Alzheimer's Disease Assessment Scale-Cognitive Research Articles

A Pilot Study Evaluating the Efficacy and Safety of Rivastigmine in Patients with Mixed Dementia

The two most common causes of dementia in the elderly are Alzheimer's disease (AD) and vascular dementia (VaD), which can coexist as mixed dementia. The object of this study was to assess the efficacy and safety of rivastigmine in patients with mixed dementia (AD with VaD). This 26-week open-label pilot study was conducted at 19 centres in the US. To reduce bias, the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) raters were blinded to all efficacy measures and to patient dosage information. Patients were treated with rivastigmine and titrated to their highest tolerated dose, up to 12 mg/day (6 mg twice daily). The primary efficacy measure was cognitive function assessed by the ADAS-Cog subscale (without the concentration/distractibility item, to be consistent with cognitive outcome measures used in previous rivastigmine trials). Forty-seven percent of patients treated with rivastigmine 6-12 mg/day demonstrated improvement on the ADAS-Cog at 26 weeks, with >25% of patients having a clinically significant improvement of > or =4 points. Treatment with rivastigmine (6-12 mg/day) was well tolerated by the majority of patients. The most common adverse effects occurring in >10% of patients were nausea, vomiting, dizziness and diarrhoea. This pilot study suggests that rivastigmine treatment may have beneficial effects in the treatment of patients with mixed dementia.

Effect of white matter changes on cognitive impairment in patients with lacunar infarcts.

Cerebral white matter changes (WMC) and lacunar infarct are both believed to be consequence of small vessel disease. Whether the extent of WMC affect the type and degree of cognitive impairment in patients with lacunar infarct is not clear. The study was undertaken to determine if WMC influences cognition in patients with lacunar infarcts. We recruited consecutive patients who were admitted to the acute stroke unit because of acute lacunar infarcts, mainly documented by diffusion-weighted magnetic resonance imaging. WMC were measured qualitatively and quantitatively. Patients were divided into quartiles according to the distribution of the volume of WMC. Cognition was assessed 12 weeks after stroke by psychometric tests (Chinese version of Mini-Mental State Examination [MMSE], Alzheimer's Disease Assessment Scale-cognition [ADAS-cog], Mattis Dementia Rating Scale-Initiation/ Perseveration subscale [MDRS I/P]) and was compared between patients with varying severity of WMC. Multivariate linear regression analysis was performed to find variables that influenced performance in the psychometric tests. Among the 94 included patients with acute lacunar infarcts, those patients (n=25) within the highest quartile of WMC were older, had more lacunar infarcts, more severe stroke, and lower prestroke cognitive function compared with those with less WMC. In addition, their performances in psychometric tests were significantly more impaired. Multivariate linear regression analysis revealed that WMC significantly influenced performance in MDRS I/P. WMC did not independently influence performance in MMSE and ADAS-cog. Extent of WMC appears to be associated with executive dysfunction in stroke patients with lacunar infarcts. Further large prospective studies with extensive scales of executive function testing are required to confirm this issue.

A study of the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) in an Icelandic elderly population

The Alzheimer's Disease Assessment Scale (ADAS) is designed for screening of cognitive and non-cognitive dysfunctions characteristic of persons with probable Alzheimer's disease (AD). The cognitive part of the scale (ADAS-Cog) is both convenient for screening of probable AD and as a measure of cognitive functioning during drug intervention. The aim of this study was to translate the ADAS-Cognitive sub-test (ADAS-Cog) into Icelandic and to study its application in an elderly Icelandic population. The Mini-Mental State Examination (MMSE) and the ADAS-Cog were administered to 20 AD patients and 20 controls. Each patient was also rated on the Global Deterioration Scale (GDS). The probable AD patients were divided into two groups based on their GDS: 3-4 and 5-6 points. The patients were also divided into two groups based on their MMSE score: very mild to mild (23-30 points) and mild to moderate (15-22 points). Furthermore, the subjects were divided into two age groups: 65-76 and 77-92 years. Results revealed a highly significant difference on MMSE (22.3 - 3.4; 26.8 - 1.6; P < 0.05) and ADAS-Cog (18.4 - 7.7; 7.3 - 3.5; P < 0.05) scores for patients and controls respectively. AD patients also performed significantly worse than the elderly control group on eight of the 11 sub-tests. Thus, the present findings are mainly in line with those of previous studies. The scale exceeds other screening tests such as the MMSE in that it addresses in more detail the symptoms of AD and is valuable for early detection of the illness and staging. ADAS-Cog plays an important role in the diagnostic makeup of AD along with other detailed investigations, such as neuropsychological assessment.

Quality indicators for dementia in vulnerable community-dwelling and hospitalized elders.

Dementia is a leading cause of disability among older adult patients. Appropriate attention to early identification, the assessment of medications and health conditions that may be contributing to ...

Alzheimer's Disease Assessment Scale–Cognitive in Clinical Practice

The goal of this article is (a) to review a series of measurement standards for group and individual-patient applications of cognitive tests for Alzheimer's disease (AD); and (b) to review the literature and to use specific data from the NORMACODEM (a project of standardization of cognitive and functional toosl for AD) to evaluate the measurement standards of the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog). Seven measurement standards for group and individual patient use were evaluated: practicality, extent of measurement, depth of measurement, cross-sectional precision, longitudinal precision, validity, and standardization. The results indicated that ADAS-Cog meets practicality standards, that the scoring method is not difficult, but training is needed to administer the test. In comparison with other rating scales, the ADAS-Cog is regarded as more comprehensive, although it is not a substitute for an extensive neuropsychological test. The ADAS-Cog is not a tool that is suitable for primary care physicians, although it is a valuable screening test that has utility in both early detection (diagnosis) and staging of AD, and is useful in the severity range of Global Dementia stages 1 to 6. Interrater reliability coefficients for the ADAS-Cog satisfy recommended standards, and the test shows good internal consistency and reproducibility. Age and education are associated with the ADAS-Cog score. There is, however, a lack of standardization, which restricts the comparability of study results, and test materials remain unpublished.

Noncognitive disturbances in Alzheimer's disease: frequency, longitudinal course, and relationship to cognitive symptoms.

To investigate the frequency and longitudinal course of symptoms of depression, agitation, and psychosis in a longitudinally studied sample of patients with Alzheimer's disease (AD). Longitudinal study of AD patients with follow-up assessments at 6-month intervals for an average of more than 3 years. Alzheimer's Disease Research Center of the Mount Sinai Medical Center and the Bronx VA Medical Center, New York. A total of 153 AD patients. Blessed Test of Information, Memory and Concentration (BIMC) and the Alzheimer's Disease Assessment Scale cognitive (ADAS-Cog) and noncognitive (ADAS-NC) subscales. At entry into the study, more than 90% of patients had a behavioral disturbance that was rated as mild or worse on one of the 10 ADAS noncognitive items; and 40% had at least one rating that was moderate or severe. Correlational analyses indicated that, with the exception of the two mood-related items, noncognitive symptoms on the ADAS were not highly correlated with one another. Only one of the noncognitive items, concentration, was strongly correlated with the severity of cognitive impairment. On average, patients showed progressively worse cognitive functioning over time as measured both by the ADAS-Cog and the BIMC. The mean severity of noncognitive symptoms did not change during the course of a 5-year follow up. The severity of behavioral disturbance at any one evaluation was negatively correlated with change in behavior during the next 6 months and was not correlated with cognitive decline. Mild behavioral disturbances are common, whereas moderate to severe behavioral symptoms are less frequent in this population of AD patients. Disturbances in mood and manifestations of agitation and psychotic symptoms are not closely related to one another and show little progressive worsening over time. Rather, they tend to be episodic such that increasing severity at one time is usually followed by improvement later. Concentration problems are a manifestation of cognitive dysfunction rather than behavioral disturbance in AD. Implications of these results for treatment of noncognitive disturbances in AD are discussed.

Cortisol secretion and Alzheimer's disease progression: A preliminary report

We report preliminary findings in a study of the relationship of plasma cortisol concentration (CORT) to the clinical progression of Alzheimer's disease (AD), testing the hypotheses that CORT predicts AD progression and that CORT increases as the disease advances. In 12 subjects with NINCDS/ADRDA probable AD, we performed cognitive testing and plasma cortisol determinations at baseline and again in 12 months. A modified Alzheimer's Disease Assessment Scale-Cognitive (ADAS-COG) measured disease progression. Plasma cortisol concentration CORT was determined at 12 am and 1 pm, and an Afternoon Cortisol Test (ACT) was used to estimate average 24-hr CORT. Baseline 12 am CORT correlated with the change in ADAS-COG from start of study to 12 months. No cortisol measure increased over the study period; estimated average 24-hr CORT and 12 am CORT remained constant, whereas while 1 pm CORT declined. There was no relationship between age or duration of illness and any of the cortisol measures at baseline.