- Email: [email protected]
SUBJECTIVE COGNITIVE COMPLAINTS CONTRIBUTE TO MISDIAGNOSIS OF MILD COGNITIVE IMPAIRMENT
Poster Presentations: P1 participants) potentially at future risk for MCI and Alzheimer disease. Among participants with high quantitative scores, only those with high error scores had larger THV volume. This group would not have been identified if quantitative test performance alone was considered. Combining MRI markers for neurodegeneration with memory test errors may optimize the identification of pre-MCI. P1-340
SUBJECTIVE COGNITIVE COMPLAINTS CONTRIBUTE TO MISDIAGNOSIS OF MILD COGNITIVE IMPAIRMENT
Emily Edmonds1, Lisa Delano-Wood1, Douglas Galasko2, David Salmon3, Mark Bondi4, 1University of California, San Diego, San Diego, California, United States; 2University of California San Diego, La Jolla, California, United States; 3University of California, San Diego, La Jolla, California, United States; 4VA San Diego Healthcare System, University of California, San Diego, San Diego, California, United States. Contact e-mail: [email protected] Background: Subjective cognitive complaints are one of the typical criteria included in the diagnosis of MCI, despite their uncertain relationship to objective memory performance in individuals with MCI. We aimed to examine self-reported cognitive complaints in subgroups of the Alzheimer’s Disease Neuroimaging Initiative (ADNI) MCI cohort in order to determine whether subjective complaints are a valuable inclusion criterion to the diagnosis of MCI or, alternatively, if their use contributes to possible misdiagnosis. Methods: Subgroups of MCI were derived using cluster analysis of baseline neuropsychological test data from 448 ADNI MCI participants. Prior to analysis, raw scores were converted into z-scores based on the performance of a "robust" normative reference group of 157 cognitively normal ADNI participants who had remained cognitively normal over 1-7 years of follow-up. Cognitive complaints were assed via the Everyday Cognition questionnaire (ECog), which assess multiple domains of cognitive abilities, and discrepancy scores were calculated between self- and informant-report. Relationships between subjective complaints and objective cognitive performance, depressive symptoms, CSF AD biomarkers, and clinical outcome were examined. Results: Cluster analysis revealed Amnestic and Mixed cognitive phenotypes as well as a third Cluster-Derived Normal subgroup (41.3%), whose neuropsychological performance and CSF AD biomarker profiles did not differ from the robust Normal Control group, and thus likely represent false positive diagnostic errors. When examining their subjective complaints, this cognitively intact phenotype of MCI participants overestimated their cognitive problems, whereas Amnestic MCI participants with objective
Figure. Mean discrepancy scores (self-rating minus informant-rating) for all 40 items on the ECog. A positive score indicates one is overestimating their cognitive decline relative to their study-partner’s report, while a negative score indicates one is underestimating their cognitive decline. Error bars denote standard errors of the mean.
P437
memory impairment underestimated their cognitive problems, potentially as a result of reduced awareness of cognitive dysfunction (i.e., anosognosia) or an under-appreciation of their deficits. Underestimation of cognitive problems was associated with positive CSF AD biomarkers and progression to dementia. There was no relationship between self-reported cognitive complaints and objective cognitive functioning, but significant correlations were observed with depressive symptoms. Conclusions: The inclusion of subjective complaints in MCI diagnostic criteria may cloud rather than clarify diagnosis and result in high rates of misclassification of MCI. Thus, self-reported subjective complaints should either be eliminated from the diagnostic criteria for MCI or perhaps modified to reflect the inverse relationship between self-awareness and objective measures.
P1-341
FREE RECALL CAN INDICATE ALZHEIMER’S DISEASE AS LONG AS THERE IS NO CEILING EFFECT
Eugen Tarnow, Earliest Detection, Fair Lawn, New Jersey, United States. Contact e-mail: [email protected] Background: It is known that the second free recall of three items in the MMSE can predict the presence of Alzheimer’s disease 5-7 years before diagnosis. It is not known why the first free recall of the same items does not. Methods: A new immediate free recall test without a ceiling effect was administered to people with MCI and early AD as well as to a control group. Results: It was found that an immediate free recall test without a ceiling effect is correlated with MCI and early AD. Conclusions: This such suggests that it is not the recall delay in the MMSE that predicts AD but free recall without a ceiling effect. P1-342
THE MONTREAL COGNITIVE ASSESSMENT INSTRUMENT: INFLUENCE OF DEPRESSIVE SYMPTOMS
Eva Dierckx1, Sebastiaan Engelborghs2, Peter Paul De Deyn3, Stefan Van der Mussele4, Ingrid Ponjaert-Kristoffersen1, 1Vrije Universiteit Brussel, Brussels, Belgium; 2University of Antwerp, Antwerp, Belgium; 3Antwerp University, Antwerp, Belgium; 4University of Antwerp, Antwerp, Belgium. Contact e-mail: [email protected] Background: The Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) was designed as a screening instrument for mild cognitive dysfunction. Although the proven superior utility of the MoCA (as compared with the MMSE) in the differentiation between Mild Cognitive Impairment/prodromal Alzheimer’s disease patients and healthy controls; with the proposed cut-off score of 26, specificity is often low. In the present study we want to explore whether depressive symptoms in community dwelling older adults have a (negative) impact on the MoCA scores. Methods: The MoCA was administered to (1) 41 community dwelling older adults with depressive symptoms (it is those who have a total score on the 30 item-Geriatric Depression Scale (GDS) > 10) and (2) an age and gender matched control group (without depressive symptoms: GDS-score < 11, n¼41). So the mean age of the experimental (mean age¼ 79,41;sd¼ 5.64) and control group did not differ significantly (mean age¼ 79,27; sd¼ 5.48). Results: According to independent sample t-tests, older adults with depressive symptoms achieved significant lower scores on the MoCA total score (without t(80)¼ 2.45, p ¼ .017 and with correction for low education t(79)¼ 2.52, p ¼ .014). More specifically lower scores were obtained on the visuospatial/executive subdomain. A Pearson correlation analysis also indicated a significant negative correlation between the visuospatial/executive subdomain of the MoCA and the GDS-score (r¼ - 0.239, n ¼82, p ¼ .031.) Conclusions: Attention should be paid when using the MoCA in the early detection of dementia, as also the presence of depressive symptoms may result in lower
SUBJECTIVE COGNITIVE COMPLAINTS CONTRIBUTE TO MISDIAGNOSIS OF MILD COGNITIVE IMPAIRMENT
Emily Edmonds1, Lisa Delano-Wood1, Douglas Galasko2, David Salmon3, Mark Bondi4, 1University of California, San Diego, San Diego, California, United States; 2University of California San Diego, La Jolla, California, United States; 3University of California, San Diego, La Jolla, California, United States; 4VA San Diego Healthcare System, University of California, San Diego, San Diego, California, United States. Contact e-mail: [email protected] Background: Subjective cognitive complaints are one of the typical criteria included in the diagnosis of MCI, despite their uncertain relationship to objective memory performance in individuals with MCI. We aimed to examine self-reported cognitive complaints in subgroups of the Alzheimer’s Disease Neuroimaging Initiative (ADNI) MCI cohort in order to determine whether subjective complaints are a valuable inclusion criterion to the diagnosis of MCI or, alternatively, if their use contributes to possible misdiagnosis. Methods: Subgroups of MCI were derived using cluster analysis of baseline neuropsychological test data from 448 ADNI MCI participants. Prior to analysis, raw scores were converted into z-scores based on the performance of a "robust" normative reference group of 157 cognitively normal ADNI participants who had remained cognitively normal over 1-7 years of follow-up. Cognitive complaints were assed via the Everyday Cognition questionnaire (ECog), which assess multiple domains of cognitive abilities, and discrepancy scores were calculated between self- and informant-report. Relationships between subjective complaints and objective cognitive performance, depressive symptoms, CSF AD biomarkers, and clinical outcome were examined. Results: Cluster analysis revealed Amnestic and Mixed cognitive phenotypes as well as a third Cluster-Derived Normal subgroup (41.3%), whose neuropsychological performance and CSF AD biomarker profiles did not differ from the robust Normal Control group, and thus likely represent false positive diagnostic errors. When examining their subjective complaints, this cognitively intact phenotype of MCI participants overestimated their cognitive problems, whereas Amnestic MCI participants with objective
Figure. Mean discrepancy scores (self-rating minus informant-rating) for all 40 items on the ECog. A positive score indicates one is overestimating their cognitive decline relative to their study-partner’s report, while a negative score indicates one is underestimating their cognitive decline. Error bars denote standard errors of the mean.
P437
memory impairment underestimated their cognitive problems, potentially as a result of reduced awareness of cognitive dysfunction (i.e., anosognosia) or an under-appreciation of their deficits. Underestimation of cognitive problems was associated with positive CSF AD biomarkers and progression to dementia. There was no relationship between self-reported cognitive complaints and objective cognitive functioning, but significant correlations were observed with depressive symptoms. Conclusions: The inclusion of subjective complaints in MCI diagnostic criteria may cloud rather than clarify diagnosis and result in high rates of misclassification of MCI. Thus, self-reported subjective complaints should either be eliminated from the diagnostic criteria for MCI or perhaps modified to reflect the inverse relationship between self-awareness and objective measures.
P1-341
FREE RECALL CAN INDICATE ALZHEIMER’S DISEASE AS LONG AS THERE IS NO CEILING EFFECT
Eugen Tarnow, Earliest Detection, Fair Lawn, New Jersey, United States. Contact e-mail: [email protected] Background: It is known that the second free recall of three items in the MMSE can predict the presence of Alzheimer’s disease 5-7 years before diagnosis. It is not known why the first free recall of the same items does not. Methods: A new immediate free recall test without a ceiling effect was administered to people with MCI and early AD as well as to a control group. Results: It was found that an immediate free recall test without a ceiling effect is correlated with MCI and early AD. Conclusions: This such suggests that it is not the recall delay in the MMSE that predicts AD but free recall without a ceiling effect. P1-342
THE MONTREAL COGNITIVE ASSESSMENT INSTRUMENT: INFLUENCE OF DEPRESSIVE SYMPTOMS
Eva Dierckx1, Sebastiaan Engelborghs2, Peter Paul De Deyn3, Stefan Van der Mussele4, Ingrid Ponjaert-Kristoffersen1, 1Vrije Universiteit Brussel, Brussels, Belgium; 2University of Antwerp, Antwerp, Belgium; 3Antwerp University, Antwerp, Belgium; 4University of Antwerp, Antwerp, Belgium. Contact e-mail: [email protected] Background: The Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) was designed as a screening instrument for mild cognitive dysfunction. Although the proven superior utility of the MoCA (as compared with the MMSE) in the differentiation between Mild Cognitive Impairment/prodromal Alzheimer’s disease patients and healthy controls; with the proposed cut-off score of 26, specificity is often low. In the present study we want to explore whether depressive symptoms in community dwelling older adults have a (negative) impact on the MoCA scores. Methods: The MoCA was administered to (1) 41 community dwelling older adults with depressive symptoms (it is those who have a total score on the 30 item-Geriatric Depression Scale (GDS) > 10) and (2) an age and gender matched control group (without depressive symptoms: GDS-score < 11, n¼41). So the mean age of the experimental (mean age¼ 79,41;sd¼ 5.64) and control group did not differ significantly (mean age¼ 79,27; sd¼ 5.48). Results: According to independent sample t-tests, older adults with depressive symptoms achieved significant lower scores on the MoCA total score (without t(80)¼ 2.45, p ¼ .017 and with correction for low education t(79)¼ 2.52, p ¼ .014). More specifically lower scores were obtained on the visuospatial/executive subdomain. A Pearson correlation analysis also indicated a significant negative correlation between the visuospatial/executive subdomain of the MoCA and the GDS-score (r¼ - 0.239, n ¼82, p ¼ .031.) Conclusions: Attention should be paid when using the MoCA in the early detection of dementia, as also the presence of depressive symptoms may result in lower