Psychometric validity and screening utility of the cognitive abilities screening instrument (CASI): preliminary data from study of guamanian chamorros

Psychometric validity and screening utility of the cognitive abilities screening instrument (CASI): preliminary data from study of guamanian chamorros

FOURTHINTERNATIONALCONFERENCEONALZHEIMER'SDISEASE rates for females from 1988 through 1991 indicates that the incidence of primary degenerative dement...

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FOURTHINTERNATIONALCONFERENCEONALZHEIMER'SDISEASE rates for females from 1988 through 1991 indicates that the incidence of primary degenerative dementia among males and females may be similar. Conclusions:

These data are useful for establishing baseline measurements of clinical

diagnosis and practices. Differences in clinical diagnosis can be used to identify trends and for targeting professional education interventions. This is especially important since the United States Public Health Service has made physician evaluation of cognitive impairment one of the Healthy Disease

Prevention

People

2000:

National

Health

Promotion

and

involving clinicians from both sites. All project clinicians were involved in WHO sponsored diagnostic training programs before the start of the project. The clinical diagnostic process is still ongoing. Preliminary data based upon 300 clinically diagnosed subjects in Indianapolis and 200 clinically diagnosed subjects in Ibadan suggest AD does occur in Ibadan but its prevalence appears to be lower in lbadan than in Indianapolis. All the clinical evaluations and consensus diagnoses will be completed by April 1994 and the final estimates will be presented at the meeting.

Objectives.

173

171 EETIIMTION OF TEE BBNBITIVITY AND SPECIFICITY OF A DBXBNTIA SCRBBNING TBBT IN A POPULATION-BABBD SURVEY. L.R. White, G.W. Ross, H. Petrovitch, K. Masaki, D. Chiu, E. Teng. National Institute on Aging, Honolulu (347 N. Kuakini Heart Program, U. of Hawaii, U.S.Calif. St., Honolulu, HI.) At the 4th examination of the Honolulu Heart and Program Cohort (1991-93), the Cognitive Abilities Screening Instrument (CASI) was administered to 3735 Study participants Japanese-American men aged 72-93. were randomly sampled from 3 strata of performance normal) to receive a two-level (low, intermediate, follow-up evaluation for dementia. At level #l they interview was standardized were retested and a conducted with the caregiver, generating a Blessed IQCODE score for cognitive scale score, an as well as a second CASI. deterioration, Level C2, conducted on a secondary (40%) sample, used a CERADbased clinical assessment carried outwithoutknowledge of screening or Level 1 findings. Using dementia or non-dementia classifications from the level #2 assessment (80% complete at abstract presentation) and subjects as considering this group of a panel, sensitivity and specificity of the screening CASI at a score of 74 were estimated at 96% and 31%. Using sampling weights to compute estimates for the source population, the sensitivity estimate fell to 83% and the specificity rose to 95%. Using a score ~74 on the screening CASI as the initial inclusion criterion and a score >82 on the Level Xl CASI as the exclusion criterion, the projected population estimates were 81% sensitivity and 97% specificity. Individual and conjoint, education-specific sensitivity and specificity estimates will be presented for the CASI, IQCODE, and Blessed scales. Our results emphasize the importance of utilizing sensitivity and specificity values relevant to the surveyed population to estimate dementia prevalence and incidence rates whenever a screening step is employed.

COMMUNITY SCREENING FOR DEMENTIA IN INDIANAPOLIS AND IBADAN, NIGERIA. K Hall, A Ogunniyi, H Hendrie, B Osuntokun, S Hui, F Unverzagt, 0 Baiyewu and the IndianapolislIbadan Team. Depts. of Psychiatry and Neurology, Indiana University School of Medicine, Indianapolis, Indiana 46202 USA and Dept. of Medicine, University of Ibadan, Ibadan, Nigeria. The IndianapolisiTbadan Dementia Project is a comparative community prevalence study of age associated dementia in African Americans 65 years old and older in Indianapolis and Nigerians in Ibadan, Nigeria. The purpose of the study is to determine the prevalence of Alzheimer’s disease and other dementias in people living in the community in both sites and also nursing homes in Indianapolis with the ultimate goal to identify environmental risk factors for Alzheimer’s disease. The study’s hypothesis, based on preliminary studies, is that the age specific prevalence and incidence of Alzheimer’s disease will be significantly lower in the Nigerians than in the African Americans. The study design involves a screening interview followed by a full clinical dementia work up in a subsample of those screened. The community screening phase was completed in August 1993, Indianapolis community N=2203, Ibadan N=2494. The sex distribution for males is 35.1% in Indianapolis and 34.9% in Ibadan, the mean age + standard deviation in Indianapolis is 73.9 I6.8) and Ibadan 72.3 f& 7.8) @= .ooOl). Literacy for Indianapolis is 97.6% and for lbadan 15.2%. The screening interview CSI “D”, first developed by this team for use with the Cree in Manitoba was translated, harmonized and tested in pilot studies in Indianapolis and Ibadan. It includes items from established instruments including MMSE, CAMDEX, Dementia Rating Scale, CARE and the East Boston Memory Test.The interview combines a cognitive score with a functional score based on an interview with a relative in a discriminant

score. The discriminant

cut off scores derived in the pilot studies

are used to classify subjects for sampling The discriminant

scores range from -39

into the clinical to

phase of the study.

1.36, the mean scores + standard

deviations are for Indianapolis ,030 + ,130and for Ibadan .062 + .I 17. The shape, the location and the scale of the distribution are comparable between the two sites. Using these scores to sample subjects for the clinical assessments 7.6% borderline and 80.7% scoring in the yields in Indianapolis 11.5% “cases,” normal

range,

normal

range.

community

in ibadan In

11.2%

conclusion,

“cases,” 7.8% this study

screening methods for dementia

borderline

has developed

and 80.9%

in the

and implemented

that are effective

in two diverse

populations.

172 A COMPARISON OF THE PREVALENCE OF DEMENTIA AND ALZHEIMER’S DISEASE IN COMMUNITY DWELLING RESIDENTS

OF IBADAN, NIGERIA AND INDIANAPOLIS, U.S.A. H Hendrie, B Osuntokun, K Hall, A Ogunniyi, M Farlow, 0 Gurege, F Unverzagt, 0 Baiyewu, S Hui and the lndianapolis/Ibadan Team. Depts. of Psychiatry and Neurology, Indiana University School of Medicine, Indianapolis, Indiana46202 USA and Dept.ofMedicine,University oflbadan,lbadan, Nigeria. Comparative cross-cultural community based studies of Alzheimer’s disease (AD) especially those involving subjects of similar ethnic heritage offer a great potential for elucidating Indianapolis-&&n study is a comparative

risk factors for AD.

The

prevalence/incidence study of subjects aged 65 years and over

dementia between community dwelling living inlbadan,Nigeria (n=2500) and African American subjects age 65

years and older living in Indianapolis (community dwelling n=2200, institutional sample n =300). The research design for the prevalence study involved two stages with an initial screening interview followed by a clinical evaluation on a subset of screened subjects. The screening is now completed and the performance of our screening instrument and the results will be discussed in an accompanying paper. Great care has been taken to ensure comparability of diagnosesacross sites.The diagnostic protocol involves arriving at consensus diagnoses first

involving

clinical

clinicians

data between

from

sites,

each

finally

site

and

arriving

then by transferring the at a consensus diagnosis

174 PBYCHONBTRIC VALIDITY ARD SCREENINQ UTILITY OF THE COGNITIVE ABILITIES SCREEUIHQ INSTRUIIBNT (CABI)I PRBLININARY DATA FROM STUDY OF QUAMRNIRN CBRMORROB. D.D. Pickett, S.C. Waring, G.E. Smith, Dept. of Heatlh Science Research, Mayo Clinic, Rochester, MN, USA The present study examined the scale structure and screening efficacy of the CASI in a sample of Guamanian Chamorros evaluated at the Mayo Clinical The CASI was developed to screen Research Center. cognition in cross-cultural epidemiological studies. It includes 9 subscores: Lonq Term Memorv, Short Term (AT),-Language pi.), Mental Memory (SM) , Attention Manipulation, Orientation, Drawing, Abstract Chamorros with ThinkincflJudcrement (Al). and Fluencv. neurodeganerative d&e&e (mean age-61.6 years) and familial controls (mean age 48.7 years), all with English as a second language (ESL), received behavioral neurology evaluations, EMG, neuroimaging, etc. The CASI and several traditional neuropsychological tests were administered in Diagnoses were established by consensus of English. Dementia diasnoses were made blinded 3 neurolosists. to CASI scores and consistent-with DSM-III-R criteria. Eighty percent of patients met criteria Logistic Regression demonstrated that for dementia. CASI scores predicted group status (p-.04) with 87% accuracy. COrrelatiOrI Values suggested STM, AT, ATJ

FOURTHINTERNATIONALCONFERENCEONALZHEIMER'SDISEASE and LA subscales to demonstrate good convergent and divergent validity with traditional neuropsychological tests. In conlusion, the CASI appears to be generally valid for screening english speaking Chamorros. Certain subscales appear to measure the same cognitive constructs assumed to underlie traditional neuropsychological tests. Additional validity studies in ESL populations should ensue.

identify subgroups (defined

on surgical histmy obtained from proxy

will present analyses attempting to

by type of surgery, date of surgery, and type of

proxy respondent) in which the validity of information to minimize

bias and the feasibility

and Alzheimer’s

disease

is satisfactory. Strategies

of a case-control study on general anesthesia

will be discussed.

E GENE IS A POTENT KISK FACTOk P. AmouyellJ, D. Cottell, C. Bed, 0. Vid#, T. Brousseau*. ‘Service d’Epid6miologie et de SaatC Publique, *JNSEBM U325,3INSEBM U360. Institut Pasteur de Lie, 1 roe Calmette, 59019 Lille Ceder FRANCE. Among the factors involved in the pathogeaesis of cognitive impairment, the apolipoprotein E (ApoE) is suspected to play a major role. This protein existed as three common isoforms 2,3 and 4 coded by specific alleles. ApoE was demonstrated to be a major risk factor for this Alzheimeh disease In a sample of 1061 subjects over 60, we explored a possible association between cognitive impairment measured with the Mini-MentalScale Examination(Mh4SE)and the presence of the APOE &4 allele. Men (n=294, age=76,3i95y) and women (n=767, age=82.4+8.7y) were randomly selected in the old people’s home of the North region of France. APOE genotypes were determined on genomic DNA. We present here a first report on 696 subjects. MMSE score WBSassociated with age (p<.OOOOl),sex (p<.Ol), education level (@<.OOOOl) aad handicaps (p<.OOOOl). Conversely, the presence of at least one APOE ~4 allele was not associakd with these variables. When adjusted on these confounding factors, we found a significant difference (p<.OOO2)between the Mh9S.E score of AF’OE ~4 allele bearers (16.5i8.6) and the Mh4SE score of non bearers (18.9i7.5). The % of APOE ~4 allele bearers in groups of subjects with MMSE score under a defined cut-off were plotted: FOR

EVALUATION OF A MODIFIED VERSION OF THE COGNITIVE ABILITIES SCREENING INSTRUMENT (CASI) FOR ASSESSMENT OF DEMENTIA IN ELDERLY CHAMORROS ON GUAM. S.C. Waring+,C. Esteban-Santillan’,E. Tengo, R.C. Petersen+, P.C. O’Brien+ and LT. Kurland+. Mayo Clinic and Mayo Foundation+, Rochester, Minnesota 55905; University of Guam’, Mangilao, Guam 96923; University of Southern California§, Los Angeles, CA 90033 USA. Dementia, alone and with parkinsonism,is a prevalentmanifestation of the spectrum of neurodegenerativedisorders (amyotrophic lateral sclerosis and parkinsonism-dementiacomplex [PDC]) that occur with high frequency among the indigenous Chamorro people of Guam This study was done to evaluate the Cognitive Abilities Screening Instrument (CASI) as a reliable test for the assessment of dementia in elderly Chamorros on Guam. The CASI was selected for this study since it was developed specifically for cross-cultural studies of dementia to be used as a screening instrument, lo provide profiles of dementia, and to monitor changes over time within individuals. Additionally, CASI could be readily modified for use in this population. Accordingly, we administered the CASI lo 51 Chamorro patients with dementia (13 with dementia only and 38 with PDC) and 13 neurologically normal Chamorro controls, similar in age and education. The diagnosis of dementia was based on DSM-III-R criteria and the severity of dementia was based on the Clinical Dementia Rating scale. Total CASI scores differed significantly between controls and cases by severity of dementia (mild [n=16], moderate [n=ll], and severe [n=24]), with median scores of 78,61, 42, and 40 respectively out of 100 (p~O.001) and 48 of 51 cases scoring below minimumscores for controls. Of the ten domain subscores, seven were significantly different between mild cases and controls (pcO.5 - pcO.001). Comparing moderate and severe cases to controls, the difference was significant for all domain subscores (p
OF TFIE APOLIPOPROTEM

COGNITIVE

IMPAIRMENT.

MMSE

score

cut-off

The special relevance of the apolipoprotein E to nervous system and the association of the presence of the ~4 allele with cognitive impairment suggest a major !imction for this protein in the brain.

178

176 VALIDITYANDRELIABILITYOFSURGICALHISTORYOBTAINEDBY INTERVIEWFROMPROXYRESPONDENTSMEPIDEMIOLOGIC STUDIESOFALZHEIMER'S DISEASE.M.Baumgarten,C.Wolfson,H. and Bergman, A.M.Clartield, S.Kleiman.Centerfor ClinicalEpidemiology B&t&tics, University of Pennsylvania, NEB332R,Philadelphia PA 191016095; University ofMontreal; and McGill University. Epidemiologic

research on the etiology of Alzheimer’s

disease constitutes a

unique challenge since victims ofthe disease are not able to provide accurate retrospective information.

In preparation for a case-control study on general

anesthesia as a risk factor for Alzheimer’s

disease, we conducted a pilot project

whose objective was to estimate the validity and reliability surgery as reported by proxy respondents. Information

of information

on lifetime

on

surgical

history was obtained by interview from proxy respondents of patients with Alzheimer’s

We conclude that, overall, information respondents may be of low quality. We

177 E4ALLELE

175

s43

disease (n=60) and compared to information

addition, information

compared to information

Proxyrespondents In preliminary

in hospital charts. In

provided by nondemented elderly subjects (n=84) was provided by their proxy respondents. 59% of the

144

were the patient’s spouse.

analysis of data from one of the study hospitals, the mean num-

ber of surgical procedures per patient, as reported in the proxy interview,

was

I .4

(range O-5). According to the hospital charts, the mean was 2.1 (range O-10). There was 52.6% agreement between chart and proxy interview when the number of surgical procedures was considered as a variable with four categories. Nondemented elderly subjects reported a mean of 4.3 surgical procedures (range O-14). Accordingtotheirproxy respondents,the meanwas3.7(range O14). Therewas51,2%agreementbetween subjectandproxy interviewwhenthe numberofsurgical procedures was considered as a variable with four categories.

A NORWEGIAN TWIN STUDY OF DEMENTIA SHOWS GENETIC PATTERN IN LATE-ONSET ALZHEIMER'S DISEASE A.L.M.Bergem, K.Engedal, E.Kringlen. Department of Psychiatry, University of Oslo, P.O.Box 85 Vinderen, 0319 Oslo, Norway Background. This study compares the relative importance of heredity and environment for the develooment of dementia of the Alzheimer type and vascular dementia. impaired subjects in Methods. 23,000 cognitively Norweoian institutions for the elderly have been check;d with the National Twin Registry. BY this means. an unselected sample of 64 complete twin pairs have been identified and thorouohlv investioated clinicallv. NO twin is younger than 66-years, and Ehe mean age ofthe sample is 80 years. In this report the Alzheimer group is compared to the vascular demented group. Results. The pairwise concordance rate in dementia of the Alzheimer type is 77.8 percent I7 of 9) among monozygotic (MZI, and 39.1% (9 of 23) among dizygotic (DZ) iwin pairs. The probandwise concordance rate is 83.3% (10 of 12) amona MZ. and 46.2% I12 of 26) among DZ. The mean age of onset-of disease was 72.7 years.Only 5 cases were younger than 65 years at age of onset. By using tetrachoric correlations, the estimated heritability (proportion of variance of liability to develop Alzheimer's disease explained by genetic effects) is approximately 0.6. Environmental factors shared by cotwins seemed to explain most of the remaining variance. With regard to vascular