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The impact of vascular comorbidities on qualitative error analysis of executive impairment in Alzheimer’s disease

Published online by Cambridge University Press:  19 October 2009

MELISSA LAMAR ,
DAVID J. LIBON ,
ANGELA V. ASHLEY ,
JAMES J. LAH ,
ALLAN I. LEVEY  and
FELICIA C. GOLDSTEIN
MELISSA LAMAR*
Affiliation:
Departments of Psychology & Section of Brain Maturation, Institute of Psychiatry, King’s College London, London, England
DAVID J. LIBON
Affiliation:
Department of Neurology, Drexel University College of Medicine, Philadelphia, Pennsylvania
ANGELA V. ASHLEY
Affiliation:
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
JAMES J. LAH
Affiliation:
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
ALLAN I. LEVEY
Affiliation:
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
FELICIA C. GOLDSTEIN
Affiliation:
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
*
*Correspondence and reprint requests to: Melissa Lamar, Institute of Psychiatry, King’s College London, M6.01, P050 De Crespigny Park, London SE5 8AH. E-mail: [email protected]
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Abstract

Recent evidence suggests that patients with Alzheimer’s disease (AD) and vascular comorbidities (VC) perform worse across measures of verbal reasoning and abstraction when compared to patients with AD alone. We performed a qualitative error analysis of Wechsler Adult Intelligence Scale-III Similarities zero-point responses in 45 AD patients with varying numbers of VC, including diabetes, hypertension, and hypercholesterolemia. Errors were scored in set if the answer was vaguely related to how the word pair was alike (e.g., dog-lion: “they can be trained”) and out of set if the response was unrelated (“a lion can eat a dog”). AD patients with 2–3 VC did not differ on Similarities total score or qualitative errors from AD patients with 0–1 VC. When analyzing the group as a whole, we found that increasing numbers of VC were significantly associated with increasing out of set errors and decreasing in set errors in AD. Of the vascular diseases investigated, it was only the severity of diastolic blood pressure that significantly correlated with out of set responses. Understanding the contribution of VC to patterns of impairment in AD may provide support for directed patient and caregiver education concerning the presentation of a more severe pattern of cognitive impairment in affected individuals. (JINS, 2010, 16, 77–83.)

Keywords

Alzheimer’s diseaseVascular comorbidityVerbal reasoningDiabetesHypertensionHypercholesterolemia
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 16 , Issue 1 , January 2010 , pp. 77 - 83
Copyright
Copyright © The International Neuropsychological Society 2009

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References

REFERENCES

Arvanitakis, Z., Wilson, R.S., Bienias, J.L., Evans, D.A., & Bennett, D.A. (2004). Diabetes mellitus and risk of Alzheimer disease and decline in cognitive function. Archives of Neurology, 61, 661–666.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (1994). DSM-IV: Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Press.Google Scholar
Baillon, S., Muhommad, S., Marudkar, M., Suribhatla, S., Dennis, M., Spreadbury, C., et al. (2003). Neuropsychological performance in Alzheimer’s disease and vascular dementia: Comparisons in a memory clinic population. International Journal of Geriatric Psychiatry, 18, 602–608.CrossRefGoogle Scholar
Bhargava, D., Weiner, M.F., Hynan, L.S., Diaz-Arrastia, R., & Lipton, A.M. (2006). Vascular disease and risk factors, rate of progression, and survival in Alzheimer’s disease. Journal of Geriatric Psychiatry and Neurology, 19, 78–82.CrossRefGoogle ScholarPubMed
Brady, C.B., Spiro, A. III, McGlinchey-Berroth, R., Milberg, W., & Gaziano, J.M. (2001). Stroke risk predicts verbal fluency decline in healthy older men: Evidence from the normative aging study. The Journals of Gerontology: B Psychological Science and Social Science, 56, P340–P346.CrossRefGoogle ScholarPubMed
Breteler, M.M. (2000). Vascular risk factors for Alzheimer’s disease: An epidemiologic perspective. Neurobiology of Aging, 21, 153–160.CrossRefGoogle ScholarPubMed
Chobanian, A.V., Bakris, G.L., Black, H.R., Cushman, W.C., Green, L.A., Izzo, J.L. Jr., et al. (2003). The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. Journal of the American Medical Association, 289, 2560–2572.CrossRefGoogle ScholarPubMed
Davis, K.L., Price, C.C., Kaplan, E., & Libon, D.J. (2002). Error analysis of the nine-word California Verbal Learning Test (CVLT-9) among older adults with and without dementia. The Clinical Neuropsychologist, 16, 81–89.CrossRefGoogle ScholarPubMed
Desmond, D.W., Tatemichi, T.K., Paik, M., & Stern, Y. (1993). Risk factors for cerebrovascular disease as correlates of cognitive function in a stroke-free cohort. Archives of Neurology, 50, 162–166.CrossRefGoogle Scholar
Elias, M.F., Elias, P.K., Sullivan, L.M., Wolf, P.A., & D’Agostino, R.B. (2005). Obesity, diabetes and cognitive deficit: The Framingham Heart Study. Neurobiology of Aging, 26(Suppl. 1), 11–16.CrossRefGoogle ScholarPubMed
Elias, M.F., Sullivan, L.M., D’Agostino, R.B., Elias, P.K., Beiser, A., Au, R., et al. (2004). Framingham stroke risk profile and lowered cognitive performance. Stroke, 35, 404–409.CrossRefGoogle ScholarPubMed
Elias, P.K., Elias, M.F., D’Agostino, R.B., Cupples, L.A., Wilson, P.W., Silbershatz, H., et al. (1997). NIDDM and blood pressure as risk factors for poor cognitive performance. The Framingham Study. Diabetes Care, 20, 1388–1395.CrossRefGoogle ScholarPubMed
Elias, P.K., Elias, M.F., D’Agostino, R.B., Sullivan, L.M., & Wolf, P.A. (2005). Serum cholesterol and cognitive performance in the Framingham Heart Study. Psychosomatic Medicine, 67, 24–30.CrossRefGoogle ScholarPubMed
Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). (2001). Journal of the American Medical Association, 285, 2486–2497.CrossRefGoogle Scholar
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. (2003). Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care, 26(Suppl. 1), S5–S20.CrossRefGoogle Scholar
Fazekas, F., Kleinert, R., Offenbacher, H., Schmidt, R., Kleinert, G., Payer, F., et al. (1993). Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology, 43, 1683–1689.CrossRefGoogle ScholarPubMed
Folstein, M.R., Folstein, S.E., & McHugh, P.R. (1974). Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle Scholar
Giovannetti, T., Lamar, M., Cloud, B.S., Swenson, R., Fein, D., Kaplan, E., et al. (2001). Different underlying mechanisms for deficits in concept formation in dementia. Archives of Clinical Neuropsychology, 16, 547–560.CrossRefGoogle ScholarPubMed
Goldstein, F.C., Ashley, A.V., Endeshaw, Y.W., Hanfelt, J., Lah, J.J., & Levey, A.I. (2008). Effects of hypertension and hypercholesterolemia on cognitive functioning in patients with Alzheimer disease. Alzheimer Disease & Associated Disorders, 22, 336–342.CrossRefGoogle ScholarPubMed
Goldstein, F.C., Ashley, A.V., Freedman, L.J., Penix, L., Lah, J.J., Hanfelt, J., et al. (2005). Hypertension and cognitive performance in African Americans with Alzheimer disease. Neurology, 64, 899–901.CrossRefGoogle ScholarPubMed
Gurol, M.E., Irizarry, M.C., Smith, E.E., Raju, S., Diaz-Arrastia, R., Bottiglieri, T., et al. (2006). Plasma beta-amyloid and white matter lesions in AD, MCI, and cerebral amyloid angiopathy. Neurology, 66, 23–29.CrossRefGoogle ScholarPubMed
Helzner, E.P., Luchsinger, J.A., Scarmeas, N., Cosentino, S., Brickman, A.M., Glymour, M.M., et al. (2009). Contribution of vascular risk factors to the progression in Alzheimer disease. Archives of Neurology, 66, 343–348.CrossRefGoogle Scholar
Kaplan, E. (1988). A process approach to neuropsychological assessment. In Boll, T. & Bryant, B.K. (Eds.), Clinical Neuropsychology and Brain Function: Research, Measurement, and Practice (pp. 129–167). Washington, DC: American Psychological Association.Google Scholar
Kilander, L., Nyman, H., Boberg, M., Hansson, L., & Lithell, H. (1998). Hypertension is related to cognitive impairment: A 20-year follow-up of 999 men. Hypertension, 31, 780–786.CrossRefGoogle ScholarPubMed
Knopman, D., Boland, L.L., Mosley, T., Howard, G., Liao, D., Szklo, M., et al. (2001). Cardiovascular risk factors and cognitive decline in middle-aged adults. Neurology, 56, 42–48.CrossRefGoogle ScholarPubMed
Lamar, M., Catani, M., Price, C.C., Heilman, K.M., & Libon, D.J. (2008). The impact of region-specific leukoaraiosis on working memory deficits in dementia. Neuropsychologia, 46, 2597–2601.CrossRefGoogle ScholarPubMed
Lamar, M., Goldstein, F.C., Libon, D.J., Ashley, A.V., Lah, J.J., & Levey, A.I. (2006). The impact of vascular risk on concept formation in Alzheimer’s disease. Alzheimer’s and Dementia, 2, S389.CrossRefGoogle Scholar
Lamar, M., Swenson, R., Kaplan, E., & Libon, D.J. (2004). Characterizing alterations in executive functioning across distinct subtypes of cortical and subcortical dementia. The Clinical Neuropsychologist, 18, 22–31.CrossRefGoogle ScholarPubMed
Launer, L.J. (2005). Diabetes and brain aging: Epidemiologic evidence. Current Diabetes Reports, 5, 59–63.CrossRefGoogle ScholarPubMed
Luchsinger, J.A., Reitz, C., Honig, A.S., Tang, M.X., Shea, S., & Mayeux, R. (2005). Aggregation of vascular risk factors and risk of incident Alzheimer’s disease. Neurology, 65, 545–551.CrossRefGoogle Scholar
Lyketsos, C.G., Toone, L., Tschanz, J., Rabins, P.V., Steinberg, M., Onyike, C.U., et al. (2005). Population-based study of medical comorbidity in early dementia and “cognitive impairment, no dementia (CIND)”: Association with functional and cognitive impairment: The Cache County Study. American Journal of Geriatric Psychiatry, 13, 656–664.Google ScholarPubMed
Mathias, J.L., & Burke, J. (2009). Cognitive functioning in Alzheimer’s and vascular dementia: A meta-analysis. Neuropsychology, 23, 411–423.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & 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, 939–944.CrossRefGoogle ScholarPubMed
The President’s Council on Bioethics. (2005). Taking Care: Ethical Caregiving in our Aging Society (pp. 1–51). Washington DC: Department of Health and Human Services.Google Scholar
Reitz, C., Patel, B., Tang, M.X., Manly, J., Mayeux, R., & Luchsinger, J.A. (2007). Relation between vascular risk factors and neuropsychological test performance among elderly persons with Alzheimer’s disease. Journal of Neurological Sciences, 257, 194–201.CrossRefGoogle ScholarPubMed
Robbins, M.A., Elias, M.F., Elias, P.K., & Budge, M.M. (2005). Blood pressure and cognitive function in an African-American and a Caucasian-American sample: The Maine-Syracuse Study. Psychosomatic Medicine, 67, 707–714.CrossRefGoogle Scholar
Traykov, L., Baudic, S., Thibaudet, M.C., Rigaud, A.S., Smagghe, A., & Boller, F. (2002). Neuropsychological deficit in early subcortical vascular dementia: Comparison to Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders, 14, 26–32.CrossRefGoogle ScholarPubMed
Wechsler, D.A. (1997). The Wechsler Adult Intelligence Scale-III. San Antonio, TX: Psychology Corporation.Google Scholar
Wolf, P.A., D’Agostino, R.B., Belanger, A.J., & Kannel, W.B. (1991). Probability of stroke: A risk profile from the Framingham Study. Stroke, 22, 312–318.CrossRefGoogle ScholarPubMed
Yesavage, J.A. (1988). Geriatric depression scale. Psychopharmacological Bulletin, 24, 709–711.Google ScholarPubMed