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How To Assess For Alzheimer’s Disease

Objective 2 Literature Search

Cognitive Assessment Tools in Alzheimer Disease

To locate all modified versions of the ADAS-Cog-11, electronic databases were searched using subject heading and key word searches related to ADAS-Cog , dementia, pre-dementia, and cognition. Original searches were performed without date restriction in June 2016, and updated in January 2018. Citation lists of relevant articles were considered. Articles were included if they presented an outcome measure that contains at least one task of the original ADAS-Cog-11 and that is intended for use in populations with dementia or pre-dementia syndromes.

presents the results of our search for modified versions of the ADAS-Cog-11 chronologically by publication date. Below, the different versions are organized by modification strategy within each subsection measures are presented chronologically by publication date. Following a brief introduction and description of each modification, we summarize available information on the performance of that measure compared to the ADAS-Cog-11. The basis for these comparisons are summarized in , which contains a chart with results of analyses that assessed responsiveness to baseline discrimination, to disease progression, or to treatment effects. We provide a qualitative comparison of measures that rely on the same modification strategy at the end of each subsection.

Timeline of ADAS-Cog 11 modifications.

Objective 1 Literature Search

We performed bibliographic searches to locate all studies that used the ADAS-Cog-11 with a sample or subsample of older adults with pre-dementia syndromes or normal cognitive abilities. MEDLINE, Embase, Cinahl, PsychINFO, PsychTests, and Proquest Psychology were searched using subject headings and key words related to ADAS-Cog , pre-dementia, cognition, mild cognitive impairment, subjective cognitive impairment, and normal cognition. Original searches were performed in June 2016 without date restriction, and updated in January 2018. Citation lists of relevant articles were considered. Studies were excluded if results were not presented separately for pre-dementia subsamples , or if a non-English version of the ADAS-Cog-11 was used. Results from included studies were organized according to the type of information they provide about the ADAS-Cog-11, as presented in the following sections.

How Does The Sage Test Work

SAGE evaluates your thinking abilities by asking you questions related to language, reasoning, problem-solving, and memory.

Scharre explains that the questions cover a wide range of cognitive domains, especially those abilities that are early predictors of mild cognitive impairment.

SAGE measures cognitive function by assessing the following areas:

  • Orientation
  • How many nickels are in 60 cents?
  • Write down the names of 12 different animals

In addition to the scored items on the test, SAGE asks questions about your medical history, such as “Have you suffered a stroke?” The test asks if youve had a family history of cognitive impairment. Youre also asked about any current symptoms you may be having, such as problems with memory, balance, or if you’ve experienced any personality changes. These answers can help your clinician identify possible causes of cognitive decline.

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Alzheimer’s Disease Assessment Scale

The Alzheimer’s Disease Assessment Scale is made up of two parts: cognitive and non-cognitive testing. The ADAS-Cog is more frequently utilized and will be the focus for this discussion. The ADAS-Cog is one of two primary cognitive outcome measures required in all current Food and Drug Administration clinical drug trials for Alzheimer’s disease in the United States.

The ADAS-Cog consists of items from the following areas chosen for their sensitivity to Alzheimer’s disease: language memory praxis and orientation. The test takes 3035 minutes to administer and the item scores generally range from 15. The total ADAS-Cog score ranges from 070 with higher scores suggesting greater impairment. In its current form, the ADAS-Cog has been shown successful in not only identifying Alzheimer’s patients from healthy elderly controls, but it has also shown to be effective in rating severity between moderate and late stage dementia based on decreasing performance on the orientation items.

David Myland Kaufman MD, … Mark J. Milstein MD, in, 2017

Instrumental Activities Of Daily Living

Alzheimers Disease &  Pain Assessment

The Instrumental Activities of Daily Living scale takes 5 min for a basically trained interviewer to assess ability in eight complex daily living tasks such as telephone use, shopping, housekeeping and finances. These abilities are more complex than the more basic abilities assessed by the Barthel scale, and therefore more sensitive to the cognitive changes seen in dementia. It is very commonly used in European memory clinics .

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The Functional Independence Measure

The Functional Independence Measure measures overall disability. It is observer rated and covers multiple important domains, including self-care, sphincters, mobility, communication, psychosocial function and cognition. Some training is required for its use. A UK version is available and it has been used in repeated observations of inpatients in general hospital . It is therefore an example of a scale which addresses cognitive as well as physical function, and is likely to be especially useful in inpatient or rehabilitation settings.

Cortical And Subcortical Dementias

Deficits in certain areas, especially relatively early in the disease, may point to a specific dementia. One of the more widely used categorisations of dementia is into cortical and subcortical forms . Examples of cortical dementias include AD and CJD. The clinical manifestations of cortical dementias include agnosia, spatial disorientation, language problems, apraxia, amnesia, and problems with visuospatial functioning depending on the location of the pathology.

Table 4

A comparison of cortical and subcortical dementia according to neuropsychological profile

Examples of subcortical dementias include Parkinsons disease, Huntingtons disease, vascular dementia, progressive supranuclear palsy, Wilsons disease, and AIDS dementia complex. Patients with a subcortical dementia show slowness and rigidity of thinking often with perseveration. Although forgetful, they do not have a severe amnesia. There is difficulty in planning and sequencing of events and the pattern of cognitive impairment may be similar to that seen in frontal lobe dysfunction.

Some disorders display signs of both a cortical and subcortical dysfunction relatively early in the disease. Examples of cortico-subcortical conditions include cortical dementia with Lewy Bodies and corticobasal degeneration .

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What About Amyloid Brain Pet Scans

Maybe youre thinking about having an FDA-approved amyloid brain PET scan. These tests involve the injection of a radioactive dye attached to a molecule that sticks to amyloid plaques in the brain. The radioactivity is then measured by special imaging technology, similar to a CT scan.

Should you get one? You could, but there are two issues to consider. First, they are not paid for by insurance and they cost about $5,000 so you either have to pay out of pocket or join a research study at a National Institute on Aging Alzheimers Disease Research Center, where you might get one for free. Second, how would the information help you?

No special amyloid brain scans are needed for the straightforward diagnosis and treatment of memory loss. If you are having significant symptoms of memory loss, such as those mentioned above, talk with your doctor about them. Your doctor will likely evaluate your overall health and the medications you take, then do some standard blood tests and brain scans as well as pencil and paper testing. Based on the results of those tests, your doctor may start you on a medication intended to boost your memory function.

Perhaps you dont have any symptoms of Alzheimers disease today, but one of your parents had it. Should you get an amyloid brain scan to find out if you are likely to develop Alzheimers in the future?

Dementia Tests And The Assessment Process

Researchers find way to assess dementia process using blood tests

This group of pages tells you what happens when someone has an assessment to find out if they have dementia. It explains the different steps involved, including what happens if a diagnosis is made. You might find it useful if you are worried about your own memory, or someone else’s.

  • You are here: Dementia tests and the assessment process
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    How Accurate And Reliable Are The Results

    Like any test, SAGE is not perfect. Scharre points out that individuals have a wide variety of cognitive talents and this needs to be taken into account. There will be individuals who score well but have a decline from their previous abilities. Repeat testing over time will find those that are progressing, he explains.

    Some individuals will not score as well, but that may represent their baseline talents, and their score would not suggest any specific brain condition,” he adds. This is why its important to have the test interpreted in light of ones medical history by a healthcare provider.

    Its important to note that other factors could be affecting your memory and thinking on any given day.

    Perhaps you dont have a memory impairment but are quite depressed, ill, or sleep deprived. explains Jessica Z. K. Caldwell, PhD, director of neuropsychology training and staff neuropsychologist at Cleveland Clinics Ruvo Center for Brain Health in Las Vegas, Nevada. If you have concerns about your memory but are also experiencing these symptoms, Dr. Caldwell suggests you see your doctor.

    Anu Alzheimer’s Disease Risk Index

    The ANU-ADRI is an evidence-based, validated, tool aimed at assessing individual exposure to risk factors known to be associated with an increased risk of developing Alzheimer’s disease in late-life, that is, over the age of 60 years.

    The ANU-ADRI is intended to provide a systematic individualised assessment and report on Alzheimer’s disease risk factor exposure. It may be useful for individuals who wish to know their risk profile and areas where they can reduce their risk. It may also be useful to clinicians who would like their patients to record their current risk profile for discussion at their next medical appointment. The ANU-ADRI is also used in research projects that aim to evaluate methods of reducing risk of Alzheimers disease.

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    Detecting Alzheimers Gets Easier With A Simple Blood Test

    New assays could reduce the need for costlier, more invasive brain scans and spinal fluid measures

    When a patient complains of forgetfulness, a neurologist might not know immediately whether it results from normal aging, reduced blood flow to the brainor, more ominously, Alzheimers disease. For much of the past century, a definitive Alzheimers diagnosis could only be made during an autopsy. Brain imaging and spinal fluid tests now make it possible to spot the disease in patients even before the initial symptoms appear. But these invasive tests are expensive and generally limited to research settings that are not part of routine care for the millions of people suffering from the most common neurodegenerative disorder.

    An era in which an Alzheimers diagnosis can begin in a doctors office is now arriving. Advances in technologies to detect early signs of disease from a blood sample are helping doctors to identify the memory-robbing disorder more accurately and to screen participants more quickly for trials of potential treatments for the more than five million people in the U.S. afflicted with Alzheimers.

    The development of a blood-based test for Alzheimers disease is just phenomenal, says Michelle Mielke, a neuroscientist and epidemiologist at the Mayo Clinic. The field has been thinking about this for a very long time. Its really been in the last couple of years that the possibility has come to fruition.

    Development Of The Alzheimers Disease Assessment Scale


    The ADAS was originally designed as a rating scale to assess the severity of cognitive and non-cognitive dysfunction from mild to severe AD . Twenty-one tasks were selected from a pool of forty candidate tasks based on reliability and validity comparisons between 27 subjects with AD and 28 subjects with NC . The full ADAS takes about 45 minutes to administer, and is scored from 0 to 150 by summing the number of errors made on each task so that higher scores indicate worse performance .

    The ADAS comprises two subscales. The non-cognitive subscale includes 10 tasks, scored from 0 to 50, which consider mood and behavioral changes . The ADAS-Noncog is not widely used and will not be reviewed further.

    The cognitive subscale includes 11 tasks that include both subject-completed tests and observer-based assessments . Together these tasks assess the cognitive domains of memory, language, and praxis . Specific tasks include Word Recall, Naming Objects and Fingers, Commands, Constructional Praxis, Ideational Praxis, Orientation, Word Recognition, and Language .

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    Exercise Daily Eat Right Stay Social Keep Active

    Lastly, dont forget that you can work to prevent Alzheimers disease every day by performing aerobic exercise, eating a Mediterranean-style diet, staying socially engaged, and keeping your mind active. These activities are the only things that have been proven to reduce your chances of developing Alzheimers disease regardless of the results of any special tests.

    Dementia Care Tips From Experienced Caregivers

    Caring for someone with dementia isnt intuitive and doesnt come naturally. Theres a lot to learn, but you dont have to figure everything out the hard way.

    In a helpful article at Verywell, social worker Esther Heerema shares 12 dementia care tips that caregivers have learned and wished theyd known sooner.

    This advice isnt meant to add pressure or expectations to your already tough job. Theyre tips from caregivers who have been there and done that that can lighten your load, reduce stress, and help you cope with the challenges.

    Here, we share highlights from Esthers article along with some of our own insights.

    1. Its not worth it to argue with someone who has dementiaAlzheimers and dementia causes your older adults brain to malfunction. When they say things that dont make sense or are clearly untrue, they believe what theyre saying because its what their brain is telling them.

    Its frustrating to hear things that arent true and instinctive to try to correct or remind. But that will only lead to both of you arguing or getting upset. And you simply cant win an argument with someone who can no longer use reason or logic consistently.

    2. Ignoring symptoms wont make them go awayWhen you notice your older adult struggling with memory, thinking, or judgement, its scary to think that they might have dementia. Because it can be so hard to accept, many people hope that the symptoms will go away on their own or that theyre mistaken.

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    How To Diagnose Alzheimers Vs Dementia

    Alzheimers is a progressive and fatal brain disorder. Dementia is not a specific disease, but an umbrella term that defines a syndrome and used to refer to a specific group of symptoms related to a decline in mental ability. Alzheimers is one of the most common causes of dementia. Both Alzheimers and dementia are diagnosed using a variety of different assessments and tests, including a physical exam, lab tests, cognitive and neuropsychological tests, and an analysis of changes in behavior.

    What Does Sage Stand For

    Delivering an Alzheimer’s Disease Diagnosis

    The Self-Administered Gerocognitive Exam, known as SAGE, is a brief, pen-and-paper cognitive assessment tool designed to detect the early signs of cognitive, memory, or thinking impairments. The test evaluates your thinking abilities. This can help your doctors understand how well your brain is functioning.

    Douglas Scharre, MD, director of the division of cognitive neurology at The Ohio State University Wexner Medical Center in Columbus, developed the test over a five-year period based on clinical experience and review of literature.

    Questions were designed to evaluate every part of a patients brain,” Dr. Scharre explains.

    The scoring for SAGE was designed to give equal weight for questions that assess brain function for the front, the back, the left, and the right side of the brain, so that no area was overrepresented.

    SAGE will not diagnose any specific condition. It will not tell your doctor if you have Alzheimers disease or any other condition that can impact your thinking.

    But it is a helpful screening tool for mild cognitive impairment from any cause and early dementia.

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    Responsiveness To Disease Progression

    Rosen et al. found a statistically significant worsening on ADAS and ADAS-Cog-11 scores over a 12-month period for ten subjects with AD but not for ten subjects with NC in their original development sample . Further studies have also detected worsening of ADAS-Cog-11 scores over time . Statistically significant differences have been found between the magnitude of change scores for subjects with NC, MCI, and AD . In general, subjects with AD have the largest change scores, followed by those with MCI, and then those with NC. Importantly, the magnitude of change scores detected in NC and MCI samples is very small . At the item level, all individual ADAS-Cog-11 tasks have been found to have smaller Standardized Response Means than the ADAS-Cog-11 total score . The three tasks demonstrating the largest SRM were Word Recall, Orientation, and Word Recognition . The magnitude of 12-month and 24-month change scores for six ADAS-Cog-11 tasks produced smaller change scores in MCI than AD groups . A separate study found groups of subjects with NC compared to MCI had statistically significant different 12-month change scores on the Word Recall and Word Recognition tasks .

    The Frontal Variant Of Ftd

    In contrast to patients with AD, those with frontal dementia often remain utterly unaware of the changes wrought to their personality. The initial presentation may be subtle but is characterised by personality change, emotional problems, and behavioural disturbance. Patients may appear apathetic, withdrawn, inappropriately jocular, socially disinhibited, facetious, or unmotivated. There is a reduced capacity to demonstrate appropriate emotional responses such as happiness, fear, and surprise. Sympathy, empathy, and embarrassment are often lacking and may be replaced by impulsivity and carelessness.

    The presentation is quite distinct from that seen in AD. Memory is typically unaffected early in the course of the disease with problems largely secondary to poor concentration and usually relating to difficulties with working memory. The severe amnesic presentation of AD is not the pattern seen here.

    Stereotyped and perseverative behaviours may develop. Deterioration in self care with neglect of washing and grooming is often reported. Many patients develop a sweet tooth and exhibit hyperorality. Sparing of the posterior cortices means that visuospatial problems are absent until the terminal stages. Neurological signs are minimal and consist of primitive reflexes, with akinesia and rigidity observed in the terminal stages.

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