Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-18T17:02:21.517Z Has data issue: false hasContentIssue false

Screening for Alzheimer's dementia at age 78 with short psychometric instruments

Published online by Cambridge University Press:  27 March 2009

S. Jungwirth*
Affiliation:
Ludwig Boltzmann Institute of Aging Research, Vienna, Austria
S. Zehetmayer
Affiliation:
Medical University of Vienna, Section for Medical Statistics, Vienna Austria
P. Bauer
Affiliation:
Medical University of Vienna, Section for Medical Statistics, Vienna Austria
S. Weissgram
Affiliation:
Ludwig Boltzmann Institute of Aging Research, Vienna, Austria
K. H. Tragl
Affiliation:
Ludwig Boltzmann Institute of Aging Research, Vienna, Austria
P. Fischer
Affiliation:
Ludwig Boltzmann Institute of Aging Research, Vienna, Austria Department of Psychiatry, Danube Hospital, Vienna, Austria
*
Correspondence should be addressed to: Susanne Jungwirth, Ludwig Boltzmann Institute of Aging Research, Langobardenstraße 122, 1220 Vienna, Austria. Phone: +43 1 28802 4209; Fax: +43 1 28802 4281. E-mail: [email protected].
Get access

Abstract

Background: To date, no single instrument has proved to be adequate for screening for Alzheimer's dementia (AD). The aim of this study was to identify a combination of instruments which were highly sensitive for screening late onset AD.

Methods: Subjects were drawn from the Vienna TransDanube Aging (VITA) study. This is an interdisciplinary, longitudinal community-based cohort study of the 21st and 22nd district of Vienna (Austria). Data refer to the cohort of 478 individuals at age 78 who took part in the first follow-up investigation of the VITA study. The psychometric instruments which were investigated were: the Ten-Point Clock Test, the Human-Figure Drawing Test, a Delayed Selective Reminding Test, Naming, the Trail Making Test-B, and Verbal Fluency. Further instruments were the Pocket Smell Test, and Subjective Memory Complaints. Data were analyzed using logistic regression analyses and cross validation.

Results: A combination of the Delayed Selective Reminding Test and Verbal Fluency was best for screening AD (R2 = 0.38, main model). An area under the ROC curve of 0.829 was reached. This model discriminated between subjects with incident AD and subjects who did not have incident AD with a sensitivity of 91% and a specificity of 56%.

Conclusion: The combination of an episodic memory test and a test of verbal fluency was an effective way of screening for AD.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arnold, S. E., Smutzer, G. S., Trojanowski, J. Q. and Moberg, P. J. (1998). Cellular and molecular neuropathology of the olfactory epithelium and central olfactory pathways in Alzheimer's disease and schizophrenia. Annals of the New York Academy of Sciences, 855, 762775.CrossRefGoogle ScholarPubMed
Bayles, K. A. (1991). Age at onset of Alzheimer's disease: relation to language dysfunction. Archives of Neurology, 48, 155159.CrossRefGoogle ScholarPubMed
Benke, T., Andree, B., Hittmair, M. and Gerstenbrand, F. (1990). Sprachveränderungen bei der Demenz. Fortschritte der Neurologie, Psychiatrie, 58, 215223.CrossRefGoogle Scholar
Berres, M., Monsch, A. U., Bernasconi, F., Thalmann, B. and Stähelin, H. B. (2000). Normal ranges of neuropsychological tests for the diagnosis of Alzheimer's disease. Studies in Health Technology and Informatics, 77, 195199.Google ScholarPubMed
Burke, W. J., Houston, M. J., Boust, S. J. and Roccaforte, W. H. (1989). Use of the Geriatric Depression Scale in dementia of the Alzheimer type. Journal of the American Geriatrics Society, 37, 856860.CrossRefGoogle ScholarPubMed
Buschke, H. and Fuld, P. A. (1974). Evaluating storage, retention, and retrieval in disordered memory and learning. Neurology, 24, 10191020.CrossRefGoogle ScholarPubMed
Chodosh, J. et al. (2004). Physician recognition of cognitive impairment: evaluating the need for improvement. Journal of the American Geriatrics Society, 52, 10511059.CrossRefGoogle ScholarPubMed
Crowe, S. F. (1998). The differential contribution of mental tracking, cognitive flexibility, visual search, and motor speed to performance on Parts A and B of the Trail Making Test. Journal of Clinical Psychology, 54, 585591.3.0.CO;2-K>CrossRefGoogle Scholar
Davies, D. C., Brooks, W. and Lewis, D. A. (1993). Axonal loss from the olfactory tracts in Alzheimer's disease. Neurobiology of Aging, 14, 353357.CrossRefGoogle ScholarPubMed
Derouesné, C., Thibault, S., Lagha-Pierucci, S., Baudouin-Madec, V., Ancri, D. and Lacomblez, L. (1999). Decreased awareness of cognitive deficits in patients with mild dementia of the Alzheimer's type. International Journal of Geriatric Psychiatry, 14, 10191030.3.0.CO;2-F>CrossRefGoogle Scholar
Elsner, R. J. (2001). Use and limitation of olfactory tests in diagnosis of Alzheimer's disease. Brain Aging, 1, 811.Google Scholar
Ericsson, K., Forsell, L., Amberla, K., Holmen, K., Viitanen, M. and Winblad, B. (1991). Graphic skills used as an instrument for detecting higher cortical dysfunctions in old age. Human Movement Science, 10, 335349.CrossRefGoogle Scholar
Fischer, P. et al. (1990). Memory deficits in advanced Parkinson's disease. Journal of Neural Transmission, 2, 5970.Google ScholarPubMed
Fischer, P. et al. (2002). Vienna-Transdanube-Aging “VITA” study: design, recruitment strategies and level of participation. Journal of Neural Transmission, 62 (Suppl.), 103114.Google Scholar
Fischer, P. et al. (2007). Conversion from subtypes of mild cognitive impairment to Alzheimer dementia. Neurology, 68, 288291.CrossRefGoogle ScholarPubMed
Fletcher, R. H. and Fletcher, S. W. (1996). Clinical Epidemiology: The Essentials. Baltimore: Williams & Wilkins.Google Scholar
Goodenough, F. L. (1926). The Measurements of Intelligence by Drawings. New York: World Book Company.Google Scholar
Hastie, T., Tibshirani, R. and Friedman, J. (2001). The Elements of Statistical Learning: Data Mining, Inference, and Prediction. New York: Springer.CrossRefGoogle Scholar
Heun, R., Papassotiropoulos, A. and Jennssen, F. (1998). The validity of psychometric instruments for detection of dementia in the elderly general population. International Journal of Geriatric Psychiatry, 13, 368380.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
Holtzer, R. et al. (2005). Depressive symptoms in alzheimer's disease: natural course and temporal relation to function and cognitive status. Journal of the American Geriatrics Society, 53, 20832089.CrossRefGoogle ScholarPubMed
Huber, W., Poeck, K., Weninger, D. and Willmes, K. (1983). Aachener Aphasie Test (AAT). Göttingen: Verlag für Psychologie, Hogrefe.Google Scholar
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566572.CrossRefGoogle ScholarPubMed
Jorm, A. F., Christensen, H., Henderson, A. S., Korten, A. E., Mackinnon, A. J. and Scott, R. (1994). Complaints of cognitive decline in the elderly: a comparison of reports by subjects and informants in a community survey. Psychological Medicine, 24, 365474.CrossRefGoogle Scholar
Kotler-Cope, S. and Camp, C. J. (1995). Anosognosia in Alzheimer disease. Alzheimer Disease and Associated Disorders, 9, 5256.CrossRefGoogle ScholarPubMed
Lawton, M. and Brody, E. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179186.CrossRefGoogle ScholarPubMed
Lee, H., Swanwick, G. R. J., Coen, R. F. and Lawlor, B. A. (1996). Use of the clock drawing task in the diagnosis of mild and very mild Alzheimer's disease. International Psychogeriatrics, 8, 469476.CrossRefGoogle ScholarPubMed
Manos, P. J. (1999). Ten-point clock test sensitivity for Alzheimer's disease in patients with MMSE scores greater than 23. International Journal of Geriatric Psychiatry, 14, 454458.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Masur, D. M., Fuld, P. A., Blau, A. D., Thal, L. J., Levin, H. S. and Aronson, M. K. (1989). Distinguishing normal and demented elderly with the Selective Reminding Test. Journal of Clinical and Experimental Neuropsychology, 11, 615630.CrossRefGoogle ScholarPubMed
McKeith, I. G. et al. (1996). Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology, 47, 11131124.CrossRefGoogle Scholar
McKhann, G., Drachman, D., Folstein, M., Katzmann, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology, 34, 939944.CrossRefGoogle ScholarPubMed
Monsch, A. U., Seifritz, E., Taylor, K. I., Ermini-Funfschilling, D., Stahelin, H. E. and Spiegel, R. (1997). Category fluency is also predominantly affected in Swiss Alzheimer's disease patients. Acta Neurologica Scandinavica, 95, 8184.CrossRefGoogle ScholarPubMed
Morris, J. C. et al. (1989). The Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Part I. Clinical and neuro-psychological assessment of Alzheimer's disease. Neurology, 39, 11591165.Google Scholar
Perry, R. J. and Hodges, J. R. (1999). Attention and executive deficits in Alzheimer's disease. A critical review. Brain, 122, 383404.CrossRefGoogle ScholarPubMed
Philpot, M. (2004). Guest editorial. The clock-drawing test: a critique. International Psychogeriatrics, 16, 251256.CrossRefGoogle Scholar
Reid, L. M. and MacLullich, A. M. J. (2006). Subjective memory complaints and cognitive impairment in older people. Dementia and Geriatric Cognitive Disorders, 22, 471485.CrossRefGoogle ScholarPubMed
Reid, M. C., Lachs, M. S. and Feinstein, A. R. (1995). Use of methodological standards in diagnostic test research. JAMA, 274, 645651.CrossRefGoogle ScholarPubMed
Reid, W. et al. (1996). Age at onset and pattern of neuropsychological impairment in mild early-stage Alzheimer disease: a study of a community-based population. Archives of Neurology, 53, 10561061.CrossRefGoogle ScholarPubMed
Reisberg, B. et al. (1999). Retrogenesis: clinical, physiologic, and pathologic mechanisms in brain aging, Alzheimer's and other dementing processes. European Archives of Psychiatry and Clinical Neuroscience, 249, 2836.CrossRefGoogle ScholarPubMed
Reitan, R. M. (1956). Trail Making Test. Manual for Administration, Scoring, and Interpretation. Indianapolis: Indiana University.Google Scholar
Román, G. C. et al. (1993). Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN international workshop. Neurology, 43, 250260.CrossRefGoogle ScholarPubMed
Sager, M. A., Hermann, B. P., La Rue, A. and Woodard, J. L. (2006). Screening for dementia in community-based memory clinics. Wisconsin Medical Journal, 105, 2529.Google ScholarPubMed
Saß, H., Wittchen, H. U. and Zaudig, M. (1996). Diagnostisches und statistisches Manual psychischer Störungen DSM-IV. Göttingen: Hogrefe.Google Scholar
Seigerschmidt, E., Mösch, E., Siemen, M., Förstl, H. and Bickel, H. (2002). The clock drawing test and questionable dementia: reliability and validity. International Journal of Geriatric Psychiatry, 17, 10481054.CrossRefGoogle ScholarPubMed
Sheikh, J. I. and Yesavage, J. A. (1986). Geriatric Depression Scale (GDS). recent evidence and development of a shorter version. Clinical Gerontology, 5, 165173.Google Scholar
Shulman, K. I. et al. (2006). IPA survey of brief cognitive screening instruments. International Psychogeriatrics, 18, 281294.CrossRefGoogle ScholarPubMed
Villareal, D. T., Grant, E., Miller, J. P., Storrandt, M., McKeel, D. W. and Morris, J. C. (2003). Clinical outcomes of possible versus probable Alzheimer's disease. Neurology, 61, 661776.CrossRefGoogle ScholarPubMed
Vogel, A., Stokholm, J., Gade, A., Andersen, B. B., Hejl, A. M. and Waldemar, G. (2004). Awareness of deficits in mild cognitive impairment and Alzheimer's disease: do MCI patients have impaired insight? Dementia and Geriatric Cognitive Disorders, 17, 181187.CrossRefGoogle ScholarPubMed
Wang, H. X., Ericsson, K., Winblad, B. and Fratiglioni, L. (1998). The Human Figure Drawing test as a screen for dementia in the elderly: a community-based study. Archives of Gerontology and Geriatrics, 27, 2534.CrossRefGoogle ScholarPubMed
Wilson, R. S., Schneider, J. A., Bienias, J. L., Arnold, S. E., Evans, D. A. and Bennett, D. A. (2003). Depressive symptoms, clinical AD, and cortical plaques and tangles in older persons. Neurology, 61, 11021107.CrossRefGoogle ScholarPubMed