Mild Memory Problems Research Articles

Diagnostic Evaluation of Elderly Patients with Mild Memory Problems

Diagnostic Evaluation of Elderly Patients with Mild Memory Problems

Early cognitive decline in Creutzfeldt-Jakob disease associated with human growth hormone treatment

Background: Most cases of Creutzfeldt-Jakob disease (CJD) in recipients of human cadaveric growth hormone present with a cerebellar syndrome. Dementia is thought to occur late and as a minor feature...

Preclinical prediction of AD using neuropsychological tests.

Normals (N = 42) and patients with mild memory difficulty (N = 123) were given a neuropsychological test battery, and then followed annually for 3 years to determine which individuals developed sufficient functional change that they met clinical criteria for AD. Twenty-three of the 123 participants with mild memory difficulty converted to a diagnosis of probable Alzheimer's disease (AD) within 3 years of follow-up. Four of the 20 neuropsychological measures obtained at baseline, were useful in discriminating the groups on the basis of their status 3 years after the tests were given. The 4 discriminating tests pertained to assessments of memory and executive function. When the controls were compared to the individuals with memory impairments who ultimately developed AD (the converters), the accuracy of discrimination was 89%, based on the neuropsychological measures at baseline. The discrimination of the controls from the individuals with mild memory problems who did not progress to the point where they met clinical criteria for probable AD over the 3 years of follow-up (the Questionables) was 74% and the discrimination of the questionables from the converters was 80%. The specific tests that contributed to these discriminations, in conjunction with recent neuropathological and neuroimaging data from preclinical cases, have implications for which brain regions may be affected during the prodromal phase of AD.

Use of structural magnetic resonance imaging to predict who will get Alzheimer's disease

We used magnetic resonance imaging (MRI) measurements to determine whether persons in the prodromal phase of Alzheimer's disease (AD) could be accurately identified before they developed clinically diagnosed dementia. Normal subjects (n = 24) and those with mild memory difficulty (n = 79) received an MRI scan at baseline and were then followed annually for 3 years to determine which individuals subsequently met clinical criteria for AD. Patients with mild AD at baseline were also evaluated (n = 16). Nineteen of the 79 subjects with mild memory difficulty "converted" to a diagnosis of probable AD after 3 years of follow-up. Baseline MRI measures of the entorhinal cortex, the banks of the superior temporal sulcus, and the anterior cingulate were most useful in discriminating the status of the subjects on follow-up examination. The accuracy of discrimination was related to the clinical similarity between groups. One hundred percent (100%) of normal subjects and patients with mild AD could be discriminated from one another based on these MRI measures. When the normals were compared with the individuals with memory impairments who ultimately developed AD (the converters), the accuracy of discrimination was 93%, based on the MRI measures at baseline (sensitivity = 0.95; specificity = 0.90). The discrimination of the normal subjects and the individuals with mild memory problems who did not progress to the point where they met clinical criteria for probable AD over the 3 years of follow-up (the "questionables") was 85% and the discrimination of the questionables and converters was 75%. The apolipoprotein E genotype did not improve the accuracy of discrimination. The specific regions selected for each of these discriminations provides information concerning the hierarchical fashion in which the pathology of AD may affect the brain during its prodromal phase.

Alzheimer's/Apo E Link Grows Stronger

AN EPIDEMIOLOGIC finding that many said did not make sense is proving to be more than a statistical fluke. Skepticism greeted reports last year of a strong association between Alzheimer's disease and the genes for apolipoprotein E (apo E), which were thought to be important only in cholesterol metabolism (<i>JAMA</i>. 1994;271:89-91). Critics scoffed that apo E could not play a role in neuronal death because it was never seen in neurons. But during this past year, dozens of studies around the world have confirmed that the apo E4 allele confers the greatest risk of developing late-onset Alzheimer's, the relatively rare<i>E2</i>allele seems to be protective in most but not all ethnic groups, and risk with the most common<i>E3</i>allele lies in the middle. One new study suggests that the<i>E4</i>allele is the strongest predictor of which patients with mild memory problems will go on to develop Alzheimer's