Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-29T17:19:20.100Z Has data issue: false hasContentIssue false
  • English
  • Français

Target Symptoms and Outcome Measures: Cognition

Published online by Cambridge University Press:  02 December 2014

Andrew Kirk
Andrew Kirk*
Affiliation:
The Division of Neurology, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada
*
University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan S7N 0W8, Canada.
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The Cognitive section of the Alzheimer's Disease Assessment Scale (ADAS-Cog) remains the most widely used cognitive measure in dementia trials although it does not assess attention, executive function, or agnosia. Designed for use in Alzheimer's disease (AD), it may not be ideal in assessing patients with other diagnoses. The ADAS-Cog differentiates between AD patients, patients with Mild Cognitive Impairment, and normal controls. It has been used in trials of drugs for vascular and mixed dementia and dementia with Lewy bodies. It is not clear that the ADAS-Cog is adequate for assessing cognition in frontotemporal dementia. Well-validated aphasia batteries, such as the Western Aphasia Battery, can be used to assess language. Brief tests of frontal function such as the Frontal Assessment Battery or the Executive Interview might be useful additions in frontotemporal dementia trials. The most widely used assessment tool for patients with advanced dementia is the Severe Impairment Battery. The domains tested are analogous to those assessed by the ADAS-Cog. The Mini-Mental State Exam and the Modified Mini-Mental State Examination are useful in stratifying patients for trial entry. Cognitive measures better tailored to the diseases in question are needed for non-Alzheimer dementias.

Résumé:

RÉSUMÉ:

La section sur la cognition de l'Alzheimer's Disease Assessment Scale (ADAS-Cog) demeure la mesure cognitive la plus utilisée dans les essais cliniques sur la démence, même si elle n'évalue pas l'attention, les fonctions exécutives ou l'agnosie. Cette échelle a été conçue pour être utilisée dans la maladie d'Alzheimer et n'est peut-être pas idéale pour évaluer les patients qui sont atteints d'autres pathologies. L'ADAS-Cog différencie les patients atteints de MA des patients ayant une atteinte cognitive légère et des témoins normaux. Elle a été utilisée dans les essais cliniques portant sur les démences vasculaires et mixtes et la démence à corps de Lewy. Il n'est pas certain que l'ADAS-Cog soit adéquat pour évaluer la cognition dans la démence fronto-temporale. Des batteries bien validées pour évaluer l'aphasie comme la Western Aphasia Battery peuvent être utilisées pour évaluer le langage. Des tests brefs de la fonction frontale comme la batterie d'évaluation frontale ou l'Executive Interview peuvent être ajoutés avec profit dans les études sur la démence fronto-temporale. L'outil le plus utilisé chez les patients qui ont une démence sévère est la Severe Impairment Battery. Les domaines évalués sont analogues à ceux qui sont évalués par l'ADAS-Cog. Le Mini-Mental State Exam et le Mini-Mental State Examination sont utiles pour stratifier les patients au début des études. Des mesures cognitives qui sont mieux adaptées aux maladies en question devront être développées pour les démences autres que la MA.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue S1 , March 2007 , pp. S42 - S46
Copyright
Copyright © The Canadian Journal of Neurological 2007

References

1. Leber, P. Guidelines for the clinical evaluation of antidementia drugs, first draft. Rockville, MD: US Food and Drug Administration; 1990.Google Scholar
2. Committee for Proprietary Medicine Products. Note for guidance on medicinal products in the treatment of Alzheimer’s disease. London UK: The European Agency for the Evaluation of Medicinal Products, Human Medicines Evaluation Unit; 1997.Google Scholar
3. Feldman, H, Gauthier, S, Hecker, J, Vellas, B, Hux, M, Xu, Y, et al. Economic evaluation of donepezil in moderate to severe Alzheimer’s disease. Neurology. 2004; 63(4):644–50.Google Scholar
4. Courtney, C, Farrell, D, Gray, R, Hills, R, Lynch, L, Sellwood, E, et al. Long-term donepezil treatment in 565 patients with Alzheimer’s disease (AD2000): randomized double-blind trial. Lancet 2004; 363(9427):2105–15.Google Scholar
5. Rockwood, K. Size of treatment effect on cognition of cholinesterase inhibition in Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 2004; 75(5):677–85.Google Scholar
6. Mohs, RC, Rosen, WG, Davis, KL. The Alzheimer’s Disease Assessment Scale: an instrument of assessing treatment efficacy. Psychopharmacol Bull. 1983; 19:448–50.Google Scholar
7. Rosen, WG, Mohs, RC, Davis, KL. A new rating scale for Alzheimer’s disease. Am J Psychiatry. 1984; 141:1356–64.Google Scholar
8. Verhey, FR, Houx, P, Van Lang, N, Huppert, F, Stoppe, G, Saerens, J, et al. Cross-national comparison and validation of the Alzheimer’s Disease Assessment Scale: results from the European Harmonization Project for Instruments in Dementia (EUROHARPID). Int J Geriatr Psychiatry. 2004; 19(1):41–50.CrossRefGoogle ScholarPubMed
9. Zee, RF, Landreth, ES, Vicari, SK, Belman, J, Feldman, E, Andrise, A, et al. Alzheimer disease assessment scale: a subtest analysis. Alzheimer Dis Assoc Disord. 1992; 6:164–81.Google Scholar
10. Doraiswamy, PM, Bieber, F, Kaiser, L, Connors, K, Krishnan, KR, Reuning-Scherer, J, et al. Memory, language and praxis in Alzheimer’s disease: norms for outpatient clinical trial populations. Psychopharmacol Bull. 1997; 33:123–8.Google Scholar
11. Rosen, WG, Mohs, RC, Davis, KL. Longitudinal changes: cognitive, behavioral, and affective patterns in Alzheimer’s disease. In: Poon, LW, editor. Handbook for clinical memory assessment of older adults. Washington DC: American Psychological Association; 1986. p. 294–301.Google Scholar
12. Doraiswamy, PM, Krishen, A, Stallone, F, Martin, WL, Potts, NL, Metz, A, et al. Cognitive performance on the Alzheimer’s Disease Assessment Scale: effect of education. Neurology. 1995; 45(11):1980–4.Google Scholar
13. Doraiswamy, PM, Bieber, F, Kaiser, L, Krishnan, KR, Reuning-Scherer, J, Gulanski, B. The Alzheimer’s Disease Assessment Scale: patterns and predictors of baseline cognitive performance in multicenter Alzheimer’s disease trials. Neurology. 1997; 48(6):1511–7.Google Scholar
14. Van Belle, G, Uhlmann, R, Hughes, JP, Larson, E. Reliability of estimates of change in mental status test performance in senile dementia of the Alzheimer type. J Clin Epidemiol. 1990; 43: 389–95.CrossRefGoogle ScholarPubMed
15. Schmeidler, J, Mohs, RC, Aryan, M. Relationship of disease severity to decline on specific cognitive and functional measures in Alzheimer disease. Alzheimer Dis Assoc Disord. 1998; 12(3):146–51.Google Scholar
16. Doraiswamy, PM, Kaiser, L, Beiber, F, Garman, RL. The Alzheimer’s Disease Assessment Scale: evaluation of psychometric properties and patterns of cognitive decline in multicenter clinical trials of mild to moderate Alzheimer’s disease. Alzheimer Dis Assoc Disord. 2001; 15(4):174–83.Google Scholar
17. Talwalker, S, Overall, JE, Sirama, MK, Cracon, SI. Cardinal features of cognitive dysfunction in Alzheimer’s disease. J Geriatr Psychiatry Neurol. 1996; 9:39–46.Google Scholar
18. Mohs, RC, Knopman, D, Petersen, RC, Ferris, SH, Ernesto, C, Grundman, M, et al. Development of cognitive instruments for use in clinical trials of antidementia drugs: additions to the Alzheimer’s Disease Assessment Scale that broaden its scope. The Alzheimer’s Disease Cooperative Study. Alzheimer Dis Assoc Disord. 1997; 11 Suppl 2:S13–S21.CrossRefGoogle Scholar
19. Grundman, M, Petersen, RC, Ferris, SH, Thomas, RG, Aisen, PS, Bennett, DA, et al. Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials. Arch Neurol. 2004; 61(1):59–66.Google Scholar
20. Salloway, S, Ferris, S, Kluger, A, Goldman, R, Griesing, T, Kumar, D, et al. Efficacy of donepezil in mild cognitive impairment: a randomized placebo-controlled trial. Neurology. 2004; 64(4):651–7.CrossRefGoogle Scholar
21. Nasreddine, ZS, Phillips, NA, Bedirian, V, Charbonneau, S, Whitehead, V, Collin, I, et al. The Montreal Cognitive Assessment: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53(3):695–9.Google Scholar
22. Bullock, R, Erkinjuntti, T, Lilienfeld, S, GAL-INT-6 Study Group. Management of patients with Alzheimer’s disease plus cerebrovascular disease: 12-month treatment with galantamine. Dement Geriatr Cogn Disord. 2004; 17(1-2):29–34.Google Scholar
23. Black, S, Roman, GC, Geldmacher, DS, Salloway, S, Hecker, J, Burns, A, et al. Efficacy and tolerability of donepezil in vascular dementia; positive results of a 24-week, multicenter, international, randomized, placebo-controlled clinical trial. Stroke. 2003; 34(10):2323–30.Google Scholar
24. Wilcock, G, Mobius, HJ, Stoffler, A; MMM 500 group. A double-blind, placebo-controlled multicentre study of memantine in mild to moderate vascular dementia (MMM500) Int Clin Psychopharmacol. 2002; 17(6):297–305.Google Scholar
25. Rockwood, K, Bowler, J, Erkinjuntti, T, Hachinski, V, Wallin, A. Subtypes of vascular dementia. Alzheimer Dis Assoc Disord. 1999; 13 Suppl 3:S59–63.Google ScholarPubMed
26. Groves, WC, Brandt, J, Steinberg, M, Warren, A, Rosenblatt, A, Baker, A, et al. Vascular dementia and Alzheimer’s disease: is there a difference? A comparison of symptoms by disease duration. J Neuropsychiatry Clin Neurosci. 2000; 12:305–15.Google Scholar
27. Kunik, ME, Huffman, JC, Bharani, N, Hillman, SL, Molinari, VA, Orengo, CA. Behavioural disturbances in geropsychiatric inpatients across dementia types. J Geriatr Psychiatry Neurol. 2000; 13:49–52.Google Scholar
28. Noe, E, Marder, K, Bell, KL, Jacobs, DM, Manly, JJ, Stern, Y. Comparisons of dementia with Lewy bodies to Alzheimer’s disease and Parkinson’s disease with dementia. Mov Disord. 2004 Jan; 19(1):60–7.Google Scholar
29. Cormack, F, Aarsland, D, Ballard, C, Tovee, MJ. Pentagon drawing and neuropsychological performance in dementia with Lewy bodies, Alzheimer’s disease and Parkinson’s disease with dementia. Int J Geriatr Psychiatry. 2004; 19:371–7.Google Scholar
30. Mormont, E, Laurier-Grymonprez, L, Baisset-Mouly, C, Pasquier, F. The profile of memory disturbance in early Lewy body dementia differs from that in Alzheimer’s disease. Rev Neurol. (Paris) 2003; 159:762–6.Google Scholar
31. Ala, TA, Hughes, LF, Kyrouac, GA, Ghobrial, MW, Elble, RJ. The Mini-Mental State exam may help in the differentiation of dementia with Lewy bodies and Alzheimer’s disease. Int J Geriatr Psychiatry. 2003; 18:855–6.Google Scholar
32. Ballard, C, O’Brien, J, Gray, A, Cormack, F, Ayre, G, Rowan, E, et al. Attention and fluctuating attention in patients with dementia with Lewy bodies and Alzheimer disease. Arch Neurol. 2001; 58:977–82.Google Scholar
33. Mori, E, Shimomura, T, Fujimori, M, Hirono, N, Imamura, T, Hashimoto, M, et al. Visuoperceptual impairment in dementia with Lewy bodies. Arch Neurol. 2000; 57:489–93.Google Scholar
34. Beversdorf, DQ, Warner, JL, Davis, RA, Sharma, UK, Nagaraja, HN, Scharre, DW. Donepezil in the treatment of dementia with lewy bodies. Am J Geriatr Psychiatry. 2004; 12:542–4.Google Scholar
35. Werber, EA, Rabey, JM. The beneficial effect of cholinesterase inhibitors on patients suffering from Parkinson’s disease and dementia. J Neural Transm. 2001; 108:1319–25.Google Scholar
36. Binetti, G, Locascio, JJ, Corkin, S, Vonsattel, JP, Growdon, JH. Differences between Pick’s disease and Alzheimer’s disease in clinical appearance and rate of cognitive decline. Arch Neurol. 2000; 57:225–32.Google Scholar
37. Rascovsky, K, Salmon, DP, Ho, GH, Galasko, D, Peavy, GM, Hansen, LA, et al. Cognitive profiles differ in autopsy-confirmed frontotemporal dementia and AD. Neurology. 2002; 58:1801–8.Google Scholar
38. Kertesz, A, Davidson, W, McCabe, P, Munoz, D. Behavioral quantitation is more sensitive than cognitive testing in frontotemporal dementia. Alzheimer Dis Assoc Disord. 2003; 17:223–9.Google Scholar
39. Kirk, A, Kertesz, A. Assessment of aphasia. In: Hanson, S, Tucker, DM, editors. Neuropsychological assessment. Philadelphia: Hanley & Belfus; 1992. p. 433–50.Google Scholar
40. Kertesz, A. The Western Aphasia Battery. New York: Grune and Stratton; 1982.Google Scholar
41. Dubois, B, Slachevsky, A, Litvan, I, Pillon, B. The FAB: a Frontal Assessment Battery at bedside. Neurology. 2000; 55:1621–6.Google Scholar
42. Slachevsky, A, Villalpando, JM, Sarazin, M, Hahn-Barma, V, Pillon, B, Dubois, B. Frontal Assessment Battery and differential diagnosis of frontotemporal dementia and Alzheimer disease. Arch Neurol. 2004; 61:1104–7.Google Scholar
43. Royall, D, Mahurin, RK, Cornell, J. Bedside assessment of frontal degeneration: distinguishing Alzheimer’s disease from non-Alzheimer’s cortical dementia. Exp Aging Res. 1994; 20:95–103.Google Scholar
44. Royall, D, Mahurin, RK, Gray, KF. Bedside assessment of executive cognitive impairment: the executive interview. J Am Geriatr Soc. 1992; 40:1221–6.Google Scholar
45. Lipton, Am, Ohman, KA, Womack, KB, Hynan, LS, Ninman, ET, Lacritz, LH. Subscores of the FAB differentiate frontotemporal lobar degeneration from AD. Neurology. 2005; 65(5):726–31.Google Scholar
46. Iavarone, A, Ronga, B, Pellegrino, L, Lore, E, Vitaliano, S, Galeone, F, et al. The Frontal Assessment Battery (FAB): normative data from an Italian sample and performances of patients with Alzheimer’s disease and frontotemporal dementia. Funct Neurol. 2004; 19(3):191–5.Google Scholar
47. Stockholm, J, Vogel, A, Gade, A, Waldemar, G. The executive interview as a screening test for executive dysfunction in patients with mild dementia. J Am Geriatr Soc. 2005; 53(9):1577–81.Google Scholar
48. Saxton, J, Swihart, AA. Neuropsychological assessment of the severely impaired elderly patient. Clin Geriatr Med. 1989; 5:531–43.Google Scholar
49. Schmitt, FA, Cragar, D, Ashford, JW, Resiberg, B, Ferris, S, Mobius, HJ, et al. Measuring cognition in advanced Alzheimer’s disease for clinical trials. J Neural Transm Suppl. 2002; 62:135–48.Google Scholar
50. Schmitt, FA, Ashford, W, Ernesto, C, Saxton, J, Schneider, LS, Clark, CM, et al. The severe impairment battery: concurrent validity and assessment of longitudinal change in Alzheimer’s disease. Alzheimer Disease Assoc Disord. 1997; 11 Suppl 2:S551–6.Google Scholar
51. Panisset, M, Roudier, M, Saxton, J, Boller, F. Severe impairment battery: a neuropsychological test for severely demented patients. Arch Neurol. 1994; 51:41–5.Google Scholar
52. Tariot, PN, Farlow, MR, Grossberg, GT, Graham, SM, McDonald, S, Gergel, I, et al. Memantine treatment in patients with moderate to severe Alzheimer’s disease already receiving donepezil: a randomized controlled trial. JAMA. 2004; 291(3):317–24.Google Scholar
53. Gauthier, S, Feldman, H, Hecker, J, Vellas, B, Ames, D, Subbiah, P, et al. Functional, cognitive and behavioral effects of donepezil in patients with moderate Alzheimer’s disease. Curr Med Res Opin. 2002; 18:347–54.Google Scholar
54. Prasher, VP, Huxley, A, Haque, MS; Down Syndrome Aging Study Group. A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Down syndrome and Alzheimer’s disease - pilot study. Int J Geriatr Psychiatry. 2002; 17:270–8.Google Scholar
55. Folstein, MF, Folstein, SE, McHugh, PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12:189–98.Google Scholar
56. Ihl, R, Frolich, L, Dierks, T, Martin, EA, Maurer, K. Differential validity of psychometric tests in dementia of the Alzheimer type. Psychiatry Res. 1992; 44:93–106.Google Scholar
57. Reisberg, B, Ferris, SH, Franssen, EH, Shulman, E, Monteiro, L, Sclan, SG, et al. Mortality and temporal course of probable Alzheimer’s disease: a 5-year prospective study. Int Psychogeriatr. 1996; 8:291–311.Google Scholar
58. Brooks, J, Yesavage, J, Taylor, J, Friedman, L, Tanks, ED, Luby, V, et al. Cognitive decline in Alzheimer’s disease: elaborating on the nature of the longitudinal factor structure of the mini-mental state examination. Int Psychogeriatr. 1993; 5:135–45.Google Scholar
59. Teri, L, Hughes, JP, Larson, EB. Cognitive deterioration in Alzheimer’s disease: behavioural and health factors. J Gerontol. 1993; 5:135–45.Google Scholar
60. Salmon, DP, Thal, LJ, Butters, N, Heindel, WC. Longitudinal evaluation of dementia of the Alzheimer type. Neurology. 1990; 40:1225–30.Google Scholar
61. Crum, RM, Anthony, JC, Bassett, SS, Folstein, MF. Population-based norms for the Mini Mental State Examination by age and educational level. JAMA. 1993; 18:2386–91.Google Scholar
62. Teng, EL, Chui, HC. The Modified Mini-Mental State (3MS) Examination. J Clin Psychiatry. 1987; 48:314–8.Google Scholar
63. Jones, TG, Schinka, JA, Vanderploeg, RD, Small, BJ, Graves, AB, Mortimer, JA. 3MS normative data for the elderly. Arch Clin Neuropsychol. 2002; 17:171–7.CrossRefGoogle ScholarPubMed
64. Bassuk, SS, Murphy, JM. Characteristics of the Modified Mini-Mental State Exam among elderly persons. J Clin Epidemiol. 2003; 56:622–8.Google Scholar
65. Correa, JA, Perrault, A, Wolfson, C. Reliable individual change scores on the 3MS in older person with dementia: results from the Canadian Study of Health and Aging. Int Psychogeriatr. 2001; 13 Supp 1:S71–8.Google Scholar
66. Jones, RW, Soininen, H, Hager, K, Aarsland, D, Passmore, P, Murthy, A, et al. A multinational, randomized, 12-week study comparing the effects of donepezil and galantamine in patients with mild to moderate Alzheimer’s disease. Int J Geriart Psychiatry. 2004; 19:58–67.Google Scholar
67. Rogers, SL, Farlow, MR, Doody, RS, Mohs, R, Friedhoff, LT. A 24—week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer’s disease. Donepezil Study Group. Neurology. 1998; 50:136–45.Google Scholar
68. Darby, D, Maruff, P, Collie, A, McStephen M. Mild cognitive impairment can be detected by multiple assessments in a single day. Neurology. 2002; 59(7):1042–6.Google Scholar
69. Cysique, LA, Maruff, P, Darby, D, Brew, BJ. The assessment of cognitive advanced HIV-1 infection and AIDS dementia complex using a new computerized cognitive test battery. Arch Clin Neuropsychol. 2006; 21(2):185–94.Google Scholar