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Woolf, Claudia, Melissa J. Slavin, Brian Draper, et al. "Can the Clinical Dementia Rating Scale Identify Mild Cognitive Impairment and Predict Cognitive and Functional Decline?" Dementia and Geriatric Cognitive Disorders 41, no. 5-6 (2016): 292–302. http://dx.doi.org/10.1159/000447057.
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Background: The Clinical Dementia Rating Scale (CDR) is used to rate dementia severity. Its utility in diagnosing mild cognitive impairment (MCI) and its predictive value remain unknown. Aims: The aim of this study was to examine the association between CDR scores and expert MCI diagnosis, and to determine whether baseline CDR scores were predictive of cognitive or functional decline and progression to dementia over 6 years. Methods: At baseline, the sample comprised 733 non-demented participants aged 70-90 years from the longitudinal Sydney Memory and Ageing Study. Global and sum of boxes CDR scores were obtained at baseline. Participants also received comprehensive neuropsychological and functional assessment as well as expert consensus diagnoses at baseline and follow-up. Results: At baseline, CDR scores had high specificity but low sensitivity for broadly defined MCI. The balance of sensitivity and specificity improved for narrowly defined MCI. Longitudinally, all baseline CDR scores predicted functional change and dementia, but CDR scores were not predictive of cognitive change. Conclusion: CDR scores do not correspond well with MCI, except when MCI is narrowly defined, suggesting that the CDR taps into the more severe end of MCI. All CDR scores usefully predict functional decline and incident dementia.
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Nosheny, Rachel L., Daniel Yen, Taylor Howell, et al. "Evaluation of the Electronic Clinical Dementia Rating for Dementia Screening." JAMA Network Open 6, no. 9 (2023): e2333786. http://dx.doi.org/10.1001/jamanetworkopen.2023.33786.
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ImportanceThe Clinical Dementia Rating (CDR) is a well-validated instrument widely used to detect and stage dementia due to Alzheimer disease. The digital Electronic Clinical Dementia Rating (eCDR) can be remotely self-administered and automatically scored, with potential to facilitate efficient dementia screening and staging.ObjectiveTo evaluate the association of the eCDR with the CDR and other in-clinic assessments for screening older adults for cognitive impairment.Design, Setting, and ParticipantsThis multisite, cross-sectional study used baseline data from a longitudinal, observational study from 2020 to 2023, including up to 3 years of follow-up. Participants were enrolled from 3 Alzheimer Disease Research Centers and the Brain Health Registry. Participants (aged ≥55 years, with a study partner, and no acute or unstable major medical conditions) were recruited during in-clinic visits or by automated emails.ExposuresParticipants completed the Uniform Data Set Version 3 (UDS; including the CDR) in supervised clinical research settings, and then completed the eCDR remotely, online and unsupervised, using their own device.Main Outcomes and MeasuresThe primary outcomes were eCDR scores (item; categorical box and global; continuous box and global), CDR scores (item; categorical box and global), and UDS assessment scores. Associations were evaluated using linear and logistic regressions.ResultsA total of 3565 participants were contacted, and 288 were enrolled. Among 173 participants with item-level data (mean [SD] age, 70.84 [7.65] years; 76 women [43.9%]), eCDR to CDR concordance was 90% or higher for 33 items (63%) and 70% to 89% for 13 items (25%). Box (domain) level concordance ranged from 80% (memory) to 99% (personal care). The global score concordance rate was 81%. κ statistics were fair to moderate. Among 206 participants with box and global scores (mean [SD] age, 71.34 [7.68] years; 95 women [46.1%]), eCDR continuous global score was associated with CDR global (categorical) score with an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.70-0.87). Correlations between eCDR and in-clinic UDS assessments were similar to those between CDR sum of box scores and the same in-clinic assessments.Conclusions and RelevanceThese findings suggest that the eCDR is valid and has potential use for screening and assessment of older adults for cognitive and functional decline related to Alzheimer disease. Instrument optimization and validation in diverse cohorts in remote settings are crucial for evaluating scalability and eCDR utility in clinical research, trials, and health care settings.
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Juva, Kati, Raimo Sulkava, Timo Erkinjuntti, Raija Ylikoski, Jaakko Valvanne, and Reijo Tilvis. "Usefulness of the Clinical Dementia Rating Scale in Screening for Dementia." International Psychogeriatrics 7, no. 1 (1995): 17–24. http://dx.doi.org/10.1017/s1041610295001815.
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The Clinical Dementia Rating (CDR) scale is a qualitative staging instrument that has traditionally been used for assessing the severity of dementia. We used it for screening dementia in a population study of 75-,80-, and 85-year-old people. The modified CDR scale was easy to establish and it proved to be useful in screening dementia. A more thorough examination is needed in the second phase to identify the false positives. The sensitivity of the CDR scale was 95% and the specificity 94%.
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Macedo Montaño, Maria Beatriz M., and Luiz Roberto Ramos. "Validade da versão em português da Clinical Dementia Rating." Revista de Saúde Pública 39, no. 6 (2005): 912–17. http://dx.doi.org/10.1590/s0034-89102005000600007.
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OBJETIVO: Analisar a validade da versão em português da Clinical Dementia Rating para classificar a função cognitiva de idosos. MÉTODOS: Utilizou-se o instrumento Mini-Mental State Examination para rastreamento de déficit cognitivo em coorte composta por 424 idosos. Foram selecionados todos que obtiveram escores <26 (108 idosos) e 48 idosos com escores >26. Os 156 idosos selecionados foram submetidos a uma avaliação clínica e testes neuropsicológicos para diagnóstico de casos de demência. Tanto os casos como os não-casos foram classificados segundo a versão em português da Clinical Dementia Rating em: normais, casos questionáveis e casos de demência leve, moderada ou grave. RESULTADOS: Entre os 156 avaliados, 122 eram não-casos, destes 62 (51%) foram classificados como normais (CDR=0) e questionáveis 60 (49%) (CDR=0,5). Entre os 34 casos de demência, 17 (50%) foram classificados como demência leve (CDR=1), 8 (23%) moderada (CDR=2) e 6 (18%) grave (CDR=3). Apenas três (9%) dos casos foram considerados questionáveis pelo Clinical Dementia Rating. Sua sensibilidade foi de 91,2% e a especificidade de 100%, com valor preditivo positivo de 100% e negativo de 97,6%. As pontuações no Mini-Mental State Examination declinaram significativamente conforme o grau de demência. CONCLUSÕES: O Clinical Dementia Rating mostrou ser instrumento válido para classificar o grau de demência entre idosos. Quase metade dos não-casos foram casos questionáveis pelo Clinical Dementia Rating e podem corresponder a casos de transtorno cognitivo leve, com maior risco de conversão em demência.
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Miller, Justin B., and John S. K. Kauwe. "Predicting Clinical Dementia Rating Using Blood RNA Levels." Genes 11, no. 6 (2020): 706. http://dx.doi.org/10.3390/genes11060706.
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The Clinical Dementia Rating (CDR) is commonly used to assess cognitive decline in Alzheimer’s disease patients and is included in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) dataset. We divided 741 ADNI participants with blood microarray data into three groups based on their most recent CDR assessment: cognitive normal (CDR = 0), mild cognitive impairment (CDR = 0.5), and probable Alzheimer’s disease (CDR ≥ 1.0). We then used machine learning to predict cognitive status using only blood RNA levels. Only one probe for chloride intracellular channel 1 (CLIC1) was significant after correction. However, by combining individually nonsignificant probes with p-values less than 0.1, we averaged 87.87% (s = 1.02) predictive accuracy for classifying the three groups, compared to a 55.46% baseline for this study due to unequal group sizes. The best model had an overall precision of 0.902, recall of 0.895, and a receiver operating characteristic (ROC) curve area of 0.904. Although we identified one significant probe in CLIC1, CLIC1 levels alone were not sufficient to predict dementia status and cannot be used alone in a clinical setting. Additional analyses combining individually suggestive, but nonsignificant, blood RNA levels were significantly predictive and may improve diagnostic accuracy for Alzheimer’s disease. Therefore, we propose that patient features that do not individually predict cognitive status might still contribute to overall cognitive decline through interactions that can be elucidated through machine learning.
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Montaño, Maria Beatriz Marcondes Macedo, Solange Andreoni, and Luiz Roberto Ramos. "Clinical Dementia Rating independently predicted conversion to dementia in a cohort of urban elderly in Brazil." International Psychogeriatrics 25, no. 2 (2012): 245–51. http://dx.doi.org/10.1017/s1041610212001615.
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ABSTRACTBackground: Dementia is a major public health problem in aging populations. The Clinical Dementia Rating (CDR) classifies the severity of dementia and identifies borderline cases that supposedly have higher rates of conversion to dementia. This study aims to verify the dementia conversion rate (CR) in a subsample of an elderly cohort (70+ free of the disease), and to identify risk factors, determining whether CDR is able to predict which individuals have high likelihood of converting.Methods: A subsample of 156 participants was clinically evaluated for dementia at baseline in which 80 patients without dementia were reassessed after 2.6 years on average to verify the conversion. The CR was analyzed according to demographic, health variables, and CDR classification at baseline, using the Poisson regression method in univariate and multivariate analyses, with exposure time as an offset variable (person-years).Results: From those re-evaluated, 50% had CDR = 0 and a CR of 38.1/1,000 person-years and the other 50%, CDR = 0.5 (70% with sum of boxes scores ≤1, CR = 145.4/1,000 person-years and 30% > 1, CR = 216.8/1,000 person-years). CR was 91.3/1,000 person-years on average. In the multivariate analysis, when compared with those with CDR = 0, the hazard ratio of those with CDR = 0.5 was 3.82; and for those with CDR = 0.5 and sum of boxes scores >1, 5.69.Conclusions: Conversion rate to dementia was significantly higher among those with CDR = 0.5 and even higher for those whose sum of boxes scores was >1. Therefore, CDR was able to predict which individuals had a higher likelihood of converting to dementia.
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Oliveira, Karla Cybele Vieira, Alcidezio Luiz Sales Barros, and Gleicy Fátima Medeiros Souza. "Mini-Exame do Estado Mental (MEEM) e Clinical Dementia Rating (CDR) em idosos com Doença de Alzheimer." Revista Neurociências 16, no. 2 (1999): 101–6. http://dx.doi.org/10.34024/rnc.2008.v16.8645.
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Objetivo. Comparar os resultados do Mini–Exame do Estado Mental (MEEM) e do Clinical Dementia Rating (CDR) na avaliação do comprometimento cognitivo-demencial em idosos com doença de Alzheimer (DA). Método. 48 idosos com DA submetidos à avaliação pelas escalas MEEM e CDR. Resultados. Predomínio do sexo feminino com grau de escolaridade acima de 4 anos de estudo (85,4%), sendo freqüente a hipertensãoarterial sistêmica (62,5%). Observou-se correlação estatística entre os escores do MEEM e CDR, ambos p < 0,001, na avaliação do comprometimento cognitivo. Não houve correlação estatisticamente significante entre MEEM e CDR e sexo, grau de escolaridade e idade. Conclusão. Os resultados do estudo apontam para uma efetiva funcionalidade das escalas MEEM e CDR na percepção de perdas cognitivas e desenvolvimento de quadros demenciais. Não houve associação entre MEEM e CDR em relação à escolaridade, idade e sexo.
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Tseng, Wen-Yih Isaac, Yung-Chin Hsu, and Te-Wei Kao. "Brain Age Difference at Baseline Predicts Clinical Dementia Rating Change in Approximately Two Years." Journal of Alzheimer's Disease 86, no. 2 (2022): 613–27. http://dx.doi.org/10.3233/jad-215380.
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Background: The Clinical Dementia Rating (CDR) has been widely used to assess dementia severity, but it is limited in predicting dementia progression, thus unable to advise preventive measures to those who are at high risk. Objective: Predicted age difference (PAD) was proposed to predict CDR change. Methods: All diffusion magnetic resonance imaging and CDR scores were obtained from the OASIS-3 databank. A brain age model was trained by a machine learning algorithm using the imaging data of 258 cognitively healthy adults. Two diffusion indices, i.e., mean diffusivity and fractional anisotropy, over the whole brain white matter were extracted to serve as the features for model training. The validated brain age model was applied to a longitudinal cohort of 217 participants who had CDR = 0 (CDR0), 0.5 (CDR0.5), and 1 (CDR1) at baseline. Participants were grouped according to different baseline CDR and their subsequent CDR in approximately 2 years of follow-up. PAD was compared between different groups with multiple comparison correction. Results: PADs were significantly different among participants with different baseline CDRs. PAD in participants with relatively stable CDR0.5 was significantly smaller than PAD in participants who had CDR0.5 at baseline but converted to CDR1 in the follow-up. Similarly, participants with relatively stable CDR0 had significantly smaller PAD than those who were CDR0 at baseline but converted to CDR0.5 in the follow-up. Conclusion: Our results imply that PAD might be a potential imaging biomarker for predicting CDR outcomes in patients with CDR0 or CDR0.5.
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Mohr, Erich, Denise Walker, Christopher Randolph, Margaret Sampson, and Tilak Mendis. "Utility of Clinical Trial Batteries in the Measurement of Alzheimer's and Huntington's Dementia." International Psychogeriatrics 8, no. 3 (1996): 397–411. http://dx.doi.org/10.1017/s1041610296002761.
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Tests used as outcome measures in clinical trials of antidementia agents are not typically employed as part of diagnostic evaluations, and little information exists as to the sensitivity of these tests in terms of either differentiating demented patients from normal individuals or in distinguishing dementias of various types and etiologies. Sensitivity to mild dementia and sensitivity to impairment of various neuropsychological domains are, however, prerequisites for valid use of an instrument as an outcome measure in this context. The present study was undertaken to directly compare six different tests (three traditional psychometric tests and three clinical trial batteries) in terms of their sensitivity to detect and distinguish between mild dementia in patients with either Alzheimer's disease (n = 15) or Huntington's disease (n = 15), when compared to normal controls (n = 15). Tests included the Mattis Dementia Rating Scale, the Mini-Mental State Examination, the Wechsler Memory Scale-Revised, the Alzheimer's Disease Assessment Scale-Cognitive Subscale, the Computerized Drug Research (CDR) Cognitive Assessment System, and the Repeatable Battery for the Assessment of Dementia (RBAD). All of the tests were roughly equivalent in terms of their ability to discriminate normal subjects from mildly demented patients. Only the CDR and RBAD, however, were able to reliably discriminate between the two patient groups. The results are discussed in terms of the applicability of these tests as outcome measures for clinical trials in dementing disorders.
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Ryu, Hui Jin, Yeonsil Moon, Minyoung Kim, Hee-Jin Kim, James E. Galvin, and Seol-Heui Han. "Validation of the Korean Quick Dementia Rating System (K-QDRS)." Journal of Alzheimer's Disease 84, no. 4 (2021): 1645–56. http://dx.doi.org/10.3233/jad-210584.
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Background: The Quick Dementia Rating System (QDRS) is a brief and rapid dementia staging tool that does not require a trained rater. Objective: The purpose of this study is to demonstrate the validity, reliability, and diagnostic usefulness of the Korean version of the QDRS (K-QDRS). Methods: We collected a total of 411 subject-informant dyads including cognitively unimpaired (CU, n = 22), mild cognitive impairment (MCI, n = 198), and dementia (n = 191). The Clinical Dementia Rating (CDR) scale, Korean version of the Mini-Mental State Examination (K-MMSE), Korean version of instrumental activity of daily living (K-IADL), Short Form of the Geriatric Depression Scale, Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI), and detailed neuropsychological tests were administered as gold standards of dementia staging, cognition, function, mood, and behavior. Results: Internal consistency of the K-QDRS was excellent with Cronbach’s alpha of 0.933. Concurrent validity was also satisfactory, with the K-QDRS correlating highly with the CDR Sum of Boxes (Pearson’s r = 0.791), K-MMSE (Pearson’s r = –0.518), K-IADL (Pearson’s r = 0.727), and CGA-NPI (Pearson’s r = 0.700). The K-QDRS was highly correlated with the global CDR, K-IADL, and CGA-NPI. We suggested two types of comparisons (for initial diagnosis and for follow-up evaluation). The cutoff scores for follow-up were 1.0 for MCI, 3.5 for very mild dementia, 6.5 for mild dementia, and 11.0 for moderate dementia. Conclusion: The K-QDRS is a valid and reliable dementia rating questionnaire and can be used, briefly and rapidly, in various settings like clinical practices, longitudinal cohort studies, and community primary care.
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Go, Rodney C. P., Linda W. Duke, Lindy E. Harrell, et al. "Development and Validation of a Structured Telephone Interview for Dementia Assessment (STIDA): The NIMH Genetics Initiative." Journal of Geriatric Psychiatry and Neurology 10, no. 4 (1997): 161–67. http://dx.doi.org/10.1177/089198879701000407.
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As part of the NIMH Genetics Initiative Alzheimer's Disease (AD) Study Group, a brief structured telephone interview to distinguish individuals with normal cognitive functioning from those with changes in cognition and daily functioning suggestive of early AD was developed. The Structured Telephone Interview for Dementia Assessment (STIDA), yields a dementia score between 0 and 81 (higher scores indicating greater impairment). Subscales corresponding to the subscales of the Clinical Dementia Rating Scale (CDR) can be derived. The STIDA performed well as a screening instrument for mildly demented individuals. When a score of 10 or more (based on informant interview and subject testing) was used to identify mildly impaired individuals, the STIDA had a sensitivity of .93 and a specificity of .92 for a clinician-derived CDR of 0.5 or more. The STIDA was also capable of accurately assessing the level of dementia. STIDA-derived CDR ratings agreed with clinician-derived CDR scores in 23 of 28 cases, corresponding to an unweighted kappa of .71 and a weighted kappa of .81. A much-abbreviated short STIDA that could be administered directly to the subject was able to detect possible impairment with a sensitivity of .93 and a specificity of .77. These results suggest that the short STIDA provides a sensitive and fairly specific telephone screen for dementia, and that the full STIDA, consisting of an interview with a knowledgeable informant and subject testing, approximates the success of a face-to-face clinical interview, and provides reliable and valid screening and staging of dementia over the telephone.
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Morris, John C. "Clinical Dementia Rating: A Reliable and Valid Diagnostic and Staging Measure for Dementia of the Alzheimer Type." International Psychogeriatrics 9, S1 (1997): 173–76. http://dx.doi.org/10.1017/s1041610297004870.
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Global staging measures for dementia of the Alzheimer type (DAT) assess the influence of cognitive loss on the ability to conduct everyday activities and represent the “ultimate test” of efficacy for antidementia drug trials. They provide information about clinically meaningful function and behavior and are less affected by the “floor” and “ceiling” effects commonly associated with psychometric test. The Washington University Clinical Dementia Rating (CDR) is a global scale developed to clinically denote the presence of DAT and stage its severity. The clinical protocol incorporates semistructured interviews with the patient and informant to obtain information necessary to rate the subject's cognitive performance in six domains: memory, orientation, judgment and problem solving, community affairs, home and hobbies, and personal care. The CDR has been standardized for multicenter use, including the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) and the Alzheimer's Disease Cooperative Study, and interrater reliability has been established. Criterion validity for both the global CDR and scores on individual domains has been demonstrated, and the CDR also has been validated neuropathologically, particularly for the presence or absence of dementia. Standardized training protocols are available. Although not well suited as a brief screening tool for population surveys of dementia because the protocol depends on sufficient time to conduct interviews, the CDR has become widely accepted in the clinical setting as a reliable and valid global assessment measure for DAT.
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Khan, Afreen, Swaleha Zubair, and Samreen Khan. "A systematic analysis of assorted machine learning classifiers to assess their potential in accurate prediction of dementia." Arab Gulf Journal of Scientific Research 40, no. 1 (2022): 2–24. http://dx.doi.org/10.1108/agjsr-04-2022-0029.
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PurposeThis study aimed to assess the potential of the Clinical Dementia Rating (CDR) Scale in the prognosis of dementia in elderly subjects.Design/methodology/approachDementia staging severity is clinically an essential task, so the authors used machine learning (ML) on the magnetic resonance imaging (MRI) features to locate and study the impact of various MR readings onto the classification of demented and nondemented patients. The authors used cross-sectional MRI data in this study. The designed ML approach established the role of CDR in the prognosis of inflicted and normal patients. Moreover, the pattern analysis indicated CDR as a strong cohort amongst the various attributes, with CDR to have a significant value of p < 0.01. The authors employed 20 ML classifiers.FindingsThe mean prediction accuracy varied with the various ML classifier used, with the bagging classifier (random forest as a base estimator) achieving the highest (93.67%). A series of ML analyses demonstrated that the model including the CDR score had better prediction accuracy and other related performance metrics.Originality/valueThe results suggest that the CDR score, a simple clinical measure, can be used in real community settings. It can be used to predict dementia progression with ML modeling.
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Caldas, Gustavo Henrique de Oliveira, Sueli Luciano Pires, and Milton Luiz Gorzoni. "Neuropsychiatric symptoms and severity of dementia." Dementia & Neuropsychologia 7, no. 2 (2013): 171–75. http://dx.doi.org/10.1590/s1980-57642013dn70200006.
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ABSTRACT Neuropsychiatric symptoms (NPS) cause distress, disabilitiy and reduced quality of life for both the patient and their families Objective: To evaluate the prevalence of NPS as a specific stage of dementia status. Methods: A cross-sectional study in patients attending an outpatient clinic for dementia was performed. We applied the Neuropsychiatric Inventory and Clinical Dementia Rating (CDR) scale. Statistical analysis was carried out with SPSS 17 software. Results: The 124 subjects (mean age of 80.4±7.0 years), 88 women (70.9%) had average duration of dementia of 7.1±3.2 years, most common dementias of Alzheimer's disease (35.5%) and mixed (31.5%) and most prevalent NPS of apathy (75%) and irritability (66.9%). Correlation between apathy and a CDR 1 had a PR (prevalence ratio) = 0.289 and p<0.001 while between apathy and CDR 4-5 (PR=8.333, p<0.005). A similar result was found between aberrant motor behavior (AMB) and CDR 1 (PR=0.352, p<0.003) and between AMB and CDR4-5 (PR=2.929, p<0.006). Conclusion: Alzheimer's disease and mixed dementia were predominant, while apathy and AMB were detected in association with the progressive stages of dementia.
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Morris, J. C. "The Clinical Dementia Rating (CDR): Current version and scoring rules." Neurology 43, no. 11 (1993): 2412. http://dx.doi.org/10.1212/wnl.43.11.2412-a.
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Deutsch, Mariel B., Li-Jung Liang, Elvira E. Jimenez, Michelle J. Mather, and Mario F. Mendez. "Are we comparing frontotemporal dementia and Alzheimer disease patients with the right measures?" International Psychogeriatrics 28, no. 9 (2016): 1481–85. http://dx.doi.org/10.1017/s1041610216000582.
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ABSTRACTBackground:Clinical research studies of behavioral variant frontotemporal dementia (bvFTD) often use Alzheimer disease (AD) as a comparison group for control of dementia variables, using tests of cognitive function to match the groups. These two dementia syndromes, however, are very different in clinical manifestations, and the comparable severity of these dementias may not be reflected by commonly used cognitive scales such as the Mini-Mental State Examination (MMSE).Methods:We evaluated different measures of dementia severity and symptoms among 20 people with bvFTD compared to 24 with early-onset AD.Results:Despite similar ages, disease-duration, education, and cognitive performance on two tests of cognitive function, the MMSE and the Montreal Cognitive Assessment (MoCA), the bvFTD participants, compared to the AD participants, were significantly more impaired on other measures of disease severity, including function (Functional Assessment Questionnaire (FAQ)), neuropsychiatric symptoms (Neuropsychiatric Inventory (NPI)), and global dementia stage (Clinical Dementia Rating Scales (CDRs)). However, when we adjusted for the frontotemporal lobar degeneration-CDR (FTLD-CDR) in the analyses, the two dementia groups were comparable across all measures despite significant differences on the cognitive scales.Conclusion:We found tests of cognitive functions (MMSE and MoCA) to be insufficient measures for ensuring comparability between bvFTD and AD groups. In clinical studies, the FTLD-CDR, which includes additional language and behavior items, may be a better overall way to match bvFTD and AD groups on dementia severity.
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Aretouli, Eleni, Ozioma C. Okonkwo, Jaclyn Samek, and Jason Brandt. "The Fate of the 0.5s: Predictors of 2-Year Outcome in Mild Cognitive Impairment." Journal of the International Neuropsychological Society 17, no. 2 (2010): 277–88. http://dx.doi.org/10.1017/s1355617710001621.
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AbstractImpairments in executive cognition (EC) may be predictive of incident dementia in patients with mild cognitive impairment (MCI). The present study examined whether specific EC tests could predict which MCI individuals progress from a Clinical Dementia Rating (CDR) score of 0.5 to a score ≥1 over a 2-year period. Eighteen clinical and experimental EC measures were administered at baseline to 104 MCI patients (amnestic and non-amnestic, single- and multiple-domain) recruited from clinical and research settings. Demographic characteristics, screening cognitive measures and measures of everyday functioning at baseline were also considered as potential predictors. Over the 2-year period, 18% of the MCI individuals progressed to CDR ≥ 1, 73.1% remained stable (CDR = 0.5), and 4.5% reverted to normal (CDR = 0). Multiple-domain MCI participants had higher rates of progression to dementia than single-domain, but amnestic and non-amnestic MCIs had similar rates of conversion. Only three EC measures were predictive of subsequent cognitive and functional decline at the univariate level, but they failed to independently predict progression to dementia after adjusting for demographic, other cognitive characteristics, and measures of everyday functioning. Decline over 2 years was best predicted by informant ratings of subtle functional impairments and lower baseline scores on memory, category fluency, and constructional praxis. (JINS, 2011,17, 277–288)
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Ouchi, Yoshitaka, Mari Kasai, Kei Nakamura, Masahiro Nakatsuka, and Kenichi Meguro. "Qualitative Assessment of Instrumental Activities of Daily Living in Older Persons with Very Mild Dementia: The Kurihara Project." Dementia and Geriatric Cognitive Disorders Extra 6, no. 2 (2016): 374–81. http://dx.doi.org/10.1159/000446769.
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Background/Aims: We investigated quantitative/qualitative changes of instrumental activities of daily living (IADL) in people with a Clinical Dementia Rating (CDR) of 0.5. Methods: IADLs were evaluated in older residents: CDR of 0 (healthy) and CDR 0.5 (questionable/very mild dementia). The subjects with CDR 0.5 were divided into 2 types: the very mild Alzheimer's disease (vmAD) type and the other type including very mild subcortical vascular dementia. IADLs were evaluated quantitatively using the Lawton and the original qualitative IADL scales. Results: CDR 0.5/vmAD type subjects had impairment of only one Lawton item (Shopping) compared to CDR 0 subjects. However, the CDR 0.5/vmAD type group and the CDR 0.5/other type group showed impairment of 3 items in the qualitative assessment (Shopping, Food preparation, and Mode of transportation). Conclusion: We suggest using both quantitative/qualitative IADL scales for assessing older adults with very mild dementia.
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Kobayashi, Yoritoshi, Yumi Takahashi, Takashi Seki, et al. "Decreased Physical Activity Associated with Executive Dysfunction Correlates with Cognitive Impairment among Older Adults in the Community: A Retrospective Analysis from the Kurihara Project." Dementia and Geriatric Cognitive Disorders Extra 6, no. 2 (2016): 350–60. http://dx.doi.org/10.1159/000448027.
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Background/Aims: No previous studies have explored the relationship between physical activity (PA) and executive dysfunction. Methods: We retrospectively evaluated the PA for 590 older participants in the Kurihara Project; 221 participants had a Clinical Dementia Rating (CDR) of 0 (healthy), 295 CDR 0.5 (very mild dementia), and 74 CDR 1+ (dementia). Results: In the complicated task, whether the motor intensity was high (e.g. farming) or low (e.g. shopping), PA exhibited an inverse relationship with the CDR level. By contrast, for simple tasks with high intensity (e.g. walking), no CDR group differences were noted. For PA with low intensity (e.g. cleaning), the CDR 1+ group exhibited decreased levels. Conclusion: PA was related to the burden of executive function in patients with mild cognitive impairment; however, in patients with dementia, PA was related to both the burden of executive function and motor intensity.
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Becker, James T., Ranjan Duara, Ching-Wen Lee, et al. "Cross-validation of brain structural biomarkers and cognitive aging in a community-based study." International Psychogeriatrics 24, no. 7 (2012): 1065–75. http://dx.doi.org/10.1017/s1041610212000191.
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ABSTRACTBackground: Population-based studies face challenges in measuring brain structure relative to cognitive aging. We examined the feasibility of acquiring state-of-the-art brain MRI images at a community hospital, and attempted to cross-validate two independent approaches to image analysis.Methods: Participants were 49 older adults (29 cognitively normal and 20 with mild cognitive impairment (MCI)) drawn from an ongoing cohort study, with annual clinical assessments within one month of scan, without overt cerebrovascular disease, and without dementia (Clinical Dementia Rating (CDR) < 1). Brain MRI images, acquired at the local hospital using the Alzheimer's Disease Neuroimaging Initiative protocol, were analyzed using (1) a visual atrophy rating scale and (2) a semi-automated voxel-level morphometric method. Atrophy and volume measures were examined in relation to cognitive classification (any MCI and amnestic MCI vs. normal cognition), CDR (0.5 vs. 0), and presumed etiology.Results: Measures indicating greater atrophy or lesser volume of the hippocampal formation, the medial temporal lobe, and the dilation of the ventricular space were significantly associated with cognitive classification, CDR = 0.5, and presumed neurodegenerative etiology, independent of the image analytic method. Statistically significant correlations were also found between the visual ratings of medial temporal lobe atrophy and the semi-automated ratings of brain structural integrity.Conclusions: High quality MRI data can be acquired and analyzed from older adults in population studies, enhancing their capacity to examine imaging biomarkers in relation to cognitive aging and dementia.
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Lima-Silva, Thais Bento, Valéria Santoro Bahia, Viviane Amaral Carvalho, et al. "Translation, cross-cultural adaptation and applicability of the Brazilian version of the Frontotemporal Dementia Rating Scale (FTD-FRS)." Dementia & Neuropsychologia 7, no. 4 (2013): 387–96. http://dx.doi.org/10.1590/s1980-57642013dn74000006.
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ABSTRACT Background: Staging scales for dementia have been devised for grading Alzheimer's disease (AD) but do not include the specific symptoms of frontotemporal lobar degeneration (FTLD). Objective: To translate and adapt the Frontotemporal Dementia Rating Scale (FTD-FRS) to Brazilian Portuguese. Methods: The cross-cultural adaptation process consisted of the following steps: translation, back-translation (prepared by independent translators), discussion with specialists, and development of a final version after minor adjustments. A pilot application was carried out with 12 patients diagnosed with bvFTD and 11 with AD, matched for disease severity (CDR=1.0). The evaluation protocol included: Addenbrooke's Cognitive Examination-Revised (ACE-R), Mini-Mental State Examination (MMSE), Executive Interview (EXIT-25), Neuropsychiatric Inventory (NPI), Frontotemporal Dementia Rating Scale (FTD-FRS) and Clinical Dementia Rating scale (CDR). Results: The Brazilian version of the FTD-FRS seemed appropriate for use in this country. Preliminary results revealed greater levels of disability in bvFTD than in AD patients (bvFTD: 25% mild, 50% moderate and 25% severe; AD: 36.36% mild, 63.64% moderate). It appears that the CDR underrates disease severity in bvFTD since a relevant proportion of patients rated as having mild dementia (CDR=1.0) in fact had moderate or severe levels of disability according to the FTD-FRS. Conclusion: The Brazilian version of the FTD-FRS seems suitable to aid staging and determining disease progression.
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Samara, Myrto, Stephen Z. Levine, Kazufumi Yoshida, et al. "Linking the Clinical Dementia Rating Scale-Sum of Boxes, the Clinician’s Interview-Based Impression Plus Caregiver Input, and the Clinical Global Impression Scale: Evidence based on Individual Participant Data from Five Randomized Clinical Trials of Donepezil." Journal of Alzheimer's Disease 82, no. 3 (2021): 1075–84. http://dx.doi.org/10.3233/jad-201541.
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Background: In patients with Alzheimer’s disease, global assessment scales, such as the Clinical Dementia Rating-Sum of Boxes (CDR-SB), the Clinician’s Interview-Based Impression Plus Caregiver Input (CIBI plus), and the Clinical Global Impression (CGI) are commonly used. Objective: To clinically understand and interpret the associations between these scales, we examined the linkages for the total and change scores of CDR-SB, CIBI plus, and CGI. Methods: Individual participant data (N = 2,198) from five pivotal randomized placebo-controlled trials of donepezil were included. Data were collected at baseline and scheduled visits for up to 6 months. Spearman’s correlation coefficients ρ were examined between corresponding total and change scores of simultaneous CDR-SB, CIBI plus, and CGI ratings. To link between the simultaneous ratings, equipercentile linking was used. Results: We found strong evidence that the Spearman’s correlation coefficients between the CDR-SB and CGI, and CDR-SB and CIBI plus total scores were at least adequately correlated (ρ= 0.50 to 0.71, with p < 0.01). The correlation coefficients between the change scores of CDR-SB and CGI were deemed adequate for weeks 6 to 24 (ρ= 0.44 to 0.65); the remaining correlations were smaller in magnitude (ρ= 0.09 to 0.35). Overall, the linkages were in-line with expectations, e.g., CDR-SB range score of 3-4 (= very mild dementia) was linked to a CGI score of 3 (= mildly ill), and an increase of CDR-SB of 1 was linked to a change of 5 (= minimal worsening) in both CGI and CIBI plus. Conclusion: The study findings can be useful for clinicians wishing to compare scores of different scales across patients. They can also help researchers understand results of studies using different scales and can facilitate meta-analyses, to increase statistical power.
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Chang, Che-Wei, Yung-Shun Juan, Yuan-Han Yang, and Hsiang-Ying Lee. "The Relationship Between Lower Urinary Tract Symptoms and Severity of Alzheimer’s Disease." American Journal of Alzheimer's Disease & Other Dementiasr 36 (January 1, 2021): 153331752199265. http://dx.doi.org/10.1177/1533317521992657.
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Introduction: Urinary incontinence (UI) is more prevalent in elderly populations with dementia than those without dementia. Alzheimer’s disease (AD) is the most common cause of dementia. Urge UI, the most common type of UI in AD patients, causes more morbidity and mortality. However, it is inconvenient to obtain the report of urodynamic study from AD patient to diagnose urinary incontinence. Nevertheless, it is easier to obtain subjective or objective questionnaires from the patients or the caregivers. The data collected from the questionnaires are used to evaluate if severity of dementia is associated with urge UI and other lower urinary tract symptoms (LUTs). Patients and Methods: A total of 43 AD patients were enrolled in this study, all of whom were checked post-void residual (PVR) urine amount by sonography after voiding. The severity of dementia was evaluated by questionnaire including Cognitive Abilities Screening Instrument (CASI), Mini Mental Status Examination (MMSE), Clinical Dementia Rating (CDR), and Clinical Dementia Rating Sub-of-Box (CDR-SB). The LUTs were assessed with International Consultation of Incontinence Questionnaire (ICIQ) and Overactive bladder symptom scores (OABSS) questionnaire. Independent t test and Pearson’s correlation analysis were calculated. Results: The average age in both AD with/without urge UI patients is 78 years old. The scores of CDR-SB, OABSS and ICIQ are significantly different in these 2 groups (p = 0.023, p = 0.003, p = 0.001; respectively). However, the neurophysiological scores of CASI, MMSE, CDR, CDR-SB is not correlated with OABSS (r = 0.047, p = 0.382; r = 0.074, p = 0.317; r = 0.087, p = 0.288; r = 0.112, p = 0.237; respectively). Interestingly, if we separate each individual symptom of OAB, there is a significant correlation between CDR-SB and urge UI score (r = 0.314, p = 0.023). Conclusions: Higher lower urinary tract symptom scores are noted in AD patients with urge UI. The CDR-SB score is highly correlated with urge UI in AD patients.
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J, Kaylegian, Ritter A, and Caldwell J. "A-011 Stability of Impairment Rating Discrepancies in a Longitudinal Observational Alzheimer’s Study." Archives of Clinical Neuropsychology 35, no. 6 (2020): 801. http://dx.doi.org/10.1093/arclin/acaa068.011.
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Abstract Objective The present study investigated frequency and 12-month persistence of discrepant Clinical Dementia Rating (CDR) and comprehensive neuropsychological assessment ratings of impairment. Methods We examined CDR and neuropsychological test scores from year 1 and 2 visits of 162 adults enrolled in a longitudinal observational study. Neuropsychological measures included Wide Range Achievement Test, American National Adult Reading Test, Rey Auditory Verbal Learning Test, Brief Visuospatial Memory Test-Revised, Dementia Rating Scale 2nd edition, Boston Naming, Verbal Fluency/Color Word Interference from the Delis-Kaplan Executive Function System, Judgment of Line Orientation, Trail Making Test, Symbol Digit Modalities Test, and Digit Span/Letter Number Sequencing from The Wechsler Adult Intelligence Scale 4th edition. Discrepancies were defined as: CDR = 0 and 2 test impairments, CDR = 0.5 and &gt; 5 or 0 impairments, CDR = 1 and 0 impairments. Results Including all test domains, 40.1% of participants in year 1 and 44.3% in year 2 showed discrepancies. 69% maintained this discrepancy at year 2 and 68% of these showed no change in discrepancy type. Considering only memory tests, 37% of participants in year 1 and 28.4% in year 2 showed discrepancies, with 45% maintaining at year 2 (74% showing no change in discrepancy type). A majority of discrepancies observed in both years 1 and 2 revealed the CDR was under reporting impairment compared to the neuropsychological battery year. Conclusions The results provide evidence that within our study population, impairment as rated by the CDR frequently does not match the level of measured cognitive impairment and this observation is stable year to year.
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GANGULI, MARY, JONI VANDER BILT, CHING-WEN LEE, et al. "Cognitive test performance predicts change in functional status at the population level: The MYHAT Project." Journal of the International Neuropsychological Society 16, no. 5 (2010): 761–70. http://dx.doi.org/10.1017/s1355617710000561.
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AbstractIn the community at large, many older adults with minimal cognitive and functional impairment remain stable or improve over time, unlike patients in clinical research settings, who typically progress to dementia. Within a prospective population-based study, we identified neuropsychological tests predicting improvement or worsening over 1 year in cognitively driven everyday functioning as measured by Clinical Dementia Rating (CDR). Participants were 1682 adults aged 65+ and dementia-free at baseline. CDR change was modeled as a function of baseline test scores, adjusting for demographics. Among those with baseline CDR = 0.5, 29.8% improved to CDR = 0; they had significantly better baseline scores on most tests. In a stepwise multiple logistic regression model, tests which remained independently associated with subsequent CDR improvement were Category Fluency, a modified Token Test, and the sum of learning trials on Object Memory Evaluation. In contrast, only 7.1% with baseline CDR = 0 worsened to CDR = 0.5. They had significantly lower baseline scores on most tests. In multiple regression analyses, only the Mini-Mental State Examination, delayed memory for visual reproduction, and recall susceptible to proactive interference, were independently associated with CDR worsening. At the population level, changes in both directions are observable in functional status, with different neuropsychological measures predicting the direction of change. (JINS, 2010, 16, 761–770.)
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Jun, Byoung Sun, Kyung Min Kim, Hyun Ju Yang, and Joon Hyuk Park. "Association Between Executive Dysfunction-Related Activities of Daily Living Disability and Clinical Dementia Rating Domain Patterns in Patients With Vascular Dementia and Age-Matched Patients With Alzheimer’s Dementia." Psychiatry Investigation 20, no. 12 (2023): 1126–32. http://dx.doi.org/10.30773/pi.2023.0092.
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Objective Although the Clinical Dementia Rating (CDR) scale was originally developed to stage Alzheimer’s dementia (AD), it is now used globally for various types of dementia. The aim of this study was to investigate the characteristic pattern of CDR domains and its association with neuropsychological findings and activities of daily living (ADL) in patients with vascular dementia (VaD) and patients with AD.Methods We recruited very mild to mild VaD and AD patients who were age-matched among the first visitors to a dementia clinic. All subjects underwent a standardized clinical interview, physical and neurological examinations, and laboratory tests, including brain magnetic resonance imaging, according to the protocol of the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease assessment battery.Results A total of 105 pairs of VaD and AD patients participated in this study. Although the adjusted scores on Korean version of the Mini-Mental State Examination were similar between the two groups, the VaD patients performed better on the Boston Naming Test, Word List Memory, Word List Recall, Word List Recognition, and Constructional Recall Test. However, the scores on global CDR, CDR sum of boxes, and ADL-related CDR domains were higher in VaD patients than in AD patients (p<0.001). The VaD patients also showed poor performances on the Disability Assessment for Dementia Scale, Frontal Assessment Battery, Executive Clock Drawing Task, and Stroop tests.Conclusion Despite similar general cognitive function and better memory function, patients with VaD tend to be staged as severer dementia on the CDR scale than patients with AD because of more impaired ADL associated with executive dysfunction.
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Takahashi, Kyoko, Katsuaki Amemiya, Masahiro Nakatsuka, Kei Nakamura, Mari Kasai, and Kenichi Meguro. "Impaired Eating and Swallowing Function in Older Adults in the Community: The Kurihara Project." International Journal of Environmental Research and Public Health 16, no. 20 (2019): 4040. http://dx.doi.org/10.3390/ijerph16204040.
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Introduction: Older adults with dementia often develop aspiration pneumonia as a complication due to deterioration of swallowing function. Herein, we report our findings of eating and swallowing-related functions in elderly local residents. Methods: The subjects were 229 elderly residents in Kurihara City, including 97 healthy (Clinical Dementia Rating (CDR): 0), 108 with mild cognitive impairment (MCI) (CDR: 0.5), and 24 with dementia (CDR: 1 or higher: CDR 1+). We analyzed the relationships between the findings, eating, and swallowing, based on the database of the Kurihara Project performed from 2008 to 2010. Results: In the CDR 0.5 group, some deterioration in oral condition, oral function and swallowing function was confirmed. In the CDR 0.5 group, tooth staining, decrease in oral diadochokinesis (oral motion velocity), increased number of points below the cut-off value in a repetitive saliva swallowing test and the questionnaire, and prolonged water swallowing time were confirmed. In the CDR 1+ group, bad breath, elimination of the pharyngeal reflex, increase in disturbed soft palate elevation, and prolonged jelly swallowing time were confirmed. Conclusions: Deterioration of swallowing function was confirmed, even in subjects with mild dementia, in addition to development of problems related to food intake.
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Borgio, João Guilherme Fiorani, Leonardo Baldaçara, Walter dos Santos Moraes, et al. "Hippocampal volume and CDR-SB can predict conversion to dementia in MCI patients." Arquivos de Neuro-Psiquiatria 70, no. 11 (2012): 839–42. http://dx.doi.org/10.1590/s0004-282x2012001100003.
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OBJECTIVE: To evaluate the combination of two factors: clinical dementia rating sum of boxes scores (CDR-SB) and hippocampal volume (HV) as predictors of conversion from mild cognitive impairment (MCI) to dementia. METHODS: Twenty-eight individuals (9 normal and 19 with MCI) were classified according to their CDR sum of boxes scores into 3 groups. RESULTS: The hippocampal volume was significantly lower in the high-risk group and in those who developed dementia after two years. The rate of conversion was crescent among the three groups. CONCLUSION: We were proposed an additional measurement of the hippocampal volume which may be helpful in the prognosis. However, we noted that the CDR-SB is a method as efficient as neuroimaging to predict dementia with the advantage of being a procedure for low cost and easy implementation, more consistent with public policy.
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KS, MH, H, HM, and KH. "Energy Intake and Severity of Dementia Are Both Associated with Health-Related Quality of Life among Older Long-Term Care Residents." Nutrients 11, no. 10 (2019): 2261. http://dx.doi.org/10.3390/nu11102261.
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: Our aim was to investigate how energy intake modifies the association of the stage of dementia with healthrelated qualityoflife (HRQoL) among institutionalized older people. A crosssectional sample of 538 older long-term care residents with dementia in Helsinki, Finland were assessed with HRQoL (15D), energy intake (from one to two days), and the stage of dementia by the clinical dementia rating (CDR) scale. The energy intakes were standardized by zscores to include both men and women in the same analyses. Severity of dementia was associated with HRQoL (15D index in CDR 0.5–1: 0.65 (0.11), CDR 2: 0.60 (0.10), CDR 3: 0.52 (0.10)). When the three groups of dementia severity were divided according to their energy intake quartiles, there was an association between the HRQoL and the stage of dementia (p < 0.001) and energy intake (p = 0.013); however, no interaction was observed (p = 0.30). While partial correlation analysis showed that energy intake correlated with HRQoL among residents with very mild/mild or moderate dementia, this was not observed among those with severe dementia. In moderate dementia, the dimensions of mobility and usual activities correlated significantly with higher energy intake. Both energy intake and severity of dementia are associated with HRQoL.
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Hessler, Johannes Baltasar, Mark Stemmler, and Horst Bickel. "Cross-Validation of the Newly-Normed SKT for the Detection of MCI and Dementia." GeroPsych 30, no. 1 (2017): 19–25. http://dx.doi.org/10.1024/1662-9647/a000154.
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Abstract. New regression-based norms for the SKT Short Cognitive Performance Test were introduced but have not been cross-validated for the detection of mild cognitive impairment (MCI) and dementia. We examined 562 (59.6% female) community-dwelling persons (mean age = 75.8, SD = 5.5) at baseline and followed up with up to three annual visits. Participants were classified as being healthy, with MCI, or with dementia according to the Clinical Dementia Rating (CDR) and the SKT. Overall congruency between the ratings was 57.8%. The correlation between SKT and MMSE scores reached r = –0.67. Sensitivity and specificity for MCI and dementia were 0.89 and 0.60 as well as 0.83 and 0.84, respectively. The SKT detected cognitive decline at early stages but produced increased rates of false positives.
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Yang, Cho-Hsiang, Yi-Ting Lin, Ming H. Hsieh, and Tzung-Jeng Hwang. "A re-evaluation study and literature review on AD8 as a screening tool for dementia." PLOS One 20, no. 5 (2025): e0321570. https://doi.org/10.1371/journal.pone.0321570.
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Background The Eight-Item Informant Interview to Differentiate Aging and Dementia (AD8) was developed as a screening tool for dementia, with a cutoff score of 2 suggested by the initial study. However, various studies have reported different cutoff values, and many have found that a cutoff of 2 may result in a high false positive rate. Furthermore, a high false positive rate has repeatedly been shown when the AD8 is self-administered in local government screening programs in Taiwan. Objectives This study aimed to test the AD8’s performance, define its best cutoff value, review factors that may affect its performance, and reconsider its role in clinical practice. Methods We recruited 118 participant-informant dyads from a university teaching hospital. For each informant, the AD8 was administered before the Clinical Dementia Rating (CDR) to minimize recall bias. Two geriatric psychiatrists made a consensus clinical diagnosis for each participant based on the DSM-5 criteria. Receiver operating characteristic analysis was used to assess the performance of the AD8. Results Thirty-seven participants had a CDR of 0, 61 had a CDR of 0.5, and 20 had a CDR ≥ 1. To discriminate between the participants with CDR 0 and those with CDR 0.5, the optimal cutoff score for the AD8 was 2. Including those with CDR ≥ 1 changed the best cutoff value to 3. In terms of the DSM-5 criteria, 59 participants had normal cognition, 28 had mild neurocognitive disorder, and 31 had major neurocognitive disorder or dementia. To discriminate between those with and without dementia, an AD8 cutoff value of 4 maximized the Youden index with more balanced sensitivity and specificity. Conclusion The AD8 may have different cutoff values depending on different purposes. Our findings suggest that the AD8 may perform better with a cutoff value of 4 to discriminate between those with and without dementia.
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Lopes, Marcos, Sonia Maria Dozzi Brucki, Viviana Giampaoli, and Letícia Lessa Mansur. "Semantic Verbal Fluency test in dementia: Preliminary retrospective analysis." Dementia & Neuropsychologia 3, no. 4 (2009): 315–20. http://dx.doi.org/10.1590/s1980-57642009dn30400009.
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Abstract The Semantic Verbal Fluency (SVF) test entails the generation of words from a given category within a pre-set time of 60 seconds. Objectives: To verify whether socio-demographic and clinical data of individuals with dementia correlate with the performance on the SVF test and to ascertain whether differences among the criteria of number of answers, clusters and data spread over the intervals, predict clinical results. Methods: This was a retrospective study of 49 charts of demented patients classified according to the Clinical Dementia Rating (CDR) scale. We correlated education, age and gender, as well as CDR and Mini-Mental State Exam (MMSE) scores with the number of answers, clustering and switching distributed over four 15-second intervals on the SVF test. Results: The correlation between number of answers and quartiles was weak (r=0.407, p=0.004; r=0.484, p<0.001) but correlation between the number of clusters and responses was strong (r=0.883, p<0.001). The number of items on the SVF was statistically significant with MMSE score (p=0.01) and there was a tendency for significance on the CDR (p=0.06). The results indicated little activity regarding what we propose to call cluster recalling in the two groups. Discussion: The SVF test, using number of items generated, was found to be more effective than classic screening tests in terms of speed and ease of application in patients with CDR 2 and 3.
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Yang, Yuan-Han, Ying-Han Lee, Chen-Wen Yen, Ling-Chun Huang, Yang-Pei Chang, and Ching-Fang Chien. "Association between Cerebral Coordination Functions and Clinical Outcomes of Alzheimer’s Dementia." Brain Sciences 12, no. 10 (2022): 1370. http://dx.doi.org/10.3390/brainsci12101370.
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Background: Alzheimer’s dementia (AD) is a degenerative disease that impairs cognitive function, initially, and then motor or other function, eventually. Motor coordination function impairment usually accompanies cognition impairment but it is seldom examined whether it can reflect the clinical outcomes of AD. Methods: 113 clinically diagnosed AD patients with a mean age of 78.9 ± 6.9 years underwent an annual neuropsychological assessment using the Mini-Mental State Examination (MMSE), the Cognitive Abilities Screening Instrument (CASI), the Sum of Boxes of Clinical Dementia Rating (CDR-SB), and the CDR. The cerebral coordination function was evaluated through correlations among 15 joints with a kinetic depth sensor annually. An intra-individual comparison of both cognitive and motor coordination functions was performed to examine their correlations. Results: The changes in coordination function in the lower limbs can significantly reflect the clinical outcomes, MMSE (p < 0.001), CASI (p = 0.006), CDR (p < 0.001), and CDR-SB (p < 0.001), but the changes in upper limbs can only reflect the clinical outcome in CDR (p < 0.001). Conclusions: The use of a kinetic depth sensor to determine the coordination between joints, especially in lower limbs, can significantly reflect the global functional and cognitive outcomes in AD. Such evaluations could be another biomarker used to evaluate non-cognitive outcomes in AD for clinical and research purposes.
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Dyer, Adam H., Claire Murphy, Ricardo Segurado, Brian Lawlor, and Sean P. Kennelly. "Is Ongoing Anticholinergic Burden Associated With Greater Cognitive Decline and Dementia Severity in Mild to Moderate Alzheimer’s Disease?" Journals of Gerontology: Series A 75, no. 5 (2019): 987–94. http://dx.doi.org/10.1093/gerona/glz244.
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Abstract Background Use of anticholinergic medication is associated with an increased risk of cognitive impairment and/or dementia. Despite this, the impact of continuing medication with anticholinergic properties in those diagnosed with Alzheimer’s Disease (AD) is not clear. Methods Analysis of data from NILVAD, an 18-month randomized controlled trial of Nilvadipine in AD. Effects of ongoing Anticholinergic Cognitive Burden (ACB) on cognition (ADAS-Cog: Alzheimer’s Disease Cog Subsection) and dementia severity (CDR-sb: Clinical Dementia Rating – Sum of Boxes/DAD: Disability Assessment for Dementia) over 18 months was evaluated adjusting for important clinical covariates. Results Just over one-quarter (27.90%, n = 142/510) of patients with mild to moderate AD were prescribed a potential/definite anticholinergic. While ACB score was not associated with greater progression on the ADAS-Cog/CDR-sb over time, a higher total ACB predicted greater dementia severity on the DAD, which persisted after robust covariate adjustment (β Coef: −1.53, 95% CI: −2.83 to −0.23, p = .021). There was a significant interaction between APOE ε4 status and ACB score, with carriers experiencing greater progression on both the CDR-Sb (β Coef: 0.36, 95% CI: 0.05–0.67, p = .021) and DAD (β Coef: −3.84, 95% CI: −7.65 to 0.03, p = .049). Conclusions Ongoing use of anticholinergic medication was associated with greater dementia progression on the DAD, but not the CDR-sb. APOE ε 4 carriers may be particularly vulnerable to the effect of ongoing anticholinergic medication on dementia severity, with significant APOE ε 4 x ACB score interactions demonstrated on both the DAD and CDR-sb.
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Snitz, Beth E., David A. Loewenstein, Chung-Chou H. Chang, et al. "A novel approach to assessing memory at the population level: vulnerability to semantic interference." International Psychogeriatrics 22, no. 5 (2010): 785–94. http://dx.doi.org/10.1017/s1041610209991657.
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ABSTRACTBackground: There is increasing interest in identifying novel cognitive paradigms to help detect preclinical dementia. Promising results have been found in clinical settings using the Semantic Interference Test (SIT), a modification of an existing episodic memory test (Fuld Object Memory Evaluation) that exploits vulnerability to semantic interference in Alzheimer's disease. It is not yet known how broadly this work will generalize to the community at large.Methods: Participants aged ≥65 years from the Monongahela-Youghiogheny Healthy Aging Team (MYHAT) were administered the SIT at study entry. Independent of neuropsychological assessment, participants were rated on the Clinical Dementia Rating (CDR) scale, based on reported loss of cognitively driven everyday functioning. In individuals free of dementia (CDR <1), the concurrent validity of the SIT was assessed by determining its association with CDR using multiple logistic regression models, with CDR 0 (no dementia) vs. 0.5 (possible dementia) as the outcome and the SIT test variables as predictors.Results: Poorer performance on all SIT variables but one was associated with higher CDR reflecting possible dementia (Odds Ratios 2.24–4.79). Younger age and female gender also conferred a performance advantage. Years of education and reading ability (a proxy for quality of education) evidenced a very weak association with SIT performance.Conclusions: The SIT shows promise as a valid, novel measure to identify early preclinical dementia in a community setting. It has potential utility for assessment of persons who may be illiterate or of low education. Finally, we provide normative SIT data stratified by age which may be utilized by clinicians or researchers in future investigations.
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Hashimoto, Mamoru, Yusuke Yatabe, Tomohisa Ishikawa, et al. "Relationship between Dementia Severity and Behavioral and Psychological Symptoms of Dementia in Dementia with Lewy Bodies and Alzheimer's Disease Patients." Dementia and Geriatric Cognitive Disorders Extra 5, no. 2 (2015): 244–52. http://dx.doi.org/10.1159/000381800.
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Background/Aims: Behavioral and psychological symptoms of dementia (BPSD) are common in the clinical manifestation of dementia. Although most patients with dementia exhibit some BPSD during the course of the illness, the association of BPSD with the stage of dementia remains unclear. It was the aim of this study to evaluate the impact of severity of dementia on the expression of BPSD in patients with dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). Methods: Ninety-seven patients with DLB and 393 patients with AD were recruited from 8 dementia clinics across Japan. BPSD were assessed by the Neuropsychiatric Inventory (NPI). A relationship between BPSD and dementia stage classified by the Clinical Dementia Rating (CDR) in each type of dementia was assessed. Results: No significant difference was seen in NPI total score across CDR staging in the DLB group. On the other hand, the NPI total score significantly increased with dementia stage in the AD group. Conclusion: The relationship of dementia stage with the expression of BPSD was different according to the type of dementia. BPSD and dementia stage were correlated in AD subjects, in whom psychiatric symptoms increase as the disease progresses, but not in DLB subjects.
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Lam, Linda C. W., Cindy W. C. Tam, Victor W. C. Lui, et al. "Prevalence of very mild and mild dementia in community-dwelling older Chinese people in Hong Kong." International Psychogeriatrics 20, no. 1 (2008): 135–48. http://dx.doi.org/10.1017/s1041610207006199.
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ABSTRACTIntroduction: In this report, the results of a household survey were used to examine the prevalence of very mild and mild dementia in Chinese older persons in Hong Kong.Methods: The study adopted a two-phase design. At Phase 1, 6100 subjects were screened using the Cantonese version of the Mini-mental State Examination (MMSE) and a short memory inventory. At Phase 2, 2073 subjects were screened positive and 737 were evaluated by psychiatrists. Clinical Dementia Rating (CDR) and cognitive assessment were used for diagnosis of dementia. Very mild dementia (VMD) was defined as a global CDR of 0.5, with memory and non-memory subscale scores of 0.5 or more. Mild dementia was classified for subjects with a CDR of 1.Results: The overall prevalence of VMD and mild dementia for persons aged 70 years or above was 8.5% (95%CI: 7.4–9.6) and 8.9% (95%CI: 7.8–10.0) respectively. Among subjects with clinical dementia, 84.6% had mild (CDR1) dementia. Logistic regression analyses revealed that older age, lower educational level and significant cerebrovascular risk factors were risk factors for dementia, while regular physical exercise was a protective factor for dementia.Conclusions: A sizable proportion of community-living subjects suffered from milder forms of dementia. They represent a high risk for early intervention to reduce potential physical and psychiatric morbidity.
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Hynninen, Minna J., Monica H. Breitve, Arvid Rongve, Dag Aarsland, and Inger Hilde Nordhus. "The frequency and correlates of anxiety in patients with first-time diagnosed mild dementia." International Psychogeriatrics 24, no. 11 (2012): 1771–78. http://dx.doi.org/10.1017/s1041610212001020.
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ABSTRACTBackground: Anxiety in persons with dementia has received little attention despite its severe consequences. In this observational cross-sectional study, we investigated the frequency of anxiety and associations between anxiety and socio-demographic and clinical variables in an outpatient sample with first-time diagnosed mild dementia.Methods: The study sample (n = 169) comprised participants recruited from clinics in geriatric medicine and old age psychiatry for a longitudinal dementia study. Symptoms of anxiety were rated by a caregiver on the Neuropsychiatric Inventory (NPI) and by the patient on the anxiety tension item on the Montgomery and Åsberg Depression Rating Scale. Measures of caregiver stress, dementia-related impairment (Clinical Dementia Rating (CDR) scale), and cognitive functioning were also included.Results: According to caregiver reports, 19.5% had clinically significant anxiety and an additional 22.5% had subclinical anxiety. Half of the patients reported experiencing anxiety from time to time. Patients with Lewy-body dementia reported anxiety more often compared to patients with Alzheimer's disease. Anxiety was associated with depression, higher caregiver stress, and more dementia-related impairment, but not with cognitive test performance. Caregiver stress and higher CDR score increased the odds for anxiety significantly, even when controlling for depression.Conclusion: Anxiety is common in patients with mild dementia, and seems to be associated not so much with cognitive test performance than with caregiver distress and the patient's ability to function in daily life. Anxiety should be taken into account when assessing dementia, as well as screened for when examining patients with known dementia.
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Grober, Ellen, Qi Qi, Lynn Kuo, Jason Hassenstab, Richard J. Perrin, and Richard B. Lipton. "Stages of Objective Memory Impairment Predict Alzheimer’s Disease Neuropathology: Comparison with the Clinical Dementia Rating Scale–Sum of Boxes." Journal of Alzheimer's Disease 80, no. 1 (2021): 185–95. http://dx.doi.org/10.3233/jad-200946.
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Background: The ultimate validation of a clinical marker for Alzheimer’s disease (AD) is its association with AD neuropathology. Objective: To examine how well the Stages of Objective Memory Impairment (SOMI) system predicts intermediate/high AD neuropathologic change and extent of neurofibrillary tangle (NFT) pathology defined by Braak stage, in comparison to the Clinical Dementia Rating (CDR) Scale sum of boxes (CDR-SB). Methods: 251 well-characterized participants from the Knight ADRC clinicopathologic series were classified into SOMI stage at their last assessment prior to death using the free recall and total recall scores from the picture version of the Free and Cued Selective Reminding Test with Immediate Recall (pFCSRT + IR). Logistic regression models assessed the predictive validity of SOMI and CDR-SB for intermediate/high AD neuropathologic change. Receiver operating characteristics (ROC) analysis evaluated the discriminative validity of SOMI and CDR-SB for AD pathology. Ordinal logistic regression was used to predict Braak stage using SOMI and CDR-SB in separate and joint models. Results: The diagnostic accuracy of SOMI for AD diagnosis was similar to that of the CDR-SB (AUC: 85%versus 83%). In separate models, both SOMI and CDR-SB predicted Braak stage. In a joint model SOMI remained a significant predictor of Braak stage but CDR-SB did not. Conclusion: SOMI provides a neuropathologically validated staging system for episodic memory impairment in the AD continuum and should be useful in predicting tau positivity based on its association with Braak stage.
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Galvin, James E., Magdalena I. Tolea, Claudia Moore, and Stephanie Chrisphonte. "The Number Symbol Coding Task: A brief measure of executive function to detect dementia and cognitive impairment." PLOS ONE 15, no. 11 (2020): e0242233. http://dx.doi.org/10.1371/journal.pone.0242233.
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Introduction Alzheimer’s disease and related dementias (ADRD) affect over 5.7 million Americans and over 35 million people worldwide. Detection of mild cognitive impairment (MCI) and early ADRD is a challenge to clinicians and researchers. Brief assessment tools frequently emphasize memory impairment, however executive dysfunction may be one of the earliest signs of impairment. To address the need for a brief, easy-to-score, open-access test of executive function for use in clinical practice and research, we created the Number Symbol Coding Task (NSCT). Methods This study analyzed 320 consecutive patient-caregiver dyads who underwent a comprehensive evaluation including the Clinical Dementia Rating (CDR), patient and caregiver versions of the Quick Dementia Rating System (QDRS), caregiver ratings of behavior and function, and neuropsychological testing, with a subset undergoing volumetric magnetic resonance imaging (MRI). Estimates of cognitive reserve were calculated using education, combined indices of education and occupation, and verbal IQ. Psychometric properties of the NSCT including data quality, data distribution, floor and ceiling effects, construct and known-groups validity, discriminability, and clinical profiles were determined. Results The patients had a mean age of 75.3±9.2 years (range 38-98y) with a mean education of 15.7±2.8 years (range 6-26y) of education. The patients had a mean CDR-SB of 4.8±4.7 (range 0–18) and a mean MoCA score of 18.6±7.1 (range 1–30). The mean NSCT score was 30.1±13.8 and followed a normal distribution. All healthy controls and MCI cases were able to complete the NSCT. The NSCT showed moderate-to-strong correlations with clinical and neuropsychological measures with the strongest association (all p’s < .001) for measures with executive components (e.g., Judgement and Problem Solving box of the CDR, Decision Making and Problem Solving domain of the QDRS, Trailmaking B, and Cognigram Attention and Executive Composite Scores). Women slightly outperformed men, and individuals with lower educational attainment and lower education-occupation indices had lower NSCT scores. Decreasing NSCT scores corresponded to older age, worse cognitive scores, higher CDR sum of boxes scores, worse caregiver ratings of function and behavior, worse patient and informant QDRS ratings, and smaller hippocampal volumes and hippocampal occupancy scores. The NSCT provided excellent discrimination (AUC: .866; 95% CI: .82-.91) with a cut-off score of 36 providing the best combination of sensitivity (0.880) and specificity (0.759). Combining the NSCT with patient QDRS and caregiver QDRS ratings improved discrimination (AUC: .908; 95% CI: .87-.94). Discussion The NSCT is a brief, 90-second executive task that incorporates attention, planning and set-switching that can be completed by individuals into the moderate-to-severe stages of dementia. The NSCT may be a useful tool for dementia screening, case-ascertainment in epidemiological or community-based ADRD studies, and in busy primary care settings where time is limited. Combining the NSCT with a brief structured interview tool such as the QDRS may provide excellent power to detect cognitive impairment. The NSCT performed well in comparison to standardized scales of a comprehensive cognitive neurology evaluation across a wide array of sociodemographic variables in a brief fashion that could facilitate its use in clinical care and research.
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Irimata, Katherine E., Brittany N. Dugger, and Jeffrey R. Wilson. "Impact of the Presence of Select Cardiovascular Risk Factors on Cognitive Changes among Dementia Subtypes." Current Alzheimer Research 15, no. 11 (2018): 1032–44. http://dx.doi.org/10.2174/1567205015666180702105119.
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Background: Studies have shown select associations between cardiovascular risk factors and dementia, but mostly focused on Alzheimer’s Disease (AD). Objective: We enhance these works by evaluating the relationship between the presence of cardiovascular risk factors and the rate of cognitive decline, measured using the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating Sum of Boxes (CDR-SUM) on four common dementia subtypes (AD, dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), and vascular dementia (VaD), as well as non-demented elderly individuals (normal)). Method: We used generalized linear mixed models with random intercepts to account for correlation at the patient and center levels for each dementia subtype adjusting for time since initial visit, baseline cognitive score, age, and demographic factors. The cardiovascular risk factors evaluated included body mass index, diabetes, years of smoking, atrial fibrillation, hypertension, and hypercholesterolemia. Results: Patients diagnosed with AD (n=1899), DLB (n=65), FTD (n=168), or VaD (n=13); or lacked cognitive impairment (normal) (n=3583) were evaluated using data from the National Alzheimer’s Coordinating Centers. Cardiovascular risk factors were associated with select dementia subtypes including AD and FTD. Using MMSE and CDR-SUM, recent or active hypertension and hypercholesterolemia were associated with a slower cognitive decline for AD patients, while higher body mass index and years of smoking were associated with a slower cognitive decline for FTD patients. However, several cardiovascular factors demonstrated associations with more rapid cognitive decline. Conclusion: These results demonstrate disease specific associations and can provide clinicians guidance on predicted cognitive changes at the group level using information about cardiovascular risk factors.
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Persoon, A., R. P. C. Kessels, L. Joosten-Weyn Banningh, J. Verkoelen, T. van Achterberg, and M. G. M. Olde Rikkert. "Assessment of memory function: the relation between daily observation and neuropsychological test performance." International Psychogeriatrics 23, no. 1 (2010): 102–6. http://dx.doi.org/10.1017/s1041610210000323.
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ABSTRACTBackground: The aim of the study was to explore the value of a daily observation scale in the assessment of patients' memory function by nurses on a geriatric ward.Methods: An observational study of 50 geriatric inpatients was carried out. The relationship between the memory items of the Nurses' Behavioral Rating Scale for Geriatric Inpatients (GIP) and four types of neuropsychological memory tests was examined: visual paired-associate learning (Visual Association Test, VAT), word-list learning (Eight Word Test, 8WT from the Amsterdam Dementia Screening, ADS), and the subtests Route Recall and Story Recall from the Rivermead Behavioural Memory Test (RBMT). Correlations with the overall measures assessing level of dementia such as the Mini-mental State Examination (MMSE), Clinical Dementia Rating scale (CDR) and the 15-item Geriatric Depression Scale (GDS-15) were examined as well.Results: The Pearson's correlation coefficients between GIP and the four memory tests were between 0.45 and 0.71 (p < 0.01). The GIP correlations with the MMSE and CDR were 0.63 and 0.46, respectively (p < 0.01). No significant correlation was found with the GDS-15. Statistically significant differences in GIP memory scores between patients with dementia and non-demented patients were found (p < 0.01).Conclusions: Results indicate that an observation scale of memory function may have value for providing information about the underlying memory impairment. The results of nurses' observations may be used in triage contributing to the diagnostic process by selecting patients requiring further neuropsychological assessment.
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Melo, Maria Clara Silva de, Susann Kelly Damião do Rego e. Silva Andrade, Vanessa Giffoni Nunes de Medeiros Pinheiro Peixoto, Fabrícia Azevedo da Costa Cavalcanti, and Juliana Maria Gazzola. "Functional Mobility and postural balance in older adults with Alzheimer's disease: comparative study between mild and moderate stages." Research, Society and Development 11, no. 16 (2022): e346111637968. http://dx.doi.org/10.33448/rsd-v11i16.37968.
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Objective: This study aimed to compare the functional mobility and postural balance of older adults among smild and moderate stages of Alzheimer's disease using the Timed Up and Go test (TUGT) and the Clinical Test of Sensory Interaction and Balance (CTSIB). Methodology: Forty elderly people were divided into two groups according to the mild (CDR1; n = 26) and moderate (CDR2; n = 14) stages of the disease. The Clinical Dementia Rating Scale (CDR) was used for staging the disease, which allows classifying the different degrees of dementia, assessing cognition and behavior. The scale allows classification into CDR 0 (normal or no alteration); 0.5 (questionable or mild cognitive impairment); 1 (mild dementia); 2 (moderate dementia) and 3 (severe dementia). In this study, only subjects classified as CDR 1 or CDR 2 were included. For the assessment of functional mobility, the Timed Up and Go Test (TUGT) was used in the conditions of single task, dual cognitive task and dual motor task, and the Clinical Test of Sensory (CTSIB) to assess postural balance. Data were compared between groups. Results: Performance on the TUGT single task, cognitive dual task, and motor dual task was significantly worse in the CDR2 group compared to the CDR1 group (p < 0.05). The CTSIB was not significantly different between the groups in the four conditions. Conclusion: Functional mobility during tasks involving cognition differs between older adults with mild and moderate dementia, and this commitment is more accentuated in dual-task situations. Postural balance did not differ between the stages of the disease.
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Laske, Christoph, Hamid R. Sohrabi, Mateusz S. Jasielec, et al. "Diagnostic Value of Subjective Memory Complaints Assessed with a Single Item in Dominantly Inherited Alzheimer’s Disease: Results of the DIAN Study." BioMed Research International 2015 (2015): 1–7. http://dx.doi.org/10.1155/2015/828120.
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Objective. We examined the diagnostic value of subjective memory complaints (SMCs) assessed with a single item in a large cross-sectional cohort consisting of families with autosomal dominant Alzheimer’s disease (ADAD) participating in the Dominantly Inherited Alzheimer Network (DIAN).Methods. The baseline sample of 183 mutation carriers (MCs) and 117 noncarriers (NCs) was divided according to Clinical Dementia Rating (CDR) scale into preclinical (CDR 0; MCs:n=107; NCs:n=109), early symptomatic (CDR 0.5; MCs:n=48; NCs:n=8), and dementia stage (CDR ≥ 1; MCs:n=28; NCs:n=0). These groups were subdivided by the presence or absence of SMCs.Results. At CDR 0, SMCs were present in 12.1% of MCs and 9.2% of NCs(P=0.6). At CDR 0.5, SMCs were present in 66.7% of MCs and 62.5% of NCs(P=1.0). At CDR ≥ 1, SMCs were present in 96.4% of MCs. SMCs in MCs were significantly associated with CDR, logical memory scores, Geriatric Depression Scale, education, and estimated years to onset.Conclusions. The present study shows that SMCs assessed by a single-item scale have no diagnostic value to identify preclinical ADAD in asymptomatic individuals. These results demonstrate the need of further improvement of SMC measures that should be examined in large clinical trials.
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Huang, Qi, Daniel Bolt, Erin Jonaitis, et al. "Performance of study partner reports in a non‐demented at‐risk sample." Alzheimer's & Dementia, December 23, 2024. https://doi.org/10.1002/alz.14470.
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AbstractINTRODUCTIONThe Clinical Dementia Rating (CDR) Scale is a gold standard for staging impairment in Alzheimer's disease and other dementias (ADRD). The Quick Dementia Rating System (QDRS) offers similar results in 3 to 5 minutes without a trained clinician. This study aimed to (1) investigate concordance between comparably derived QDRS and CDR global scores, (2) examine item‐level QDRS/CDR agreement, and (3) compare sample characteristics and cognitive performance across QDRS/CDR global concordant/discordant groups.METHODSThe study included 351 QDRS/CDR pairs from 297 participants in the Wisconsin Registry for Alzheimer's Prevention (WRAP). Analyses included descriptive indices of QDRS/CDR agreement, lasso logistic regression, tetrachoric correlations, and linear mixed models.RESULTSThe QDRS global/CDR global concordance rate is 70.66%. Memory item discrepancies were primarily responsible for QDRS/CDR global rating discordance. Average cognitive scores were highest in concordant‐normal QDRS/CDR and lowest in concordant‐abnormal QDRS/CDR.DISCUSSIONThe QDRS effectively screened for impairment in this sample. Future analyses will investigate QDRS relations to ADRD biomarkers.Highlights The Quick Dementia Rating System (QDRS) effectively screened for impairment in Alzheimer's disease and other dementias (ADRD) in a non‐demented sample. Concordance rate between QDRSCDR global and Clinical Dementia Rating (CDR) Scale global scores is 70.66%. Memory item discrepancies primarily cause QDRS/CDR global score discordance. Cognitive scores are associated with QDRS/CDR concordances/discordances. Future analyses will explore QDRS relations to ADRD biomarkers.
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"Clinical dementia rating (CDR) -scale in screening dementia." Neurobiology of Aging 13 (January 1992): S2—S3. http://dx.doi.org/10.1016/0197-4580(92)90131-g.
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Huang, Qi, Daniel M. Bolt, Erin M. Jonaitis, et al. "The Quick Dementia Rating System and the Clinical Dementia Rating Scale: Investigation of agreement and related features in a predominantly unimpaired sample." Alzheimer's & Dementia 20, S3 (2024). https://doi.org/10.1002/alz.090957.
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AbstractBackgroundThe Clinical Dementia Rating Scale (CDR) is a gold standard metric for staging the nature and severity of global cognitive and functional impairment in Alzheimer’s disease (AD) and other dementias. Prior evidence from older and/or smaller samples suggests that The Quick Dementia Rating System (QDRS) informant questionnaire provides results comparable to the CDR and can be completed in just 3‐5 minutes, sans a trained clinician or rater. This study aimed to: 1) investigate concordance between the QDRS‐derived global CDR (“QDRS‐global”; Galvin, 2015) and CDR‐global scores; 2) examine item‐level QDRS/CDR agreement; and (3) evaluate QDRS‐global/CDR‐global concordant/discordant groups against concurrent Preclinical Alzheimer’s Cognitive Composite (PACC3) performance.MethodThe study included 351 QDRS/CDR pairs (n = 297 participants) from the Wisconsin Registry for Alzheimer’s Prevention (WRAP). Analyses include descriptive indices of QDRS/CDR agreement (e.g., QDRS‐global false negative [FN], false positive [FP] rates relative to CDR‐global scores (each collapsed to 0 = unimpaired;.5 = impaired due to few values>.5), Lasso logistic regression identifying QDRS items associated with discordance, tetrachoric correlations evaluating psychometric functioning of CDR and QDRS items, and linear mixed models examining associations between QDRS/CDR concordant/discordant groups and PACC3 performance.ResultThe QDRS‐global/CDR‐global scores concordance rate was 70.66% (see also Table 1). Relative to CDR‐global, the QDRS‐global FP and FN rates were 39.2% and 11.3%, respectively. Item‐level results were consistent with this pattern for all item pairs, except for FuncHome/HomeHob showing a greater tendency for QDRS FNs. Logistic regression and psychometric analyses highlighted the QDRS Memory item as primarily responsible for FPs and FNs (Figure 1). After adjusting for covariates, QDRS‐concurrent PACC3 scores differed significantly for two pairs of QDRS‐global/CDR‐global concordance/discordance groups — True Negative (TN) vs. True Positive (TP), FP vs. TP (Table 2; Tukey‐adjusted pairwise comparisons). The latter suggests that QDRS‐global classification of impairment is more likely to be a FP‐misclassification for participants with high PACC3 scores than for those with low PACC3 scores.ConclusionIn this late‐middle‐aged, predominantly unimpaired sample, the QDRS appears well‐suited for screening for impairment. Future analyses will examine whether more nuanced scoring of the QDRS Memory item may reduce FP and FN rates and will investigate relations to biomarkers for AD and other dementias.
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Samra, Kiran, Georgia Peakman, Amy M. MacDougall, et al. "Extending the phenotypic spectrum assessed by the CDR plus NACC FTLD in genetic frontotemporal dementia." Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring 16, no. 2 (2024). http://dx.doi.org/10.1002/dad2.12571.
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AbstractINTRODUCTIONWe aimed to expand the range of the frontotemporal dementia (FTD) phenotypes assessed by the Clinical Dementia Rating Dementia Staging Instrument plus National Alzheimer's Coordinating Center Behavior and Language Domains (CDR plus NACC FTLD).METHODSNeuropsychiatric and motor domains were added to the standard CDR plus NACC FTLD generating a new CDR plus NACC FTLD‐NM scale. This was assessed in 522 mutation carriers and 310 mutation‐negative controls from the Genetic Frontotemporal dementia Initiative (GENFI).RESULTSThe new scale led to higher global severity scores than the CDR plus NACC FTLD: 1.4% of participants were now considered prodromal rather than asymptomatic, while 1.3% were now considered symptomatic rather than asymptomatic or prodromal. No participants with a clinical diagnosis of an FTD spectrum disorder were classified as asymptomatic using the new scales.DISCUSSIONAdding new domains to the CDR plus NACC FTLD leads to a scale that encompasses the wider phenotypic spectrum of FTD with further work needed to validate its use more widely.Highlights The new Clinical Dementia Rating Dementia Staging Instrument plus National Alzheimer's Coordinating Center Behavior and Language Domains neuropsychiatric and motor (CDR plus NACC FTLD‐NM) rating scale was significantly positively correlated with the original CDR plus NACC FTLD and negatively correlated with the FTD Rating Scale (FRS). No participants with a clinical diagnosis in the frontotemporal dementia spectrum were classified as asymptomatic with the new CDR plus NACC FTLD‐NM rating scale. Individuals had higher global severity scores with the addition of the neuropsychiatric and motor domains. A receiver operating characteristic analysis of symptomatic diagnosis showed nominally higher areas under the curve for the new scales.
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Wilks, Hannah, Tammie L. S. Benzinger, Suzanne E. Schindler, Carlos Cruchaga, John C. Morris, and Jason Hassenstab. "Predictors and outcomes of fluctuations in the clinical dementia rating scale." Alzheimer's & Dementia, January 15, 2024. http://dx.doi.org/10.1002/alz.13679.
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AbstractINTRODUCTIONReversion, or change in cognitive status from impaired to normal, is common in aging and dementia studies, but it remains unclear what factors predict reversion.METHODSWe investigated whether reverters, defined as those who revert from a Clinical Dementia Rating® (CDR®) scale score of 0.5 to CDR 0) differed on cognition and biomarkers from unimpaired participants (always CDR 0) and impaired participants (converted to CDR > 0 and had no reversion events). Models evaluated relationships between biomarker status, apolipoprotein E (APOE) ε4 status, and cognition. Additional models described predictors of reversion and predictors of eventual progression to CDR > 0.RESULTSCDR reversion was associated with younger age, better cognition, and negative amyloid biomarker status. Reverters that eventually progressed to CDR > 0 had more visits, were older, and were more likely to have an APOE ε4 allele.DISCUSSIONCDR reversion occupies a transitional phase in disease progression between cognitive normality and overt dementia. Reverters may be ideal candidates for secondary prevention Alzheimer's disease (AD) trials.Highlights Reverters had more longitudinal cognitive decline than those who remained cognitively normal. Predictors of reversion: younger age, better cognition, and negative amyloid biomarker status. Reverting from CDR 0.5 to 0 is a risk factor for future conversion to CDR > 0. CDR reversion may be a transitional phase in Alzheimer's Disease progression. CDR reverters may be ideal for Alzheimer's disease secondary prevention trials.
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Tzeng, Ray-Chang, Yu-Wan Yang, Kai-Cheng Hsu, Hsin-Te Chang, and Pai-Yi Chiu. "Sum of boxes of the clinical dementia rating scale highly predicts conversion or reversion in predementia stages." Frontiers in Aging Neuroscience 14 (September 23, 2022). http://dx.doi.org/10.3389/fnagi.2022.1021792.
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BackgroundThe clinical dementia rating (CDR) scale is commonly used to diagnose dementia due to Alzheimer’s disease (AD). The sum of boxes of the CDR (CDR-SB) has recently been emphasized and applied to interventional trials for tracing the progression of cognitive impairment (CI) in the early stages of AD. We aimed to study the influence of baseline CDR-SB on disease progression to dementia or reversion to normal cognition (NC).Materials and methodsThe baseline CDR &lt; 1 cohort registered from September 2015 to August 2020 with longitudinal follow-up in the History-based Artificial Intelligence Clinical Dementia Diagnostic System (HAICDDS) database was retrospectively analyzed for the rates of conversion to CDR ≥ 1. A Cox regression model was applied to study the influence of CDR-SB levels on progression, adjusting for age, education, sex, neuropsychological tests, neuropsychiatric symptoms, parkinsonism, and multiple vascular risk factors.ResultsA total of 1,827 participants were analyzed, including 1,258 (68.9%) non-converters, and 569 (31.1%) converters with mean follow-up of 2.1 (range 0.4–5.5) and 1.8 (range 0.3–5.0) years, respectively. Conversion rates increased with increasing CDR-SB scores. Compared to a CDR-SB score of 0, the hazard ratios (HR) for conversion to dementia were 1.51, 1.91, 2.58, 2.13, 3.46, 3.85, 3.19, 5.12, and 5.22 for CDR-SB scores of 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, and ≥4.5, respectively (all p &lt; 0.05 except for CDR-SB score = 0.5). In addition, older age, lower education, lower cognitive performance, and a history of diabetes also increased conversion rates. Furthermore, reversions to NC were 12.5, 5.6, 0.9, and 0% for CDR-SB scores of 0.5, 1.0–2.0, 2.5–3.5 and ≥4.0, respectively (p &lt; 0.001).ConclusionCDR-SB in predementia or very mild dementia (VMD) stages highly predicts progression to dementia or reversion to NC. Therefore, CDR-SB could be a good candidate for tracing the effectiveness of pharmacological and non-pharmacological interventions in populations without dementia.