Cambridge Cognitive Examination-Revised Research Articles

Predicting progression to Alzheimer’s disease dementia using cognitive measures: findings from the Essex Memory Clinic

AbstractBackgroundTimely diagnosis of Alzheimer’s disease (AD) is important for patients, carers and healthcare systems. It is therefore imperative to identify measures with the greatest power to predict future AD dementia. In contrast to research settings, expensive biomarkers are not always available in memory clinics. It is therefore vital to identify predictive measures which can be used in ordinary clinical settings.MethodThis study utilized clinical assessment data from 328 patients assessed in the Essex Memory Clinic between 2002 and 2019. Only patients with a diagnosis of subjective cognitive decline (SCD) or mild cognitive impairment (MCI) at baseline and a minimum of two follow‐up visits were included in analyses. Lasso logistic regression (using AD at visit 3 as the outcome) and Lasso Cox proportional hazards models (using time to AD at visit 3 and beyond as outcome) were fitted in two stages. The first stage included baseline cognitive scores only, while the second stage also included change scores for these measures (derived by subtracting scores at baseline from those at the first follow‐up visit).ResultIn the first stage models, lower Mini‐Mental State Examination (MMSE) and Logical Memory Test (LMT) delayed recall scores, and longer Trail‐Making Test part A (TMT‐A) time were associated with greater odds (logistic regression) and hazards (Cox proportional hazards) of progression to AD. In addition, in the Cox model (only), lower baseline Cambridge Cognitive Examination‐Revised (CAMCOG‐R) score was associated with greater hazard of AD. In the second stage models, worsening CAMCOG‐R and LMT (delayed recall) scores were independently associated with both the odds/hazards of AD.ConclusionIn this memory clinic cohort, the cognitive scores most predictive of progression to AD were the delayed LMT, TMT‐A, CAMCOG‐R and MMSE. These results are in‐keeping with earlier work conducted in research cohorts. The inclusion of cognitive change scores over one year follow‐up improved predictive accuracy versus baseline scores alone.

Cognitive Correlates of Perseverations in Individuals with Memory Impairment.

This study examines which cognitive measure best accounts for perseverations in individuals with memory impairment. The sample included 85 individuals, of whom 21 had subjective memory concerns, 27 had mild cognitive impairment, and 37 had Alzheimer's disease. Participants produced responses on a semantic category fluency task and on the ideational fluency (IF) task from the Cambridge Cognitive Examination-Revised. Measures of word finding, working memory, and abstract thinking were also assessed. Significant group differences in percentage of perseverations emerged on both tasks. No cognitive measure accounted for the percentage of perseverations on the semantic fluency task. A measure of abstract thinking was the best predictor of the percentage of perseverations on the IF task, followed by a measure of working memory. The underlying cognitive mechanisms that lead to perseverations differ across tasks, with perseverations on the IF task reflecting both conceptual deficits and working memory limitations.

Relation between subcortical grey matter atrophy and conversion from mild cognitive impairment to Alzheimer's disease

ObjectiveTo investigate whether subcortical grey matter atrophy predicts progression from mild cognitive impairment (MCI) to Alzheimer's disease (AD), and to compare subcortical volumes between AD, MCI and controls. To assess...

Factors that predict cognitive decline in patients with subjective cognitive impairment.

Current evidence supports the concept of a preclinical phase of Alzheimer's disease (AD) where pathological and imaging changes are present in asymptomatic individuals. Subjective cognitive impairment (SCI) may represent the earliest point on the continuum of AD. A better understanding of the baseline characteristics of this group of patients that later decline in cognition will enhance our knowledge of the very early disease processes, facilitate preventive strategies, early diagnosis, timely follow-up and treatment. An observational exploratory study which followed up 62 consecutive patients with SCI presenting to a memory clinic and compared baseline characteristics of SCI patients who declined cognitively with those who did not. Cognitive decline was defined as a progression to a diagnosis of amnestic mild cognitive impairment (aMCI) or dementia at follow-up. Patients were followed up for a mean of 44 months (range 12-112 months). At the time of follow up, 24% of patients had declined. Patients that declined were significantly older at onset of symptoms and first presentation to memory clinic, and took significantly more medications for physical illnesses. Patients that declined also performed significantly worse on Trail Making Test (TMT) B and Cambridge Cognitive Examination - Revised (CAMCOG-R) at baseline. Survival analysis identified key variables that predicted decline (later age of onset and later age at first assessment). Patients who present with subjective memory complaints and are over the age of 61 years are at high risk of cognitive decline and warrant an in-depth assessment and follow-up.

An investigation of the efficiency of the mini-Kingston standardized cognitive assessment-revised in classifying patients according to DSM-5 major and mild neurocognitive disorders due to possible Alzheimer's disease

The aim of this study was to examine the efficiency of the mini-Kingston standardized cognitive assessment-revised (mini-KSCAr) in classifying patients according to DSM-5 major and mild neurocognitive disorders (NCD) due to possible Alzheimer's disease (AD). Files of 85 individuals who were tested on the Kingston standardized cognitive assessment-revised were reviewed and scores were calculated for the mini-KSCAr. Medical history, psychiatric and physical status, basic and instrumental activities of daily living, as well as scores on the Cambridge cognitive examination-revised (CAMCOG-R), and the clinical dementia rating (CDR) scale were used to establish DSM-5 diagnoses of major or mild neurocognitive disorders (NCD) due to possible AD or no cognitive decline. All participants were tested on the Mini-Mental State Examination (MMSE) and the clock drawing test (CDT), and a subset (N = 28) were also tested on three well-known memory tasks. Scores on the MMSE, CDT, and mini-KSCAr differed across groups, but only the mini-KSCAr significantly distinguished each group from the other two. The mini-KSCAr showed better sensitivity, specificity, and likelihood ratios (LRs) than did the MMSE and the CDT. A regression analysis revealed that the mini-KSCAr accounted for almost half of the variance in memory performance, whereas the MMSE and the CDT contributed nothing to this prediction once the mini-KSCAr was used. The mini-KSCAr is an efficient instrument for the diagnosis of DSM-5 major and mild NCD due to possible AD in a specialized psychogeriatric setting, and its utility is greater than that of the MMSE and the CDT.

A depressive endophenotype of poorer cognition among cognitively healthy community-dwelling adults: results from the Western Australia memory study.

The objective was to evaluate in a cognitively normal population the utility of an endophenotype of the depression-cognition link previously shown to be related to cognitive functioning in mild cognitive impairment and Alzheimer's disease. The data of 460 cognitively normal adults aged 32-92 years (M = 63.5, standard deviation = 9.24) from the Western Australian Memory Study with the Cross-national comparisons of the Cambridge Cognitive Examination-revised (CAMCOG-R) scores and 30-item Geriatric Depression Scale (GDS) scores were analyzed to determine the relationship between the five-item depressive endophenotype (DepE) scale drawn from the GDS and level of performance on a measure of cognitive functioning. For the entire sample, there was a nonsignificant trend toward a negative relationship between DepE and CAMCOG-R scores. When analyzed for those 65 years and older, there was a significant negative relationship between the two measures (p = 0.001) with DepE scores significantly increasing the risk for performing more poorly on the CAMCOG-R (odds ratio = 1.53). Analysis of data for those 70 years and older showed that DepE was the only predictor significantly related to poorer CAMCOG-R performance (p = 0.001). For the 70 years and older group, DepE scores significantly increased the risk of poorer CAMCOG-R scores (odds ratio = 2.23). Analysis of the entire sample on the basis of ApoEε4 carrier status revealed that DepE scores were significantly negatively related only to ApoEε4 noncarrier regardless of age. Elevated DepE scores are associated with poor neuropsychological performance among cognitively normal older adults. Use of the DepE may allow for the identification of a subset of older adults where depression is a primary factor in cognitive decline and who may benefit from antidepressant therapies.

Associations between CAMCOG-R subscale performance and formal education attainment in South African older adults.

ABSTRACT Background: The Cambridge Cognitive Examination-Revised (CAMCOG-R) is a sensitive screening tool for the early diagnosis of dementia in older adults. Overall performance on the CAMCOG-R is influenced by educational attainment. Few studies have, however, examined the association between educational attainment and performance on the individual CAMCOG subscales. We aimed to address this question in a sample from a low-and middle-income country (LAMIC), where resource constraints may have compromised access to, and quality of, education for many older adults. Methods: Participants, all over 60 years of age, were 51 cognitively healthy community-dwelling volunteers and 47 individuals diagnosed with mild-moderate stage Alzheimer's disease (AD). Most participants had some high school education. They were administered the CAMCOG-R under standardized conditions. Results: Within both the control and AD patient groups, there were significant associations between years of completed education and CAMCOG-R total score, MMSE score, and CAMCOG-R Language subscale score. In both groups, level of education was not associated with scores on these subscales: in controls, recent memory, R 2 = .21, p = .055, learning memory, R 2 = .16, p = .398, attention/calculation, R 2 = .19, p = .467, and perception, R 2 = .18, p = .984; in AD patients, recent memory, R 2 = .14, p = .340, learning memory, R 2 = .03, p = .680, perception, R 2 = .09, p = .723, and attention/calculation, R 2 = .19, p = .097. Conclusions: Some CAMCOG-R subscale scores were more strongly associated with educational attainment than others. Importantly, however, performance on the recent memory and learning memory subscales was not affected by education. These subscales are sensitive indicators of amnestic mild cognitive impairment (MCI) and early AD. These subscales may therefore remain valid for use as an AD screening tool in resource-poor healthcare settings.

The PACE study: a randomized clinical trial of cognitive activity strategy training for older people with mild cognitive impairment.

The role of cognition-focused interventions in reducing cognitive decline in older people remains uncertain. This study aimed to clarify whether a group cognitive activity (CA) strategy-training program would decrease the 2-year rate of cognitive decline of people with mild cognitive impairment (MCI). Randomized controlled trial. One study site. 160 older adults with MCI≥65 years of age (mean: 75, SD: 5.8). Five-week CA strategy training or a control nonspecific educational program. The primary outcome measure was change from baseline in the total score on the Cambridge Cognitive Examination-Revised (CAMCOG-R). Secondary outcomes of interest included changes in memory, attention, executive functions, mood, and quality of life. Endpoints were collected 10, 52, and 104 weeks post baseline. Intention to treat analysis identified no significant difference in CAMCOG-R scores over time between the two groups (mean difference:-0.36, 95% CI:-1.02,0.29) or across secondary outcome measures. The exceptions were better performance of the CA group on immediate attention (Digit Span Forwards, adjusted mean difference: 0.15, 95% CI: 0.01,0.30) and better quality of life (adjusted mean difference: 0.57, 95% CI: 0.10,1.04) compared with controls. The devised program of CA did not improve general cognitive performance of older adults with MCI over a period of 2 years. Although favorable, the beneficial effects of the intervention on attention and quality of life were small, and of uncertain significance.

Clinician and caregiver agreement on neuropsychiatric symptom severity: a study using the Neuropsychiatric Inventory – Clinician rating scale (NPI-C)

Neuropsychiatric symptoms (NPS) are highly prevalent in dementia. The recently developed Neuropsychiatric Inventory - Clinician rating scale (NPI-C) includes clinical judgment and new symptom domains. Our objective was to evaluate NPI-C reliability and to compare caregiver and clinician ratings across the range of mild to severe cognitive impairment. This is a cross-sectional observational study. Participants were geriatric memory clinic patients and nursing-home residents (n = 30) with an established diagnosis of dementia or Mild Cognitive Impairment (MCI). A psychiatrist (MK) interviewed caregiver-patient dyads using the NPI-C. Neuropsychological tests and Mini-Mental State Examination (MMSE) were used to assess cognitive impairment. Two NPI-C caregiver interviews were videotaped and rated by psychologists and geriatricians. Intra-class correlations (ICCs) were used to examine inter-rater agreement. Correlation coefficients were calculated to evaluate caregiver and psychiatrist NPI-C ratings. Disagreement between caregiver and clinician was expressed in delta scores and examined across the range of mild to severe cognitive impairment, using Levene's homogeneity of variances tests. Inter-rater agreement on ratings of two caregiver videos was high (ICC = 0.99-1.0). Clinician-caregiver concordance on NPI-C total severity ratings was high (r = 0.77). Variability in clinician-caregiver concordance was associated with cognitive impairment: MMSE (P = 0.02), CAMCOG-R (Cambridge Cognitive Examination-revised) total scores (P = 0.02), CAMCOG-R Memory scores (P = 0.04) and Language scores (P = 0.01). The NPI-C is a reliable measure of NPS in patients with MCI or dementia. Clinician-caregiver agreement on NPS severity may vary with cognitive impairment, underlining the importance of clinician-based measures of NPS.

Attention and inhibition in Mild Cognitive Impairment and Alzheimer's Disease

Mild cognitive impairment is understood as a cognitive deficit of insufficient severity to fulfil the criteria for Alzheimer’s disease. Many studies have attempted to identify which cognitive functions are most affected by this type of impairment and which is the most sensitive neuropsychological test for early detection. This study investigated sustained and selective attention, processing speed, and the inhibition process using a sample of people divided into three groups mild cognitive impairment, Alzheimer disease and cognitively healthy controls selected and grouped based on their scores in the Mini Mental State Examination and Cambridge Cognitive Examination-revised. Three tests from the Cambridge Neuropsychological Test Automated Battery (Motor Screening Task, Stop Signal Task and Reaction time) were used as well as the d2 attention test. The results show that that participants with mild cognitive impairment and Alzheimer disease showed lower levels of concentration compared with the cognitively healthy controls group in the d2 test and longer reaction times in the Cambridge Neuropsychological Test Automated Battery, although the differences were not marked in the latter test. The impairments in basic cognitive processes, such as reaction time and sustained attention, indicate the need to take these functions into account in the test protocols when discriminating between normal aging and early and preclinical dementia processes.

Impairment of Executive Function and Attention Predicts Onset of Affective Disorder in Healthy High-Risk Twins

To investigate whether measures of cognitive function can predict onset of affective disorder in individuals at heritable risk. In a high-risk study, 234 healthy monozygotic and dizygotic twins with and without a co-twin history of affective disorder (high- and low-risk twins, respectively) were identified through nationwide registers and assessed at baseline using the Schedules for Clinical Assessment in Neuropsychiatry, the 17-item Hamilton Depression Rating Scale (HDRS), and the cognitive tests Trail Making Test Parts A and B, the Stroop test, and the Cambridge Cognitive Examination-Revised (CAMCOR). Participants were followed longitudinally at 6-month intervals for up to 9 years and finally reassessed with a personal interview to obtain information on whether they had developed psychiatric illness. The study was conducted between 2003 and 2012. 36 participants (15.4%) developed psychiatric disorder, mainly affective and anxiety disorders (31 diagnoses) (ICD-10). Onset was predicted by decreased executive function as reflected by performance on the Trail Making Test A - B (hazard ratio [HR] = 1.02; 95% CI, 1.00-1.03) when adjusted for sex, age, years of education and HDRS score at baseline. Reduced global cognitive function as indicated by a lower CAMCOR score at baseline showed a trend toward an association with subsequent illness onset (P = .08). With regard to the 5 CAMCOR subscales, lower scores on attention (HR = 0.71; 95%, CI, 0.54-0.94) and language (HR = 0.76; 95% CI, 0.58-0.99) were significantly associated with subsequent illness onset. Among healthy individuals at heritable risk for affective disorder, discrete cognitive deficits, especially within executive function and attention, seem to predict subsequent onset of affective illness.

Cerebrospinal Fluid Tau and Amyloid β Proteins Do Not Correlate With Cognitive Functioning in Cognitively Impaired Memory Clinic Patients

ABSTRACTObjective: The aim of this study was to investigate the influence of cerebrospinal fluid (CSF), amyloid β42(Aβ42), phosphorylated tau181 (p-tau), and total tau (t-tau) on cognitive functioning.Methods: We analyzed the ability of the CSF biomarkers Aβ42, p-tau, and t-tau to predict the results on the Cambridge Cognitive Examination–Revised (CAMCOG-R), a cognitive screening test that assesses multiple cognitive domains, in 65 memory clinic patients (73.1±8.2 years) (n=30 probable Alzheimer's disease [AD], n=7 possible AD, n=12 non-AD dementia, n=16 mild cognitive impairment).Results: We found no correlations between CSF biomarkers and CAMCOG-R performance in the whole group, nor in subgroups based on aberrant biomarker concentrations.Discussion: Changed concentrations of CSF amyloid β42, p-tau, and t-tau cannot be directly linked to cognitive function in our sample of patients with cognitive impairment. Possibly, compensatory mechanisms such as cognitive reserve determine cognitive performance, rather than the absolute amount of damage caused by Aβ deposition and tangle formation. In addition, abnormal CSF biomarker concentrations may not be a direct reflection of the amount of neuronal damage, but merely serve as an indicator of AD pathology.Conclusion: While CSF biomarkers are valuable in establishing AD pathology, they cannot be used to predict severity of cognitive impairment.

Adaptação para o português do Cambridge Cognitive Examination-Revised aplicado em um ambulatório público de geriatria

This paper presents the results of the first four steps (conceptual, item, semantic, and operational equivalences) of cross-cultural adaptation to Portuguese of the Cambridge Cognitive Examination-Revised (CAMCOG-R). The process was based on the theoretical model proposed by Herdman et al., which includes not only the four steps described above, but also measurement and functional equivalences, not evaluated in the current study. A panel of experts evaluated whether all dimensions that comprise the CAMCOG-R were present in Brazilian reality. Two translations and back-translations were performed, in addition to the 'focus group' technique. The Brazilian Portuguese version of the CAMCOG-R (Br-CAMCOG-R) was developed, maintaining the 69 items from the original instrument, with different levels of difficulty. It was then applied to 196 elders, with the test lasting an average of 43 +/- 9.4 minutes, and an average total score of 67 +/- 14.8 points. The Br-CAMCOG-R can be a useful tool for the cognitive evaluation of elders that tested positive during initial screening.

The Clock Drawing Test—Modified and Integrated Approach (CDT-MIA) as an Instrument for Detecting Mild Cognitive Impairment in a Specialized Outpatient Setting

This study examined the accuracy of the Clock Drawing Test--Modified and Integrated Approach (CDT-MIA) alone and combined with the Mini-Mental State Examination (MMSE) to detect Mild Cognitive Impairment (MCI) in patients with suspected MCI. For comparison, the accuracy of the Cambridge Cognitive Examination-Revised (CAMCOG-R) was tested. A total of 65 elderly outpatients with suspected MCI underwent a comprehensive evaluation. Following assessment, the entire sample was classified into: dementia (mild)--24 participants, MCI--22 participants, no cognitive impairment (NCI)--19 participants. CDT-MIA and the MMSE alone failed to appropriately discriminate demented from nondemented (MCI and NCI) and MCI from NCI. The best acceptable diagnostic accuracy to discriminate between demented and nondemented was obtained with CDT-MIA/MMSE combined and with CAMCOG-R. CDT-MIA/MMSE combined failed to appropriately discriminate MCI from NCI. The best diagnostic accuracy in this regard was obtained with CAMCOG-R.