Blessed Dementia Rating Scale Research Articles

Deep Brain Stimulation of the Nucleus Basalis of Meynert for Parkinson's Disease Dementia: A 36 Months Follow Up Study.

ABSTRACTBackgroundDegeneration of the nucleus basalis of Meynert (NBM) and cortical cholinergic dysfunction are hallmarks of Parkinson's disease dementia (PDD). There is no effective therapy for PDD. Deep brain stimulation of the NBM (NBM‐DBS) has been trialed as a potential treatment.ObjectiveOur primary aim was to evaluate the sustained tolerability of NBM‐DBS in PDD, and its impact on global cognition, behavioral symptoms, quality of life and caregiver burden and distress. Second, we aimed to determine whether baseline measures of arousal, alertness, and attention were predictive of the three year response to NBM‐DBS in PDD patients.MethodsFive of the six PDD patients who completed the baseline assessment participated in a 3 year follow up assessment. We assessed the participants after three years of NBM‐DBS on the Mini Mental State Examination, Dementia Rating Scale‐2, Blessed Dementia Rating Scale, Neuropsychiatric Inventory, and the SF36.ResultsThe five patients showed varying trajectories of cognitive decline, with two showing a slower progression over the three‐year follow‐up period. A slower progression of decline on global cognition was associated with higher baseline accuracy on the Posner covert orienting of attention test, and less daytime sleepiness.ConclusionsWhether slower progression of cognitive decline in two patients was in any way related to individual variability in responsiveness to NBM‐DBS requires confirmation in a larger series including an unoperated PDD control group. Higher accuracy in covertly orienting attention and better sleep quality at baseline were associated with better cognitive outcomes at 36 months assessment. These results require validation in future studies with larger samples.

Pesticide Use and its Effects on Daily Functioning among Elderly Farmers

Background: Poor pesticide handling practices are recorded on a regular basis in Greece, where the average farmer is elderly. This raises concerns regarding their compliance with pesticide regulations and the associated health implications. Our purpose in undertaking the present study was to examine elderly farmers’ attitudes regarding pesticide handling and safety issues, as well as, the potential link between pesticide exposure and daily functioning capacity. Methods: Participants were 1443 elderly individuals, 276 of whom reported long-term, direct exposure to pesticides (spraying in gardens, open fields, and/or a greenhouse). Several aspects of pesticide handling were gleaned via a self-report questionnaire. Ability to perform everyday tasks was assessed with the Blessed Dementia Rating Scale. Results: On average, participants were not consistent with respect to safety practices. Half could not recall the specific brand names of the pesticides they used and 47.5% reported using chemical cocktails, often exceeding the maximum recommended frequency of applications per year. In many cases, they reported application of banned pesticides, such as DDT, and more than half reported applying pesticides without protective equipment. Analyses showed that exposure to pesticides was associated with impaired everyday functioning (OR = 1.16; 95%, CI = 1.04-1.28) and specifically, with an inability to interpret surroundings and recall recent events, a tendency to dwell on the past and changes in bladder-sphincter control. Conclusion: We found poor awareness and adherence to safety practices regarding pesticide use among elderly farmers, as well as an association between pesticide use and everyday functioning. Relevant health and environmental implications are discussed.

An automatic Alzheimer’s disease classifier based on spontaneous spoken English

According to the World Health Organization, the number of people suffering from dementia worldwide will grow to 150 million by mid-century, and Alzheimer’s disease is the most common form of dementia contributing to 60%–70% of cases. The problem is compounded by the fact that current pharmacologic treatments are only symptomatic, and therapies are ineffective in slow down or cure the degenerative process. An automatic and standardize classifier for Alzheimer’s disease is thereby extremely important to rapidly respond and deliver as preventive as possible interventions. Speech alterations might be one of the earliest signs of cognitive defect and, recently, the researchers showed that they can be observable well in advance other cognitive deficits become manifest. In this paper, we propose a full automated method able to classify the spontaneous spoken production of the subjects. In particular, we trained an artificial neural network using the spectrogram of the audio signal, which is the visual representation of the speech of the subject. Moreover, to overcome the problem of the large amount of annotated data usually required for training deep learning models, we used a specific data augmentation approach that avoids distorting the original samples. We evaluated the proposed method using the English Pitt Corpus from DementiaBank. The used dataset consists of 180 subjects: 43 healthy controls and 137 Alzheimer’s disease patients. The proposed method outperformed the other approaches in the literature based on manual and semi-automatic transcription and annotation of speech, improving the classification capability by 5.93%, and obtained good classification results compared to the state-of-the-art neuropsychological screening tests (i.e., the Mini-Mental State Examination and the Activities of Daily Living portion of the Blessed Dementia Rating Scale) exhibiting an accuracy of 93.30% and an F1 score of 88.50%.

Extrapyramidal signs and Alzheimer's disease prognosis in a multiethnic, community-based sample of demented elders.

Extrapyramidal signs (EPS) are a common feature of Alzheimer's disease associated with worse outcomes in observational studies of dementia. Less research has been conducted on ethnic minority and non-clinic-based populations. One hundred and forty-two multiethnic community-dwelling participants with dementia were selected. Adjusted Cox models were fitted for mortality, cognitive (Mini Mental State Examination ≤10), functional (Blessed Dementia Rating Scale ≥10), and dependency (needs full-time care) endpoints with baseline EPS as predictor. Thirty-seven participants (26.06%) had EPS at baseline. EPS predicted more rapid time to death (hazard ratio [HR] = 2.76, 95% confidence interval [CI] = 1.49, 5.42), and functional endpoint (HR = 3.88, 95% CI = 1.75, 8.62) but not cognitive and dependency endpoints. No evidence of interaction by ethnicity, age, sex, education, or apolipoprotein E ε4 polymorphism was found. Our results partially confirm previous studies on predominantly White, clinic-based samples. Further research is needed to better understand the etiological role of EPS in AD.

Association Between Early Psychotic Symptoms and Alzheimer's Disease Prognosis in a Community-Based Cohort.

Psychotic symptoms are an important and increasingly recognized aspect of Alzheimer's disease (AD). They have been shown to contribute to faster disease progression in clinic-based, demographically homogenous samples with high educational attainment. We studied the association between baseline psychotic symptoms and disease progression among individuals with incident AD or 'at risk' of developing AD, from a demographically heterogenous, community-based cohort with minimal educational attainment. 212 participants received the Columbia University Scale of Psychopathology in Alzheimer's Disease scale. Participants had psychotic symptoms with any of: visual illusions, delusions, hallucinations, or agitation/aggression. Disease progression was measured yearly and defined by meeting cognitive (≤10 on the Folstein MMSE) or functional endpoints (≥10 on the Blessed Dementia Rating Scale or ≥4 on the Dependence Scale). The mean age was 85 years old. The cohort was 78.3% female, 75.9% Hispanic, and had a mean 6.96 years of education. Within the follow-up period (mean: 3.69 years), 24 met the cognitive endpoint, 59 met the functional endpoint, and 132 met the cutoff for dependence. The presence of at least one psychotic symptom was initially associated with an increased risk of reaching the functional endpoint (HR 3.12, 95% CI 1.67-5.86, p < 0.001) and the endpoint of dependence (HR = 1.498, 95% CI 1.05-2.13, p = 0.03). However, these associations were attenuated and non-significant when adjusted for baseline functional status. Psychotic symptoms were not associated with the cognitive endpoint. Psychotic symptoms may predict functional decline in patients of non-Caucasian ethnicity and with lower educational attainment.

How does what study partners report differ based on their relationship to the primary subject?

AbstractBackgroundStudies of persons with Alzheimer’s disease (AD) and related dementias typically require “study partners” (SPs) to report on the subject’s wellbeing and function. But little is known about how who a SP is might impact on these reports. Knowing this may help inform the interpretation of AD research.MethodsWe analyzed data from 730 older adults and their SPs enrolled in the Aging, Demographics and Memory Study (ADAMS). SPs provided data on their assessment of subjects’ functioning through the following: (1) the Blessed Dementia Rating Scale (BDRS), a multi‐domain informant measure of functional capacity; (2) three single‐item ratings of the subject’s “memory at the present time,” ability “in making judgments and decisions,” and ability to “organize his/her daily activities”; (3) instrumental/basic activities of daily living (IADL/BADL) scales. Subject cognition was assessed in an independent neuropsychological assessment using the mini‐mental status exam (MMSE), Trails A/B, Serial 7s, Boston Naming, and Animal Fluency. Bivariate and multivariable regression analyses were used to examine differences in SP reports based on their relationship to the subject. Demographics of SPs and subjects were also analyzed.ResultsOf SPs, 34.9% (n=255) were spouses, 38.4% (n=281) were adult children, and 26.6% (n=194) had a different relationship to the subject. In bivariate models, adult children were more likely to be college educated and provide care to the subject than spouses. In bivariate analyses, adult children rated subjects as more impaired on the BDRS and single‐item measures of memory, judgment and organizational abilities than did spouses(p&lt;0.05). In multivariable analyses that controlled for differences in cognitive and functional performances, adult children, on average, rated subjects as less impaired on measures of memory, judgment, and organizational abilities than spouses(p&lt;0.05). But, reporting varied in subgroups; in cognitively unimpaired subjects (MMSE&gt;28), only 63.0% of child SPs reported a BDRS that indicated lack of impairment while 90.8% of spousal SPs did so (p&lt;0.05).ConclusionsSpouses and adult children are similarly likely to serve as SPs, but there are differences in how they report on subject functioning. Our findings have important implications for interpreting informant reports, particularly, of persons with no or mild cognitive impairment.

The presence of moderate extrapyramidal signs predicts poorer outcomes in a community‐based cohort of multi‐ethnic demented elders

AbstractBackgroundExtrapyramidal signs (EPS) are a common feature of Alzheimer's Disease (AD) associated with worse outcomes in observational studies of dementia. Prior studies have been primarily conducted in predominately white, clinic‐based samples. Less is known regarding the role of EPS in the disease course of dementia in ethnic minority and non‐clinic‐based populations.MethodPredictors 3 (P3) is a multi‐ethnic community‐based cohort study of dementia. Recruitment began in 2011 and is ongoing. Participants are evaluated annually by trained investigators. 142 P3 participants with a baseline diagnosis of probable dementia were selected for this study. Moderate EPS was defined as a score of 2 or more on selected items from the Unified Parkinson's Disease Rating Scale. The cognitive endpoint was defined as a score of &lt;= 10 on the Folstein MMSE, the functional endpoint as a score of &gt;= 10 on the 17‐point Blessed Dementia Rating Scale, and the institutional equivalent endpoint as need for equivalent to nursing home care. Adjusted Cox models were fitted for time to death and cognitive, functional, and institutional equivalent endpoints with baseline moderate EPS as predictor. Effect modification was assessed by fitting cross‐product terms for moderate EPS by ethnicity, sex, age, education, and APOE polymorphism.ResultMean follow‐up time was 3.61 years (range: 0.29 ‐ 7.50, SD = 1.95). 33 participants (23.2%) had moderate EPS at baseline. 53 died (37.3%), 23 (17.2%) reached the cognitive endpoint, 45 (36.3%) the functional endpoint, and 44 (37.9%) the institutional equivalent endpoint post‐baseline. Moderate EPS at baseline was significantly associated with an increased hazard of death (HR = 2.57, 95% CI = 1.30, 5.10) and of reaching the functional endpoint (5.59, 95% CI = 2.36, 13.27). Associations between moderate EPS and the cognitive and institutional equivalent endpoints were not statistically significant. No evidence was found for effect modification of associations on either additive or multiplicative scales.ConclusionIn a multi‐ethnic community‐dwelling cohort of demented elders, we found that baseline moderate EPS significantly predicted time to death and time to functional endpoint, but not time to cognitive and institutional equivalent care endpoints. These findings confirm those of previous studies conducted on predominately white, clinic‐based samples.

Social cognition in Alzheimer's disease: A separate construct contributing to dependence

The extent to which social cognitive changes reflect a discrete constellation of symptoms dissociable from general cognitive changes in Alzheimer's disease (AD) is unclear. Moreover, whether social cognitive symptoms contribute to disease severity and progression is unknown. The current multicenter study investigated cross-sectional and longitudinal associations between social cognition measured with six items from the Blessed Dementia Rating Scale, general cognition, and dependence in 517 participants with probable AD. Participants were monitored every 6 months for 5.5 years. Results from multivariate latent growth curve models adjusted for sex, age, education, depression, and recruitment site revealed that social cognition and general cognition were unrelated cross-sectionally and throughout time. However, baseline levels of each were related independently to dependence, and change values of each were related independently to change in dependence. These findings highlight the separability of social and general cognition in AD. Results underscore the relevance of considering social cognition when modeling disease and estimating clinical outcomes related to patient disability.

Cognitive declines precede and predict functional declines in aging and Alzheimer's disease.

ObjectiveTo investigate the temporal ordering of cognitive and functional declines separately in older adults with or without Alzheimer’s disease (AD).Design and SettingA community-based longitudinal study of aging and dementia in Northern Manhattan (Washington Heights/Hamilton Heights Inwood Columbia Aging Project) and a multicenter, clinic-based longitudinal study of prevalent AD at Columbia University Medical Center, Johns Hopkins School of Medicine, Massachusetts General Hospital, and the Hôpital de la Salpêtrière in Paris, France (the Predictors Study).Participants3,443 initially non-demented older adults (612 with eventual incident dementia) and 517 patients with AD.Main Outcome MeasuresCognitive measures included the modified Mini-Mental State Exam and composite scores of memory and language derived from a standardized neuropsychological battery. Function was measured with the Blessed Dementia Rating Scale, completed by the participant (in the sample of non-demented older adults) or an informant (in the sample of prevalent AD patients). Data were analyzed with autoregressive cross-lagged panel analysis.ResultsCognitive scores more consistently predicted subsequent functional abilities than vice versa in non-demented older adults, participants with eventual incident dementia, and patients with prevalent AD.ConclusionsCognitive declines appear to precede and cause functional declines prior to and following dementia diagnosis. Standardized neuropsychological tests are valid predictors of later functional changes in both non-demented and demented older adults.

The Predictive Value of the Memory Impairment Screen in Patients With Subjective Memory Complaints

The use of biomarkers in early Alzheimer's disease detection is growing. However, it is not clear whether sophisticated biomarker testing is more efficient than neuropsychological tests focused on memory. The goal of this study was to evaluate the predictive value of the Memory Impairment Screen (MIS), a simple and brief memory test, in elderly subjects with subjective memory loss. A prospective cohort of 105 patients with subjective memory loss was followed up from December 2007 to April 2011 in Zaragoza, Spain. At baseline, the patients underwent neuropsychological examination with Mini-Examen-Cognoscivo (Spanish adaptation of the Mini-Mental State Examination), MIS, Clinical Dementia Rating scale, Blessed Dementia Rating Scale, and Geriatric Depression Scale. The final endpoint of the study was the conversion to dementia, mostly of probable Alzheimer's disease type according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association work group criteria. The patients were reevaluated every 6 months. After a mean follow-up of 2 years (range, 1-4 years), 57 patients developed Alzheimer's disease and 48 did not. A baseline score of 0 or 1 on the MIS predicted conversion to Alzheimer's disease, with a sensitivity of 42.9%, a specificity of 98%, and a positive predictive value of 96%. The area under the curve was 0.76 (95% CI, 0.66-0.83). In the clinical setting in patients referred for memory complaints, the MIS score at baseline (0 and 1) is useful to predict who may develop Alzheimer's disease within at least a year. The MIS would be more useful when combined with a higher sensitivity test.

Long-term associations between cholinesterase inhibitors and memantine use and health outcomes among patients with Alzheimer's disease

ObjectivesTo examine in an observational study (1) relationships between cholinesterase inhibitors (ChEI) and memantine use, and functional and cognitive end points and mortality in patients with Alzheimer's disease (AD); (2) relationships between other patient characteristics and these clinical end points; and (3) whether effects of the predictors change across time. MethodsThe authors conducted a multicenter, natural history study that included three university-based AD centers in the United States. A total of 201 patients diagnosed with probable AD with modified Mini-Mental State Examination (MMSE) scores ≥ 30 at study entry were monitored annually for 6 years. Discrete-time hazard analyses were used to examine relationships between ChEI and memantine use during the previous 6 months reported at each assessment, and time to cognitive (MMSE score ≤ 10) and functional (Blessed Dementia Rating Scale score ≥ 10) end points and mortality. Analyses controlled for clinical characteristics, including baseline cognition, function, and comorbid conditions, and presence of extrapyramidal signs and psychiatric symptoms at each assessment interval. Demographic characteristics included baseline age, sex, education, and living arrangement at each assessment interval. ResultsChEI use was associated with delayed time in reaching the functional end point and death. Memantine use was associated with delayed time to death. Different patient characteristics were associated with different clinical end points. ConclusionsResults suggest long-term beneficial effects of ChEI and memantine use on patient outcomes. As for all observational cohort studies, observed relationships should not be interpreted as causal effects.

Impact of Delirium on the Course of Alzheimer Disease

Delirium is characterized by acute cognitive impairment. We examined the association of delirium with long-term cognitive trajectories in older adults with Alzheimer disease (AD). We evaluated prospectively collected data from a nested cohort of hospitalized patients with AD (n=263) in the Massachusetts Alzheimer Disease Research Center patient registry between January 1, 1991, and June 30, 2006 (median follow-up duration, 3.2 years). Cognitive function was measured using the information-memory-concentration (IMC) section of the Blessed Dementia Rating Scale. Delirium was identified using a validated medical record review method. The rate of cognitive deterioration was contrasted using random-effects regression models. Fifty-six percent of patients with AD developed delirium during hospitalization. The rate of cognitive deterioration before hospitalization did not differ significantly between patients who developed delirium (1.4 [95% CI, 0.7-2.1] IMC points per year) and patients who did not develop delirium (0.8 [95% CI, 0.3-1.3] IMC points per year) (P=.24). After adjusting for dementia severity, comorbidity, and demographic characteristics, patients who had developed delirium experienced greater cognitive deterioration in the year following hospitalization (3.1 [95% CI, 2.1-4.1] IMC points per year) relative to patients who had not developed delirium (1.4 [95% CI, 0.2-2.6] IMC points per year). The ratio of these changes suggests that cognitive deterioration following delirium proceeds at twice the rate in the year after hospitalization compared with patients who did not develop delirium. Patients who had developed delirium maintained a more rapid rate of cognitive deterioration throughout a 5-year period following hospitalization. Sensitivity analyses that excluded rehospitalized patients and included matching on baseline cognitive function and baseline rate of cognitive deterioration produced essentially identical results. Delirium is highly prevalent among persons with AD who are hospitalized and is associated with an increased rate of cognitive deterioration that is maintained for up to 5 years. Strategies to prevent delirium may represent a promising avenue to explore for ameliorating cognitive deterioration in AD.

Delirium and Long-term Cognitive Trajectory Among Persons With Dementia

BACKGROUND Delirium is characterized by acute cognitive impairment. We examined the association of delirium with long-term cognitive trajectories in older adults with Alzheimer disease (AD). METHODS We evaluated prospectively collected data from a nested cohort of hospitalized patients with AD (n=263) in the Massachusetts Alzheimer Disease Research Center patient registry between January 1, 1991, and June 30, 2006 (median follow-up duration, 3.2 years). Cognitive function was measured using the information-memory-concentration (IMC) section of the Blessed Dementia Rating Scale. Delirium was identified using a validated medical record review method. The rate of cognitive deterioration was contrasted using random-effects regression models. RESULTS Fifty-six percent of patients with AD developed delirium during hospitalization. The rate of cognitive deterioration before hospitalization did not differ significantly between patients who developed delirium (1.4 [95% CI, 0.7-2.1] IMC points per year) and patients who did not develop delirium (0.8 [95% CI, 0.3-1.3] IMC points per year) (P=.24). After adjusting for dementia severity, comorbidity, and demographic characteristics, patients who had developed delirium experienced greater cognitive deterioration in the year following hospitalization (3.1 [95% CI, 2.1-4.1] IMC points per year) relative to patients who had not developed delirium (1.4 [95% CI, 0.2-2.6] IMC points per year). The ratio of these changes suggests that cognitive deterioration following delirium proceeds at twice the rate in the year after hospitalization compared with patients who did not develop delirium. Patients who had developed delirium maintained a more rapid rate of cognitive deterioration throughout a 5-year period following hospitalization. Sensitivity analyses that excluded rehospitalized patients and included matching on baseline cognitive function and baseline rate of cognitive deterioration produced essentially identical results. CONCLUSIONS Delirium is highly prevalent among persons with AD who are hospitalized and is associated with an increased rate of cognitive deterioration that is maintained for up to 5 years. Strategies to prevent delirium may represent a promising avenue to explore for ameliorating cognitive deterioration in AD.

Viabilidad de un sistema de telemedicina de soporte para el diagnóstico de demencia en atención primaria

The Computerised Support System for the Diagnosis of Dementia in Primary Care (SISDDAP, in Spanish) is an asynchronous telemedicine programme that establishes protocols for the screening and diagnosis of dementia, thereby enabling primary care (PC) and specialised care (SC) professionals to reach shared diagnoses of dementia.To determine the feasibility and degree of implementation of an asynchronous telemedicine programme and to evaluate the rate of agreement between the cognitive and functional measures taken by professionals from two different levels of healthcare.The study examines the use of the SISDDAP programme by professionals from four basic areas of healthcare (BAH) in which the programme was introduced on a voluntary basis. The absolute and relative frequency of use of the SISDDAP programme and the number of variables registered were calculated, together with the intra-class correlation coefficient among the scores obtained by PC and SC professionals on the different psychometric instruments, including the SISDDAP diagnostic module (Mini-Mental State Examination, Blessed Dementia Rating Scale and Patient Health Questionnaire 9).The four BAH that incorporated the SISDDAP referred 215 (45.3%) applications via the telemedicine programme, and 82.2% of these applications had a maximum of two data items missing. The intra-class correlation coefficient was above 0.70 among all the instruments evaluated.The SISDDAP is an asynchronous telemedicine programme that is well accepted among PC professionals. After suitable training, the level of agreement among the psychometric instruments is acceptable.

SP5-2 Identifying a hidden problem-dementia- in elderly people living in old-age homes

ObjectiveTo identify dementia in geriatric people living in old-age homes and to study the risk factors of dementia in them.Material and MethodsSetting:-Eight old-age homes in Mysore City were selected at...

Clinical and Radiological Differences in Alzheimer's Disease with and without a History of Mild Cognitive Impairment

We assessed the influence of a history of amnesic mild cognitive impairment (MCI) in patients with Alzheimer's disease (AD) at presentation from a clinical and radiological point of view. A consecutive sample of patients fulfilling the criteria of probable Alzheimer's disease according to the NINCDS-ADRDA work group not previously diagnosed nor treated underwent neuropsychological assessment including mini-mental test, Blessed dementia rating scale (BDRS), ADAS-Cog, neuropsychiatric inventory (NPI), and a daily living activities scale (DAD). Radiological evaluation consisted of magnetic resonance imaging, left hippocampal volumetry and magnetic resonance spectroscopy (MRS) of the brain. We divided the patients into two groups according to positive/negative history of MCI for a period longer than one year. The AD patients with a history of MCI were more likely to have a history of depression (OR: 5.5; 95% CI: 1.12-26) and have more depressive symptoms at presentation in the NPI than those without a history of MCI. They also had a history of hypertension more frequently than the remainder. The presence/absence of ApoE4 alleles did not have influence in the clinical course. With regard to radiological findings the patients with previous MCI showed lower values of N-acetyl-aspartate (NAA) in parietal (p=0.0001) temporal (p=0.08) and occipital (p=0.00001) lobes than the other group, as well as a smaller left hippocampus although the difference was not statistically significant. A history of MCI in AD patients represents a form of the disease with slower progression from clinical and radiological viewpoints. These patients present with more depressive symptoms and a history of depression than the remainder. The lower NAA levels on MRS are compatible with a longer disease duration when AD is preceded by amnesic MCI.

Development and Validation of a Brief Cognitive Assessment Tool

Cognitive impairment is often unrecognized among older adults. Meanwhile, current assessment instruments are underused, lack sensitivity, or may be restricted by copyright laws. To address these limitations, we created a new brief cognitive assessment tool: the Sweet 16. The Sweet 16 was developed in a cohort from a large post-acute hospitalization study (n=774) and compared with the Mini-Mental State Examination (MMSE). Equipercentile equating identified Sweet 16 cut points that correlated with widely used MMSE cut points. Sweet 16 performance characteristics were independently validated in a cohort from the Aging, Demographics, and Memory Study (n=709) using clinical consensus diagnosis, the modified Blessed Dementia Rating Scale, and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). The Sweet 16 correlated highly with the MMSE (Spearman r, 0.94; P<.001). Validated against the IQCODE, the area under the curve was 0.84 for the Sweet 16 and 0.81 for the MMSE (P=.06). A Sweet 16 score of less than 14 (approximating an MMSE score <24) demonstrated a sensitivity of 80% and a specificity of 70%, whereas an MMSE score of less than 24 showed a sensitivity of 64% and a specificity of 86% against the IQCODE. When compared with clinical diagnosis, a Sweet 16 score of less than 14 showed a sensitivity of 99% and a specificity of 72% in contrast to an MMSE score with a sensitivity of 87% and a specificity of 89%. For education of 12 years or more, the area under the curve was 0.90 for the Sweet 16 and 0.84 for the MMSE (P=.03). The Sweet 16 is simple, quick to administer, and will be available open access. The performance of the Sweet 16 is equivalent or superior to that of the MMSE.

The CERAD Neuropsychologic Battery Total Score and the Progression of Alzheimer Disease

To establish the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychologic battery as a valid measure of cognitive progression in Alzheimer disease (AD) by deriving annualized CERAD Total Change Scores and corresponding confidence intervals in AD and controls from which to define clinically meaningful change. Subjects included 383 normal control (NC) and 655 AD subjects with serial data from the CERAD registry database. Annualized CERAD Total Change Scores were derived and Reliable Change Indexes (RCIs) calculated to establish statistically reliable change values. CERAD Change Scores were compared with annualized change scores from the Mini-Mental State Examination (MMSE), Clinical Dementia Rating Scale (CDR) Sum of Boxes, and Blessed Dementia Rating Scale (BDRS). For the CERAD Total Score, the AD sample showed significantly greater decline than the NC sample over the 4-year interval, with AD subjects declining an average of 22.2 points compared with the NCs' improving an average 2.8 points from baseline to last visit [Group x Time interaction [F(4,1031)=246.08, P<0.001)]. By Visit 3, the majority of AD subjects (65.2%) showed a degree of cognitive decline that fell outside the RCI. CERAD Change Scores significantly correlated (P<0.001) with MMSE (r=-0.66), CDR (r=-0.42), and BDRS (r=-0.38) change scores. Results support the utility of the CERAD Total Score as a measure of AD progression and provide comparative data for annualized change in CERAD Total Score and other summary measures.

Psychometric evaluation of personality in a patient with FTDP‐17

FRONTOTEMPORAL DEMENTIA WITH parkinsonism linked to chromosome 17 (FTDP-17) is characterized by motor, psychiatric and cognitive symptoms. Executive dysfunction and behavioral disturbances such as disinhibition, socially inappropriate behavior, and unsafe driving habits1 are crucial for differential diagnosis and are usually described as changes in personality. In most cases of frontotemporal dementia, personality assessment is limited to the detection of behavioral abnormalities by means of symptom-oriented scales such as Neuropsychiatric Inventory. To our knowledge, personality changes in FTDP-17 have never been described in the paradigm of individual differences to show which personality traits are altered by the disease. The use of personality questionnaires enables direct observation of personality changes during progression of the disease, and the results can be interpreted in the context of personality dimensions according to a given personality theory. Herein we present the case of a 58-year-old man diagnosed with FTDP-17 due to the P301L mutation in the tau gene (MAPT) who developed early personality changes, 7 years before the onset of motor symptoms. Psychometric assessment of personality was administered using the Minnesota Multiphasic Personality Inventory (MMPI), a common patient-derived test, and an informant questionnaire based on Big Five personality model derived from the International Personality Item Pool,2 the International Personality Item Pool–Questionnaire, Polish Version (IPIP-QPV).3 The MMPI was performed at the age of 53, 5 years before motor symptoms onset. Results (L-52, F-65, K-41, 1-Hs 86, 2-D 75, 3-Hy 87, 4-Pd 47, 5-Mf 51, 6-Pa 65, 7-Pt 81, 8-Sc 67, 9-Ma 47, 0-Si 80) showed lack of foresight, poor insight, egocentrism, somatization tendencies, fatigue, depressed mood and introversion. Slightly elevated F score may be associated with somatic complaints (Hy4-115). The IPIP-QPV was completed by the patient's wife when he was 58. At the time of this assessment the patient scored 24 on Mini Mental State Examination and 11 on the Blessed Dementia Rating Scale, which highlights the discrepancy between relatively mildly affected cognitive status and moderate impairment in daily living activities, mostly due to executive dysfunction, personality and emotional changes. The results (min. −20, max. 20 for each trait) are presented here as: before the disease onset/at the time of testing: extraversion −14/−13, openness to experience 7/−6, agreeableness 3/−1, conscientiousness 5/1, neuroticism −1/−4. The IPIP-QPV indicated that introversion was independent of the disease progression. Interestingly, the patient became not only less open to experience, less agreeable and conscientious, but also less neurotic. Low openness to experience and decreased agreeableness seem connected to dysexecutive syndrome with impaired mental flexibility, set shifting and inhibition, while decreased neuroticism may be related to poor insight and disinhibition. This report shows that analyzing personality changes in dementia with reference to psychological theories can provide complementary information to cognitive and behavioral data. Personality assessment shows the dynamic aspect of individual personality during disease progression and provides useful data for patient care.

Memantine versus donepezil in mild to moderate Alzheimer’s disease: a randomized trial with magnetic resonance spectroscopy

To compare memantine with the most prescribed cholinesterase inhibitor (donepezil) from a clinical viewpoint when administered in early phases of Alzheimer disease (AD), and to find out whether memantine may produce changes in brain metabolite concentrations in comparison with donepezil. In this comparative rater-blinded parallel group randomized trial we recruited a consecutive sample of patients with probable mild to moderate AD. At baseline we carried out neuropsychological assessment with mini-mental, Clinical Dementia Rating Scale (CDR), Blessed Dementia Rating Scale, Alzheimer's Disease Assessment Scale, cognitive part (ADAS-cog), neuropsychiatric inventory (NPI), and disability assessment for dementia (DAD), as well as (1)H magnetic resonance spectroscopy (MRS) in several areas of the brain. Patients were randomized to receive either donepezil or memantine for 6 months. After this elapse of time we repeated the same procedures and observed the changes in clinical scales (ADAS-cog, NPI, DAD), as well as the changes in metabolite levels in every area of exploration (temporal, pre-frontal, posterior cingulated (PCG), and occipital), especially those of N-acetyl-aspartate (NAA) which is regarded as a surrogate marker of neuronal density. A total of sixty-three patients completed the trial. We did not see significant differences in clinical scales and metabolite levels between those on donepezil (n = 32) and those on memantine (n = 31). In general, more patients worsened than improved on either of the drugs. The changes in the NAA/creatine ratio in the PCG correlated significantly with the changes in the ADAS-cog (P = 0.004). Donepezil and memantine have similar modest clinical and spectroscopic effect on mild to moderate AD. MRS could be useful to monitor progression of the disease.