Outpatient Memory Clinic Research Articles

Pain in dementia: prevalence and associated factors: protocol of a multidisciplinary study.

BackgroundPain is a common problem in people with dementia, however the exact prevalence of pain in dementia subtypes, e.g. Alzheimer’s Disease (AD), Vascular Dementia (VaD), Frontotemporal Dementia (FTD) and dementia with Lewy Bodies (DLB), is unknown, as is the relation between pain and the different subtypes of dementia. In this study, the prevalence of pain in people with dementia will be investigated per dementia subtype and the relationship between the various subtypes of dementia and the presence of specific types of pain (i.e. musculoskeletal pain, neuropathic pain and orofacial pain) will be examined. Secondly, associations between various types of pain, cognitive functioning, neuropsychiatric symptoms and quality of life in people with dementia will be examined. A third purpose is to study the value of the assessment of autonomic responses in assessing pain in people with dementia. Finally, the effect of feedback to the attending physician on the presence of pain, based on examination by investigators with backgrounds in neuropsychology, geriatric dentistry and elderly care medicine, will be evaluated.Methods/DesignA cross-sectional, partially longitudinal observational study in 400 participants with dementia, aged 60 years and older. Participants will be recruited from an outpatient memory clinic and dementia special care units. All participants will be examined by an elderly care medicine trainee, a dentist with experience in geriatric dentistry, and a neuropsychologist. The primary outcome is presence of pain. Secondary outcomes will include oral health, autonomic responses to pain stimulus, vital sensibility and gnostic sensibility, musculoskeletal examination, cognitive functioning, neuropsychiatric symptoms, and quality of life.DiscussionThis study will help to enhance our knowledge regarding the prevalence of different types of pain in different dementia subtypes i.e. AD, VaD, FTD and DLB. This study also aims to contribute to a better understanding of oral health status in people with dementia, the use of autonomic responses in the assessment of pain in people with dementia and the relationships between pain and cognitive symptoms, neuropsychiatric symptoms and quality of life in people with various dementia subtypes and in different stages of the disease.

Exploring the prevalence of and factors associated with pain: a cross-sectional study of community-dwelling people with dementia.

Few pain studies have made community-dwelling people with dementia (PWD) their focus. The aim of this study was to determine the prevalence of pain among this patient population and to explore medication use. Moreover, we sought to investigate patient and caregiver variables associated with the presence of pain. Community-dwelling PWD and their caregivers were recruited between May 2009 and July 2012 from outpatient memory clinics in Northern Ireland to take part in a face-to-face structured interview with a researcher. Patients' cognitive status and presence of depression were established. A full medication history was taken. Both patients and caregivers were asked to rate patients' pain, at the time of the interview and on an average day, using a 7-point verbal descriptor scale. From the 206 patients who were eligible to take part, 75 patient-caregiver dyads participated in the study (participation rate = 36.4%). The majority of patients (92.0%) had dementia classed as mild or moderate. Pain was commonly reported among the sample, with 57.3% of patients and 70.7% of caregivers reporting patient pain on an average day. Significant differences were found between patients' and caregivers' reports of pain. Two-fifths of patients (40.0%) were prescribed analgesia. Antipsychotic, hypnotic and anxiolytic drug use was low, whereas antidepressant drugs were prescribed more commonly. Presence of pain was unaffected by dementia severity; however, the use of prescribed analgesic medication was a significant predictor of the presence of pain in these patients, whether reported by the patient or their caregiver 'right now' or 'on an average day' (P < 0.001). Patient and caregiver recruitment was challenging, and remains a barrier to research in this area in the future.

Using Magnetic Resonance Imaging in Diagnosing Dementia: A Dutch Outpatient Memory Clinics Survey

Background: In the Netherlands, dementia syndromes are diagnosed in specialized memory outpatient clinics (MC). Many radiologists are not trained to assess magnetic resonance imaging (MRI) scans with respect to possible radiological changes that may indicate neurodegenerative disease. Methods: This is a cross-sectional descriptive study. A survey was sent to all Dutch MC and included questions as to how MRI scans are assessed by radiologists and how these assessments are used in the diagnostic process. Results: In most MC, radiologists report on typical Alzheimer pathology and large vessel disease. Small vessel disease and other anatomical changes signifying neurodegenerative disease frequently are not assessed. In the majority of MC, the radiological assessment is not standardized, and physicians assess MRI for themselves to use this information to discuss the consensus diagnosis subsequently. Conclusion: MRI assessment by radiologists in Dutch MC probably underestimates the presence of cerebrovascular and neurodegenerative disease. The validity of standardized assessment protocols in routine clinical practice deserves further study, as the implementation of standardization outside research settings could improve diagnostic accuracy.

Standardized mini-mental state examination scores and verbal memory performance at a memory center: implications for cognitive screening.

Memory decline is often among the first signs heralding the emergence of mild cognitive impairment or dementia regardless of etiology. Despite its limited inclusion of memory screening, the Mini-Mental State Exam (MMSE) continues to be the most ubiquitous, first-line screening tool for dementia and cognitive decline. In response to well documented problems with the sensitivity of this instrument and the growing importance of cognitive screening, we assessed the utility of the MMSE as a screening tool among older adults presenting for evaluation at a memory clinic. The Standardized MMSE and a standardized verbal memory test - the Hopkins Verbal Learning Test-Revised (HVLT-R) - were administered to 304 consecutive referrals at a university-based outpatient memory clinic. Among patients scoring above 25 on the MMSE (n = 169), over half exhibited at least moderate memory impairment (HVLT-R delayed recall z ≤ -2.0) and more than 25% showed severe impairment (delayed recall z ≤ -3.0). Perhaps even more striking was that among those who achieved perfect (30/30) or near perfect (29/30) scores on the MMSE (n = 70), 43% displayed moderate to severe memory impairment. Although newer screening measures have shown improved sensitivity, more in-depth memory testing appears to be a vital component of successful screening and early detection.

How does additional diagnostic testing influence the initial diagnosis in patients with cognitive complaints in a memory clinic setting?

patients suspected of dementia frequently undergo additional diagnostic testing (e.g. brain imaging or neuropsychological assessment) after standard clinical assessment at a memory clinic. This study investigates the use of additional testing in an academic outpatient memory clinic and how it influences the initial diagnosis. the initial diagnosis after standard clinical assessment (history, laboratory tests, cognitive screening and physical and neurological examination) and the final diagnosis after additional testing of 752 memory clinic patients were collected. We specifically registered if, and what type of, additional testing was requested. additional testing was performed in 518 patients (69%), 67% of whom underwent magnetic resonance imaging, 45% had neuropsychological assessment, 14% had cerebrospinal fluid analysis and 49% had (combinations of) other tests. This led to a modification of the initial diagnosis in 17% of the patients. The frequency of change was highest in patients with an initial non-Alzheimer's disease (AD) dementia diagnosis (54%, compared with 11 and 14% in patients with AD and 'no dementia'; P < 0.01). Finally, after additional testing 44% was diagnosed with AD, 9% with non-AD dementia and 47% with 'no dementia'. additional testing should especially be considered in non-AD patients. In the large group of patients with an initial AD or 'no dementia' diagnosis, additional tests have little diagnostic impact and may perhaps be used with more restraint.

Web-based cognitive training: patient adherence and intensity of treatment in an outpatient memory clinic.

BackgroundCognitive training has been playing an increasing role in the treatment of patients with cognitive deficits. This type of intervention, namely its intensity, can be optimized by incorporating information technology-based systems.ObjectiveThe intent of the study was to determine the treatment intensity and patient adherence to home-based cognitive training strategies (Web-based cognitive training).MethodsA cohort of 45 patients with neurologic and psychiatric diseases attending an outpatient memory clinic (average age 50.7 years, SD 17.0; average education 7.8 years, SD 4.9) was followed over 18 months. Participants were challenged to use a Web-based cognitive training system, “COGWEB”, on a daily basis, and fulfilled at least four weeks of training supervised remotely. Additionally, 11 patients attended face-to-face sessions.ResultsThe average duration of continuous cognitive training was 18.8 weeks (SD 18.9). Each patient performed on average 363.5 minutes/week (SD 136.6). At 6-month follow-up, 82.8% complied with their treatment plan. The average proportion of complete weeks was 0.75 (SD 0.22). Patients with dementia trained more intensively (444.6 minutes/week), followed by patients with static brain lesion (414.5 minutes/week; P=.01). The group that held face-to-face sessions performed more training overall (481.4 vs 366.9 minutes/week), achieving a stronger expression and statistical significance in the last week of training (652.6 versus 354.9 minutes/week, P=.027).ConclusionsOverall, the weekly training intensity was high. Patients with dementia and static lesions performed more cognitive training. Face-to-face sessions were associated with higher intensities. The combination of classical methods with information technology systems seems to ensure greater training intensity.

Phenotypic cognitive impairment in late-onset delusional disorder

Previous use of heterogeneous diagnostic criteria and insensitive cognitive measures has impeded clarification of the extent and type of cognitive impairment specific to late-onset delusional disorder. We examined whether clinical presentations of late-onset delusional disorder are associated with prodromal or established dementia, and whether it might be a discrete clinical syndrome characterized by its own profile of cognitive impairment. Nineteen patients with late-onset delusional disorder from a hospital psychiatric service and 20 patients with dementia of the Alzheimer's type (AD) from an outpatient memory clinic were recruited in a consecutive case series. All patients underwent comprehensive neuropsychological assessment that included general intellectual function, executive function, new learning and delayed memory, language, processing speed, and visuo-perceptual skills. Late-onset delusional disorder patients showed moderate impairment to conceptual reasoning, visual object recognition, processing speed, and confrontation naming. Severe impairment appeared in visuo-perceptual planning and organization, and divided attention. Compared with the Alzheimer's disease (AD) group, the late-onset delusional disorder group demonstrated significantly poorer visuo-perceptual skills but a significantly better capacity to consolidate information into delayed memory. A high rate of marked cognitive impairment occurs in late-onset delusional disorder. There was evidence of a conceptual reasoning deficit, plus the presence of a visuo-perceptual impairment affecting object recognition. This impairment profile can explain the genesis and maintenance of the observed delusions. Understanding late-onset delusional disorder as other than a purely psychiatric phenomenon or a precursor to AD will lead to better assessment and management approaches.

Neurosyphilis Presenting as Primary Progressive Aphasia

Back to table of contents Previous article Next article LettersFull AccessNeurosyphilis Presenting as Primary Progressive AphasiaPanagiotis Ioannidis, M.D., Ph.D., Athanasios Lourbopoulos, M.D., Ph.D., Dimitra Mamouli, M.D., Eleni Polichroniadou, M.D., George Papadopoulos, M.D., and Dimitris Karacostas, M.D., Ph.D.Panagiotis IoannidisSearch for more papers by this author, M.D., Ph.D., Athanasios LourbopoulosSearch for more papers by this author, M.D., Ph.D., Dimitra MamouliSearch for more papers by this author, M.D., Eleni PolichroniadouSearch for more papers by this author, M.D., George PapadopoulosSearch for more papers by this author, M.D., and Dimitris KaracostasSearch for more papers by this author, M.D., Ph.D.Published Online:1 Jan 2014https://doi.org/10.1176/appi.neuropsych.13010018AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Primary progressive nonfluent aphasia (PPnfA) is an aphasic disorder that is classified in the spectrum of frontotemporal dementia diseases.1 It is characterized by disturbed grammatical comprehension and expression, as well as reduction of speech sound production. We present a adult man whose initial symptoms and signs were compatible with PPnfA in whom later work-up surprisingly unmasked neurosyphilis.Case ReportA 52-year-old normotensive native man was admitted from the outpatient memory clinic of our department for evaluation of speech difficulties that started 6 months earlier. His past medical history was otherwise unremarkable. Neurological examination revealed mild cogwheel rigidity, positive grasp reflexes, and bilateral Babinski signs. MMSE score was 28, and the Addenbrooke Cognitive Examination–Revised (ACE–R) test score was 74/100. He presented reduced verbal fluency, with word-finding difficulties. Brain MRI showed bilateral perisylvian cortical atrophy, more prominent in the left hemisphere (Figure 1), and routine EEG revealed theta-wave activity in the left frontotemporal area. Extensive serology and hematological tests were normal except for positive Venereal Disease Research Laboratory (VDRL) test (titer: 1/128). Subsequently, serum tests for rapid plasma regain (RPR) and fluorescent treponemal antibody absorption (FTA-Abs) were both positive, with RPR titer: 1/128. Spinal tap demonstrated clear CSF with 160 cells/mm3 (50% neutrophils), along with protein: 135 mg/dl, glucose: 28 mg/dl, and positive VDRL (1:16), RPR (1:32), and positive FTA-Abs.FIGURE 1. Neurosyphilis Patient’s MRI[A]: T1-weighted image with contrast medium; [B]: T2-weighted image shows ventricular enlargement due to parenchymal atrophy, incompatible with his age.The patient was treated with IV 4×106 units of penicillin administrated 6 times daily for 15 days and followed by 2.4 million units of benzathine penicillin 5 IM once a week for 3 weeks. A second spinal tap showed clear, acellular CSF, with protein 95 mg/dl, glucose 37 mg/dl, positive VDRL (1:8), and RPR (1:16).On follow-up 6 months later, a significant improvement of language production was observed; his ACE–R score was 92/100; MMSE score was 30; and the rest of the neurological signs remained unchanged.DiscussionNeurosyphilis can present with progressive cognitive deterioration accompanied by psychiatric manifestations,2 and it is considered one of the treatable and reversible causes of dementia.3 With the present progress of socioeconomic globalization, the spread of migration from developing countries, and the recently-published increasing spread of syphilis,4 we have to reconsider neurosyphilis even in immunocompetent adults. The correct diagnosis could be crucial because early therapy could dramatically affect prognosis.5 Also, our case was atypical because it presented with progressive aphasic disturbances resembling PPnfA. Had we omitted the special serological tests for syphilis, our case could had probably remained undiagnosed.In conclusion, syphilis should be included in the differential diagnosis of early-onset dementias, even if the initial symptoms and neuroimaging findings point toward a degenerative dementing process.Dept. of Neurology, AHEPA University Hospital, Aristotle University School of Medicine, Thessaloniki, Macedonia, GreeceCorrespondence: Dr. Ioannidis; e-mail: [email protected]grThe authors report no conflict of interest related to the present study.References1 Gorno-Tempini ML, Hillis AE, Weintraub S, et al.: Classification of primary progressive aphasia and its variants. Neurology 2011; 76:1006–1014Crossref, Medline, Google Scholar2 Nagappa M, Sinha S, Taly AB, et al.: Neurosyphilis: MRI features and their phenotypic correlation in a cohort of 35 patients from a tertiary care university hospital. Neuroradiology 2013; 55:379–388; available at doi: 10.1007/s00234-012-1017-9Crossref, Medline, Google Scholar3 Yu Y, Wei M, Huang Y, et al.: Clinical presentation and imaging of general paresis due to neurosyphilis in patients negative for human immunodeficiency virus. J Clin Neurosci 2010; 17:308–310Crossref, Medline, Google Scholar4 Mayer KH, Mimiaga MJ: Resurgent syphilis in the United States: urgent need to address an evolving epidemic. Ann Intern Med 2011; 155:192–193Crossref, Medline, Google Scholar5 Ghanem KG: Review: Neurosyphilis: a historical perspective and review. CNS Neurosci Ther 2010; 16:e157–e168Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByLanguage impairments and CNS infections: a review29 July 2021 | Aphasiology, Vol. 36, No. 10Neurosyphilis Mimicking Behavioral Variant of Frontotemporal Dementia in a 59-Year-Old Man1 June 2022 | Cognitive and Behavioral Neurology, Vol. 35, No. 2Current Infectious Disease Reports, Vol. 17, No. 5 Volume 26Issue 1 Winter 2014Pages E27-E28 Metrics PDF download History Published online 1 January 2014 Published in print 1 January 2014

Subjective memory complaints, depressive symptoms and cognition in patients attending a memory outpatient clinic

The goals of this study were to establish prevalence of subjective memory complaints (SMC) and depressive symptoms (DS) and their relation to cognitive functioning and cognitive status in an outpatient memory clinic cohort. Two hundred forty-eight cognitively healthy controls and 581 consecutive patients with cognitive complaints who fulfilled the inclusion criteria were included in the study. A statistically significant difference (p < 0.001) between control group and patient group regarding mean SMC was detected. 7.7% of controls reported a considerable degree of SMC, whereas 35.8% of patients reported considerable SMC. Additionally, a statistically significant difference (p < 0.001) between controls and patient group regarding Beck depression score was detected. 16.6% of controls showed a clinical relevant degree of DS, whereas 48.5% of patients showed DS. An analysis of variance revealed a statistically significant difference across all four groups (control group, SCI group, naMCI group, aMCI group) (p < 0.001). Whereas 8% of controls reported a considerable degree of SMC, 34% of the SCI group, 31% of the naMCI group, and 54% of the aMCI group reported considerable SMC. A two-factor analysis of variance with the factors cognitive status (controls, SCI group, naMCI group, aMCI group) and depressive status (depressed vs. not depressed) and SMC as dependent variable revealed that both factors were significant (p < 0.001), whereas the interaction was not (p = 0.820). A large proportion of patients seeking help in a memory outpatient clinic report considerable SMC, with an increasing degree from cognitively healthy elderly to aMCI. Depressive status increases SMC consistently across groups with different cognitive status.

Evidence of the Sensitivity of the MoCA Alternate Forms in Monitoring Cognitive Change in Early Alzheimer's Disease

Background/Aims: There is an increasing interest in using the Montreal Cognitive Assessment (MoCA) test as a monitoring tool in Alzheimer's disease (AD) in both research and clinical settings. Our aim was to investigate the utility of alternate forms of the MoCA in detecting cognitive deterioration in a sample of early AD patients followed longitudinally in an outpatient memory clinic. Method: Twenty-five patients with early-stage AD (prodromal or mild dementia) were administered the original version and one of two previously validated alternate forms of the MoCA within an interval of about 1 year. The decline over time and the rate of change of the MoCA were compared to the total score of a standardized neuropsychological assessment battery (Consortium to Establish a Registry of Alzheimer's Disease; CERAD-Plus). Responsiveness to change was determined by calculating standard response means and the respective effect sizes. Results: Sixty percent of the sample showed a clinical decline on the clinical dementia rating (CDR) scale. There was significant deterioration in the MoCA and CERAD total scores. Conclusion: The results demonstrate that the MoCA is capable of detecting change over time and seems to be a valid tool with small to moderate sensitivity for monitoring cognitive change in early AD.

Subjective memory complaints, depressive symptoms and cognition in patients attending a memory outpatient clinic

Subjective memory complaints, depressive symptoms and cognition in patients attending a memory outpatient clinic

Neuropsychiatric Symptoms (NPS) in patients with pure Vascular Dementia (VaD) and Mixed Dementia (MD) from a memory outpatient clinic in southeast Brazil.

Vascular Dementia (VaD) and Vascular Cognitive Impairment (VCI) are increasingly common worldwide. Nevertheless, the clinical-neuropsychiatric profile of these patients at presentation is still poorly characterized in developing countries.OBJECTIVEWe aimed to characterize the prevalence of neuropsychiatric symptoms, as well as the clinical and cognitive profile of patients with VaD and VCI in our tertiary University outpatient cognitive clinic.METHODSWe reviewed data on 253 patients diagnosed with VaD or VCI at our center between January 1996 and December 2005, located in an industrial region of the state of Sao Paulo, southeast Brazil. We excluded 19 patients who did not complete the medical investigation or who did not meet the clinical or neuroimaging criteria for vascular dementia. We collected socio-demographic data, educational level, vascular risk factors, behavioral and neuropsychological symptoms and cognitive complaints at presentation.RESULTSTwo hundred and thirty-four cases were included in this analysis. The mean age was 67.77±10.35 years; 72% were males and 82% had less than four years of education (average 2.84±2.96 years). The initial Clinical Dementia Rating score was 2 & 3 in 68%. A total of 185 patients had neuropsychiatric symptoms distributed in main categories as follows: psychosis (52.6%), hallucinations (23.5%), psychomotor agitation (22.5%), depression (17.5%) and apathy (17.5%). Hypertension and previous stroke were the most prevalent risk factors.CONCLUSIONWe found a high prevalence of neuropsychiatric symptoms. The clinical-neuropsychiatric profile of patients presenting to cognitive clinics in developing countries may differ greatly to that of more developed nations. These characteristics may have implications for public health strategies.

Using Hamilton Depression Scale in a geriatric outpatient memory clinic

Using Hamilton Depression Scale in a geriatric outpatient memory clinic

The hard Test Your Memory. Evaluation of a short cognitive test to detect mild Alzheimer's disease and amnestic mild cognitive impairment

The aim of this study is the evaluation of a novel cognitive test, the hard Test Your Memory (H-TYM), in the detection of mild Alzheimer's disease (AD) and amnestic mild cognitive impairment (aMCI). This paper uses a prospective study in an outpatient memory clinic. We recruited 97 patients with a diagnosis of mild AD or aMCI aged between 50 and 80 years. All scored 20 or more on the mini mental state examination (MMSE). We recruited 200 controls from a similar background. The patients were given a novel short cognitive test (H-TYM) designed to test recall of newly learnt visual and verbal material together with the Addenbrooke's Cognitive Assessment Revised, MMSE, and TYM test. Alzheimer's disease/aMCI patients completed the H-TYM with an average recall score of 6.69 (SD 3.45); control participants scored an average of 20.4 (SD 4.54). The H-TYM detected 95% of cases of mild AD/aMCI on the basis of an optimum cutoff point. The area under the receiver operating characteristic for the H-TYM ratio was calculated to be 0.989 with a 95% confidence interval of 0.980-0.997. The H-TYM test has an excellent ability to discriminate between AD/aMCI cases and healthy controls. The H-TYM is a useful tool for the detection of mild AD/aMCI, and it detects AD/aMCI in the majority of patients who "pass" the MMSE and Addenbrooke's Cognitive Assessment Revised.

Disability in Instrumental Activities of Daily Living in Elderly Patients with Mild Cognitive Impairment and Alzheimer‘s Disease

Background/Aims: The aim is to examine disability in instrumental activities of daily living (IADL) in elderly persons with mild cognitive impairment (MCI) and Alzheimer‘s disease (AD), further to identify items of IADL which separate the two conditions and to explore potential gender differences. Methods: A cross-sectional study of 729 patients aged ≥65 years recruited from outpatient memory clinics. Multiple logistic regression analysis was used in the main analysis to explore the association between IADL and diagnosis. Results and Conclusions: We found an association between IADL and diagnosis, and a difference in the proportion of disability in IADL in patients with MCI and AD, i.e. 66 and 88%, respectively. Six of the 8 items revealed differences in the proportions of patients with IADL disability among MCI and AD. No substantial gender differences were found, except for laundry.

Feasibility of evidence-based hand exercises in a home-based program for patients with Alzheimer's disease and depression

Ever-growing attention is being focused on the preservation of cognitive ability and on slowing the decline in people with Alzheimer's dementia (AD) utilizing an integrative treatment model (combination of medications and non-pharmacological interventions). The interventions related to increasing regional cerebral blood flow (CBF) for people with AD are in the earliest stages of development. An increased regional CRF in healthy individuals, during hand movements, has been described (Roland, P.E., 1982, Kawashima, R., 1996). To facilitate the CBF in demented, depressed seniors we have developed a set of hand - tennis ball exercises ™ for home-based programs (Bragin V., 2007). In this presentation it will be a description of the latest set of hand exercises (2010–2012) for patients with dementia and physical disabilities, applicable to office and home-based interventions. The set of hand exercises consists of hand and finger movements performed with one or both hands. After completion of the initial assessment of hand movements, all patients receive in-office training and a workbook for home-based programs plus a DVD that demonstrates the exercises. The patients are asked to pay close attention and memorize the series of hand and finger movements. Later on the dual-task portion of the program is introduced, which incorporates breathing or counting during hand exercises. We use video recording and simple computer registration of motor speed and reaction time to monitor the progress of training and finger mobility. The patients tolerate these exercises very well and over time they memorize the movements using their procedural memory capacities. These exercises help the patients regain hand and finger mobility, coordinate hand movements, and increase attention, procedural memory, and brain speed. These movements also have immediate positive effect on emotions. Patients and their caregivers report an absence of intrusive thoughts during exercises and lessened feelings of depression and anxiety. Hand exercises as a component of a home-based integrative program could positively improve hand movements for seniors living with AD. This program appears feasible for outpatient memory clinics, rehabilitation facilities, and nursing homes. The effectiveness of this model in various settings requires and deserves further research.

Spouse caregivers and behavioral and psychological symptoms of dementia

Background: Only a few studies have specifically considered the role of caregiver characteristics in the presence of behavioral and psychological symptoms of dementia (BPSD). The aim of this study was to determine whether there were differences in the presence of individual BPSD between community-dwelling dementia care recipients with spouse caregivers and those with non-spouse caregivers.Methods: Care recipients (n = 109) and their primary caregivers were recruited from memory clinic outpatients at the public psychiatric hospital in Sapporo City, Japan. Data were collected by questionnaire. Relationship with the care recipient was categorized as either ‘spouse’ or ‘non-spouse.’ The frequency of BPSD occurrence observed by the caregiver was assessed using the Troublesome Behavior Scale (TBS). Logistic regression analyses were performed to examine whether there were differences with regard to each of the 14 TBS items between spouse and non-spouse caregivers.Results: The number of spouse caregivers was 47 (43.1%). TBS items presented by >50% care recipients were ‘repetition and/or clinging’ and ‘ill-natured denial and/or distortion.’ After adjustment for the characteristics of caregivers and care recipients, non-spouse caregivers were found to be significantly associated with the presence of ‘hiding and/or losing things,’ ‘rummaging,’ ‘crying and/or screaming,’ and ‘interfering with a happy home circle,’ compared with spouse caregivers.Conclusions: Our results suggest that non-spouse caregivers need more support with regard to certain symptoms of individual BPSD compared with spouse caregivers. Identifying caregiver characteristics that are independently associated with each individual BPSD may help customize interventions for caregivers with specific characteristics.

Limitations for Interpreting Failure on Individual Subtests of the Montreal Cognitive Assessment

The Montreal Cognitive Assessment (MoCA) is sensitive to mild forms of cognitive impairment in geriatric populations and asks questions under the subheadings visuospatial/executive, naming, attention, language, abstraction, delayed recall, and orientation. This study examined the extent to which these subsets of MoCA items evaluate their intended cognitive domains. Clinical data from 185 geriatric memory clinic outpatients who underwent cognitive screening and subsequent neuropsychological assessment were analyzed. Factor analysis of their neuropsychological test scores identified 5 cognitive domains memory, language, visuospatial ability, attention/processing speed, and cognitive control. Scores on MoCA subtests were examined for their correlations with individual factor scores and for their sensitivity and specificity in predicting impairment within each domain. The MoCA subtest scores correlated significantly but modestly with neuropsychological test factor scores in their corresponding domains, for example, the correlation between 5-word recall and the memory factor was 0.46. However, subtest scores were poor predictors of impaired performance on the tests contributing to each cognitive domain. The best predictive accuracy was seen for the visuospatial/executive subtest that showed fair accuracy at predicting impairment on tests in the visuospatial domain. Other subtests showed unacceptably poor levels of accuracy when predicting impaired scores in their respective domains (60%-67%). In a sample of geriatric outpatients referred for cognitive assessment, performance on individual items and subtests of the MoCA yields insufficient information to draw conclusions about impairment in specific cognitive domains as determined by neuropsychological testing.

Diagnostic accuracy of markers for prodromal Alzheimer's disease in independent clinical series

ObjectiveTo capitalize on data from different clinical series to compare sensitivity and specificity of individual biomarkers for predicting mild cognitive impairment (MCI) progression to Alzheimer's disease (AD). MethodsMedial temporal atrophy, cortical hypometabolism, and cerebrospinal fluid biomarkers were assessed in 18 patients with mild cognitive impairment (MCI) with prodromal AD (pAD; conversion time, 26 ± 12 months) and 18 stable MCI (sMCI) patients from the Translational Outpatient Memory Clinic cohort, as well as in 24 pAD patients (conversion time, 36 ± 12 months) and 33 sMCI patients from the Alzheimer's Disease Neuroimaging Initiative cohort. Medial temporal atrophy was measured by manual, semi-automated, and automated hippocampal volumetry; cortical hypometabolism was measured using several indices of AD-related hypometabolism pattern; and cerebrospinal fluid markers were amyloid β (Aβ)42 and total tau protein concentrations. For each biomarker, sensitivity for pAD, specificity for sMCI, and diagnostic accuracy were computed. ResultsSensitivity to predict MCI conversion to AD in the Alzheimer's Disease Neuroimaging Initiative and Translational Outpatient Memory Clinic cohorts was 79% and 94% based on Aβ42, 46% and 28% based on hippocampal volumes, 33% to 66% and 56% to 78% based on different hypometabolism indices, and 46% and 61% based on total tau levels, respectively. Specificity to exclude sMCI was 27% and 50% based on Aβ42, 76% and 94% based on hippocampal volumes, 58% to 67% and 55% to 83% based on different hypometabolism indices, and 61% and 83% based on total tau levels, respectively. ConclusionsCurrent findings suggest that Aβ42 concentrations and hippocampal volumes may be used in combination to best identify pAD.

Cognitive Outcomes After Sertaline Treatment in Patients With Depression of Alzheimer Disease

Although many depressed patients with Alzheimer disease (AD) are treated with antidepressants, the effect of such treatment on cognitive performance in these patients is not known. The authors report cognitive outcomes in patients with depression of AD (dAD) after a 24-week trial of sertraline or placebo. Placebo-controlled, randomized, double-blind trial. Outpatient memory clinics at five academic medical centers in the United States. A total of 131 patients with dAD (60 men) and Mini-Mental State Examination scores of 10-26. Sertraline (n = 67), target dose of 100 mg daily or matching placebo (n = 64). Caregivers received standardized psychosocial intervention throughout the trial. Mini-Mental State Examination, cognitive subscale of the Alzheimer's Disease Assessment Scale, letter fluency, backward digit span, Symbol Digit Modalities Test, and Finger Tapping Test, administered at baseline, and 8, 16, and 24 weeks following baseline. A series of linear models indicated no effect of treatment or of depression remission on cognitive test performance at 24 weeks. Regardless of treatment condition, very little change in cognitive test performance was noted in general. Treatment with sertraline in patients with dAD is not associated with greater improvement in cognition at week 24 than treatment with placebo.