Alzheimer's Disease Diagnostic And Treatment Centers Research Articles

The Vascular Behavioral and Cognitive Disorders criteria for vascular cognitive disorders: a validation study.

The Vascular Behavioral and Cognitive Disorders (VASCOG) criteria for vascular cognitive disorders were published in 2014, but their concurrent and predictive validity have not been examined. Participants (N=165, aged 49-86years) were from Sydney Stroke Study, a longitudinal study of post-stroke cognitive impairment and dementia. Diagnoses using the National Institute of Neurological Disorders and Stroke - Association Internationale pour la Recherché et l'Enseignement en Neurosciences (NINDS-AIREN), the Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), criteria for vascular dementia (VaD) were made by consensus at multidisciplinary case conferences. Diagnoses for mild vascular cognitive disorder (mVCD) and VaD using VASCOG, DSM-5 and the Vascular Impairment of Cognition Classification Consensus Study (VICCCS) criteria were made by two study authors. Agreement levels between criteria sets were examined using Cohen's kappa (κ). The ability of VaD diagnoses to predict mortality over 10years and of mVCD to predict dementia over 5years was investigated. The VASCOG criteria yielded rates of mVCD slightly lower than for DSM-5 and VICCCS. VaD rates were similar for all criteria, although slightly lower for DSM-IV. Agreement between the VASCOG, VICCCS and DSM-5 criteria was excellent for VaD and mVCD (κ=0.83-1.0), but lower for VaD between VASCOG and the other criteria (κ=0.47-0.63). VaD-based mortality predictions were similar for the VASCOG, VICCCS and DSM-5 criteria, and higher than those for other criteria. The prediction of incident dementia within 5years from mVCD was slightly lower with VASCOG criteria than with DSM-5 and VICCCS criteria. The VASCOG criteria have greater sensitivity, modest concurrent validity and better predictive validity than older criteria for VaD, but are comparable to DSM-5 and VICCCS criteria. Their operationalization and inclusion of a mild VCD category make them useful for clinical and research applications.

Validación de la escala Quality of Life in Alzheimer’s Disease (QOL-AD) en pacientes mexicanos con demencia tipo Alzheimer, vascular y mixta

To adapt the Quality of Life in Alzheimer's Disease (QOL-AD) scale to Spanish, as well as to evaluate its reliability and validity in Mexico.The study involved a sample of 114 patients diagnosed with Alzheimer, vascular and mixed-type dementia, according to the criteria of the National Institute for Neurological and Communicative Disorders/Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA), the National Institute of Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) and the Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC), respectively. Their primary caregivers (n = 114) and a control group (n = 30) of persons aged 60 or over without dementia and their closest relatives were also evaluated.The total group with dementia obtained a mean age and a standard deviation of 80.15 +/- 7.13. The Folstein minimental test was 18.55 +/- 4.99. We obtained a Cronbach's alpha of 0.88 for the patient version of the QOL-AD (QOL-ADp) and 0.82 for the caregiver version of the QOL-AD (QOL-ADc). The test-retest yielded an intraclass correlation coefficient of 0.9 (p < 0.001; 95% confidence interval, CI 95% = 0.58-0.91) for the QOL-ADp and 0.81 (p < 0.001; CI 95% = 0.78-0.95) for the QOL-ADc. Moreover, the QOL-ADp showed a significant correlation with the geriatric depression scale (r = -0.73; p < 0.001) and with the neuropsychiatric inventory (r = -0.44; p < 0.001). With the QOL-ADc, these correlations were r = -0.5 (p < 0.001) and r = -0.3 (p < 0.001), respectively. Both versions of the QOL-AD were able to distinguish between the group of subjects with dementia and the control group.The QOL-AD yielded satisfactory results in terms of internal and external reliability, validity between measurements and between known groups. Thus, we can recommend its use to evaluate the quality of life of patients with dementia.

Disturbances in Everyday Life Activities and Sequence Disabilities in Tool use for Alzheimer Disease and Vascular Dementia

To determine whether everyday life activities are affected by general cognitive impairment or tool using disabilities in Alzheimer disease (AD) and vascular dementia (VaD). Thirty AD the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) and 30 VaD the state of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) patients and 10 normal controls (NC) were studied. Everyday activities in the community were assessed with the Social Activities Questionnaire (SAQ), and tool uses were evaluated with the single-tool and the multiple-tool sequence tasks. The SAQ scores of the AD and VaD groups were significantly lower than that of the NC group. For the single tool tasks, the AD and VaD groups exhibited lower scores than the NC group. The sequence score of the VaD group was lower than that of the AD group. The multiple regression analysis disclosed that the SAQ of the AD group was explained by the Mini-Mental State Examination and sequence scores. However, that of the VaD group was mainly explained by the sequence scores. Disturbances in everyday life activities of AD are associated with general cognitive impairment and sequence disabilities. By contrast, those of VaD may be based only on sequence disabilities.

Comparability of the Clinical Diagnostic Criteria for Vascular Dementia: A Critical Review. Part I

This review is the first of a two-part series focusing on the comparability of eight clinical criteria used for the diagnosis of vascular dementia: the Hachinski Ischemic Scale; the Ischemic Scale of Rosen; the criteria proposed by the Diagnostic and Statistical Manual of Mental Disorder-Third Edition (DSM-III), DSM-III-R, DSM-IV; International Classification of Diseases, 10th Revision (ICD-10); State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC); and the National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN). The authors discuss the critical issues related to the definition of the cognitive syndromes as well as the vascular causes and associated heterogeneity of symptomatology across these criteria.

Validity of the Clinical Diagnostic Criteria for Vascular Dementia: A Critical Review. Part II

This review is the second of a two-part series focusing on the validity of eight clinical criteria for vascular dementia. Sixteen studies were selected according to their purposes and quality of experimental design. The analysis revealed that criteria for vascular dementia are not interchangeable; the eight criteria sets yielded different sensitivity and specificity results, as well as marked variability in incidence, prevalence, and frequency rates. Although the State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) were the most sensitive and useful criteria in clinical settings and the National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) were the most specific and useful criteria in research, all criteria shared similar flaws. A definition of the cognitive syndrome, associated vascular causes or lesions, and methods of assessment should be clearly specified in the future. Suggestions for improvement are made.

Validation of clinical criteria for possible vascular dementia in the oldest-old

Although vascular dementia (VaD) is a main pathology in nonagenarians and centenarians, the validity of clinical criteria for this diagnosis is unknown. We analyzed 110 autopsy cases and reported sensitivities and specificities of the State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) and National Institute for Neurological Disorders and Stroke (NINDS-AIREN) criteria for possible VaD as well as Hachinski ischemic score (HIS). Among them, there were 36 neuropathologically confirmed VaD cases. All criteria displayed comparable sensitivities (0.56–0.58). Specificities values were 0.74, 0.73 and 0.66, respectively. There was an age-related decrease on ADDTC criteria sensitivity due to the fact that 42% of pure VaD cases did not present with stroke. Thirty percent of mixed dementia (MD) cases were diagnosed as VaD by both NINDS-AIREN and ADDTC criteria. This proportion reached 45.9% for the HIS. These data demonstrate that the new diagnostic criteria for possible VaD do not provide a substantial gain of sensitivity compared to the HIS. Although their specificity was significantly lower in this age group compared to younger cohorts, all of them successfully exclude AD cases.

Clinicopathological validation study of four sets of clinical criteria for vascular dementia.

The authors' goal was to validate the clinical criteria for vascular dementia of the State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC), the National Institute for Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN), DSM-IV, and ICD-10. Sensitivity and specificity were assessed by comparing the clinical with the neuropathological diagnosis of 89 autopsied patients with dementia from a geriatric and psychiatric hospital. All cases were reviewed by a clinician and a neuropathologist who were blind to each other's findings. Neuropathologically there were 20 cases of vascular dementia, 23 cases of mixed dementia, and 46 cases of Alzheimer's disease among the autopsied patients. The sensitivity was 0.50 for DSM-IV criteria for vascular dementia, 0.70 for ADDTC criteria for possible vascular dementia, 0.55 for NINDS-AIREN criteria for possible vascular dementia, 0.20 for ICD-10 criteria for vascular dementia, 0.25 for ADDTC criteria for probable vascular dementia, and 0.20 for NINDS-AIREN criteria for probable vascular dementia. Specificity was 0.84, 0.78, 0.84, 0.94, 0.91, and 0.93, respectively. The proportion of cases clinically classified as vascular dementia ranged from 0% to 13% for neuropathologically confirmed cases of Alzheimer's disease and 9% to 39% for neuropathologically confirmed cases of mixed dementia. There was no statistically significant relationship between the neuropathological diagnosis and three of the clinical criteria sets studied (ICD-10 criteria for vascular dementia and ADDTC and NINDS-AIREN criteria for probable vascular dementia). Clinical criteria for vascular dementia are not interchangeable. The ADDTC criteria for possible vascular dementia are the most sensitive for the detection of vascular dementia; however, the DSM-IV criteria for vascular dementia and the NINDS-AIREN criteria for possible vascular dementia may be more effective in excluding mixed dementia. Given their inability to detect the vast majority of cases of vascular dementia, the ICD-10 criteria for vascular dementia and the ADDTC and NINDS-AIREN criteria for probable vascular dementia should be revised.

Sensitivity and specificity of newly proposed clinical criteria for possible vascular dementia.

The objective of this study was to determine the sensitivity and specificity of clinical criteria for possible vascular dementia (VaD) recently developed independently by two groups: the State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) and the National Institute for Neurological Disorders and Stroke with the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN). We also wished to compare the performance of the new criteria to that of the Hachinski Ischemic Score (HIS). The study was comprised of a retrospective chart review and clinicopathologic correlation, and took place in 304-bed acute-care geriatric hospital. The subjects were 113 autopsied elderly patients with dementia, who were assessed to determine sensitivity and specificity of the ADDTC and NINDS-AIREN criteria for possible VaD. Sensitivity and specificity were calculated using the neuropathologic diagnosis as a gold standard. Sensitivity was 0.63, and specificity was 0.64 for the ADDTC, 0.58 sensitivity and 0.80 specificity for the NINDS, and 0.43 sensitivity and 0.88 specificity for the HIS. Test combinations did not lead to substantial gains in sensitivity or specificity. The majority of patients with Alzheimer's disease were successfully excluded by the ADDTC (87%), the NINDS-AIREN (91%), and the HIS (97%). The proportion of mixed dementia cases clinically misclassified as VaD was 54% for the ADDTC, 29% for the NINDS-AIREN, and 18% for the HIS. Low sensitivity is the main weakness of the above clinical criteria for possible VaD. Mixed dementia is better excluded by the NINDS-AIREN than the ADDTC. Data from this validation study should provide valuable information to clinicians and researchers who wish to apply these criteria to the diagnosis of VaD.

Service Selection: Concordance Between Alzheimer's Disease Diagnostic and Treatment Center Clients' Choices and Program Staff Recommendations

Service choices of Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) enrollees (N = 822) and ADDTC professional staff are compared. Results suggest that community- dwelling Alzheimer's patients are not high service consumers, and ADDTC staff generally agree with their service choices. Limited discordance noted pertained to recommended decreases in homemaker chore, senior center, meals, transportation, and home health use; and suggested increases in psychiatric service, case management, and adult day care use. Findings confirm the high degree of informal care of the demented and the reluctance or inability of patients and caregivers to use formal services. Results also indicate that as ADDTC-like programs prolifer ate, long-term care costs may remain unchanged because patients and caregivers may already know what formal care they need and want.

Eligibility of Alzheimer's disease clinic patients for clinical trials.

To identify the percentage of patients with Alzheimer's disease (AD) in a general clinic population who would be provisionally eligible for randomized clinical trials and the extent to which these patients represent the overall clinic-based population. Many randomized clinical trials have restricted enrollment criteria that may limit generalizability, i.e., AD patients who fulfill selection criteria for phase III clinical trials may not be representative of other AD patients in clinical settings. Patients diagnosed as probable or possible AD from the nine clinical sites of the State of California's Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) were selected on the basis of their provisionally fulfilling the inclusion and exclusion criteria of two typical AD clinical trials at the time of their first visit (ECG and brain imaging criteria were not available). From a sample of 3470 subjects with possible or probable AD, overall, only 4.4% or 7.9% would have been provisionally eligible for each of two trials. Patients provisionally eligible were younger, relatively underrepresented by women, better educated, wealthier, and more likely to be white than ineligible patients. The major independent demographic predictors for eligibility were (1) income greater than $15,000 per year, (2) male gender, and (3) college education. More than 60% of probable AD patients were excluded because of significant behavioral problems; approximately one-quarter each were excluded because of significant medical or neurological problems. Allowing patients with probable or possible AD to enroll would have resulted in 10.6% being eligible. Selection criteria for AD clinical trials result in a demographically and clinically constrained subgroup that is not representative of the overall clinic population.

Psychotic Symptoms in Parkinson's Disease Patients with Dementia

To assess the prevalence of psychotic symptoms in a group of patients with Parkinson's disease (PD) and dementia and examine the association of psychotic symptoms with neuropsychiatric problems, the level of distress reported by caregivers, and cognitive and functional impairment. The psychotic and nonpsychotic patients with PD dementia were compared on a series of demographic, neuropsychiatric, behavioral, caregiver complaint, and cognitive measures. The database from nine university-based State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTCs). 101 patients diagnosed with PD. A total of 36 of the 101 patients (35.6%) had either hallucinations, delusions, or both. The psychotic patients had significantly more insomnia, confusion, agitation, personality changes, and self-care problems and were noted by their caregivers to be significantly more unmanageable at home than their nonpsychotic counterparts. On cognitive scales, psychotic patients were significantly more impaired. Many patients with PD and dementia experience psychosis. Psychotic symptoms in PD dementia patients are associated with major behavioral, cognitive, and functional problems.

Comparison of Seven Sets of Criteria Used for the Diagnosis of Vascular Dementia

At least seven different sets of criteria are commonly used for the diagnosis of vascular dementia (VaD). These are the ischemic scales (IS) of Hachinski, Rosen and Loeb, the criteria from the DSM-III-R, those outlined by Erkinjuntti et al., the State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) and the international workgroup of the American National Institute of Neurological Disorders and Stroke (NINDS) and the European "Association Internationale pour la Recherche et l'Enseignement en Neurosciences'. To investigate the differences and similarities of these criteria, we applied them to a sample of 124 demented patients from the Maastricht Memory Clinic. Only 8 patients were diagnosed as having VaD by all criteria. Depending on which criteria were used, the frequencies of VaD and Alzheimer's disease (AD) ranged from 6 to 32%, and from 48 to 56%, respectively. The IS of Hachinski and Rosen resulted in the highest frequencies of VaD, whereas the criteria of Erkinjuntti and those from the ADDTC and the NINDS workgroup yielded the lowest. The number of patients with VaD was reduced substantially when neuroradiological data and the temporal relationship between stroke and dementia were taken into consideration. We conclude that the seven sets of criteria cannot be regarded as interchangeable. Differences in the criteria for VaD and AD may be an overlooked source of interstudy variance

Why home health services are provided to Alzheimer's disease patients in California's Alzheimer's disease program: an exploration.

Logistic regression is used to examine why formal home health service recommendations are made to Alzheimer's disease patients (N = 822) by staff at each of six Alzheimer's Disease Diagnostic and Treatment Centers (ADDTCs) in California. Patients are selected on the basis of their having Alzheimer's disease, and not having any physical co-morbid health problems noted at the time of their clinical assessment. Using Medicare Part A to pay for care, previous home health use, having regular access to and prior use of a primary care physician, prior hospitalization, client agitation and apathy, and family's social isolation were significant predictors of the latent propensity to recommend formal home health services to members of this sample.

Clinical Features Distinguishing Large Cohorts with Possible AD, Probable AD, and Mixed Dementia

To determine whether clinical features and rate of cognitive and functional decline differed in cohorts of possible AD (poAD), probable AD (prAD), and mixed dementia (MIX) patients. Cohort study with 1-year follow-up examination, comparing three groups of subjects. Outpatient evaluation at nine California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC). There were 1701 elderly patients who presented for evaluation of memory complaints. Historical, physical, and neurological variables for cross-sectional comparisons and 1-year rate of change on the Mini-Mental State Examination (MMSE), Blessed Information-Memory-Concentration test (BIMC), and Blessed Dementia Scale (BDS). Mean initial MMSE scores for poAD (n = 279), prAD (n = 928) and MIX (n = 430) were 17.9 (+/- 7.4), 13.9 (+/- 7.5), and 15.4 (+/- 7.1). Delusions and psychosis occurred in about one-third of each group, most often in those with moderate dementia (MMSE 11-20). PoAD were distinguished from prAD by significantly more alcohol abuse, physical health problems, and focal motor or sensory findings. MIX differed from AD alone by increased prevalence of cardiovascular disease, hypertension, stroke, TIA, and exposure to general anesthesia, and by a greater frequency on exam of depressed mood, focal motor or sensory findings, and gait disorder. All groups declined by about 2.8 points on the BIMC, 2.9 points on the MMSE, and 1.8 points on the BDS, a functional scale, over 1 year. Neither extrapyramidal signs nor psychosis predicted a more rapid rate of decline. Various features help to distinguish poAD, prAD, and MIX in a large cohort of patients, but do not predict the rate of progression.