuela. Contact e-mail: [email protected] Introduction: Current clinical practice and research request for precise and accessible instruments to detect early cognitive impairment (CI). Folstein’s Mini Mental State Examination (MMSE)1 is widely used in screening studies. Unfortunately, its specificity is hampered by being affected by age, education level and cultural environment. It is also very sensitive to moderate to severe-, but not to mild cognitive impairment (MCI). Teng y Chang Chui developed a more extensive version (3MS)2 which may overcome such limitations. Objectives: Since the 3MS has not been validated in Venezuela, we correlated both instruments’ scores and evaluated their sensitivity and specificity compared to the clinical diagnosis. Methods: The scales were administered in a random sequence to 93 outpatients aged 50 or more years who were assessed in the neurology or psychiatry departments. Cut-off scores for CI were 23 for the MMSE and ⬍ 79 for the 3MS. Results: We evaluated 36 healthy subjects (89% women; age (years: average ⫾ SD): 65.4 ⫾ 7.7); 25 with MCI (72% women; age: 69.4 ⫾ 10.1) and 32 demented patients (78% women; age: 73.7 ⫾ 7.3). A significant positive correlation was found between the MMSE and the 3MS: whole sample [r (93) ⫽ 0.876, p ⫽ 0.0001]; healthy subjects [r (36) ⫽ 0.466, p ⫽ 0.004]; MCI [r (25) ⫽ 0.644, p ⫽ 0.001] and dementia [r (32) ⫽ 0.854, p ⫽ 0.0001]. The MMSE specificity reached 100%, but its sensitivity was of 12% for MCI and 44 % for dementia. The 3MS specificity was of 83.3%, and the sensitivity reached 44% for MCI and 69% for dementia. Conclusions: In spite of an excellent numeric correlation between both instruments, the MMSE displayed a very low sensitivity for the MCI in our population. Since sensitivity was better for the 3MS, additional validation studies for this instrument are warranted in Venezuela. References: (1) Folstein, M., Folstein, S., McHugh P. (1975) Mini-Mental State Examination: a practical method for grading the cognitive sate of patients for the clinician. J Psychiatr Res, 12: 189-198. (1) Teng, E., Chang, H. (1987) The Modified Mini-Mental State (3MS) Examination. J Clin Psychiatry, 48: 314-318. P2-188
PREDICTION OF COGNITIVE IMPAIRMENT AMONG ELDERLY PERSONS USING A BRIEF COGNITIVE SCREENING BATTERY
Anthony LoGalbo1, Laura Baker2, Suzanne Craft1,2, The ADAPT Research Group2, 1VA Puget Sound Health Care System, Seattle, WA, USA; 2University of Washington, Seattle, WA, USA. Contact e-mail: [email protected] Background: Early detection of cognitive impairment among the elderly is becoming increasingly important. There is a need for brief measures that
can reliably predict the presence of clinically significant cognitive impairment. Objective: To decipher which brief cognitive tests most reliably predict cognitive impairment, particularly amnestic Mild Cognitive Impairment (aMCI), among elderly persons. Methods: Participants aged 70⫹ with normal baseline cognitive functioning were subsequently administered yearly 30-35 minute cognitive screening batteries, including the Modified Mini Mental State Examination (3MSE), generative verbal fluency (supermarket items), Narratives from the Rivermead Behavioral Memory Test (RBMT), Brief Visuospatial Memory Test, Revised (BVMT-R), Hopkins Verbal Learning Test, Revised (HVLT-R), digit span (DS), and the Geriatric Depression Scale (GDS). When participants’ scores on these measures fell below pre-specified cut points, a more expansive dementia evaluation was triggered to assist in diagnosing the presence and extent of cognitive impairment. Results: Scores on the cognitive screening measures were entered into a stepwise logistic regression analysis to predict outcome of the dementia evaluation. The 3MSE, RBMT delay, HVLT-R delay, DS backward, and GDS were identified as significant predictors of normal versus impaired cognitive functioning. However, when participants with normal cognitive functioning were compared only to those with aMCI, the 3MSE and RBMT delay were the only significant predictors. Furthermore, only the 3MSE was identified as a significant predictor of aMCI versus Alzheimer’s disease (AD). Conclusions: Brief cognitive screening measures are capable of differentiating between normal and impaired cognitive functioning upon more in-depth cognitive evaluation. The fact that fewer and less diverse measures reliably predicted cognitive impairment when the outcome was narrowed to normal versus aMCI supports the notion that diverse cognitive impairment can result from a variety of factors among the elderly. This finding also highlights the benefit of using certain screening measures to assist in differentiating aMCI from other forms of cognitive impairment. Results of this study further suggest that some measures are not helpful in predicting dementia evaluation outcome. Thus, their utility in triggering a dementia evaluation should be further examined. Overall results of this study have implications for the effective early evaluation and diagnosis of aMCI. P2-189
A METHODOLOGICAL APPROACH FOR ASSESSING NEUROPSYCHOLOGICAL CHANGES IN THE PRECLINICAL STAGE OF ALZHEIMER’S DISEASE (AD)
Andreas U. Monsch1, Antoinette Zehnder1, Stefan Blaesi1, Manfred Berres2, Rene´ Spiegel1, Hannes B. Staehelin1, 1Memory Clinic, Basel, Switzerland; 2RheinAhrCampus, Remagen, Germany. Contact e-mail: [email protected] Background: The characterization of cognitive changes in healthy elderly individuals is a critical prerequisite for the detection of preclinical AD. Objective(s): To develop a methodological protocol to quantify neuropsychological practice/test sophistication effects of elderly individuals and to conduct a preliminary validation with longitudinal data of early AD patients. Methods: Three-hundred seventy-four cognitively normal elderly individuals (NC) (128 women, 246 men; age [baseline] ⫽ 68.3 ⫾ 7.5 years; education ⫽ 12.8 ⫾ 3.1 years) were administered the German version of the Consortium to Establish a Registry for Alzheimer’s DiseaseNeuropsychological Assessment Battery (CERAD-NAB) at baseline (T0) and 2.4 ⫾ 0.28 years later (T1). Practice effects were calculated as differences in demographically (age, gender, education) adjusted standard scores (T1-T0), and these values were again adjusted for demographic variables and baseline performance, yielding accurate normative change scores. These results were validated against those of 95 AD patients (57 women, 38 men; age [baseline] ⫽ 74.2 ⫾ 6.4 years; education ⫽ 11.8 ⫾ 2.9 years; MMSE [baseline] ⫽ 24.1 ⫾ 3.4) who had been tested at baseline (T0) and 1.1 ⫾ 0.24 years later (T1). The apolipoprotein E (ApoE) genotype was determined in all NC subjects in order to study differential patterns of cognitive change. Conclusions: Assessment of neuropsychological change will serve as a much better basis in our effort to diagnose dementia in its preclinical stages. Results: Within the NC subjects, individuals with one or