Validity of the clinical dementia rating for early screening of Alzheimer's disease in community / 中华行为医学与脑科学杂志

Objective:To verify the validity of the clinical dementia rating(CDR) for early screening of Alzheimer's disease in the community.Methods:One thousand two hundred and eighty-one community volunteers (580 males and 701 females) came to hospital for clinical interviews, laboratory tests and a series of psychological assessment, including CDR, brief elderly cognitive screening inventory (BECSI), quickly cognitive screening scale for elderly (QCSS-E), mini-mental state examination (MMSE) and core neurocognitive test (CNT). According to clinical interview, assessment and DSM-5 criteria, 623 normal cognition, 570 mild cognitive impairment (MCI) and 88 dementia with Alzheimer's type (DAT) were screened.Results:(1) The results of CDR-global scores (CDR-GS)in the community volunteers showed that 506 (39.5%) scored 0, 688 (53.7%) scored 0.5, 72 (5.6%) scored 1, and 15 (1.2%) scored 2 or more.(2) There were significantly differences on the BECSI score, QCSS-E score, MMSE score and CNT score among people with different CDR-GS ( P<0.01). In the total or dementia sample, CDR-sum of box score (CDR-SB) and CDR-GS were significantly correlated with BECSI score ( r=0.577-0.639), QCSS-E score ( r=-0.586--0.680), MMSE score ( r=-0.570--0.764) and CNT score ( r=-0.244--0.357)( P<0.01). (3) The accuracy (95.8%) and specificity (99.8%) of the CDR-GS screening DAT were slightly higher than those of the CDR-SB(91.1%, 92.0%), and its sensitivity (65.9%) was lower than that of CDR-SB(82.5%). The accuracy (72.6%), sensitivity (81.9%) and specificity (64.0%)of the CDR-GS were close to those of CDR-SB(72.1%, 83.3%, and 61.8% respectively) in screening MCI. Conclusion:The CDR can be used for screening of AD in community populations.CDR-GS and CDR-SB have their own advantages, and combination of both advantages can improve the screening efficiency.

Association of head circumference with cognitive decline and symptoms of depression in elderly: a 3-year prospective study / 영남의대학술지

BACKGROUND: Brain volume is associated with dementia and depression in the elderly. An easy way to predict relative brain volume is to measure head circumference. In this study, we investigated the relationship between head circumference and cognition as well as depression in a non-demented elderly community.METHODS: Baseline and follow-up surveys were conducted in 2007 and 2010. At baseline, community residents aged 65 years or over (n=382) within a rural area of South Korea were screened for dementia and symptoms of depression and were followed using the same screening battery after 3 years (n=279). Data from anthropometric measurements (head circumference, height, and body weight), demographics, and blood tests were gathered. Neuropsychological tests, including the Korean version of mini-mental state examination (K-MMSE), clinical dementia rating (CDR) including the CDR-sum of boxes, the Korean version of instrumental activities of daily living, and geriatric depression scale (GDS), were performed. None of the 279 subjects followed were demented.RESULTS: Baseline performance on the K-MMSE and GDS was poorer for participants with smaller head circumferences. Follow-up performance on the MMSE was also poorer for participants with smaller head circumferences. Interestingly, participants with smaller head circumference showed worse GDS scores at baseline but on follow-up examination, participants with larger head circumference showed rapid worsening than those with smaller head circumference with marginal significance by ANOVA test. In regression coefficient analysis, GDS decline showed significant difference.CONCLUSION: Head circumference was not associated with cognitive change but was associated with symptoms of depression in non-demented community residents.

Validación y precisión de la escala de deterioro global (GDS) para establecer severidad de demencia en una población de Lima / Validation and diagnostic accuracy of the global deterioration scale (GDS) to establish severity of dementia in a population of Lima

Resumen Objetivo : validar y evaluar el rendimiento de la Global Deteriorarion Scale (GDS) en una población que acude a una unidad especializada de Lima. Pacientes y métodos: investigación de tipo transversal con un diseño descriptivo comparativo. El estudio incluyó 215 individuos seleccionados de forma abierta, que acudieron a la unidad de diagnóstico de deterioro cognitivo y prevención de demencia. Se estudiaron tres grupos: 60 controles, 40 con diagnóstico de deterioro cognitivo leve y 115 con demencia. Los individuos fueron sometidos a evaluaciones sucesivas: cribado, diagnóstico y estadiaje de demencia y tipo de demencia. La validez y fiabilidad de la clasificación de severidad fue demostrada mediante la concordancia entre la medición del Global Deteriorarion Scale con el Clinical Dementia Rating (CDR). El rendimiento de Global Deteriorarion Scale se valoró mediante la obtención de los valores de sensibilidad y especificidad. Resultados : los promedios de edad fueron de 69, 70, y 74 años para los controles, los pacientes con deterioro cognitivo leve y los pacientes con demencia, respectivamente. La Global Deteriorarion Scale tuvo una buena correlación con Clinical Dementia Rating (r de Spearman =0,97; P=0,0001). La sensibilidad de la escala para establecer estadio de demencia fue de 79 %, con especificidad del 100 % para cualquier categoría de demencia según los criterios diagnósticos estándares y según Clinical Dementia Rating. Conclusiones : se encontró una correlación casi perfecta entre Global Deteriorarion Scale y Clinical Dementia Rating; sin embargo, la Global Deteriorarion Scale presenta una sensibilidad moderada para establecer el estadio de demencia con respecto a Clinical Dementia Rating, mostrando además ser utilidad en el diagnóstico de deterioro cognitivo leve.

Abstract Objective: To validate and evaluate diagnostic accuracy of the Global Deteriorarion Scale (GDS) in a population of a specialized unit of Lima. Patients and Methods: This research is a comparative cross-sectional descriptive design. The study included 215 individuals selected openly, who attending in the diagnostic unit of cognitive impairment and dementia prevention. Three groups were studied: 60 controls, 40 individuals diagnosed with mild cognitive impairment (MCI) and 115 with dementia diagnosis. They were assessments in three phases: screening, diagnosis and staging of dementia, and type of dementia. The validity and reliability of the classification of severity was demonstrated by measuring the correlation between the GDS with the CDR (Clinical Dementia Rating). The diagnostic accuracy of GDS was evaluated by obtaining the values of sensitivity and specificity. Results: The average age was 69, 70, and 74 years for controls, patients with MCI and patients with dementia respectively. GDS had a good correlation with CDR (Spearman r = 0.97, P = 0.0001). The sensitivity of the GDS to set stage of dementia for any category of dementia was 79 % and specificity of 100 % according to standard diagnostic criteria and according to CDR. Conclusions: We demonstrated an almost perfect correlation between GDS and CDR, however GDS has a moderate sensitivity to set the stage dementia regarding CDR also proving to be useful in the diagnosis of MCI.

Clinical Dementia Rating Orientation Score as an Excellent Predictor of the Progression to Alzheimer's Disease in Mild Cognitive Impairment

OBJECTIVE: This study aimed to examine the usefulness of each subscale score of the Clinical Dementia Rating (CDR) for predicting Alzheimer's disease (AD) dementia progression in amnestic mild cognitive impairment (MCI) elderly subjects. METHODS: Fifty-nine elderly MCI individuals were recruited from a university dementia and memory disorder clinic. Standardized clinical and neuropsychological tests were performed both at baseline and at the time of 2 years follow-up. Logistic regression analyses were conducted to examine the ability of various clinical measures or their combinations to predict progression to AD dementia in MCI individuals. RESULTS: MCIp individuals showed significantly higher CDR Orientation subscale and CDR sum-of-boxes (SOB) score than MCInp ones, while there were no significant differences in other CDR subscale scores between the two. MCIp individuals also showed marginally higher MMSE scores than MCInp ones. A series of logistic regression analyses demonstrated that the model including CDR Orientation subscale had better AD dementia prediction accuracy than either the model with either MMSE or CDR-SOB. CONCLUSION: Our findings suggest that CDR Orientation subscale score, a simple and easily available clinical measure, could provide very useful information to predict AD dementia progression in amnestic MCI individuals in real clinical settings.

Cognitive functioning in patients presenting with memory problems: A study from Gandhi Hospital A Tertiary Care Teaching Government Hospital of Hyderabad

Background: Many people come to memory clinic for memory problems, most of them for the fear of developing dementia. Majority of such subjects are normal however a sizable number show cognitive decline on Neuro-psychological tests. Aim and objectives: The aim of this study was to find out the incidence of normal cognition, mild cognitive impairment and dementia in patients attending Memory Clinic of Gandhi Hospital with forgetfulness. Santhoshi Kumari CH, Kamera S, Narisetty V, Jala S, Pokalkar D. Cognitive functioning in patients presenting with memory problems: A study from Gandhi Hospital – A Tertiary Care Teaching Government Hospital of Hyderabad. IAIM, 2016; 3(10): 42-47. Page 43 Materials and methods: Patients attending Neurology OPD with memory complaints were initially screened for any neurological deficit by a neurologist. Then a Psychologist assessed cognition with Neuro-psychological tests. A total of 1894 patients attending the memory clinic from January 2007 to June 2015 were included in the study. Results: Normal cognition was seen in 62% (n=1,166) and were labeled as Worried Well. Another 17% (n=328) were with borderline problems in cognition and were categorized as Mild Cognitive Impairment and the remaining 21% (n=400) were diagnosed with abnormal cognition and diagnosed as dementia. Atherosclerotic risk factors such as hypertension, diabetes, coronary artery disease, smoking and alcoholism were higher in the subjects who had abnormal results on neurocognitive tests. Conclusion: Many patients seek medical help for forgetfulness and fear of developing dementia. Majority of them have normal cognition on neuropsychological tests. Patients having abnormality on cognitive evaluation also have atherosclerotic risk factors. Dementia was detected in 23% of patients attending Memory Clinic.

Elderly and Dementia in Nepal / 国際保健医療

<b>Background</b><BR>  Dementia is defined as a decline in cognition or behavior in one or more of the following areas: memory, social-interpersonal behaviors etc. It is regarded differently depending on the society of each country. To compare the effect that it has on Japanese society, we started research in Nepal.<BR><b>Methods</b><BR>  We asked Medical doctors and nurses in remote areas and the capital city in Nepal about their awareness of dementia. We also examined the elderly in communities and hospitals, using the Mini-Mental State Examination (MMSE) and Hasegawa Dementia Scale Revised (HDS-R), and asked family members about the elderly’s daily life and checked Clinical Dementia Rating (CDR).<BR><b>Results</b><BR>  Three out of six medical staff members in remote areas did not know the word “dementia.” However, most medical staff had seen cases of suspected dementia. The averages and deviations of MMSE and HDS-R in 6 elderly in community were 16±4.2 and 17±5.0, respectively. The average of CDR was 0.9.<BR><b>Conclusions</b><BR>  There was a lack of awareness about dementia in remote areas. Nepali society was found to be tolerant of aging and dementia.

A Comparison of the Performances on the MMSE, HDS-R, and MoCA According to the CDR Sum of Boxes in Amnestic Mild Cognitive Impairment and Vascular Mild Cognitive Impairment

BACKGROUND: O'Bryant et al. (2008) argued that the CDR Sum of Boxes (CDR-SB) can be used to distinguish MCI from very early dementia in patients with CDR-GS of 0.5. They reported that the optimal CDR-SB cut-off score was 2.5. The present study was conducted to examine whether the subgroups classified with CDR-SB scores showed the corresponding group differences on the cognitive tests. METHODS: The subjects were 45 amnestic multi-domain MCI (amMCI) and 53 vascular MCI (VaMCI) with CDR-GS of 0.5. Each patient group was classified into "mild (0.5-2.0)" and "severe (2.5-4.0)" subgroups based on the CDR-SB. As the result, 4 groups were formed such as mild amMCI (n=23), severe amMCI (n=22), mild VaMCI (n=29), and severe VaMCI (n=24). The subjects were given the MMSE, HDS-R, and MoCA. The MANCOVA was conducted separately for each test with a Bonferroni correction for multiple comparisons. RESULTS: Severe groups of both amMCI and VaMCI showed significantly lower performances than two mild groups in MMSE, HDS-R, and MoCA. It was found that "serial 100-7" was a good item to discriminate between the mild and severe groups in both amMCI and VaMCI. Items measuring "orientation" or "naming" showed significant subgroup differences in the amMCI, whereas items related to "memory," "visuospatial construction," or "frontal/executive function" showed significant subgroup differences in the VaMCI. CONCLUSION: These results showed that there were significant differences in cognitive functions between the two subgroups with CDR-GS of 0.5. The results about the items discriminating between subgroups in amMCI and VaMCI were consistent with the previous findings about the progression of cognitive impairments in AD and VaD. Therefore, these results support the use of CDR-SB as a guideline for distinguishing MCI from early dementia.

Clinical profile of dementia and its association with homocysteine.

Background & Objectives : Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal ageing. This cross sectional study was undertaken to study clinical profile of dementia and its association with plasma homocysteine levels. Methods : 30 patients (indoor or outdoor) > 55 years with dementia were screened on Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR) Scale. A clinical dementia rating questionnaire was asked and plasma homocysteine levels measured by ELISA using Bio-rad reagents. Data was collected and statistically analyzed. Results : There was a statistically significant correlation between loss of memory (p = 0.047), orientation (p = 0.038), judgement/problem solving (p = 0.048), outer (p = 0.042), household (p = 0.048) and personal care activity (p = 0.0099) with hyperhomocysteinemia. A statistically significant correlation was found between CDR (p = 0.0081) and MMSE (p = 0.0095) score with hyperhomocysteinemia. Interpretation & Conclusion : A significant correlation was seen between memory loss, worsening of cognitive dementia, limitation of household activity, worsening of personal care, impairment of judgment and problem solving with hyperhomocysteinemia. As hyperhomocysteinemia can be effectively treated with a low cost therapy of B vitamin supplements, it is important to recognize these problems and treat them early.

Olfactory Dysfunction and Cognitive Impairment

BACKGROUND: The aim of the current study was to investigate the changes of the olfactory function in the Korean elderly population related to cognitive decline by using the CDR (Clinical Dementia Rating scale) and KVSS Test (Korean Version of Sniffin' Sticks Test). METHODS: 41 subjects between the ages of 65-85 years, were included in this study. All subjects were screened to exclude conditions affecting olfactory functions. These subjects were divided into three groups according to CDR. 23 subjects belonged to the CDR 0 group, 9 to the CDR 0.5 group and 9 to the CDR 1 group. The KVSS Test consisted of the olfactory threshold test and olfactory identification test. RESULTS: Significant differences were found among the CDR 0 group, CDR 0.5 group and CDR 1 group (p0.05). CONCLUSIONS: These results suggest that the cognitive deficits were associated with the decrease of scores in the olfactory identification test and that the olfactory identification test may have clinical utility in the diagnosis of the dementia.