- Email: [email protected]
Use of cued recall and selective reminding to detect dementia in a geriatric population
260 ABSTRACTS
NEUROBIOLOGY OF AGING, VOLUME I i, t990 OF SECOND INTERNATIONAL CONFERENCE ON ALZHEIMER'S DISEASE NEUROIMAGING/BRAIN ENERGY METABOLISM
between: i) velocity and Reisberg scale, and 2) compliance score and Reisberg scale. Velocity declined significantly as stage of the disease progressed (p
31 T E L E P H O N E S C R E E N I N G FOR D E M E N T I A IN CON~JNITY D W E L L I N G ELDERLY. *K.A. Welsh, J.C.S. Breltner, K.M. Magruder-Habib. Bryan Alzheimer's Disease Research Center, Duke University, Durham, North Carolina, 27710 USA. A new Telephone Interview for Cognitive Status (TICS) appears promising a s a m e a n s of screenlng coqnltiv, function in .ituatlon, where tradltional methods of in-person interviewing is not feasible. The procedure has apparent discriminative validity in cllnical samples studied in the laboratory [Brandt et al, 1988, Neuropsychiatr. Neuropsyc/~ol. Behav. Neurol. 1, 111-117]; however, the predictive validlty of the TICS in noncllnical populations where impairments may be subtle has not been established, in the present study we explored the validity of the TICS in a sample of 208 elderly residents of congregate housing facilitles. Subjects were clinlcally examined and placed into one of three groups [normal (M-165); questionable- without clear evidence of dementia (N=23); demented (N=20)] based on their performance on a brief neuropsychological assessment [Esllnger et al, 1985; JAMA, 253, 670-674]. The results of the TICS were compared against clinical aseigrumnt. Based on this procedure, the Receiver Operating Characteristics of the TICS revealed 85% sensitivity with specificity of 83.1% at a cutoff score of ~30/50. Logistic regression and weighting of indivldual items yielded Improved sensitivity of 90.0% with specificity of 83.1% Identical cut-off procedures correctly c l a s s i f l e d a 1 1 of 19 cllnic patients with Probable AD (NINCD~ criteria). The results suggest that the TICS m a y be a sensitive screen for subtle cognitive impairment in the elderly. It must be emphasized that telephone screening does not replace a clinical evaluatlcn of dementia but it may provide an economical alternative screening approach for research studies where in-person interviewing may not be fsaslble. Supported by the Sandoz Foundation for Gerontologic Research and NIH grant AG07922.
32 USE O F C U E D R E C A L L A N D S E L E C T I V E R E M I N D I N G T O D E T E C T D E M E N T I A I N A G E R I A T R I C P O P U L A T I O N . *R.A. J e n k i n and R.D. I--lelme, National Research Irmtitute o f Gerontology and G e r i a t r i c Medicine, M o u n t Royal Hospital, Parkville, Victoria, 30.52, A U S T R A L I A . A l z h e i m e r ' s disease is one of the most c o m m o n dementias associated with ageing. This study was undertaken to v e r i f y the use of specific neuropsychological tests for m e m o r y in conjunction with more general mental status tests in the detection of cognitive i m p a i r m e n t suggestive of early A l z h e i m e r ' s disease in a geriatric population. T w o specific m e m o r y tasks were investigated - cued rec~dl (CR; 1) and selective r e m i n d i n g (SR; 2) - together with a general cognitive screening instrument - the ten item H o d k i n s o n ' s Mental Test Score (MTS; 3). 77 subjects (51 female and 26 male) were recruited f r o m acute care and nursing h o m e wards at Mount Royal Hospital. Subjeet~ were excluded if there was clinical evidence of psychiatric disease, epilepsy, alcohol or d r u g related cognitive i m p a i r m e n t or Parkinson's disease. For p e r f o r m a n c e analysis, subjeets were divided into three g r o u p s on the basis o f their MTS; group 1 scores 0 - 4 (n = 13), group 2 scores 5 - 7 (21) and g r o u p 3 scores 8 - 10 (43). G r o u p 1 subjects were significantly older than those in g r o u p 3 but not than those in group 2. T h e education level for all groups was equivalent at 8.2 + 0.2 years. A comparison of the p e r f o r m a n c e of the three groups on both the C R and S R tasks showed that group 1 p e r f o r m e d significantly worse than both g r o u p s 2 and 3 and that s u b j e c t s in group 2 also showed poorer p e r f o r m a n c e on both tasks than subjects in group 3 (CR: m e a n total recall (out of possible 32 items) for group 1 - 10.1 +_ 1.4 (s.e.m),
group 2 = 15.2 + 0.7, group 3 = 20.2 + 0.6, P < 0.01 tot aii comparisons, Student's T-test; SR: m e a n m a x i m u m n u m b e r of words r e m e m b e r e d (on any one trial out of possible 12 items) for group 1 = 4.1 0.5, group 2 = 6.9 + 0 . 4 , group 3 = 9 . 7 +_0.3, P < 0 . 0 0 1 for all comparisons, Student's T-test). Individual components of both tasks including free recall on the CR, and m a x i m u m n u m b e r of words encoded into long term m e m o r y on the SR task, also showed significant d i f f e r e n c e s between the groups. Matching subjects for age failed to remove the significance of the differences in performance on all aspects of both tasks across all the groups. The present study suggests that using specific m e m o r y tasks in conjunction with more general cognitive evaluation tests could provide a simple but useful means ~f screening a geriatric population for cognitive impairment. 1. G r o b e r , E. et al., Neurology, 1988; 38:900 - 903. 2 Buschke, H., J. Verbal Learning & Behaviour, 1973; 12:543 - 550. 3. ltodkinson, H., Age and Ageing, 1972: [: 233 - 238.
NEUROIMAGING/BRAIN ENERGY METABOLISM
33 BRAIN E N E R G Y M E T A B O L I S M AND ITS SIGNIFICANCE FOR ALZHEIMER'S DISEASE. *S. Hoyer. Dept. of Pathochemistry & General Neurochemistry, University of Heidelberg, D-6900 Heidelberg, FRG The sufficient formation and turn-over rate of energy as ATP guarantees the maintainance of intracellular ion homeostasis, axoplasmatic flux, synapse function and structural integrity of a neuron. In the healthy brain, ATP derives from glucose only, the glycolytic breakdown of which yields 20 ~ of total ATP only, whereas 80 ~ of total ATP are formed by glucose oxidation. Any perturbation of the neuronal glucose metabolism may thus give rise to a cellular energy deficit which subsequently induces abnormalities in neuronal homeostasis and thus neuronal stress. In normoglycemic patients suffering from early-onset dementia of Alzheimer type (DAT), an early and predominant disturbance was found in a 44 ~ reduction in cerebral glucose utilization whereas cerebral blood flow and oxygen utilization were unaltered. In normoglycemic late-onset DAT. cerebral glucose utilization was likewise diminished, but cerebral blood flow and oxygen utilization were starting to fall. In both conditions, there is evidence that the disturbance in neuronal glucose homeostasis generates neuronal stress because of an energy deficit and changes in the amino acid composition at the cellular level. The latter includes an increase of the concentration of aspartic acid which may change the neuronal calcium homeostasis via the N-methyl-D-aspartate receptor, and an increase in ammonia to neurotoxic levels, the latter being a potent factor for glial proliferation. Cellular stress is assumed to induce the amyloid A4 precursor gene via heat shock activator proteins which bind specifically to heat shock control elements of that gene. Thus, the damage in neuronal glucose homeostasis and related metabolism may play a pivotal role in the generation of amyloid in DAT brain, and may precede this morphological abnormality.
34
REGIONAL D~ICITS IN CORTICAL METABOLI~ IN PET-
f~cEs ~ ~
~:NOT Wt~ C ~
ACETYL~RASE. *P.L ~ , E.G. ~ r , H. Akiyama, R. Harrop. Kinsmen Laboratory of Neurotog~l Research, Dept. of Psychiatry, U.B.C., vancouver V6T 1W5;
NEUROBIOLOGY OF AGING, VOLUME I i, t990 OF SECOND INTERNATIONAL CONFERENCE ON ALZHEIMER'S DISEASE NEUROIMAGING/BRAIN ENERGY METABOLISM
between: i) velocity and Reisberg scale, and 2) compliance score and Reisberg scale. Velocity declined significantly as stage of the disease progressed (p
31 T E L E P H O N E S C R E E N I N G FOR D E M E N T I A IN CON~JNITY D W E L L I N G ELDERLY. *K.A. Welsh, J.C.S. Breltner, K.M. Magruder-Habib. Bryan Alzheimer's Disease Research Center, Duke University, Durham, North Carolina, 27710 USA. A new Telephone Interview for Cognitive Status (TICS) appears promising a s a m e a n s of screenlng coqnltiv, function in .ituatlon, where tradltional methods of in-person interviewing is not feasible. The procedure has apparent discriminative validity in cllnical samples studied in the laboratory [Brandt et al, 1988, Neuropsychiatr. Neuropsyc/~ol. Behav. Neurol. 1, 111-117]; however, the predictive validlty of the TICS in noncllnical populations where impairments may be subtle has not been established, in the present study we explored the validity of the TICS in a sample of 208 elderly residents of congregate housing facilitles. Subjects were clinlcally examined and placed into one of three groups [normal (M-165); questionable- without clear evidence of dementia (N=23); demented (N=20)] based on their performance on a brief neuropsychological assessment [Esllnger et al, 1985; JAMA, 253, 670-674]. The results of the TICS were compared against clinical aseigrumnt. Based on this procedure, the Receiver Operating Characteristics of the TICS revealed 85% sensitivity with specificity of 83.1% at a cutoff score of ~30/50. Logistic regression and weighting of indivldual items yielded Improved sensitivity of 90.0% with specificity of 83.1% Identical cut-off procedures correctly c l a s s i f l e d a 1 1 of 19 cllnic patients with Probable AD (NINCD~ criteria). The results suggest that the TICS m a y be a sensitive screen for subtle cognitive impairment in the elderly. It must be emphasized that telephone screening does not replace a clinical evaluatlcn of dementia but it may provide an economical alternative screening approach for research studies where in-person interviewing may not be fsaslble. Supported by the Sandoz Foundation for Gerontologic Research and NIH grant AG07922.
32 USE O F C U E D R E C A L L A N D S E L E C T I V E R E M I N D I N G T O D E T E C T D E M E N T I A I N A G E R I A T R I C P O P U L A T I O N . *R.A. J e n k i n and R.D. I--lelme, National Research Irmtitute o f Gerontology and G e r i a t r i c Medicine, M o u n t Royal Hospital, Parkville, Victoria, 30.52, A U S T R A L I A . A l z h e i m e r ' s disease is one of the most c o m m o n dementias associated with ageing. This study was undertaken to v e r i f y the use of specific neuropsychological tests for m e m o r y in conjunction with more general mental status tests in the detection of cognitive i m p a i r m e n t suggestive of early A l z h e i m e r ' s disease in a geriatric population. T w o specific m e m o r y tasks were investigated - cued rec~dl (CR; 1) and selective r e m i n d i n g (SR; 2) - together with a general cognitive screening instrument - the ten item H o d k i n s o n ' s Mental Test Score (MTS; 3). 77 subjects (51 female and 26 male) were recruited f r o m acute care and nursing h o m e wards at Mount Royal Hospital. Subjeet~ were excluded if there was clinical evidence of psychiatric disease, epilepsy, alcohol or d r u g related cognitive i m p a i r m e n t or Parkinson's disease. For p e r f o r m a n c e analysis, subjeets were divided into three g r o u p s on the basis o f their MTS; group 1 scores 0 - 4 (n = 13), group 2 scores 5 - 7 (21) and g r o u p 3 scores 8 - 10 (43). G r o u p 1 subjects were significantly older than those in g r o u p 3 but not than those in group 2. T h e education level for all groups was equivalent at 8.2 + 0.2 years. A comparison of the p e r f o r m a n c e of the three groups on both the C R and S R tasks showed that group 1 p e r f o r m e d significantly worse than both g r o u p s 2 and 3 and that s u b j e c t s in group 2 also showed poorer p e r f o r m a n c e on both tasks than subjects in group 3 (CR: m e a n total recall (out of possible 32 items) for group 1 - 10.1 +_ 1.4 (s.e.m),
group 2 = 15.2 + 0.7, group 3 = 20.2 + 0.6, P < 0.01 tot aii comparisons, Student's T-test; SR: m e a n m a x i m u m n u m b e r of words r e m e m b e r e d (on any one trial out of possible 12 items) for group 1 = 4.1 0.5, group 2 = 6.9 + 0 . 4 , group 3 = 9 . 7 +_0.3, P < 0 . 0 0 1 for all comparisons, Student's T-test). Individual components of both tasks including free recall on the CR, and m a x i m u m n u m b e r of words encoded into long term m e m o r y on the SR task, also showed significant d i f f e r e n c e s between the groups. Matching subjects for age failed to remove the significance of the differences in performance on all aspects of both tasks across all the groups. The present study suggests that using specific m e m o r y tasks in conjunction with more general cognitive evaluation tests could provide a simple but useful means ~f screening a geriatric population for cognitive impairment. 1. G r o b e r , E. et al., Neurology, 1988; 38:900 - 903. 2 Buschke, H., J. Verbal Learning & Behaviour, 1973; 12:543 - 550. 3. ltodkinson, H., Age and Ageing, 1972: [: 233 - 238.
NEUROIMAGING/BRAIN ENERGY METABOLISM
33 BRAIN E N E R G Y M E T A B O L I S M AND ITS SIGNIFICANCE FOR ALZHEIMER'S DISEASE. *S. Hoyer. Dept. of Pathochemistry & General Neurochemistry, University of Heidelberg, D-6900 Heidelberg, FRG The sufficient formation and turn-over rate of energy as ATP guarantees the maintainance of intracellular ion homeostasis, axoplasmatic flux, synapse function and structural integrity of a neuron. In the healthy brain, ATP derives from glucose only, the glycolytic breakdown of which yields 20 ~ of total ATP only, whereas 80 ~ of total ATP are formed by glucose oxidation. Any perturbation of the neuronal glucose metabolism may thus give rise to a cellular energy deficit which subsequently induces abnormalities in neuronal homeostasis and thus neuronal stress. In normoglycemic patients suffering from early-onset dementia of Alzheimer type (DAT), an early and predominant disturbance was found in a 44 ~ reduction in cerebral glucose utilization whereas cerebral blood flow and oxygen utilization were unaltered. In normoglycemic late-onset DAT. cerebral glucose utilization was likewise diminished, but cerebral blood flow and oxygen utilization were starting to fall. In both conditions, there is evidence that the disturbance in neuronal glucose homeostasis generates neuronal stress because of an energy deficit and changes in the amino acid composition at the cellular level. The latter includes an increase of the concentration of aspartic acid which may change the neuronal calcium homeostasis via the N-methyl-D-aspartate receptor, and an increase in ammonia to neurotoxic levels, the latter being a potent factor for glial proliferation. Cellular stress is assumed to induce the amyloid A4 precursor gene via heat shock activator proteins which bind specifically to heat shock control elements of that gene. Thus, the damage in neuronal glucose homeostasis and related metabolism may play a pivotal role in the generation of amyloid in DAT brain, and may precede this morphological abnormality.
34
REGIONAL D~ICITS IN CORTICAL METABOLI~ IN PET-
f~cEs ~ ~
~:NOT Wt~ C ~
ACETYL~RASE. *P.L ~ , E.G. ~ r , H. Akiyama, R. Harrop. Kinsmen Laboratory of Neurotog~l Research, Dept. of Psychiatry, U.B.C., vancouver V6T 1W5;