Cambridge Examination For Mental Disorders Research Articles

Measurement properties of the German version of the Cambridge examination for mental disorders of older people with Down syndrome and others with intellectual disabilities (CAMDEX-DS)

ABSTRACT Background The CAMDEX-DS is an instrument to diagnose Alzheimer’s disease (AD) in Down syndrome consisting of an informant interview and a cognitive test battery (CAMCOG-DS). Measurement properties of the German CAMDEX-DS were investigated. Method Fifty-five adults with Down syndrome (19–58 years) participated in this observational study. “Dementia” and “Alzheimer's dementia” (Alzheimer's disease) were diagnosed clinically and operationalised CAMDEX-ICD-10 criteria were applied to evaluate criterion validity. Validity and reliability of the CAMCOG-DS were analysed. Results Specificity of the interview was 69–93%; sensitivity 0–80% for “dementia”; and 0-20% for Alzheimer's disease. A complete CAMCOG-DS score was obtained in 85% (item difficulty 0.11–0.96). Construct validity and retest-reliability were low to moderate (τ = .04–.79), inter-rater reliability excellent (τ = .70–.89), internal consistency and selectivity acceptable to excellent. Conclusions Currently, the CAMDEX-DS including the CAMCOG-DS are the outcome assessments for assessing dementia in Down syndrome with the best psychometric properties; however, revision is recommended.

Associations of Gait and Cognitive Impairment and Dementia in Individuals with Down Syndrome

AbstractBackgroundLife expectancy of individuals with Down syndrome (DS) has increased considerably over the years. Atypical aging in Down syndrome (DS) is associated with neuropathological characteristics consistent with Alzheimer disease (AD). Significant gait alterations are associated with an increased risk of dementia for the general population. The aim of this study was to determine whether gait performance is associated with cognitive performance and dementia in adults with DS.MethodThis study included 66 individuals with DS over 20 years of age, divided into three diagnostic groups: stable cognition, prodromal dementia, and dementia. They were evaluated with the Performance‐Oriented Mobility Assessment (POMA), Timed Up and Go test, and Cambridge Examination for Mental Disorders of Older People with Down’s Syndrome and Others with Intellectual Disabilities (CAMDEX‐DS), which includes the Cambridge Cognitive Examination (CAMCOG). Logistic regression model was used to assess the effects of gait and balance on the diagnosis (prodromal dementia and dementia versus stable cognition) adjusting for age, sex, body mass index (BMI), degree of intellectual disability and physical inactivity.ResultThe score on the POMA‐Gait subscale score and body mass index (BMI) were found to be independent predictors of prodromal dementia and dementia (Poma‐Gait OR = 0.67, 0.53‐0.85 CI, p<0.001; and BMI OR = 1.12, 1.021.24 CI, p<0.001). A lower POMA‐Total score indicates a higher fall risk. With the exception of perception, all cognitive domains correlated with the POMA total score (P<0.05).ConclusionThese data indicate that poor gait performance, as assessed by the POMA, as well as a high BMI, were associated with a diagnosis of prodromal dementia or dementia. In those individuals, applying the POMA could facilitate the early diagnosis of dementia, help identify fall risks, and promote the adoption of geriatric interventions focused on improving functional mobility. There is a need for longitudinal studies to characterize the true nature of the associations found, to validate gait instruments specifics to this population, and for future analyses in order to clarify the role that gait and balance play in cognitive decline and the development of dementia.

Predictive ability of the IQCODE items for detection of cognitive decline and dementia in aging adults with Down syndrome

AbstractBackgroundThere is evidence of a genetic association between Down Syndrome (DS) and early progression of Alzheimer’s disease (AD). Few brief instruments have been validated for the screening of dementia in this population. Previously, we showed that the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) may be useful for cognitive screening in adults with DS1. Nonetheless, the adaptation of certain items to account for the presence of intellectual deficiency may increase diagnostic accuracy. The aim of the present study is to evaluate the predictive ability of IQCODE items for adults with DS.MethodUnivariate and multivariate logistic regressions were used to assess the effects of the 26 IQCODE items on the diagnosis of cognitive decline (prodromal dementia or dementia versus stable cognition) according to the Cambridge Examination for Mental Disorders of Older People with DS and Others with Intellectual Disabilities, CAMDEX‐DS. The study comprised 92 participants with DS aged ≥35 years. The accuracy of the final multivariate model was evaluated using receiver operator characteristics (ROC) curve.ResultAssociations were found between all IQCODE items and diagnosis, except for two items (handling money for shopping and financial matters). Multivariate logistic regression using the CAMDEX‐DS diagnosis as dependent and the items of IQCODE as predictors, showed that four items remained in the model (remembering: members of family and friends, day and month, things they learned when they were younger, and adjusting to change in routine). Participants who presented more difficult with these items were, respectively, 84.1, 86.1, 10.1 and 23.6 times more likely to have a diagnosis of prodromal dementia or dementia. Using the estimated probability of these 4 items, we found an area under the ROC curve of 0.961.ConclusionThe IQCODE items showed good ability to discriminate subjects with cognitive decline as indicated by the CAMDEX‐DS. The use of 4 of the IQCODE items proved to suffice to discriminate between diagnostic groups. We will next perform an adaptation and validation study to warrant the “IQCODE‐DS” as a reliable, brief test for the cognitive screening in this population.

Balance and Gait: Associations With Cognitive Impairment and Dementia in Individuals With Down Syndrome.

Atypical aging in Down syndrome (DS) is associated with neuropathological characteristics consistent with Alzheimer disease. Gait abnormalities have been shown to be associated with an increased risk of dementia for the general population. The aim of this study was to determine whether gait disorders are associated with worse cognitive performance and dementia in adults with DS. We evaluated 66 individuals with DS (≥20y of age), divided into 3 groups: stable cognition, prodromal dementia, and dementia (presumed Alzheimer disease). Each individual was evaluated with the Performance-Oriented Mobility Assessment (POMA), Timed Up and Go test, and Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities (CAMDEX-DS), in addition to a comprehensive clinical protocol to ascertain the occurrence of medical or psychiatric comorbidities. The score on the POMA-Gait subscale score and body mass index were found to be independent predictors of prodromal dementia and dementia ( P <0.001 for both). With the exception of perception, all cognitive domains correlated with the POMA-Total score ( P <0.05). A lower POMA-Gait score increases the chance of prodromal dementia and dementia in adults with DS. Unlike other research, in this study higher body mass index was also found to increase the chance of prodromal dementia and dementia. In those individuals, applying the POMA could facilitate the early diagnosis of dementia, help identify fall risks, and promote the adoption of geriatric interventions focused on improving functional mobility.

[Regression in Young Adults with Down-Syndrome: A Case Series].

Regression in young adults with Down syndrome can present itself with an acute loss of acquired skills and change in behavior. The aim of our case series was to describe the heterogeneous clinical presentation of this syndrome as well as accompanying diagnostic and therapeutic challenges and consequences. All three patients were assessed with the CAMDEX-DS (Cambridge Examination for Mental Disorders of Older People with Down Syndrome and Others with Intellectual Disabilities) and the criteria published by the DSMIG-USA (Down-Syndrome Medical Interest Group USA). After ruling out somatic or other psychiatric causes, the application of the DSMIG-USA criteria resulted in diagnosing at least a probable unexplained regression in all three patients. The thorough diagnostic investigation of unexplained acute regression in young adults with Down syndrome allows for quick initiation of therapeutic and supportive measures. Using the DMSIG-USA criteria facilitates the assessment of the underlying diffuse and heterogenous pathology.

Screening for Dementia and Cognitive Decline in Adults With Down Syndrome: A Novel Approach Using the Informant Questionnaire on Cognitive Decline in the Elderly.

The aim was to examine the psychometric properties of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a diagnostic tool to screen for dementia in aging individuals with Down syndrome (DS). This was a cross-sectional study of 92 individuals with DS 30 y or above of age) evaluated with the IQCODE. Using the informant questionnaire of the Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities, we divided the subjects into 3 diagnostic groups: stable cognition; prodromal dementia; and dementia. The ability of the IQCODE to discriminate between diagnostic groups was analyzed by calculating the areas under the receiver operator characteristic curves (AUCs). The optimal IQCODE cutoffs were 3.14 for dementia versus stable cognition (AUC=0.993; P<0.001) and 3.11 for prodromal dementia+dementia versus stable cognition (AUC=0.975; P<0.001), with sensitivity/specificity/accuracy of 100%/96.8%/97.3%, and 93.3%/91.9%/92.4%, respectively. The IQCODE showed a weak-to-moderate correlation with cognitive performance (P<0.05). The IQCODE is a useful tool to screen for cognitive decline in individuals with DS and is suitable for use in a primary care setting.

Informant-based assessment instruments for dementia in people with intellectual disability: A systematic review and standardised evaluation

BackgroundDementia in people with intellectual disability (ID) is frequent but hard to recognise. Evidence-based recommendations for suitable instruments are lacking. AimsThe present study set out to evaluate informant-based dementia assessment instruments and to provide evidence-based recommendations for instruments most suitable in clinical practice and research. Method and proceduresA systematic review was conducted across ten international electronic databases. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines, including a risk of bias assessment, was applied to extract information and to evaluate measurement properties and the quality of available evidence. Outcomes and resultsIn total, 42 studies evaluating 18 informant-based assessment instruments were analysed. For screening purposes, we recommend the Behavioral and Psychological Symptoms of Dementia in Down Syndrome Scale (BPSD-DS), the Cognitive Scale for Down Syndrome (CS-DS), and the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID). For a more thorough dementia assessment, we recommend the Cambridge Examination for Mental Disorders of Older People with Down’s Syndrome and Others with Intellectual Disabilities (CAMDEX-DS). Conclusions and implicationsOur study informs clinicians and researchers about adequate, well-evaluated dementia assessment instruments for people with ID, and highlights the need for high quality studies, especially regarding content validity.

The Association between Physical Activity and CAMDEX-DS Changes Prior to the Onset of Alzheimer's Disease in Down Syndrome.

Background: People with Down syndrome are at ultra-high risk of developing Alzheimer’s dementia. At present, there are no preventative or curative treatments. Evidence from sporadic Alzheimer’s disease literature suggests that lifestyle factors including physical activity may help maintain cognitive and functional skills and reduce dementia risk. Our study aimed to explore the association between regular exercise undertaken by participants with Down syndrome and changes in dementia-related domains of cognition and function. This was to consider whether physical activity may be a protective measure to delay cognitive decline and dementia in Down syndrome. Methods: Demographic, lifestyle, and health information was collected at baseline and at a two year follow up from 214 adults with Down syndrome without dementia, who also underwent assessment using the Cambridge Examination for Mental Disorders of Older People with Down Syndrome and Others with Intellectual Disabilities (CAMDEX-DS) and genetic analysis. Logistic regression models were used to examine the potential associations between decline in CAMDEX-DS domains and exercise whilst controlling for key variables. Results: At baseline, engaging in moderate intensity exercise was associated with a 47% reduced risk of everyday skills decline and engaging in high intensity exercise was associated with a 62% reduced risk of decline in personality and behaviour. At follow-up, high levels of exercise were associated with an 87% reduced risk of decline in personality and behaviour. Moderate intensity exercise at baseline was associated with a 62% reduction in risk of decline during the follow-up period in memory and orientation. Discussion: Based on our data it appears that regular moderate and high intensity exercise could reduce the risk of clinically detectable decline in a Down syndrome population with possible long-term benefits. People with Down syndrome may engage in less physical activity than their peers, and barriers remain which can prevent people with Down syndrome engaging in exercise. Our work highlights how important it is that people with Down syndrome are supported to be physically active, and to promote exercise as part of a healthy ageing plan. Clinical trials in this area would be justified to determine if engaging in exercise can lead to realistic improvements in maintaining functioning and delaying dementia onset in Down syndrome and to help develop guidance in this area.

Establishing diagnostic thresholds for Alzheimer's disease in adults with Down syndrome: the Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities (CAMDEX-DS).

Diagnosis of prodromal Alzheimer's disease and Alzheimer's disease dementia in people with Down syndrome is a major challenge. The Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities (CAMDEX-DS) has been validated for diagnosing prodromal Alzheimer's disease and Alzheimer's disease dementia, but the diagnostic process lacks guidance. To derive CAMDEX-DS informant interview threshold scores to enable accurate diagnosis of prodromal Alzheimer's disease and Alzheimer's disease dementia in adults with Down syndrome. Psychiatrists classified participants with Down syndrome into no dementia, prodromal Alzheimer's disease and Alzheimer's disease dementia groups. Receiver operating characteristic analyses assessed the diagnostic accuracy of CAMDEX-DS informant interview-derived scores. Spearman partial correlations investigated associations between CAMDEX-DS scores, regional Aβ binding (positron emission tomography) and regional cortical thickness (magnetic resonance imaging). Diagnostic performance of CAMDEX-DS total scores were high for Alzheimer's disease dementia (area under the curve (AUC), 0.998; 95% CI 0.953-0.999) and prodromal Alzheimer's disease (AUC = 0.954; 95% CI 0.887-0.982) when compared with healthy adults with Down syndrome. When compared with those with mental health conditions but no Alzheimer's disease, CAMDEX-DS Section B scores, denoting memory and orientation ability, accurately diagnosed Alzheimer's disease dementia (AUC = 0.958; 95% CI 0.892-0.984), but were unable to diagnose prodromal Alzheimer's disease. CAMDEX-DS total scores exhibited moderate correlations with cortical Aβ (r ~ 0.4 to 0.6, P ≤ 0.05) and thickness (r ~ -0.4 to -0.44, P ≤ 0.05) in specific regions. CAMDEX-DS total score accurately diagnoses Alzheimer's disease dementia and prodromal Alzheimer's disease in healthy adults with Down syndrome.

Neuropsychiatric Symptoms of Alzheimer's Disease in Down Syndrome and Its Impact on Caregiver Distress.

Neuropsychiatric symptoms (NPS) are non-cognitive manifestations common to dementia and other medical conditions, with important consequences for the patient, caregivers, and society. Studies investigating NPS in individuals with Down syndrome (DS) and dementia are scarce. Characterize NPS and caregiver distress among adults with DS using the Neuropsychiatric Inventory (NPI). We evaluated 92 individuals with DS (≥30 years of age), divided by clinical diagnosis: stable cognition, prodromal dementia, and AD. Diagnosis was determined by a psychiatrist using the Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities (CAMDEX-DS). NPS and caregiver distress were evaluated by an independent psychiatrist using the NPI, and participants underwent a neuropsychological assessment with Cambridge Cognitive Examination (CAMCOG-DS). Symptom severity differed between-groups for delusion, agitation, apathy, aberrant motor behavior, nighttime behavior disturbance, and total NPI scores, with NPS total score being found to be a predictor of AD in comparison to stable cognition (OR for one-point increase in the NPI = 1.342, p = 0.012). Agitation, apathy, nighttime behavior disturbances, and total NPI were associated with CAMCOG-DS, and 62% of caregivers of individuals with AD reported severe distress related to NPS. Caregiver distress was most impacted by symptoms of apathy followed by nighttime behavior, appetite/eating abnormalities, anxiety, irritability, disinhibition, and depression (R2 = 0.627, F(15,76) = 8.510, p < 0.001). NPS are frequent and severe in individuals with DS and AD, contributing to caregiver distress. NPS in DS must be considered of critical relevance demanding management and treatment. Further studies are warranted to understand the biological underpinnings of such symptoms.

Screening for dementia in Down syndrome using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)

AbstractBackgroundDown syndrome (DS) is genetically associated with Alzheimer´s disease (AD), and the neuropathological features of AD can be found in DS brains since early adulthood. Screening tests are required for the clinical assessment of dementia; however, the presence of intellectual disability at various degrees precludes the use of most of the available cognitive screening tests in this population, and few instruments have so far been validated for this purpose. The aim of the present study was to examine the psychometric properties of the IQCODE for the screening for cognitive/functional decline and dementia in DS.Method92 aging adults with DS (mean age 43.45 SD 8.51; 61.0% males) were enrolled for a cross‐sectional assessment by two independent psychiatrists. Inclusion criteria were: diagnosis of DS according to the International Classification of Diseases, tenth edition (ICD‐10); minimum age of 30 years; and having an informant with daily contact with the subject for the past 10 years at least. Participants were assessed by the Cambridge Examination for Mental Disorders of Older People with Down syndrome and others with Intellectual Disability (CAMDEX‐DS) using a validated Brazilian version, and by the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). The concurrent validity of the IQCODE was analyzed in relation to the gold standard CAMDEX‐DS diagnosis.ResultParticipants were allocated into three diagnostic groups according to the CAMDEX‐DS: 1‐ dementia (N= 13); 2‐ prodromal dementia (N=17); and 3‐ stable cognition (N=62). ROC curve analyses were carried out to determine the diagnostic accuracy of the IQCODE in comparison to CAMDEX‐DS by diagnostic pairs indicated that the IQCODE optimal cut‐off scores for each diagnostic pair were as follows: (a) AD versus stable cognition: 3.14 (AUC=0.993; sensitivity: 100% specificity: 96.8%; (b) AD + prodromal versus stable cognition: 3.11 (AUC=0.975; sensitivity: 93.3%; specificity: 91.9%).ConclusionThe IQCODE appears to be a suitable tool for the brief screening of cognitive/functional decline in aging DS adults.

Prevalence of neuropsychiatric symptoms related to dementia in individuals with Down syndrome

AbstractBackgroundNeuropsychiatric symptoms (NPS) are significant manifestations of dementia, with important consequences for patients and caregivers. Despite the established genetic link between Down syndrome (DS) and Alzheimer’s disease (AD), studies investigating NPS in individuals with DS and dementia are scarce. The Neuropsychiatric Inventory (NPI) was developed to identify symptoms of dementia and while it is widely used for the assessment of individuals with dementia in the general population, we have found no studies using the NPI in those with DS. The aim of this study is to characterize NPS in a sample with DS with heterogeneous cognitive profiles using the NPIMethodParticipants (N=92) with DS, ≥30 years of age were assessed with the Cambridge Examination for Mental Disorders of Older People with Down’s Syndrome and Others with Intellectual Disabilities (CAMDEX‐DS). They were classified by a psychiatrist into three categories: AD, prodromal dementia, and stable cognition. Another psychiatrist blinded to the CAMDEX‐DS dementia diagnosis, evaluated the participants using the NPI. Chi‐square tests were used to check for significant differences in frequency of symptoms.ResultThirteen participants (14.1%) had AD, 17 (18.4%) were classified as prodromal dementia and 62 (67.5%) were in the stable cognition group. Prevalence of delusion, depression, anxiety, disinhibition, irritability, appetite abnormalities and total NPI did not differ between groups. Anxiety and irritability were common across all groups (∼50% of the total), while euphoria was not present in any participant. Hallucination, agitation, apathy, aberrant motor behaviour and night‐time behaviour disturbance showed significant difference among the groups (p&lt;0.05), with higher prevalence in the group with AD.ConclusionThe results indicate that individuals with DS and AD have some of the symptoms that are characteristically present among the general population with AD. Future studies are needed to understand if AD in DS is associated with a similar pattern of NPS observed among people with AD in the general population or may follow a specific NPS pattern. The high frequency of some NPS in individuals with DS and stable cognition should be considered in the diagnostic process in order to reduce the odds of generating a false positive.

Role of gait and speed performance in predicting cognitive decline and dementia in people with Down syndrome: Preliminary findings

AbstractBackgroundThe longevity of people with DS has increased substantially in recent decades. This population shows signs of premature aging in many organs and systems. The neuropathology of Alzheimer's disease (AD) is overexpressed in DS. Cognitive and functional losses, such as decline in executive function and apraxia, interfere with the sequencing of movements and the integrity of gait. There is evidence that a decrease in gait may precede other clinical symptoms of dementia in AD in the general population, but we found no studies investigating gait performance and decline in DS. The aim of this study is to characterize gait and speed performance in a sample of adults with DS divided into three groups by diagnosis: stable cognition, prodromal dementia and AD.MethodsWe used the Performance Oriented Mobility Assessment (POMA) to address balance, gait and the risk of falls and the Timed “Up and Go” test (TUG) to assess gait speed in a sample of 35 individuals with DS over 35 years of age. Dementia diagnosis was based on the Cambridge Examination for Mental Disorders of Older People with Down’s Syndrome and Others with Intellectual Disabilities (CAMDEX‐DS). The 1‐factor, 3‐level ANOVA model was used in the 3 groups.Results9 participants (25.7%) had AD (mean POMA 12.0 ± 7.1; mean TUG 18.0 ±5.8), 8 (22.9%) were classified as prodromal dementia (mean POMA 19.0 ± 5.6; mean TUG 21.0± 6.1) and 18 (51.4%) were in the stable cognition group (mean POMA score 20 ± 4.5; mean TUG 17.0 ±5.5). Mean POMA scores were significant different among the groups (p&lt;0.05) with higher impairment in the group with AD relative to those with prodromal dementia and stable cognition. We did not find difference for the TUG scores among the groups.ConclusionsPOMA results indicates that those with AD have worse balance, gait performance and higher risk of falls relative to those with prodromal dementia and stable cognition, suggesting that gait performance may be more affected in later stages of neurodegeneration. Gait speed does not seem to be useful differentiating the groups. Further longitudinal studies with bigger samples are needed to confirm our results.

Cognitive impairment among Hindi mental state examination positive community-dwelling rural older adults

Background: Cognitive impairment is emerging as one of the greatest mental health challenges in older adults. Its proper screening is required primarily. This article aimed to determine the usefulness of cognitive screening and assessment tools for ascertaining cognitive impairments among community-dwelling rural older adults. Methods: Lucknow rural elderly project was funded by the Indian Council of Medical Research, carried out in randomly selected rural areas of Lucknow district. The present article is based on the archived data of the same project. We have analyzed 1243 patients' data, who participated in the referred study. Data related to sociodemographic details, Hindi Mental State Examination (HMSE), were extracted. There were 81 patients who screened as HMSE positives (scored ≤23). These patients were then assessed using the Cambridge Examination for Mental Disorders of the Elderly-Revised to reach to a diagnostic category as per the International Classification of Diseases-10th Revision DCR criteria. Further, a triad of Brief Cognitive Rating Scale (BCRS), Functional Assessment Staging (FAST), and Global Deterioration Scale (GDS) administered on the cognitively impaired patients. The data were analyzed by employing SPSS version 15. Results: Among HMSE positives, 81.5% (66) had a diagnosable cognitive impairment and 18.5% (15) non-cases. FAST, BCRS, and GDS had concordant findings and were found to be effective instruments for the assessment of severity of cognitive decline. Conclusion: HMSE is a useful cognitive screening tool for rural older adults. A triad of BCRS, and GDS is found to be useful in determining the severity of cognitive impairment.

Sex differences in memory clinic patients with possible vascular cognitive impairment.

IntroductionWe aimed to establish sex differences in vascular brain damage of memory clinic patients with possible vascular cognitive impairment (VCI).MethodsA total of 860 memory clinic patients (aged 67.7 ± 8.5; 46% female) with cognitive complaints and vascular brain damage (ie, possible VCI) from the prospective TRACE‐VCI (Utrecht‐Amsterdam Clinical Features and Prognosis in Vascular Cognitive Impairment) cohort study with 2‐year follow‐up were included. Age‐adjusted female‐to‐male differences were calculated with general linear models, for demographic variables, vascular risk factors, clinical diagnosis, cognitive performance, and brain magnetic resonance imaging markers.ResultsWe found no difference in age nor distribution of clinical diagnoses between females and males. Females performed worse on the MMSE (Mini‐Mental State Examination) and CAMCOG (Cognitive and Self‐Contained Part of the Cambridge Examination for Mental Disorders of the Elderly). Females had a larger white matter hyperintensity volume, while males more often showed (lacunar) infarcts. There was no difference in microbleed prevalence. Males had smaller normalized total brain and gray matter volumes. During follow‐up, occurrence of cognitive decline and institutionalization was comparable, but mortality was higher in males.DiscussionOur results suggest that susceptibility and underlying etiology of VCI might differ by sex. Males seem to have more large vessel brain damage compared to females that have more small vessel brain damage.

[A German version of the Cambridge examination for mental disorders of older people with Down's syndrome and others with intellectual disabilities : A diagnostic procedure for detecting dementia in people with Down's syndrome].

Although people with Down's syndrome (DS) are at ahigh risk of developing an Alzheimer type dementia (AD) due to atriplication of the amyloid precursor gene, there are practically no internationally available test procedures to detect cognitive deficits in this at risk population in the German language. The aim was to provide aGerman translation and intercultural adaptation of the Cambridge examination for mental disorders of older people with Down's syndrome and others with intellectual disabilities (CAMDEX-DS), which is available in English and Spanish. This instrument for diagnostics and monitoring consists of a psychological test examination (CAMCOG-DS) and a caregiver interview. The translation and adaptation of the CAMDEX-DS were achieved through amultistep translation process, whereby two independent forward and back translations were provided by professional translators and a consensus version was finalized and tested. The final version of the caregiver interview was applied to 11subjects and the CAMCOG-DS was conducted with 28patients. The German version of the CAMDEX-DS proved to be easily administered. The CAMCOG-DS could be fully administered to 21 out of 28patients (75%). The CAMCOG-DS values were much lower for older patients aged ≥45years than for younger patients (46/109 vs. 73.5/109; p = 0.033). The German version of the CAMDEX-DS provides an internationally recognized tool for the diagnostics and monitoring of cognitive decline in Down's syndrome. Furthermore, the German version can standardize medical care of these patients. In particular it provides ameans of participation in international research trials for this at risk population.

The validity and reliability of the CAMDEX-DS for assessing dementia in adults with Down syndrome in Brazil.

Objective:Alzheimer’s disease occurs at a higher prevalence and an earlier age in individuals with Down syndrome (DS) than typically developing individuals. However, diagnosing dementia in individuals with intellectual disability remains a challenge due to pre-existing cognitive deficits. The aim of this study was to investigate the validity and reliability of the Brazilian version of the Cambridge Examination for Mental Disorders of Older People with Down’s syndrome and Others with Intellectual Disabilities (CAMDEX-DS) for individuals with DS.Methods:Two psychiatrists, working independently, evaluated 92 adults with DS ≥ 30 years of age. The concurrent validity of the CAMDEX-DS was analyzed in relation to the gold standard of established international criteria. In a subgroup of 20 subjects, the concurrent validity of the CAMDEX-DS was analyzed in relation to an independent objective assessment of cognitive decline over three years. We analyzed the inter-rater reliability of cognitive assessment.Results:The diagnostic accuracy of the CAMDEX-DS compared to the gold standard was 96.7%. CAMDEX-DS-based diagnosis was considered consistent with cognitive decline. The probability of a participant with dementia having cognitive decline was 83%. Inter-rater reliability for the participant assessment was good, with a kappa of > 0.8 for 93% of the CAMDEX-DS items.Conclusion:The CAMDEX-DS can be considered the first valid and reliable instrument for evaluating dementia in adults with DS in Brazil. Its use in such individuals could improve clinical practice and research.

Deterioro cognitivo y trastorno neurodegenerativo en personas con discapacidad intelectual

The aim of this study is to explore the prevalence of cognitive impairment in a sample of individuals with intellectual disability (ID) aged 35 years old and over, with the purpose of establishing an early diagnosis. Participants were 36 individuals with ID whose ages ranged from 35 to 61 years old, all of them receiving services at Fundacion Personas (Asprosub) in Zamora. The Spanish version (Esteba-Castillo et al., 2013) of the Cambridge examination for mental disorders of older people with Down syndrome and others with intellectual disabilities, CAMDEX-DS (Ball, Dodd, Holland, Huppert and Treppner, 2006) was applied. As part of this assessment instrument, the neuropsychological Cambridge Cognitive Examination battery, CAMCOG, aimed at measuring cognitive impairment, was applied; when scores indicated a suspicion of cognitive impairment, an interview with a professional was carried out to obtain information about possible changes that could have arisen in the behavior of our participants. Results indicated that 22% of the sample has a risk of cognitive impairment. According to the informants, these individuals have manifested behavioral and personality changes, and changes in their abilities of daily life. No significant differences were found in the diagnosis of cognitive impairment as a function of age. On the other hand, when analyzing the etiology and the degree of ID (mild or moderate), people with Down syndrome scored significantly lower than those whose ID was not due to this etiology. On the other hand, individuals with moderate ID presented a higher ratio of cognitive impairment than those with mild ID. The results obtained are discussed and the limitations of the study are indicated.

Paraphrenia and Persecutory Delusions: Brief Reflection about Neuropsychology Evaluation in the Elderly without Dementia

Delusions are negative experiences and it can be vivid and clear, with all the power and impact of real or true perceptions. It may occur in any sensory modality, while auditory hallucinations are more common in schizophrenia and related disorders. The aim of this study was to describe the behavioral and cognitive profile of five cases of persecutory hallucination in elderly with no cognitive impairment. Case series study that analyze the characteristics, functional and cognitive abilities, of 5 patients older than 60 years, 4 to 9 years of schooling, with paranoid disorder. For the description of the personality, functionality and paranoid characteristics it were used structured interview of the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) and the cognitive functions were applied by the Cambridge Cognitive Examination (CAMCOG). The assessment of the results was made through a qualitative and quantitative analysis of the instruments. Outcomes pointed to a preservation of functional and cognitive abilities, whereas delusions were persecutory and well elaborated. Neuroimaging was normal. Due to the cognitive preservation, lack of insight, several adjustments of the medication, for the duration and intensity of the delusions, the final diagnosis was paraphrenia. It can be concluded that it is necessary to continue following the five patients and to perform a new neuropsychological evaluation after one year of conduct.

Validation and Normalization of the Tower of London-Drexel University Test 2nd Edition in an Adult Population with Intellectual Disability.

Despite how important it is to assess executive functioning in persons with Intellectual Disability (ID), instruments adapted and validated for this population are scarce. This study's primary goal was to find evidence for the validity of the ID version of the Tower of London (TOLDXtm) test in persons with mild (IDMi) and moderate (IDMo) levels of ID with Down Syndrome (DS). A multicenter study was carried out. Subjects (n = 63, ≥ 39 years old) had DS with mild (n = 39) or moderate ID (n = 24) with no minor neurocognitive disorder or Alzheimer's disease. Assessment protocol: TOLDXtm for ID, Kaufman Brief Intelligence Test Second Edition (K-BIT II), Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities (CAMDEX-DS), Weigl's Color-Form Sorting Test (WCFST), Barcelona Test for Intellectual Disability (BT-ID), and the Behavior Rating Inventory of Executive Function (BRIEF-P). The internal consistency (IDMi and IDMo), factor structure of the different subscales, and relationship between TOLDXtm subscales and other cognitive measures (BT-ID, WCFST, and BRIEF-P) were analyzed. A normative data table with ID population quartiles is provided. TOLDXtm for ID showed a robust one factor structure and coherentassociations with other, related neuropsychological instruments. Significant differences between IDMi and IDMo on movement-related variables like Correct (Corr; p = .002) and Moves (Mov; p = .042) were observed, along with good internal consistency values, Corr (α = .75), Mov (α = .52). Regarding internal consistency, no between-groups differences were observed (all p-value > 0.05). The TOLDXtm for ID is thus an instrument, supported by good validity evidence, to evaluate problem-solving and planning in ID. It distinguishes between individuals with mild and moderate ID, and is highly associated with other measures of executive functioning.