Effects of educational background on verbal fluency task performance in older adults with Alzheimer's disease and mild cognitive impairment.

BACKGROUND: Previous studies have shown that the verbal fluency test (VFT) is a sensitive measure of cognitive dysfunction in Alzheimer's disease (AD). However, other studies have shown that the performances were significantly influenced by education in the normal elderly population. In order to examine the utility of the VFT as a tool for screening for AD, it is necessary to study the effect of education not only in the cognitively intact population but also in the population of early AD patients. METHODS: Patients with AD (n = 345) and individuals with amnestic type of mild cognitive impairment (MCI) (n = 123) were asked to generate as many words as possible belonging to a category "animal" and beginning with " [ka]" in syllabic Japanese "kana" script. In order to determine the education effect after adjusting for age and cognitive state on the VFT performance in early stage of AD, we performed multiple regression analysis with 396 individuals including both amnestic MCI and AD. RESULTS: After adjusting for patients' age, sex, and cognitive state, the years of education were significantly related to category fluency test scores, but not significantly related to letter fluency test scores. CONCLUSION: Our results demonstrated that a category fluency performance reflected not only AD-specific changes but also educational background. These results suggest the limitation of using the category fluency task for screening subjects at risk for developing AD without taking subjects' educational background into consideration.

[An overview and prospect of demented outpatient care in a department of geriatric medicine: report based on statistical review of the memory clinic at the geriatric outpatient unit of the Nagoya University Hospital].

AIM: Although there are many reports regarding the status of memory clinics in Japan, most are from the clinical departments of psychiatry or neurology, and there are few from the geriatric outpatient clinics. This study aimed to review the status of the memory clinic at the geriatric outpatient unit of a university hospital and also to compare the results with other reports. METHODS: Patient records of the memory clinic at the geriatric outpatient unit of the Nagoya University Hospital between January 2000 and June 2006, which included clinical information and neuropsychological profiles were extensively reviewed for statistical analyses. Of the patients who first visited the memory clinic between January 2004 and June 2006, prior written consent are obtained from 232 outpatients, among which 223 individuals who had intact sets of data were subjected to detailed analyses. RESULTS: During the period investigated, we had a total of 778 visits by 577 patients. The characteristics of patients were: age: 74.5+/-8.3 years; MMSE: 23.8+/-4.7; education year: 10.7+/-2.9. Clinical profiles of the patients who visited during the most recent 2.5 years were as follow: cognitively normal, 8.1%; dementia of Alzheimer's type, 45.3%; vascular type, 5.4%; mixed type, 2.2%; frontotemporal dementia, 3.1%; mild cognitive impairment, 15.7%, and others. CONCLUSION: Compared with previous reports from other institutions, we observed that the visitors to our geriatric memory clinic had a relatively higher educational background with earlier stages of dementing disorders, which also included pre-clinical cognitive impairment.

[The delayed word recall task using ADAS-Jcog word booklet effectively divides patients with mild cognitive impairment from normal elderly people].

AIM: A new screening test for detecting mild cognitive impairment (MCI) with higher sensitivity that can easily be administered at the bedside is necessary. In this study, we proposed the delayed recall task using the word booklet of Alzheimer's Disease Assessment Scale-cognitive component-Japanese version (ADAS-Jcog) and compared the score of the task in patients with MCI with that of cognitive normal elderly (NE) and patients with AD. METHODS: Thirty six patients with MCI, 13 very mild AD, 104 mild AD, 13 moderate AD, and age- and education-matched 19 NE, recruited from the memory clinic of Nagoya University Hospital, were evaluated by the ADAS-Jcog word recall task which consisted of immediate recall (IR), a classical method on ADAS-Jcog, and delayed recall (DR) that has been newly introduced. RESULTS: Compared with controls, patients with MCI were significantly impaired on both IR and DR. On the other hand, DR is more sensitive than IR for distinguishing MCI from NE. The highest sensitivity (94.4%) and specificity (68.4%) were achieved when the results of IR were combined with those of DR. CONCLUSION: The result suggests that the delayed word recall task using the word booklet of ADAS-Jcog may be a useful tool as a screening method for the detection of MCI.

The clock drawing test as a valid screening method for mild cognitive impairment.

To validate the Clock Drawing Test (CDT) as a screening method for detecting mild cognitive impairment (MCI) and to find the appropriate scoring protocol and its cutoff point, we compared the sensitivity and specificity of three CDT protocols. Subjects included 219 outpatients with memory complaints, who were attending the geriatric memory clinic. Cahn's protocol, with a cutoff point of 7, was more successful at differentiating clinically diagnosed MCI subjects from normal elderly individuals, with higher sensitivity (74.7%) and specificity (75.6%), than were the other protocols. The CDT, as a handy screening method, may be useful for clinicians to reliably identify subjects with MCI, and it may contribute to early detection of dementia.

Cognitive function in Japanese elderly with type 2 diabetes mellitus.

The current study was conducted to investigate the cognitive function in Japanese elderly with type 2 diabetes mellitus (DM). Participants included 69 diabetic and 27 nondiabetic subjects (60 to 85 years old). The cognitive functional tests conducted were the Mini-Mental State Examination (MMSE), Word Lists Recall (immediate, delayed), Digit Symbol Test (Wechsler Adult Intelligence Scale-Revised [WAIS-R]), and the Stroop Color Word Test. Hemoglobin A1c (HbA1c) was measured as the index of glycemic control, and information about recent hypoglycemic episodes was gathered by using questionnaires. Student's t test showed that DM subjects had significantly lower scores in the MMSE (P<.01) and Digit Symbol Test (P<.05) than non-DM subjects. The scores of the Digit Symbol Test in diabetes subjects had a significant negative relationship with HbA1c (r=-.433; P<.001), and insulin-use had a significant relationship with the scores of the MMSE and Digit Symbol Test. Subjects in the DM group were further divided by insulin use. Comparison of insulin-treated DM subjects, non-insulin-treated DM subjects, and nondiabetic subjects by analysis of variance followed by Bonferroni's post hoc test showed that insulin-treated DM subjects had significantly lower scores in the MMSE and Digit Symbol Tests than both non-insulin-treated DM subjects (P<.05) and nondiabetic subjects (P<.01). Our study suggests that Japanese elderly DM subjects, especially those with insulin treatment, have poor cognitive function.

[An elderly case with sarcoidosis whose symptom of dementia was effectively treated by steroid].

We report a case of a 74-year-old woman whose symptoms of dementia may have been caused by sarcoidosis and in whom steroid treatment was effective. The patient, who had recieved treatment for hypertension, started to exhibit symptoms of dementia one year previously and progressively deteriorated during the month before she was admitted. Brain computed tomography showed multiple lacunae infarctions. Chest X-ray showed mild swelling of bilateral lymph nodes in the mediastinum. The patient was referred to an ophthalmologist because of complaints of disturbed visual field, and bilateral uveitis was diagnosed. Negative tuberculin, high serum ACE value and high absorbance in the lung hila on Ga scintigram were recognized. Lymph node biopsy revealed typical granuloma compatible with sarcoidosis. Cerebrospinal fluid (CSF) showed elevated protein concentration without an increased cell count. EEG showed a diffuse slow wave pattern. We observed the progression of dementia shown by declining scores of Mini-Mental State Examination (MMSE) from 17/30 on admission to 7/30 on day 30 after admission. Although enhanced MRI of the brain showed no typical findings of sarcoidosis, we started treatment with prednisolone (50 mg/day) based on the suspicion that the progression of dementia was caused by sarcoidosis. One month after the start of steroid treatment, we observed gradual improvement of symptoms. The MMSE score increased to 20/30. According to previous reports, elderly sarcoidosis patients relatively rare by show dementia, but sarcoidosis should be considered in the differential diagnosis because steroid treatment can be effective.