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Sawang J, Numbers K, Lam BCP, Reppermund S. Relationships Between Functional Impairment, Depressive Symptoms, and Ageing Attitudes in Older Adults. Diagnostics (Basel) 2025; 15:1145. [PMID: 40361965 PMCID: PMC12072153 DOI: 10.3390/diagnostics15091145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2025] [Revised: 04/27/2025] [Accepted: 04/28/2025] [Indexed: 05/15/2025] Open
Abstract
Background/Objectives: Negative attitudes towards ageing, depressive symptoms, and impairment in instrumental activities of daily living (IADL) are associated with worse health outcomes in older adults, including increased risk of dementia. Little is known about the longitudinal impact of depressive symptoms and functional impairment on ageing attitudes in older people. Identifying the relationships between these risk factors may help inform interventions targeting early dementia. The aim of this study was to determine whether depressive symptoms and functional impairment are associated with ageing attitudes over 6 years. Methods: Participants included 172 community-dwelling adults aged 76-96 years without dementia from the Sydney Memory and Ageing Study who were followed up over 6 years. Multiple linear regression models were used to examine prospective relationships between depressive symptoms, IADL (informant-reported or performance-based) and ageing attitudes. Results: After adjusting for potential confounding variables, more baseline depressive symptoms were associated with more negative ageing attitudes towards physical change (B = -0.10, 95%CI -0.18 to -0.02, p = 0.021) and psychological growth (B = -0.09, 95%CI -0.17 to -0.01, p = 0.037), and worse informant-reported IADL was associated with more negative ageing attitudes towards psychosocial change (B = -0.36, 95%CI -0.64 to -0.09, p = 0.010) over 6 years. Conclusions: The results highlight the importance of assessing and treating depressive symptoms and functional decline in older people, as they are significantly associated with negative attitudes about the ageing process, a known risk factor of worse health outcomes, including dementia.
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Affiliation(s)
- Jessica Sawang
- Centre for Healthy Brain Ageing, Discipline of Psychiatry & Mental Health, Faculty of Medicine & Health, University of New South Wales (UNSW), Sydney 2052, Australia
| | - Katya Numbers
- Centre for Healthy Brain Ageing, Discipline of Psychiatry & Mental Health, Faculty of Medicine & Health, University of New South Wales (UNSW), Sydney 2052, Australia
| | - Ben C. P. Lam
- School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia
| | - Simone Reppermund
- Centre for Healthy Brain Ageing, Discipline of Psychiatry & Mental Health, Faculty of Medicine & Health, University of New South Wales (UNSW), Sydney 2052, Australia
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Makino K, Lee S, Katayama O, Tomida K, Yamaguchi R, Yamagiwa D, Shimada H. Prediction of dementia risk by instrumental activities of daily living limitations and its impact on dementia onset in combination with mild cognitive impairment: a population-based longitudinal study. BMC Public Health 2025; 25:1535. [PMID: 40281495 PMCID: PMC12023375 DOI: 10.1186/s12889-025-22788-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 04/14/2025] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND Instrumental activities of daily living (IADL) limitations are important risk factors for dementia. IADL is lifestyle-based, therefore, its assessment content must be updated to reflect recent lifestyle changes. We evaluated the predictive validity of the National Center for Geriatrics and Gerontology Activities of Daily Living (NCGG-ADL), an IADL scale we previously developed, to identify dementia risk and the combined impact of mild cognitive impairment (MCI) and IADL limitations on dementia onset. METHODS This population-based longitudinal study included 2,118 adults aged ≥ 65 years without dementia at baseline. At baseline, IADL limitations and MCI were assessed using the NCGG-ADL and a multi-domain neuropsychological test, respectively. The participants were followed up for new-onset dementia monthly for 5 years. RESULTS Among all participants, 247 (11.7%) had IADL limitations at baseline, and 151 (7.1%) developed dementia during follow-up. Compared to participants without IADL limitations (NCGG-ADL 13 points), those with IADL limitations (NCGG-ADL ≤ 12 points) showed a significantly higher dementia onset risk (HR: 1.55 [95% CI: 1.04-2.31]). Regarding the combined impact of MCI and IADL limitations on dementia, the HRs (95% CIs) (reference: unimpaired cognition without IADL limitations) of unimpaired cognition with IADL limitations, MCI without IADL limitations, and MCI with IADL limitations were 1.53 (0.90-2.61), 1.87 (1.28-2.74), and 2.88 (1.65-5.03), respectively. CONCLUSIONS This study validated the NCGG-ADL as an effective screening tool for assessing dementia risk among community-dwelling older adults. Furthermore, concomitant MCI and IADL limitations was associated with a higher risk of dementia onset more than either condition alone. Therefore, this coexisting condition should be carefully monitored to prevent dementia.
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Affiliation(s)
- Keitaro Makino
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo, 060-0812, Japan.
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan.
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Osamu Katayama
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kouki Tomida
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ryo Yamaguchi
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Daiki Yamagiwa
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
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Rahman S, Dai S, Libon DJ, Woo E, Schmitter-Edgecombe M. Cutoffs of the Instrumental Activities of Daily Living-Compensation (IADL-C) Scale for Identification of Functional Limitations Consistent With Mild Cognitive Impairment and Dementia. Arch Clin Neuropsychol 2025:acaf028. [PMID: 40188476 DOI: 10.1093/arclin/acaf028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 01/24/2025] [Accepted: 03/10/2025] [Indexed: 04/08/2025] Open
Abstract
OBJECTIVE Understanding how well older individuals with suspected cognitive impairment are functioning within the real-world environment can have important implications for diagnosis and treatment. To evaluate whether an individual is experiencing functional limitations suggesting the presence of mild cognitive impairment (MCI) or dementia, we establish diagnostic cutoff scores for the informant version of the Instrumental Activities of Daily Living-Compensation (IADL-C) scale. METHOD Informants of research (n = 488) and clinical (n = 119) samples of participants designated as healthy older controls, MCI, or dementia completed the IADL-C. Receiver operating characteristic curve analyses and diagnostic statistics were used to determine optimal cutoffs on the IADL-C for both the 27-item IADL-C and an 11-item short form created using item-level analysis. RESULTS The optimal cutoff scores that maximized the Youden Index for the research sample long-form were 1.41 in distinguishing cognitively healthy versus MCI participants, and 3.60 in distinguishing dementia from MCI participants, favoring specificity for the clinical sample, the optimal cutoffs were 1.32 and 3.06, yielding higher sensitivity. CONCLUSIONS These cutoff scores, when used as a screening measure or combined with other clinical and cognitive measures, may be useful for understanding whether an individual may be experiencing functional difficulties in everyday life consistent with a diagnosis of MCI or dementia.
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Affiliation(s)
- Samina Rahman
- Department of Psychology, Washington State University, Pullman, WA, USA
| | - Shenghai Dai
- Department of Kinesiology and Educational Psychology, Washington State University, Pullman, WA, USA
| | - David J Libon
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, Rowan University-School of Osteopathic Medicine, Stratford, NJ, USA
- Department of Psychology, Rowan University, Glassboro, NJ, USA
| | - Ellen Woo
- Department of Psychology, California State University Fresno, Fresno, CA, USA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
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Shimosaka M, Nishimoto H, Okahashi S, Zeng D, Fukui K, Kawasaki T, Akiguchi I, Kinoshita A. Assessment of instrumental activities of daily living in patients with cognitive impairment based on their ability to use household appliances. J Alzheimers Dis 2025; 104:919-932. [PMID: 40134265 DOI: 10.1177/13872877251320668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2025]
Abstract
BackgroundDetecting life disability is crucial in diagnosing dementia; however, early detection has proven challenging with previous assessment scales. This study focused on an individual's ability to use household appliances as a means of detecting life disability.ObjectiveThe objectives of this study are threefold: (1) to compare the ability to use household appliances between the non-dementia and dementia groups, (2) to determine whether the level of life disability based on the ability to use appliances is at the level of diagnosed dementia or non-dementia, and (3) to explore the impact of age and gender on the ability to use appliances.MethodsWe selected 13 essential household appliances for elderly individuals and proposed an instrumental activities of daily living (IADL) assessment tool to evaluate their usage. Our sample consisted of 98 patients with cognitive impairment, divided into a non-dementia group (N = 34) and a dementia group (N = 64). Most participants in the dementia group had Alzheimer's disease or related conditions. Through multiple logistic regression, the model equation aimed to determine whether a subject's functional disability indicated a potential dementia diagnosis.ResultsThe optimal model equation identified the microwave oven and air conditioner as key factors, achieving an area under the curve (AUC) of 0.78. Additionally, analysis by age and gender enhanced the discriminative power of the results.ConclusionsOur proposed scoring system can efficiently determine the degree of life disability by assessing appliance usage, demonstrating comparable discriminatory ability to existing scales.
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Affiliation(s)
- Momoyo Shimosaka
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto-city, Kyoto, Japan
| | - Hiroyuki Nishimoto
- Department of Information Systems Engineering, Faculty of Design Technology, Osaka Sangyo University, Daito-city, Osaka, Japan
| | - Sayaka Okahashi
- Research Institute, National Center for Geriatrics and Gerontology Center, Obu-city, Aichi, Japan
| | - Derong Zeng
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto-city, Kyoto, Japan
| | - Kayoko Fukui
- Department of Clinical Nursing, Division of Geriatric Nursing, Shiga University of Medical Science, Otsu-city, Shiga, Japan
| | - Teruaki Kawasaki
- Center of Neurological and Cerebrovascular Diseases, Koseikai Takeda Hospital, Shimogyo-ku, Kyoto-city, Kyoto, Japan
| | - Ichiro Akiguchi
- Center of Neurological and Cerebrovascular Diseases, Koseikai Takeda Hospital, Shimogyo-ku, Kyoto-city, Kyoto, Japan
| | - Ayae Kinoshita
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto-city, Kyoto, Japan
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Karpouzian-Rogers T, Dworak EM, Bucko P, Ho EH, Ece B, Mather MA, Novack MA, Pila S, Hosseinian Z, Hall L, Mkhize T, Bassard AM, Gershon RC, Weintraub S. Measures of decision-making ability and functional outcomes in older adults: results from a scoping review in the ARMCADA study. Front Psychol 2025; 16:1540493. [PMID: 40191575 PMCID: PMC11968701 DOI: 10.3389/fpsyg.2025.1540493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Accepted: 02/26/2025] [Indexed: 04/09/2025] Open
Abstract
Background Though often not routinely assessed in older adults, declines in decision-making (DM) abilities are often observed in aging and may lead to adverse outcomes in multiple aspects of daily functioning. The Advancing Reliable Measurement in Cognitive Aging and Decision-making Ability (ARMCADA) research initiative seeks to address these issues. This scoping review investigates the current published literature on existing DM measures in aging samples, with emphasis on the domain of functional outcomes, defined as skills or behaviors related to one's ability to live independently. Methods We identified studies published between 2018-2023 using key words related to DM abilities and functional outcomes in aging populations through multiple databases. Titles and abstracts were first reviewed by two reviewers, full texts were then screened, and data were extracted from included articles. Results The scoping review identified 16,278 articles across domains with adults aged 45 and older. After screening and extraction, 705 total articles were included; 301 were related to functional outcomes and, from these, 231 distinct measures were identified. Mode of administration of most measures were self-administered with supervision, followed by examiner-administered, and most were conducted with clinical samples (e.g., MCI/AD, chronic health conditions, and Parkinson's disease, or clinical samples and a control group). Discussion The goal of the current scoping review is to provide a comprehensive examination of the current DM measures in older adults; this article focuses on the domain of functional outcomes. This scoping review guides a project to create and validate measures that can efficiently assess DM abilities in older adults across the cognitive aging spectrum.
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Affiliation(s)
- Tatiana Karpouzian-Rogers
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Elizabeth M. Dworak
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Patricia Bucko
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Emily H. Ho
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Berivan Ece
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Molly A. Mather
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Miriam A. Novack
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sarah Pila
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Zahra Hosseinian
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - LaToya Hall
- Department of Gerontology, Wayne State University, Detroit, MI, United States
| | - Tarry Mkhize
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Adrianna M. Bassard
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Richard C. Gershon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sandra Weintraub
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Brouwer J, van den Berg F, Knooihuizen R, Loerts H, Keijzer M. The effects of language learning on cognitive functioning and psychosocial well-being in cognitively healthy older adults: A semi-blind randomized controlled trial. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2025; 32:270-306. [PMID: 39115962 DOI: 10.1080/13825585.2024.2384107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 07/19/2024] [Indexed: 08/10/2024]
Abstract
This study investigated the impact of language learning in comparison to other complex learning activities on cognitive functioning and psychosocial well-being in cognitively healthy, community-dwelling older adults. In a randomized controlled trial, 43 Dutch functionally monolinguals aged 65-78 completed a three-month English course (n = 15), music training (n = 13), or a lecture series (n = 15). Cognitive functioning (global cognition, cognitive flexibility, episodic memory, working memory, verbal fluency, and attention) and psychosocial well-being were assessed before and immediately after the intervention, and at a four-month follow-up. The language learners significantly improved on episodic memory and cognitive flexibility. However, the magnitude of cognitive change did not significantly differ between the language learning and music training conditions, except for a larger positive change in cognitive flexibility for the language learners from pretest to follow-up. Our results suggest that language learning in later life can improve some cognitive functions and fluency in the additional language, but that its unique effects seem limited.
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Affiliation(s)
- Jelle Brouwer
- Center for Language and Cognition Groningen, Bilingualism and Aging Lab, University of Groningen, Groningen, the Netherlands
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands
| | - Floor van den Berg
- Center for Language and Cognition Groningen, Bilingualism and Aging Lab, University of Groningen, Groningen, the Netherlands
| | - Remco Knooihuizen
- Center for Language and Cognition Groningen, Bilingualism and Aging Lab, University of Groningen, Groningen, the Netherlands
| | - Hanneke Loerts
- Center for Language and Cognition Groningen, Bilingualism and Aging Lab, University of Groningen, Groningen, the Netherlands
| | - Merel Keijzer
- Center for Language and Cognition Groningen, Bilingualism and Aging Lab, University of Groningen, Groningen, the Netherlands
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Osman A, Radman D, Belchior P, Gélinas I. A systematic review of psychometric properties of questionnaires assessing activities of daily living among older adults with neurocognitive disorders. Aust Occup Ther J 2025; 72:e13013. [PMID: 39853749 PMCID: PMC11758263 DOI: 10.1111/1440-1630.13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 10/15/2024] [Accepted: 12/20/2024] [Indexed: 01/26/2025]
Abstract
INTRODUCTION Mild cognitive impairment (MCI) and Alzheimer's disease (AD) lead to decline in performance in activities of daily living (ADLs). Multiple questionnaires assess this construct among older adults. The objective of this study was to review existing literature studying psychometric properties of questionnaires assessing performance in ADLs of older adults living with MCI and AD specifically. METHODS A systematic review was conducted across Medline, CINAHL and PsychINFO using a combination of keywords related to ADLs, psychometrics, MCI and AD. Studies were included if they met the following criteria: assessments of performance of ADLs for older adults living with AD or MCI, reporting a minimum of one measurement property (e.g. internal consistency), primary research articles, published before June 2023 in English or French. Data extraction and analysis were conducted by two researchers. The methodological quality of psychometric properties was assessed using the COSMIN checklist. CONSUMER AND COMMUNITY INVOLVEMENT No consumer or community involvement occurred. RESULTS A total of 2539 articles were screened and filtered down to 50 articles including 24 questionnaires respecting inclusion criteria. Of these questionnaires, the three most validated were the Amsterdam Instrumental activities of daily living, the disability assessment for dementia (DAD), and the Bayer ADL scale. Overall, for these three questionnaires, internal consistency, reliability and structural validity were the most studied psychometric properties while criterion validity and hypothesis testing were the least. CONCLUSION This study reveals the Amsterdam IADLs as the most validated questionnaire across psychometric properties and the DAD as the most validated across languages. Considering the increasing prevalence of older adults with MCI or AD, questionnaires established on strong measurement properties are valuable tools to evaluate decline in ADL performance and plan suitable interventions. This review provides evidence for clinicians and researchers for the selection of questionnaires to evaluate this population. PLAIN LANGUAGE SUMMARY Cognitive impairment affects memory and thinking. It makes tasks like dressing, bathing and eating harder. Health-care workers use questionnaires to find out where someone struggles. This helps them plan better care. We reviewed questionnaires for older adults with memory and thinking problems. We found good ones that give important information. Using these questionnaires helps health-care workers support people with daily tasks. This study suggests testing the questionnaires more to improve them.
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Affiliation(s)
- Alia Osman
- School of Physical and Occupational Therapy, Faculty of MedicineMcGill UniversityMontrealQuebecCanada
| | - Dennis Radman
- School of Physical and Occupational Therapy, Faculty of MedicineMcGill UniversityMontrealQuebecCanada
| | - Patricia Belchior
- School of Physical and Occupational Therapy, Faculty of MedicineMcGill UniversityMontrealQuebecCanada
| | - Isabelle Gélinas
- School of Physical and Occupational Therapy, Faculty of MedicineMcGill UniversityMontrealQuebecCanada
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Atri A, Dickerson BC, Clevenger C, Karlawish J, Knopman D, Lin P, Norman M, Onyike C, Sano M, Scanland S, Carrillo M. The Alzheimer's Association clinical practice guideline for the diagnostic evaluation, testing, counseling, and disclosure of suspected Alzheimer's disease and related disorders (DETeCD-ADRD): Validated clinical assessment instruments. Alzheimers Dement 2025; 21:e14335. [PMID: 39713939 PMCID: PMC11772712 DOI: 10.1002/alz.14335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/19/2024] [Accepted: 09/21/2024] [Indexed: 12/24/2024]
Abstract
US clinical practice guidelines for the diagnostic evaluation of cognitive impairment due to Alzheimer's Disease (AD) or AD and related dementias (ADRD) are decades old and aimed at specialists. This evidence-based guideline was developed to empower all-including primary care-clinicians to implement a structured approach for evaluating a patient with symptoms that may represent clinical AD/ADRD. As part of the modified Delphi approach and guideline development process (7374 publications were reviewed; 133 met inclusion criteria) an expert workgroup developed recommendations as steps in a patient-centered evaluation process. The workgroup provided a summary of validated instruments to measure symptoms in daily life (including cognition, mood and behavior, and daily function) and to test for signs of cognitive impairment in the office. This article distills this information to provide a resource to support clinicians in the implementation of this approach in clinical practice. The companion articles provide context for primary care and specialty clinicians with regard to how to fit these instruments into the workflow and actions to take when integration of performance on these instruments with clinical profile and clinician judgment support potential cognitive impairment.
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Affiliation(s)
- Alireza Atri
- Banner Sun Health Research Institute and Banner Alzheimer's InstituteSun CityArizonaUSA
- Center for Brain/Mind Medicine, Department of NeurologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Bradford C. Dickerson
- Frontotemporal Disorders Unit and Alzheimer's Disease Research Center, Department of NeurologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Carolyn Clevenger
- Department of NeurologyNell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| | - Jason Karlawish
- Departments of MedicineMedical Ethics and Health Policy, and Neurology, Perelman School of Medicine, Penn Memory CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - David Knopman
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Pei‐Jung Lin
- Center for the Evaluation of Value and Risk in HealthInstitute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonMassachusettsUSA
| | - Mary Norman
- Cedars‐Sinai Medical CenterCulver CityCaliforniaUSA
| | - Chiadi Onyike
- Division of Geriatric Psychiatry and NeuropsychiatryThe Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Mary Sano
- James J. Peters VAMCBronxNew YorkUSA
- Department of PsychiatryAlzheimer's Disease Research CenterIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - Maria Carrillo
- Medical & Scientific Relations DivisionAlzheimer's AssociationChicagoIllinoisUSA
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9
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Chui A, Boccone G, Rico P, Ngo V, Zhang A, Colquhoun H, Rotenberg S. Everyday functioning among older adults with subjective cognitive decline: a scoping review. Disabil Rehabil 2024; 46:5761-5770. [PMID: 38339977 DOI: 10.1080/09638288.2024.2313127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 01/22/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE Older adults with subjective cognitive decline (SCD) experience cognitive difficulties without objectively measurable cognitive impairments but which may affect their everyday functioning. However, everyday functioning in this population has not yet been characterized. We sought to describe the empirical literature on the everyday functioning of community-dwelling older adults with SCD, their recruitment methods, and the measurements used. METHODS A scoping review was conducted for primary research articles including at least one measure of everyday functioning. Retrieved records were independently screened. Data were extracted then analyzed using descriptive statistics and summative content analysis. RESULTS 6544 studies were screened; 21 studies were included. All were observational analytic studies. Most compared an SCD group with a group of healthy control (47.6%), mild cognitive impairment (71.5%), and/or dementia (33.3%). Subjective cognition was measured via interview (28.6%) or clinical question(s) (14.3%). Normal cognition was determined by a wide variety of cognitive tests. The most studied everyday functioning domain was instrumental activities of daily living (90.5%). Most studies used questionnaires (81.0%), and measured ability to do an everyday life task (76.2%). CONCLUSIONS More research is needed on everyday functioning other than IADL, with greater focus on measures that consider an individual's real-life participation.
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Affiliation(s)
- Adora Chui
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Rotman Research Institute, Baycrest, Toronto, Canada
| | - Gabriella Boccone
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Paula Rico
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Vivian Ngo
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Alan Zhang
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Heather Colquhoun
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Shlomit Rotenberg
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Rotman Research Institute, Baycrest, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
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10
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Oort Q, Reijneveld JC, Sikkes SAM, Koekkoek JAF, Boele F, Young T, Brannan C, Chalk T, Talacchi A, Mazzotta A, Narita Y, Sato H, Miyakita Y, Shamieh O, Alrjoob W, Pace A, Petranovic D, Ploh M, Capela A, Silva J, Hjermstad MJ, Purkart TU, Seidel C, Talhi N, Pichler J, Höllmüller I, Brown L, Hand M, Klein M, Aaronson NK, Uitdehaag BMJ, Taphoorn MJB, Dirven L. Instrumental activities of daily living in neuro-oncology: International validation of the EORTC IADL-BN32 questionnaire. Eur J Cancer 2024; 212:114335. [PMID: 39332215 DOI: 10.1016/j.ejca.2024.114335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 09/13/2024] [Accepted: 09/14/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND Neurocognitive impairments are common in patients with a brain tumour, and may negatively impact on functioning in daily life, particularly on instrumental activities of daily living (IADL). The EORTC IADL-BN32 questionnaire was developed to measure IADL in this patient population. METHODS In this international validation study, we evaluated the EORTC IADL-BN32 questionnaire on several psychometric properties in a large sample of patients with a primary or metastatic brain tumour. We administered the 32-item questionnaire three times: at 'baseline', after 2 weeks and after 3 months. Procedures were in accordance with EORTC Quality of Life Group module development guidelines. RESULTS In total, 326 patients participated in the study. A bifactor scale structure showed satisfactory model fit measures, with five multi-item scales and two single items, and an IADL sum score. The internal consistency of the multi-item scales ranged from good to excellent (range Cronbach's α: 0.86-0.97). We found significant differences in scale scores between patients with and without neurocognitive impairments or complaints, supporting the construct validity. Initial cross-cultural validity analyses showed indications of item response biases for certain items. Analyses indicated moderate to good test-retest agreement (intraclass correlation coefficient > 0.70) between baseline and the 2-week follow-up assessment for all but one scale. Deterioration of EORTC IADL-BN32 scale scores were consistent with clinically relevant deterioration on other functional measures with small to large effect sizes, however, subgroup sample sizes were small. CONCLUSION Overall, the EORTC IADL-BN32 questionnaire exhibited adequate to excellent psychometric properties. Cross-cultural validity and responsiveness should be further explored.
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Affiliation(s)
- Q Oort
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, the Netherlands; Department of Neurology & Brain Tumor Center Amsterdam, Amsterdam University Medical Centers (Location VUmc), Amsterdam, the Netherlands
| | - J C Reijneveld
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, the Netherlands; Department of Neurology & Brain Tumor Center Amsterdam, Amsterdam University Medical Centers (Location VUmc), Amsterdam, the Netherlands; Department of Neurology, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - S A M Sikkes
- Alzheimer Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Faculty of Behavioural and Movement Sciences (FGB), Department of Clinical Developmental & Clinical Neuropsychology, Amsterdam, the Netherlands
| | - J A F Koekkoek
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands; Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - F Boele
- Leeds Institute of Medical Research, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - T Young
- East & North Hertfordshire NHS Trust Incorporating Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - C Brannan
- East & North Hertfordshire NHS Trust Incorporating Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - T Chalk
- East & North Hertfordshire NHS Trust Incorporating Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - A Talacchi
- Department of Neurosurgery, Azienda Ospedaliera San Giovanni Addolorata, Roma, Italy
| | - A Mazzotta
- Department of Neurosurgery, Azienda Ospedaliera San Giovanni Addolorata, Roma, Italy
| | - Y Narita
- Department of Neurosurgery and Neuro-oncology, National Cancer Center Hospital, Tokyo, Japan
| | - H Sato
- Department of Neurosurgery and Neuro-oncology, National Cancer Center Hospital, Tokyo, Japan; Department of Nursing, Teikyo Heisei University, Tokyo, Japan
| | - Y Miyakita
- Department of Neurosurgery and Neuro-oncology, National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - O Shamieh
- Department of Palliative Medicine, King Hussein Cancer Center (KHCC), Amman, Jordan; School of Medicine, University of Jordan, Amman, Jordan; Center for Palliative & Cancer Care in Conflict (CPCCC), KHCC, Amman, Jordan
| | - W Alrjoob
- Center for Palliative & Cancer Care in Conflict (CPCCC), KHCC, Amman, Jordan
| | - A Pace
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - D Petranovic
- Department of Hematology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - M Ploh
- Department of Hematology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - A Capela
- Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Portugal; Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - J Silva
- Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Portugal; Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - M J Hjermstad
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine of University of Oslo, Oslo, Norway; Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - T Urbanic Purkart
- Department of Neurology and Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Austria
| | - C Seidel
- Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
| | - N Talhi
- Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
| | - J Pichler
- Institut für Innere Medizin mit Neuroonkologie, Kepler Universitätsklinikum GmbH, Linz, Austria
| | - I Höllmüller
- Institut für Innere Medizin mit Neuroonkologie, Kepler Universitätsklinikum GmbH, Linz, Austria
| | - L Brown
- John Eastwood Hospice, Sutton-in-Ashfield, United Kingdom
| | - M Hand
- John Eastwood Hospice, Sutton-in-Ashfield, United Kingdom
| | - M Klein
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, the Netherlands; Department of Medical Psychology, Amsterdam University Medical Centers (Location VUmc), Amsterdam, the Netherlands
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - B M J Uitdehaag
- Department of Neurology & Brain Tumor Center Amsterdam, Amsterdam University Medical Centers (Location VUmc), Amsterdam, the Netherlands
| | - M J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands; Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
| | - L Dirven
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands; Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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11
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Benge JF, Ali A, Chandna N, Rana N, Mis R, González DA, Kiselica AM, Scullin MK, Hilsabeck RC. Technology-based instrumental activities of daily living in persons with Alzheimer's disease and related disorders. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e70022. [PMID: 39391022 PMCID: PMC11465837 DOI: 10.1002/dad2.70022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 09/11/2024] [Accepted: 09/11/2024] [Indexed: 10/12/2024]
Abstract
INTRODUCTION Instrumental activities of daily living (iADLs) increasingly involve technology (e.g., making payments online, texting). The current study examined the applicability and diagnostic accuracy of technology-based iADLs in those evaluated for Alzheimer's disease and related dementias (ADRD). METHODS A total of 264 care partners of persons undergoing comprehensive interdisciplinary evaluations completed the Functional Activities Questionnaire and 11 technology-based iADL items. RESULTS Technology-based iADLs applied to more than 80% of patients. Average dependence on technology-based items was overall less than for traditional iADLs. The addition of technology-based items to traditional iADL items slightly improved the ability to identify individuals with dementia. When considered separately, technology-based iADL items demonstrated comparable ability to distinguish between diagnostic stages. DISCUSSION Technology use is common in older adults with ADRD for a range of daily activities. Accounting for technology use increases the content validity of existing iADL measures for the modern context and yields comparable diagnostic accuracy. Highlights Technology use is often integral to daily activity performance for individuals with Alzheimer's disease and related dementias (ADRD).Daily technologies, such as smartphones, were used frequently by those with ADRD.Many individuals were less dependent on technology activities than traditional activities.Adding technology questions slightly increased diagnostic accuracy for detecting dementia.
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Affiliation(s)
- Jared F. Benge
- Department of NeurologyDell Medical SchoolUniversity of Texas at AustinAustinTexasUSA
- Mulva Clinic for the NeurosciencesUniversity of Texas at AustinAustinTexasUSA
| | - Arsh Ali
- Department of NeurologyDell Medical SchoolUniversity of Texas at AustinAustinTexasUSA
| | - Neha Chandna
- Department of NeurologyDell Medical SchoolUniversity of Texas at AustinAustinTexasUSA
| | - Noor Rana
- Department of NeurologyDell Medical SchoolUniversity of Texas at AustinAustinTexasUSA
| | - Rachel Mis
- Department of NeurologyDell Medical SchoolUniversity of Texas at AustinAustinTexasUSA
- Mulva Clinic for the NeurosciencesUniversity of Texas at AustinAustinTexasUSA
| | - David A. González
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Andrew M. Kiselica
- Department of Health PsychologyUniversity of MissouriColumbiaMissouriUSA
| | | | - Robin C. Hilsabeck
- Department of NeurologyDell Medical SchoolUniversity of Texas at AustinAustinTexasUSA
- Mulva Clinic for the NeurosciencesUniversity of Texas at AustinAustinTexasUSA
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12
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Minnis M, Burton JK, Kelbling E, Gallacher KI, Quinn TJ. Not daily, sometimes not ever - mixed methods exploration of the contemporary relevance of tasks contained in extended activities of daily living scales. Age Ageing 2024; 53:afae185. [PMID: 39171388 PMCID: PMC11339544 DOI: 10.1093/ageing/afae185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Assessment of functional status is an integral part of older adult healthcare and research. Therefore, it is essential that tools to capture function are contextually appropriate. Many tools designed to evaluate extended Activities of Daily Living (eADLs) were developed decades ago. OBJECTIVE Our aim was to explore which eADL tasks are commonly performed by older adults and map these tasks to popular eADL scales, seeking stakeholder perspectives to inform recommendations on scale content. DESIGN Online survey with quantitative questions and free text followed-by semi-structured interviews. SUBJECTS Older adults (≥60-years), carers and health, social care and voluntary/community professionals. METHODS We extracted eADL tasks from existing scales to develop a survey on frequency of performance, with space for additional comment. The survey was disseminated via Join Dementia Research and other clinical and professional networks. Online semi-structured interviews were undertaken with thematic analysis of verbatim transcripts. RESULTS From 2244 online survey responses, 87% came from older people and two-thirds of respondents were female. Some eADL tasks were never performed by many participants. Tasks not part of existing tools included online banking and mobile phone use. From fifteen interviews, a recurring theme was that technological and societal changes have altered daily tasks. CONCLUSIONS Commonly used eADL scales contain obsolete tasks and omit tasks older people consider part of their everyday lives. There is a need to work collaboratively to update eADL tools to reflect the priorities and activities of older people to ensure these remain valid measures for use in practice and research. To complement this abstract, a video abstract is available online. A more detailed video-based summary of the content is also available as supplemental material.
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Affiliation(s)
- Meghan Minnis
- Academic Geriatric Medicine, School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Jennifer Kirsty Burton
- Academic Geriatric Medicine, School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Eline Kelbling
- Academic Geriatric Medicine, School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Katie I Gallacher
- General Practice & Primary Care, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Terence J Quinn
- Academic Geriatric Medicine, School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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13
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Zhang LL, Numbers K, Brodaty H, Lam BCP, Mahalingam G, Reppermund S. Does Mild Functional Impairment Predict Dementia in Older Adults With Normal Cognition? Alzheimer Dis Assoc Disord 2024; 38:257-264. [PMID: 39177170 DOI: 10.1097/wad.0000000000000638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 07/09/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES Functional impairment can be an early indicator of cognitive decline. However, its predictive utility in cognitively normal (CN) older adults remains unclear. This study aimed to determine whether mild functional impairment (MFI) in CN older adults could predict incident dementia over 6 years, in addition to assessing its association with cognitive performance. DESIGN A longitudinal study with a 6-year follow-up. PARTICIPANTS A cohort of 296 community-dwelling CN older adults. MEASUREMENTS MFI was defined by cutoffs for impairment on an objective performance-based and/or subjective questionnaire-based functional assessment. Cox regression analysis was conducted to assess the relationship between MFI and risk of incident dementia and cognitive performances over 6 years. Linear regression analysis examined the association between MFI and baseline cognitive performance. RESULTS There were no significant longitudinal associations between MFI and incident dementia or changes in cognitive performance over 6 years. Defining MFI using both performance-based and informant-reported assessments was predictive of dementia. Cross-sectional analyses demonstrated significant associations between MFI and poorer baseline global cognition and performance in attention, visuospatial ability, and executive functioning. CONCLUSIONS CN older adults with MFI were not at an increased risk of developing dementia over 6 years. A definition of functional impairment requiring both performance-based and informant-based assessments may be useful in predicting dementia.
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Affiliation(s)
- Lei Lei Zhang
- School of Psychiatry, Centre for Healthy Brain Ageing (CHeBA)
| | - Katya Numbers
- School of Psychiatry, Centre for Healthy Brain Ageing (CHeBA)
| | - Henry Brodaty
- School of Psychiatry, Centre for Healthy Brain Ageing (CHeBA)
| | - Ben C P Lam
- School of Psychiatry, Centre for Healthy Brain Ageing (CHeBA)
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | | | - Simone Reppermund
- School of Psychiatry, Centre for Healthy Brain Ageing (CHeBA)
- Department of Developmental Disability Neuropsychiatry (3DN), Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW
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14
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Quenon L, Collij LE, Garcia DV, Lopes Alves I, Gérard T, Malotaux V, Huyghe L, Gispert JD, Jessen F, Visser PJ, den Braber A, Ritchie CW, Boada M, Marquié M, Vandenberghe R, Luckett ES, Schöll M, Frisoni GB, Buckley C, Stephens A, Altomare D, Ford L, Birck C, Mett A, Gismondi R, Wolz R, Grootoonk S, Manber R, Shekari M, Lhommel R, Dricot L, Ivanoiu A, Farrar G, Barkhof F, Hanseeuw BJ. Amyloid-PET imaging predicts functional decline in clinically normal individuals. Alzheimers Res Ther 2024; 16:130. [PMID: 38886831 PMCID: PMC11181677 DOI: 10.1186/s13195-024-01494-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/09/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND There is good evidence that elevated amyloid-β (Aβ) positron emission tomography (PET) signal is associated with cognitive decline in clinically normal (CN) individuals. However, it is less well established whether there is an association between the Aβ burden and decline in daily living activities in this population. Moreover, Aβ-PET Centiloids (CL) thresholds that can optimally predict functional decline have not yet been established. METHODS Cross-sectional and longitudinal analyses over a mean three-year timeframe were performed on the European amyloid-PET imaging AMYPAD-PNHS dataset that phenotypes 1260 individuals, including 1032 CN individuals and 228 participants with questionable functional impairment. Amyloid-PET was assessed continuously on the Centiloid (CL) scale and using Aβ groups (CL < 12 = Aβ-, 12 ≤ CL ≤ 50 = Aβ-intermediate/Aβ± , CL > 50 = Aβ+). Functional abilities were longitudinally assessed using the Clinical Dementia Rating (Global-CDR, CDR-SOB) and the Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL-Q). The Global-CDR was available for the 1260 participants at baseline, while baseline CDR-SOB and A-IADL-Q scores and longitudinal functional data were available for different subsamples that had similar characteristics to those of the entire sample. RESULTS Participants included 765 Aβ- (61%, Mdnage = 66.0, IQRage = 61.0-71.0; 59% women), 301 Aβ± (24%; Mdnage = 69.0, IQRage = 64.0-75.0; 53% women) and 194 Aβ+ individuals (15%, Mdnage = 73.0, IQRage = 68.0-78.0; 53% women). Cross-sectionally, CL values were associated with CDR outcomes. Longitudinally, baseline CL values predicted prospective changes in the CDR-SOB (bCL*Time = 0.001/CL/year, 95% CI [0.0005,0.0024], p = .003) and A-IADL-Q (bCL*Time = -0.010/CL/year, 95% CI [-0.016,-0.004], p = .002) scores in initially CN participants. Increased clinical progression (Global-CDR > 0) was mainly observed in Aβ+ CN individuals (HRAβ+ vs Aβ- = 2.55, 95% CI [1.16,5.60], p = .020). Optimal thresholds for predicting decline were found at 41 CL using the CDR-SOB (bAβ+ vs Aβ- = 0.137/year, 95% CI [0.069,0.206], p < .001) and 28 CL using the A-IADL-Q (bAβ+ vs Aβ- = -0.693/year, 95% CI [-1.179,-0.208], p = .005). CONCLUSIONS Amyloid-PET quantification supports the identification of CN individuals at risk of functional decline. TRIAL REGISTRATION The AMYPAD PNHS is registered at www.clinicaltrialsregister.eu with the EudraCT Number: 2018-002277-22.
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Affiliation(s)
- Lisa Quenon
- Institute of Neuroscience, UCLouvain, Brussels, Belgium.
- Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
| | - Lyduine E Collij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Clinical Memory Research Unit, Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - David Vállez Garcia
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Isadora Lopes Alves
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Brain Research Center, Amsterdam, The Netherlands
| | - Thomas Gérard
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Vincent Malotaux
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Lara Huyghe
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Frank Jessen
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
| | - Pieter Jelle Visser
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherlands
| | - Anouk den Braber
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Craig W Ritchie
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mercè Boada
- Ace Alzheimer Center Barcelona - Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center for Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Marquié
- Ace Alzheimer Center Barcelona - Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center for Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Louvain, Belgium
- Neurology Service, University Hospital Leuven, Louvain, Belgium
| | - Emma S Luckett
- Laboratory for Cognitive Neurology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Louvain, Belgium
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Michael Schöll
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Göteborg, Sweden
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Mölndal, Sweden
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, London, UK
| | - Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Clinic, University Hospital of Geneva, Geneva, Switzerland
| | | | | | - Daniele Altomare
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lisa Ford
- Johnson & Johnson Innovative Medicine, Titusville, NJ, USA
| | | | - Anja Mett
- GE HealthCare, Glattbrugg, Switzerland
| | | | | | | | | | - Mahnaz Shekari
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Renaud Lhommel
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Adrian Ivanoiu
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - Bernard J Hanseeuw
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Gordon Center for Medical Imaging, Department of Radiology, Mass General Brigham, Boston, MA, USA
- WELBIO Department, WEL Research Institute, Wavre, Belgium
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15
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Deckers K, Zwan MD, Soons LM, Waterink L, Beers S, van Houdt S, Stiensma B, Kwant JZ, Wimmers SCPM, Heutz RAM, Claassen JAHR, Oosterman JM, de Heus RAA, van de Rest O, Vermeiren Y, Voshaar RCO, Smidt N, Broersen LM, Sikkes SAM, Aarts E, Köhler S, van der Flier WM. A multidomain lifestyle intervention to maintain optimal cognitive functioning in Dutch older adults-study design and baseline characteristics of the FINGER-NL randomized controlled trial. Alzheimers Res Ther 2024; 16:126. [PMID: 38872204 PMCID: PMC11170777 DOI: 10.1186/s13195-024-01495-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/10/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Evidence on the effectiveness of multidomain lifestyle interventions to prevent cognitive decline in older people without dementia is mixed. Embedded in the World-Wide FINGERS initiative, FINGER-NL aims to investigate the effectiveness of a 2-year multidomain lifestyle intervention on cognitive functioning in older Dutch at risk individuals. METHODS Multi-center, randomized, controlled, multidomain lifestyle intervention trial with a duration of 24 months. 1210 adults between 60-79 years old with presence of ≥ 2 modifiable risk factors and ≥ 1 non-modifiable risk factor for cognitive decline were recruited between January 2022 and May 2023 via the Dutch Brain Research Registry and across five study sites in the Netherlands. Participants were randomized to either a high-intensity or a low-intensity intervention group. The multidomain intervention comprises a combination of 7 lifestyle components (physical activity, cognitive training, cardiovascular risk factor management, nutritional counseling, sleep counseling, stress management, and social activities) and 1 nutritional product (Souvenaid®) that could help maintain cognitive functioning. The high-intensity intervention group receives a personalized, supervised and hybrid intervention consisting of group meetings (on-site and online) and individual sessions guided by a trained lifestyle coach, and access to a digital intervention platform that provides custom-made training materials and selected lifestyle apps. The low-intensity intervention group receives bi-monthly online lifestyle-related health advice via the digital intervention platform. Primary outcome is 2-year change on a cognitive composite score covering processing speed, executive function, and memory. RESULTS Within 17 months, participant recruitment has been successfully completed (N = 1210; mean age: 67.7 years (SD: 4.6); 64% female). Modifiable risk factors commonly present at baseline were physical inactivity (89%), low mental/cognitive activity (50%), low social engagement (39%), hypertension (39%) and high alcohol consumption (39%). The mean body mass index of participants was 28.3 (SD: 4.2) and the total serum cholesterol was 5.4 mmol/L (SD: 1.2). CONCLUSIONS Baseline lifestyle and clinical measurements showed successful recruitment of participants with sufficient potential for prevention. Results of FINGER-NL will provide further insight into the efficacy of a multidomain lifestyle intervention to prevent cognitive decline in older adults. TRIAL REGISTRATION ClinicalTrials.gov (ID: NCT05256199)/2022-01-11.
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Affiliation(s)
- Kay Deckers
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Marissa D Zwan
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Lion M Soons
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Lisa Waterink
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Sonja Beers
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Sofie van Houdt
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Berrit Stiensma
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Judy Z Kwant
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sophie C P M Wimmers
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Rachel A M Heutz
- Department of Geriatrics, Radboud University Medical Center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Jurgen A H R Claassen
- Department of Geriatrics, Radboud University Medical Center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Cardiovascular Sciences, Leicester University, Leicester, UK
| | - Joukje M Oosterman
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Rianne A A de Heus
- Department of Geriatrics, Radboud University Medical Center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ondine van de Rest
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Yannick Vermeiren
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Richard C Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nynke Smidt
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sietske A M Sikkes
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
| | - Esther Aarts
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Epidemiology & Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
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Leroi I, Dolphin H, Dinh R, Foley T, Kennelly S, Kinchin I, O'Caoimh R, O'Dowd S, O'Philbin L, O'Reilly S, Trepel D, Timmons S. Navigating the future of Alzheimer's care in Ireland - a service model for disease-modifying therapies in small and medium-sized healthcare systems. BMC Health Serv Res 2024; 24:705. [PMID: 38840115 PMCID: PMC11151472 DOI: 10.1186/s12913-024-11019-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/19/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND A new class of antibody-based drug therapy with the potential for disease modification is now available for Alzheimer's disease (AD). However, the complexity of drug eligibility, administration, cost, and safety of such disease modifying therapies (DMTs) necessitates adopting new treatment and care pathways. A working group was convened in Ireland to consider the implications of, and health system readiness for, DMTs for AD, and to describe a service model for the detection, diagnosis, and management of early AD in the Irish context, providing a template for similar small-medium sized healthcare systems. METHODS A series of facilitated workshops with a multidisciplinary working group, including Patient and Public Involvement (PPI) members, were undertaken. This informed a series of recommendations for the implementation of new DMTs using an evidence-based conceptual framework for health system readiness based on [1] material resources and structures and [2] human and institutional relationships, values, and norms. RESULTS We describe a hub-and-spoke model, which utilises the existing dementia care ecosystem as outlined in Ireland's Model of Care for Dementia, with Regional Specialist Memory Services (RSMS) acting as central hubs and Memory Assessment and Support Services (MASS) functioning as spokes for less central areas. We provide criteria for DMT referral, eligibility, administration, and ongoing monitoring. CONCLUSIONS Healthcare systems worldwide are acknowledging the need for advanced clinical pathways for AD, driven by better diagnostics and the emergence of DMTs. Despite facing significant challenges in integrating DMTs into existing care models, the potential for overcoming challenges exists through increased funding, resources, and the development of a structured national treatment network, as proposed in Ireland's Model of Care for Dementia. This approach offers a replicable blueprint for other healthcare systems with similar scale and complexity.
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Affiliation(s)
- Iracema Leroi
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Lloyd Building, Dublin 2, Dublin, Ireland.
- Global Brain Health Institute, Dublin, Ireland.
- HRB-CTN Dementia Trials Ireland, Dublin, Ireland.
| | - Helena Dolphin
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Lloyd Building, Dublin 2, Dublin, Ireland
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
| | - Rachel Dinh
- Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Tony Foley
- Department of General Practice, School of Medicine, University College Cork, Cork, Ireland
| | - Sean Kennelly
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Lloyd Building, Dublin 2, Dublin, Ireland
- Global Brain Health Institute, Dublin, Ireland
- HRB-CTN Dementia Trials Ireland, Dublin, Ireland
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
| | - Irina Kinchin
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Lloyd Building, Dublin 2, Dublin, Ireland
- Global Brain Health Institute, Dublin, Ireland
| | - Rónán O'Caoimh
- HRB-CTN Dementia Trials Ireland, Dublin, Ireland
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
| | - Sean O'Dowd
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Lloyd Building, Dublin 2, Dublin, Ireland
- Institute of Memory and Cognition, Tallaght University Hospital, Dublin, Ireland
- Health Service Executive's National Dementia Office, Dublin, Ireland
| | | | | | - Dominic Trepel
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Lloyd Building, Dublin 2, Dublin, Ireland
- Global Brain Health Institute, Dublin, Ireland
| | - Suzanne Timmons
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Lloyd Building, Dublin 2, Dublin, Ireland
- HRB-CTN Dementia Trials Ireland, Dublin, Ireland
- Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland
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Galvin JE, Cummings JL, Benea ML, de Moor C, Allegri RF, Atri A, Chertkow H, Paquet C, Porter VR, Ritchie CW, Sikkes SAM, Smith MR, Grassi CM, Rubino I. Generating real-world evidence in Alzheimer's disease: Considerations for establishing a core dataset. Alzheimers Dement 2024; 20:4331-4341. [PMID: 38706421 PMCID: PMC11180865 DOI: 10.1002/alz.13785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/18/2024] [Accepted: 02/12/2024] [Indexed: 05/07/2024]
Abstract
Ongoing assessment of patients with Alzheimer's disease (AD) in postapproval studies is important for mapping disease progression and evaluating real-world treatment effectiveness and safety. However, interpreting outcomes in the real world is challenging owing to variation in data collected across centers and specialties and greater heterogeneity of patients compared with trial participants. Here, we share considerations for observational postapproval studies designed to collect harmonized longitudinal data from individuals with mild cognitive impairment or mild dementia stage of disease who receive therapies targeting the underlying pathological processes of AD in routine practice. This paper considers key study design parameters, including proposed aims and objectives, study populations, approaches to data collection, and measures of cognition, functional abilities, neuropsychiatric status, quality of life, health economics, safety, and drug utilization. Postapproval studies that capture these considerations will be important to provide standardized data on AD treatment effectiveness and safety in real-world settings.
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Affiliation(s)
- James E. Galvin
- Comprehensive Center for Brain HealthDepartment of NeurologyUniversity of Miami Miller School of MedicineBoca RatonFloridaUSA
| | - Jeffrey L. Cummings
- Chambers‐Grundy Center for Transformative NeuroscienceDepartment of Brain HealthUniversity of Nevada Las Vegas (UNLV)Las VegasNevadaUSA
| | | | | | - Ricardo F. Allegri
- Instituto de Investigaciones Neurológicas FleniBuenos AiresArgentina
- Departamento de NeurocienciasUniversidad De La Costa (CUC), BarranquillaAtlánticoColombia
| | - Alireza Atri
- Banner Sun Health Research InstituteSun CityArizonaUSA
- Center for Brain/Mind Medicine, Department of NeurologyBrigham and Women's Hospital – Main CampusBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Howard Chertkow
- Rotman Research Institute, Baycrest Health SciencesTorontoOntarioCanada
| | - Claire Paquet
- Université de Paris GHU AP‐HP Nord Lariboisière HospitalParisFrance
| | - Verna R. Porter
- Pacific Brain Health Center, Pacific Neuroscience InstituteSanta MonicaCaliforniaUSA
- Saint John's Cancer InstituteSanta MonicaCaliforniaUSA
| | | | - Sietske A. M. Sikkes
- Alzheimer Center AmsterdamAmsterdam University Medical CenterAmsterdamThe Netherlands
- Department of Clinical, Neuro‐ and Developmental PsychologyVrije Universiteit (VU) AmsterdamAmsterdamThe Netherlands
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18
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Grammatikopoulou M, Lazarou I, Alepopoulos V, Mpaltadoros L, Oikonomou VP, Stavropoulos TG, Nikolopoulos S, Kompatsiaris I, Tsolaki M. Assessing the cognitive decline of people in the spectrum of AD by monitoring their activities of daily living in an IoT-enabled smart home environment: a cross-sectional pilot study. Front Aging Neurosci 2024; 16:1375131. [PMID: 38605862 PMCID: PMC11007144 DOI: 10.3389/fnagi.2024.1375131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/06/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Assessing functional decline related to activities of daily living (ADLs) is deemed significant for the early diagnosis of dementia. As current assessment methods for ADLs often lack the ability to capture subtle changes, technology-based approaches are perceived as advantageous. Specifically, digital biomarkers are emerging, offering a promising avenue for research, as they allow unobtrusive and objective monitoring. Methods A study was conducted with the involvement of 36 participants assigned to three known groups (Healthy Controls, participants with Subjective Cognitive Decline and participants with Mild Cognitive Impairment). Participants visited the CERTH-IT Smart Home, an environment that simulates a fully functional residence, and were asked to follow a protocol describing different ADL Tasks (namely Task 1 - Meal, Task 2 - Beverage and Task 3 - Snack Preparation). By utilizing data from fixed in-home sensors installed in the Smart Home, the identification of the performed Tasks and their derived features was explored through the developed CARL platform. Furthermore, differences between groups were investigated. Finally, overall feasibility and study satisfaction were evaluated. Results The composition of the ADLs was attainable, and differentiation among the HC group compared to the SCD and the MCI groups considering the feature "Activity Duration" in Task 1 - Meal Preparation was possible, while no difference could be noted between the SCD and the MCI groups. Discussion This ecologically valid study was determined as feasible, with participants expressing positive feedback. The findings additionally reinforce the interest and need to include people in preclinical stages of dementia in research to further evolve and develop clinically relevant digital biomarkers.
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Affiliation(s)
- Margarita Grammatikopoulou
- Information Technologies Institute, Centre for Research and Technology Hellas (CERTH-ITI), Thessaloniki, Greece
| | - Ioulietta Lazarou
- Information Technologies Institute, Centre for Research and Technology Hellas (CERTH-ITI), Thessaloniki, Greece
| | - Vasilis Alepopoulos
- Information Technologies Institute, Centre for Research and Technology Hellas (CERTH-ITI), Thessaloniki, Greece
| | - Lampros Mpaltadoros
- Information Technologies Institute, Centre for Research and Technology Hellas (CERTH-ITI), Thessaloniki, Greece
| | - Vangelis P. Oikonomou
- Information Technologies Institute, Centre for Research and Technology Hellas (CERTH-ITI), Thessaloniki, Greece
| | - Thanos G. Stavropoulos
- Information Technologies Institute, Centre for Research and Technology Hellas (CERTH-ITI), Thessaloniki, Greece
| | - Spiros Nikolopoulos
- Information Technologies Institute, Centre for Research and Technology Hellas (CERTH-ITI), Thessaloniki, Greece
| | - Ioannis Kompatsiaris
- Information Technologies Institute, Centre for Research and Technology Hellas (CERTH-ITI), Thessaloniki, Greece
| | - Magda Tsolaki
- 1st Department of Neurology, G.H. “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
- Greek Association of Alzheimer’s Disease and Related Disorders (GAADRD), Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI - AUTh), Balkan Center, Buildings A & B, Aristotle University of Thessaloniki, Thessaloniki, Greece
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19
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Aiello EN, Solca F, Torre S, Gentile F, Scheveger F, Olivero M, Colombo E, Maranzano A, Manzoni M, Morelli C, Doretti A, Verde F, Silani V, Ticozzi N, Poletti B. Frontotemporal-spectrum disorders and functional independence in non-demented ALS patients. Neurol Sci 2024; 45:1087-1095. [PMID: 37773576 PMCID: PMC10858065 DOI: 10.1007/s10072-023-07074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/10/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The present study aimed at determining whether, net of motor confounders, neuropsychological features affect functional independence (FI) in activities of daily living (ADLs) in non-demented amyotrophic lateral sclerosis (ALS) patients. METHODS N = 88 ALS patients without frontotemporal dementia were assessed for FI-Katz's Basic ADL Scale (BADL) and Lawton-Brody's Instrumental ADL Scale (IADL)-, cognition-Edinburgh Cognitive and Behavioural ALS Screen (ECAS)-and behaviour-Beaumont Behavioural Inventory and Dimensional Apathy Scale. The association between cognitive and behavioural measures and BADL/IADL scores was assessed by covarying for demographics, anxiety and depression levels, disease duration and motor confounders-i.e. ALS Functional Rating Scale-Revised (ALSFRS-R) scores, progression rate and both King's and Milano-Torino stages. RESULTS Higher scores on the ECAS-Language were associated with higher IADL scores (p = 0.005), whilst higher apathetic features-as measured by the Dimensional Apathy Scale (DAS)-were inversely related to the BADL (p = 0.003). Whilst IADL scores were related to all ECAS-Language tasks, the DAS-Initiation was the only subscale associated with BADL scores. Patients with abnormal ECAS-Language (p = 0.023) and DAS (p = 0.008) scores were more functionally dependent than those without. DISCUSSION Among non-motor features, language changes and apathetic features detrimentally affect FI in non-demented ALS patients.
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Affiliation(s)
- Edoardo Nicolò Aiello
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
| | - Silvia Torre
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
| | - Francesco Gentile
- Neurology Residency Program, Università Degli Studi Di Milano, Milan, Italy
| | | | - Marco Olivero
- Neurology Residency Program, Università Degli Studi Di Milano, Milan, Italy
| | - Eleonora Colombo
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
| | - Alessio Maranzano
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
| | - Martina Manzoni
- Child Psychopathology Unit, Scientific Institute, IRCCS E. Medea - La Nostra Famiglia, Bosisio Parini, Lecco, Italy
| | - Claudia Morelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
| | - Alberto Doretti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
| | - Federico Verde
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy.
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy.
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20
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Slachevsky A, Grandi F, Thumala D, Baez S, Santamaria-García H, Schmitter-Edgecombe M, Parra MA. A Multidimensional, Person-Centered Framework for Functional Assessment in Dementia: Insights from the 'What', 'How', 'To Whom', and 'How Much' Questions. J Alzheimers Dis 2024; 99:1187-1205. [PMID: 38758997 PMCID: PMC11178450 DOI: 10.3233/jad-230376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Dementia is a syndrome characterized by cognitive and neuropsychiatric symptoms associated with progressive functional decline (FD). FD is a core diagnostic criterion for dementia, setting the threshold between its prodromal stages and the full-blown disease. The operationalization of FD continues to generate a great deal of controversy. For instance, the threshold of FD for the diagnosis of dementia varies across diagnostic criteria, supporting the need for standardization of this construct. Moreover, there is a need to reconsider how we are measuring FD to set boundaries between normal aging, mild cognitive impairment, and dementia. In this paper, we propose a multidimensional framework that addresses outstanding issues in the assessment of FD: i) What activities of daily living (ADLs) are necessary to sustain an independent living in aging? ii) How to assess FD in individuals with suspected neurocognitive disorders? iii) To whom is the assessment directed? and iv) How much does FD differentiate healthy aging from mild and major neurocognitive disorders? Importantly, the To Whom Question introduces a person-centered approach that regards patients and caregivers as active agents in the assessment process of FD. Thus, once impaired ADLs have been identified, patients can indicate how significant such impairments are for them in daily life. We envisage that this new framework will guide future strategies to enhance functional assessment and treatment of patients with dementia and their caregivers.
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Affiliation(s)
- Andrea Slachevsky
- Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Center (CMYN) Neurology Department, Hospital del Salvador & Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – ICBM, Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Providencia, Santiago, Chile
- Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Fabrissio Grandi
- Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile
- School of Psychology, Universidad de los Andes, Santiago, Chile
| | - Daniela Thumala
- Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Psychology Department, Faculty of Social Sciences, Universidad de Chile, Santiago, Chile
| | - Sandra Baez
- Universidad de los Andes, Bogotá, Colombia
- Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute (GBHI), Trinity College Dublin (TCD), Dublin, Ireland
| | - Hernando Santamaria-García
- Pontificia Universidad Javeriana, PhD Program of Neuroscience, Bogotá, Colombia
- Center for Brain and Memory Intellectus. Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Maureen Schmitter-Edgecombe
- Herbert L. Eastlick Distinguished Professor in the Department of Psychology, Washington State University, Pullman, WA, USA
| | - Mario A. Parra
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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21
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Peeters M, Ottenheijm G, Bienfait P, Eekers D, Gijtenbeek A, Hanse M, Koekkoek J, van Leeuwen L, Tijssen C, Dirven L, Taphoorn M. Glioma patient-reported outcomes: patients and clinicians. BMJ Support Palliat Care 2023; 13:e205-e212. [PMID: 33653735 DOI: 10.1136/bmjspcare-2020-002699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/23/2020] [Accepted: 01/06/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Routine assessment of patient-reported outcomes (PROs) in oncology has shown to improve the quality of the delivered care and to prolong survival. However, for successful implementation of routine assessment of PROs, more knowledge on their usability in clinical practice is needed. OBJECTIVE This study aimed to cross-sectionally assess the perspective of patients and clinicians on the practicality of routinely measuring PROs in clinical practice for glioma patients. METHODS Semistructured interviews were conducted evaluating the role of healthcare professionals (HCP) in discussing results of PRO measures (PROMs), and the preferred topics, methods and frequency of PRO assessment. Glioma patients, their proxies and HCPs involved in the treatment of glioma patients from eight centres in the Netherlands were included. RESULTS Twenty-four patients, 16 proxies and 35 HCPs were interviewed. The majority of patients, proxies and HCPs (92%, 81% and 80%, respectively) were willing to discuss PRO results during consultations. Although HCPs prefer that results are discussed with the nurse specialist, only one-third of patients/proxies agreed. Functioning of daily life was considered important in all three groups. Most participants indicated that discussion of PROM results should take place during standard follow-up visits, and completed at home about 1 week in advance. On group level, there was no preference for administration of questionnaires on paper or digitally. Lastly, all centres had staff available to send questionnaires on paper. CONCLUSION This study shows that routine assessment of PROs is desired by patients, proxies and HCP's in neuro-oncological care in Dutch hospitals.
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Affiliation(s)
- Marthe Peeters
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Germaine Ottenheijm
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul Bienfait
- Department of Neurology, Gelre Ziekenhuizen Apeldoorn, Apeldoorn, The Netherlands
| | - Daniëlle Eekers
- Department of Radiation Oncology (Maastro), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Anja Gijtenbeek
- Department of Neurology, Radboudumc, Nijmegen, The Netherlands
| | - Monique Hanse
- Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | - Johan Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Medisch Centrum Haaglanden, Den Haag, The Netherlands
| | - Leonie van Leeuwen
- Department of Neurology and Neurosurgery, UMC Utrecht, Utrecht, The Netherlands
| | - Cees Tijssen
- Department of Neurology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Medisch Centrum Haaglanden, Den Haag, The Netherlands
| | - Martin Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Medisch Centrum Haaglanden, Den Haag, The Netherlands
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22
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Arola A, Laakso HM, Heinonen H, Pitkänen J, Ahlström M, Lempiäinen J, Paajanen T, Virkkala J, Koikkalainen J, Lötjönen J, Korvenoja A, Melkas S, Jokinen H. Subjective vs informant-reported cognitive complaints have differential clinical significance in covert cerebral small vessel disease. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 5:100182. [PMID: 37745893 PMCID: PMC10514088 DOI: 10.1016/j.cccb.2023.100182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/30/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023]
Abstract
Objective Subjective cognitive complaints are common in patients with cerebral small vessel disease (cSVD), yet their relationship with informant evaluations, objective cognitive functions and severity of brain changes are poorly understood. We studied the associations of subjective and informant reports with findings from comprehensive neuropsychological assessment and brain MRI. Method In the Helsinki SVD Study, 152 older adults with varying degrees of white matter hyperintensities (WMH) but without stroke or dementia were classified as having normal cognition or mild cognitive impairment (MCI) based on neuropsychological criteria. The measures also included continuous domain scores for memory and executive functions. Cognitive complaints were evaluated with the subjective and informant versions of the Prospective and Retrospective Memory Questionnaire (PRMQ) and Dysexecutive Questionnaire (DEX); functional abilities with the Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL); and depressive symptoms with the Geriatric Depression Scale (GDS-15). Results Subjective cognitive complaints correlated significantly with informant reports (r=0.40-0.50, p<0.001). After controlling for demographics, subjective and informant DEX and PRMQ were not related to MCI, memory or executive functions. Instead, subjective DEX and PRMQ significantly associated with GDS-15 and informant DEX and PRMQ with WMH volume and A-IADL. Conclusions Neither subjective nor informant-reported cognitive complaints associated with objective cognitive performance. Informant-evaluations were related to functional impairment and more severe WMH, whereas subjective complaints only associated with mild depressive symptoms. These findings suggest that awareness of cognitive impairment may be limited in early-stage cSVD and highlight the value of informant assessments in the identification of patients with functional impairment.
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Affiliation(s)
- Anne Arola
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hanna M. Laakso
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Heidi Heinonen
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Johanna Pitkänen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Matti Ahlström
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juha Lempiäinen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Teemu Paajanen
- Work ability and working careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jussi Virkkala
- Department of Neurophysiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Koikkalainen
- Combinostics Ltd, Tampere, Finland
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jyrki Lötjönen
- Combinostics Ltd, Tampere, Finland
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, Espoo, Finland
| | - Antti Korvenoja
- Medical Imaging Center, Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Susanna Melkas
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hanna Jokinen
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Lin P, LaMonica HM, Naismith SL, Mowszowski L. Identifying subtle functional change in individuals with mild cognitive impairment: development and validation of the Healthy Brain Ageing - Functional Assessment Questionnaire. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2023; 30:536-554. [PMID: 35345965 DOI: 10.1080/13825585.2022.2057910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 03/21/2022] [Indexed: 05/10/2023]
Abstract
Accumulating research suggests that individuals with Mild Cognitive Impairment (MCI) experience subtle functional changes, but that available functional assessment tools are insensitive to this. To address this gap, we describe the development and validation of the self-report, "Healthy Brain Ageing Functional Assessment Questionnaire" (HBA-FAQ). We examined the factor structure and psychometric properties of the HBA-FAQ in 503 participants with normal cognition, subjective cognitive decline (SCD), MCI or dementia. Our results found the HBA-FAQ to have good reliability, validity and stronger discriminative ability between healthy control participants and those with SCD (0.734, p = .001), MCI (0.666, p = .012) and dementia (0.798, p < .001) compared to a widely-used instrumental activities of daily living screener. In conclusion, the HBA-FAQ is a valid, reliable self-report tool, providing an efficient and sensitive approach to identifying subtle changes in daily functioning in older people at risk of dementia.
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Affiliation(s)
- Pinghsiu Lin
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, Nsw, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Nsw, Australia
| | - Haley M LaMonica
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, Nsw, Australia
- Translational Research Collective, The University of Sydney, Nsw, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, Nsw, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Nsw, Australia
- Charles Perkins Centre, the University of Sydney, Sydney, Nsw, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, Nsw, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Nsw, Australia
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Brem AK, Kuruppu S, de Boer C, Muurling M, Diaz-Ponce A, Gove D, Curcic J, Pilotto A, Ng WF, Cummins N, Malzbender K, Nies VJM, Erdemli G, Graeber J, Narayan VA, Rochester L, Maetzler W, Aarsland D. Digital endpoints in clinical trials of Alzheimer's disease and other neurodegenerative diseases: challenges and opportunities. Front Neurol 2023; 14:1210974. [PMID: 37435159 PMCID: PMC10332162 DOI: 10.3389/fneur.2023.1210974] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/26/2023] [Indexed: 07/13/2023] Open
Abstract
Alzheimer's disease (AD) and other neurodegenerative diseases such as Parkinson's disease (PD) and Huntington's disease (HD) are associated with progressive cognitive, motor, affective and consequently functional decline considerably affecting Activities of Daily Living (ADL) and quality of life. Standard assessments, such as questionnaires and interviews, cognitive testing, and mobility assessments, lack sensitivity, especially in early stages of neurodegenerative diseases and in the disease progression, and have therefore a limited utility as outcome measurements in clinical trials. Major advances in the last decade in digital technologies have opened a window of opportunity to introduce digital endpoints into clinical trials that can reform the assessment and tracking of neurodegenerative symptoms. The Innovative Health Initiative (IMI)-funded projects RADAR-AD (Remote assessment of disease and relapse-Alzheimer's disease), IDEA-FAST (Identifying digital endpoints to assess fatigue, sleep and ADL in neurodegenerative disorders and immune-mediated inflammatory diseases) and Mobilise-D (Connecting digital mobility assessment to clinical outcomes for regulatory and clinical endorsement) aim to identify digital endpoints relevant for neurodegenerative diseases that provide reliable, objective, and sensitive evaluation of disability and health-related quality of life. In this article, we will draw from the findings and experiences of the different IMI projects in discussing (1) the value of remote technologies to assess neurodegenerative diseases; (2) feasibility, acceptability and usability of digital assessments; (3) challenges related to the use of digital tools; (4) public involvement and the implementation of patient advisory boards; (5) regulatory learnings; and (6) the significance of inter-project exchange and data- and algorithm-sharing.
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Affiliation(s)
- Anna-Katharine Brem
- Department of Old Age Psychiatry, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - Sajini Kuruppu
- Department of Old Age Psychiatry, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Casper de Boer
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Marijn Muurling
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | | | | | - Jelena Curcic
- Novartis Institutes for Biomedical Research (NIBR), Basel, Switzerland
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Continuity of Care and Frailty, ASST Spedali Civili Brescia Hospital, Brescia, Italy
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Newcastle Biomedical Research Centre and Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Nicholas Cummins
- Department of Biostats and Health Informatics, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | | | | | - Gul Erdemli
- Novartis Pharmaceuticals Corporations, Cambridge, MA, United States
| | - Johanna Graeber
- Institute of General Practice, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | | | - Lynn Rochester
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Dag Aarsland
- Department of Old Age Psychiatry, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
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25
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Ellison TS, Cappa SF, Garrett D, Georges J, Iwatsubo T, Kramer JH, Lehmann M, Lyketsos C, Maier AB, Merrilees J, Morris JC, Naismith SL, Nobili F, Pahor M, Pond D, Robinson L, Soysal P, Vandenbulcke M, Weber CJ, Visser PJ, Weiner M, Frisoni GB. Outcome measures for Alzheimer's disease: A global inter-societal Delphi consensus. Alzheimers Dement 2023; 19:2707-2729. [PMID: 36749854 PMCID: PMC11010236 DOI: 10.1002/alz.12945] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION We aim to provide guidance on outcomes and measures for use in patients with Alzheimer's clinical syndrome. METHODS A consensus group of 20 voting members nominated by 10 professional societies, and a non-voting chair, used a Delphi approach and modified GRADE criteria. RESULTS Consensus was reached on priority outcomes (n = 66), measures (n = 49) and statements (n = 37) across nine domains. A number of outcomes and measurement instruments were ranked for: Cognitive abilities; Functional abilities/dependency; Behavioural and neuropsychiatric symptoms; Patient quality of life (QoL); Caregiver QoL; Healthcare and treatment-related outcomes; Medical investigations; Disease-related life events; and Global outcomes. DISCUSSION This work provides indications on the domains and ideal pertinent measurement instruments that clinicians may wish to use to follow patients with cognitive impairment. More work is needed to develop instruments that are more feasible in the context of the constraints of clinical routine.
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Affiliation(s)
| | - Stefano F. Cappa
- Scuola Universitaria Superiore IUSS Pavia, Pavia, Italy
- Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | | | | | - Takeshi Iwatsubo
- Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan
- Department of Neuropathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | | | - Constantine Lyketsos
- Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University and Medicine, Baltimore, USA
| | - Andrea B. Maier
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore
| | - Jennifer Merrilees
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - John C. Morris
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Sharon L. Naismith
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Flavio Nobili
- UO Clinica Neurologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Child and Mother Health, University of Genoa, Genova, Italy
| | - Marco Pahor
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Dimity Pond
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
- European Society of Geriatric Medicine, Dementia Special Interest Group
| | - Mathieu Vandenbulcke
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Centre KU Leuven, Leuven, Belgium
| | | | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
- Alzheimer Center, Department of Neurology, Neuroscience Campus Amsterdam, Amsterdam University Medical Center, VU Medical Center, Amsterdam, Netherlands
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institute, Stockholm, Sweden
| | - Michael Weiner
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Giovanni B. Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Clinic, Department of Readaptation and Geriatrics, Geneva University and University Hospitals, Geneva, Switzerland
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Lesoil C, Bombois S, Guinebretiere O, Houot M, Bahrami M, Levy M, Genthon R, Bozon F, Jean-Marie H, Epelbaum S, Foulon P, Villain N, Dubois B. Validation study of "Santé-Cerveau", a digital tool for early cognitive changes identification. Alzheimers Res Ther 2023; 15:70. [PMID: 37013590 PMCID: PMC10068729 DOI: 10.1186/s13195-023-01204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/11/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND There is a need for a reliable, easy-to-use, widely available, and validated tool for timely cognitive impairment identification. We created a computerized cognitive screening tool (Santé-Cerveau digital tool (SCD-T)) including validated questionnaires and the following neuropsychological tests: 5 Word Test (5-WT) for episodic memory, Trail Making Test (TMT) for executive functions, and a number coding test (NCT) adapted from the Digit Symbol Substitution Test for global intellectual efficiency. This study aimed to evaluate the performance of SCD-T to identify cognitive deficit and to determine its usability. METHODS Three groups were constituted including 65 elderly Controls, 64 patients with neurodegenerative diseases (NDG): 50 AD and 14 non-AD, and 20 post-COVID-19 patients. The minimum MMSE score for inclusion was 20. Association between computerized SCD-T cognitive tests and their standard equivalent was assessed using Pearson's correlation coefficients. Two algorithms (a simple clinician-guided algorithm involving the 5-WT and the NCT; and a machine learning classifier based on 8 scores from the SCD-T tests extracted from a multiple logistic regression model, and data from the SCD-T questionnaires) were evaluated. The acceptability of SCD-T was investigated through a questionnaire and scale. RESULTS AD and non-AD participants were older (mean ± standard deviation (SD): 72.61 ± 6.79 vs 69.91 ± 4.86 years old, p = 0.011) and had a lower MMSE score (Mean difference estimate ± standard error: 1.74 ± 0.14, p < 0.001) than Controls; post-COVID-19 patients were younger than Controls (mean ± SD: 45.07 ± 11.36 years old, p < 0.001). All the computerized SCD-T cognitive tests were significantly associated with their reference version. In the pooled Controls and NDG group, the correlation coefficient was 0.84 for verbal memory, -0.60 for executive functions, and 0.72 for global intellectual efficiency. The clinician-guided algorithm demonstrated 94.4% ± 3.8% sensitivity and 80.5% ± 8.7% specificity, and the machine learning classifier 96.8% ± 3.9% sensitivity and 90.7% ± 5.8% specificity. The acceptability of SCD-T was good to excellent. CONCLUSIONS We demonstrate the high accuracy of SCD-T in screening cognitive disorders and its good acceptance even in individuals with prodromal and mild dementia stages. SCD-T would be useful in primary care to faster refer subjects with significant cognitive impairment (and limit unnecessary referrals) to specialized consultation, improve the AD care pathway and the pre-screening in clinical trials.
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Affiliation(s)
- Constance Lesoil
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Paris, France
| | - Stéphanie Bombois
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Paris, France
- INSERM U1171 - Degenerative and Vascular Cognitive Disorders, University of Lille, Lille, France
| | - Octave Guinebretiere
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Paris, France
| | - Marion Houot
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Paris, France
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière, Institut du Cerveau - Paris Brain Institute - ICM, Paris, France
| | - Mahsa Bahrami
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Paris, France
| | - Marcel Levy
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Paris, France
| | - Rémy Genthon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Paris, France
| | - Frédérique Bozon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Paris, France
| | | | - Stéphane Epelbaum
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Paris, France
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière, Institut du Cerveau - Paris Brain Institute - ICM, Paris, France
| | | | - Nicolas Villain
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Paris, France
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière, Institut du Cerveau - Paris Brain Institute - ICM, Paris, France
- Sorbonne Université, INSERM U1127, CNRS 7225, Paris, France
| | - Bruno Dubois
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Paris, France.
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière, Institut du Cerveau - Paris Brain Institute - ICM, Paris, France.
- Sorbonne Université, INSERM U1127, CNRS 7225, Paris, France.
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Teng E, Li Y, Manser PT, Pickthorn K, Butcher BD, Blendstrup M, Randolph C, Sikkes SA. Cross-sectional and longitudinal assessments of function in prodromal-to-mild Alzheimer's disease: A comparison of the ADCS-ADL and A-IADL-Q scales. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12452. [PMID: 37325545 PMCID: PMC10262908 DOI: 10.1002/dad2.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/01/2023] [Indexed: 06/17/2023]
Abstract
Introduction Prior observational work in a heterogeneous cohort of participants with mild cognitive impairment suggests the Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL-Q) may have greater sensitivity for functional decline than the more established Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) scale. However, the relative utility of the A-IADL-Q versus the ADCS-ADL for clinical trials in early Alzheimer's disease (AD) remains uncertain. Methods We compared baseline and longitudinal performance of the A-IADL-Q and ADCS-ADL in participants with biomarker-confirmed prodromal (pAD; n = 158) or mild (mAD; n = 283) AD enrolled in the 18-month Tauriel study of semorinemab (NCT03289143). Results The A-IADL-Q exhibited numerically stronger discrimination between pAD and mAD participants at baseline per Cohen's d analyses and similar sensitivity to longitudinal decline across cohorts over 18 months relative to the ADCS-ADL. Discussion The comparable performance of the ADCS-ADL and A-IADL-Q supports the utility of the A-IADL-Q in early AD clinical trials. Highlights The Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL-Q) may be more sensitive than the Alzheimer's Disease Cooperative Study-Activities of Daily Living Scale (ADCS-ADL) for distinguishing prodromal and mild Alzheimer's disease (AD).A-IADL-Q and ADCS-ADL are similarly sensitive to decline in early AD over 18 months.Comparable performance of these indices supports A-IADL-Q use in future AD trials.Additional AD clinical trial data could extend findings across more diverse cohorts.
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Affiliation(s)
- Edmond Teng
- GenentechInc.South San FranciscoCaliforniaUSA
| | - Yihao Li
- GenentechInc.South San FranciscoCaliforniaUSA
| | | | | | | | | | | | - Sietske A.M. Sikkes
- Alzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterVU University AmsterdamAmsterdamthe Netherlands
- Department of ClinicalNeuro‐ and Developmental PsychologyVU UniversityAmsterdamthe Netherlands
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Jutten RJ, Papp KV, Hendrix S, Ellison N, Langbaum JB, Donohue MC, Hassenstab J, Maruff P, Rentz DM, Harrison J, Cummings J, Scheltens P, Sikkes SAM. Why a clinical trial is as good as its outcome measure: A framework for the selection and use of cognitive outcome measures for clinical trials of Alzheimer's disease. Alzheimers Dement 2023; 19:708-720. [PMID: 36086926 PMCID: PMC9931632 DOI: 10.1002/alz.12773] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/29/2022] [Accepted: 07/22/2022] [Indexed: 11/11/2022]
Abstract
A crucial aspect of any clinical trial is using the right outcome measure to assess treatment efficacy. Compared to the rapidly evolved understanding and measurement of pathophysiology in preclinical and early symptomatic stages of Alzheimer's disease (AD), relatively less progress has been made in the evolution of clinical outcome assessments (COAs) for those stages. The current paper aims to provide a benchmark for the design and evaluation of COAs for use in early AD trials. We discuss lessons learned on capturing cognitive changes in predementia stages of AD, including challenges when validating novel COAs for those early stages and necessary evidence for their implementation in clinical trials. Moving forward, we propose a multi-step framework to advance the use of more effective COAs to assess clinically meaningful changes in early AD, which will hopefully contribute to the much-needed consensus around more appropriate outcome measures to assess clinical efficacy of putative treatments. HIGHLIGHTS: We discuss lessons learned on capturing cognitive changes in predementia stages of AD. We propose a framework for the design and evaluation of performance based cognitive tests for use in early AD trials. We provide recommendations to facilitate the implementation of more effective cognitive outcome measures in AD trials.
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Affiliation(s)
- Roos J. Jutten
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn V. Papp
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Michael C. Donohue
- Alzheimer’s Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego, California, USA
| | - Jason Hassenstab
- Knight Alzheimer Disease Research Center, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Paul Maruff
- Cogstate Ltd., Melbourne, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Dorene M. Rentz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John Harrison
- Metis Cognition Ltd., Kilmington, UK
- Department of Psychiatry, Psychology & Neuroscience, King’s College London, UK
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, location VUmc, VU University, Amsterdam, The Netherlands
| | - Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas (UNLV), Las Vegas, Nevada, USA
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, location VUmc, VU University, Amsterdam, The Netherlands
| | - Sietske A. M. Sikkes
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, location VUmc, VU University, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Movement and Behavioral Sciences, VU University, Amsterdam, The Netherlands
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29
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Dubbelman MA, Verrijp M, Terwee CB, Jutten RJ, Postema MC, Barkhof F, Berckel BNM, Gillissen F, Teeuwen V, Teunissen C, van de Flier WM, Scheltens P, Sikkes SAM. Determining the Minimal Important Change of Everyday Functioning in Dementia: Pursuing Clinical Meaningfulness. Neurology 2022; 99:e954-e964. [PMID: 35641309 PMCID: PMC9502738 DOI: 10.1212/wnl.0000000000200781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Decline in everyday functioning is a key clinical change in Alzheimer disease and related disorders (ADRD). An important challenge remains the determination of what constitutes a clinically meaningful change in everyday functioning. We aimed to investigate this by establishing the minimal important change (MIC): the smallest amount of change that has a meaningful effect on patients' lives. We retrospectively investigated meaningful change in a memory clinic cohort. METHODS In the first, qualitative part of the study, community-recruited informal caregivers of patients with ADRD and memory clinic clinicians completed a survey in which they judged various situations representing changes in everyday functioning. Their judgments of meaningful change were used to determine thresholds for MIC, both for decline and improvement, on the Amsterdam Instrumental Activities of Daily Living (IADL) Questionnaire. In the second, quantitative part, we applied these values in an independent longitudinal cohort study of unselected memory clinic patients. RESULTS MIC thresholds were established at the average threshold of caregivers (N = 1,629; 62.4 ± 9.5 years; 77% female) and clinicians (N = 13): -2.2 points for clinically meaningful decline and +5.0 points for clinically meaningful improvement. Memory clinic patients (N = 230; 64.3 ± 7.7 years; 39% female; 60% dementia diagnosis) were followed for 1 year, 102 (45%) of whom showed a decline larger than the MIC, after a mean of 6.7 ± 3.5 months. Patients with a dementia diagnosis and more atrophy of the medial temporal lobe had larger odds (odds ratio [OR] = 3.4, 95% CI [1.5-7.8] and OR = 5.0, 95% CI [1.2-20.0], respectively) for passing the MIC threshold for decline than those with subjective cognitive complaints and no atrophy. DISCUSSION We were able to operationalize clinically meaningful decline in IADL by determining the MIC. The usefulness of the MIC was supported by our findings from the clinical sample that nearly half of a sample of unselected memory clinic patients showed a meaningful decline in less than a year. Disease stage and medial temporal atrophy were predictors of functional decline greater than the MIC. Our findings provide guidance in interpreting changes in IADL and may help evaluate treatment effects and monitor disease progression.
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Affiliation(s)
- Mark A Dubbelman
- From the Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (M.A.D., M.V., M.C.P., F.G., V.T., W.M.F., P.S., S.A.M.S.); Department of Epidemiology and Data Science, Amsterdam UMC, The Netherlands (C.B.T., W.M.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (R.J.J.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (F.B., B.N.M.B.); Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom (F.B.); Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands (C.T.); and Faculty of Behavioural and Movement Sciences (S.A.M.S.), Clinical Developmental Psychology & Clinical Neuropsychology, Vrije Universiteit Amsterdam, the Netherlands.
| | - Merike Verrijp
- From the Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (M.A.D., M.V., M.C.P., F.G., V.T., W.M.F., P.S., S.A.M.S.); Department of Epidemiology and Data Science, Amsterdam UMC, The Netherlands (C.B.T., W.M.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (R.J.J.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (F.B., B.N.M.B.); Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom (F.B.); Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands (C.T.); and Faculty of Behavioural and Movement Sciences (S.A.M.S.), Clinical Developmental Psychology & Clinical Neuropsychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Caroline B Terwee
- From the Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (M.A.D., M.V., M.C.P., F.G., V.T., W.M.F., P.S., S.A.M.S.); Department of Epidemiology and Data Science, Amsterdam UMC, The Netherlands (C.B.T., W.M.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (R.J.J.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (F.B., B.N.M.B.); Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom (F.B.); Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands (C.T.); and Faculty of Behavioural and Movement Sciences (S.A.M.S.), Clinical Developmental Psychology & Clinical Neuropsychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Roos J Jutten
- From the Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (M.A.D., M.V., M.C.P., F.G., V.T., W.M.F., P.S., S.A.M.S.); Department of Epidemiology and Data Science, Amsterdam UMC, The Netherlands (C.B.T., W.M.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (R.J.J.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (F.B., B.N.M.B.); Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom (F.B.); Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands (C.T.); and Faculty of Behavioural and Movement Sciences (S.A.M.S.), Clinical Developmental Psychology & Clinical Neuropsychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Merel C Postema
- From the Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (M.A.D., M.V., M.C.P., F.G., V.T., W.M.F., P.S., S.A.M.S.); Department of Epidemiology and Data Science, Amsterdam UMC, The Netherlands (C.B.T., W.M.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (R.J.J.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (F.B., B.N.M.B.); Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom (F.B.); Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands (C.T.); and Faculty of Behavioural and Movement Sciences (S.A.M.S.), Clinical Developmental Psychology & Clinical Neuropsychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Frederik Barkhof
- From the Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (M.A.D., M.V., M.C.P., F.G., V.T., W.M.F., P.S., S.A.M.S.); Department of Epidemiology and Data Science, Amsterdam UMC, The Netherlands (C.B.T., W.M.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (R.J.J.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (F.B., B.N.M.B.); Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom (F.B.); Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands (C.T.); and Faculty of Behavioural and Movement Sciences (S.A.M.S.), Clinical Developmental Psychology & Clinical Neuropsychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Bart N M Berckel
- From the Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (M.A.D., M.V., M.C.P., F.G., V.T., W.M.F., P.S., S.A.M.S.); Department of Epidemiology and Data Science, Amsterdam UMC, The Netherlands (C.B.T., W.M.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (R.J.J.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (F.B., B.N.M.B.); Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom (F.B.); Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands (C.T.); and Faculty of Behavioural and Movement Sciences (S.A.M.S.), Clinical Developmental Psychology & Clinical Neuropsychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Freek Gillissen
- From the Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (M.A.D., M.V., M.C.P., F.G., V.T., W.M.F., P.S., S.A.M.S.); Department of Epidemiology and Data Science, Amsterdam UMC, The Netherlands (C.B.T., W.M.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (R.J.J.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (F.B., B.N.M.B.); Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom (F.B.); Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands (C.T.); and Faculty of Behavioural and Movement Sciences (S.A.M.S.), Clinical Developmental Psychology & Clinical Neuropsychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Vivianne Teeuwen
- From the Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (M.A.D., M.V., M.C.P., F.G., V.T., W.M.F., P.S., S.A.M.S.); Department of Epidemiology and Data Science, Amsterdam UMC, The Netherlands (C.B.T., W.M.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (R.J.J.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (F.B., B.N.M.B.); Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom (F.B.); Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands (C.T.); and Faculty of Behavioural and Movement Sciences (S.A.M.S.), Clinical Developmental Psychology & Clinical Neuropsychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Charlotte Teunissen
- From the Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (M.A.D., M.V., M.C.P., F.G., V.T., W.M.F., P.S., S.A.M.S.); Department of Epidemiology and Data Science, Amsterdam UMC, The Netherlands (C.B.T., W.M.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (R.J.J.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (F.B., B.N.M.B.); Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom (F.B.); Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands (C.T.); and Faculty of Behavioural and Movement Sciences (S.A.M.S.), Clinical Developmental Psychology & Clinical Neuropsychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Wiesje M van de Flier
- From the Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (M.A.D., M.V., M.C.P., F.G., V.T., W.M.F., P.S., S.A.M.S.); Department of Epidemiology and Data Science, Amsterdam UMC, The Netherlands (C.B.T., W.M.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (R.J.J.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (F.B., B.N.M.B.); Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom (F.B.); Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands (C.T.); and Faculty of Behavioural and Movement Sciences (S.A.M.S.), Clinical Developmental Psychology & Clinical Neuropsychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Philip Scheltens
- From the Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (M.A.D., M.V., M.C.P., F.G., V.T., W.M.F., P.S., S.A.M.S.); Department of Epidemiology and Data Science, Amsterdam UMC, The Netherlands (C.B.T., W.M.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (R.J.J.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (F.B., B.N.M.B.); Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom (F.B.); Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands (C.T.); and Faculty of Behavioural and Movement Sciences (S.A.M.S.), Clinical Developmental Psychology & Clinical Neuropsychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Sietske A M Sikkes
- From the Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (M.A.D., M.V., M.C.P., F.G., V.T., W.M.F., P.S., S.A.M.S.); Department of Epidemiology and Data Science, Amsterdam UMC, The Netherlands (C.B.T., W.M.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (R.J.J.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands (F.B., B.N.M.B.); Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom (F.B.); Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands (C.T.); and Faculty of Behavioural and Movement Sciences (S.A.M.S.), Clinical Developmental Psychology & Clinical Neuropsychology, Vrije Universiteit Amsterdam, the Netherlands
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Teng E, Manser PT, Pickthorn K, Brunstein F, Blendstrup M, Sanabria Bohorquez S, Wildsmith KR, Toth B, Dolton M, Ramakrishnan V, Bobbala A, Sikkes SAM, Ward M, Fuji RN, Kerchner GA. Safety and Efficacy of Semorinemab in Individuals With Prodromal to Mild Alzheimer Disease: A Randomized Clinical Trial. JAMA Neurol 2022; 79:758-767. [PMID: 35696185 PMCID: PMC9194753 DOI: 10.1001/jamaneurol.2022.1375] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/17/2022] [Indexed: 12/23/2022]
Abstract
Importance Neurofibrillary tangles composed of aggregated tau protein are one of the neuropathological hallmarks of Alzheimer disease (AD) and correlate with clinical disease severity. Monoclonal antibodies targeting tau may have the potential to ameliorate AD progression by slowing or stopping the spread and/or accumulation of pathological tau. Objective To evaluate the safety and efficacy of the monoclonal anti-tau antibody semorinemab in prodromal to mild AD. Design, Setting, and Participants This phase 2 randomized, double-blind, placebo-controlled, parallel-group clinical trial was conducted between October 18, 2017, and July 16, 2020, at 97 sites in North America, Europe, and Australia. Individuals aged 50 to 80 years (inclusive) with prodromal to mild AD, Mini-Mental State Examination scores between 20 and 30 (inclusive), and confirmed β-amyloid pathology (by positron emission tomography or cerebrospinal fluid) were included. Interventions During the 73-week blinded study period, participants received intravenous infusions of placebo or semorinemab (1500 mg, 4500 mg, or 8100 mg) every 2 weeks for the first 3 infusions and every 4 weeks thereafter. Main Outcomes and Measures The primary outcomes were change from baseline on the Clinical Dementia Rating-Sum of Boxes score from baseline to week 73 and assessments of the safety and tolerability for semorinemab compared with placebo. Results In the modified intent-to-treat cohort (n = 422; mean [SD] age, 69.6 [7.0] years; 235 women [55.7%]), similar increases were seen on the Clinical Dementia Rating-Sum of Boxes score in the placebo (n = 126; Δ = 2.19 [95% CI, 1.74-2.63]) and semorinemab (1500 mg: n = 86; Δ = 2.36 [95% CI, 1.83-2.89]; 4500 mg: n = 126; Δ = 2.36 [95% CI, 1.92-2.79]; 8100 mg: n = 84; Δ = 2.41 [95% CI, 1.88-2.94]) arms. In the safety-evaluable cohort (n = 441), similar proportions of participants experienced adverse events in the placebo (130 [93.1%]) and semorinemab (1500 mg: 89 [88.8%]; 4500 mg: 132 [94.7%]; 8100 mg: 90 [92.2%]) arms. Conclusions and Relevance In participants with prodromal to mild AD in this randomized clinical trial, semorinemab did not slow clinical AD progression compared with placebo throughout the 73-week study period but did demonstrate an acceptable and well-tolerated safety profile. Additional studies of anti-tau antibodies may be needed to determine the clinical utility of this therapeutic approach. Trial Registration ClinicalTrials.gov Identifier: NCT03289143.
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Affiliation(s)
- Edmond Teng
- Early Clinical Development, Genentech Inc, South San Francisco, California
| | - Paul T. Manser
- Biostatistics, Genentech Inc, South San Francisco, California
| | - Karen Pickthorn
- Early Clinical Development, Genentech Inc, South San Francisco, California
| | - Flavia Brunstein
- Product Development Safety, Genentech Inc, South San Francisco, California
| | - Mira Blendstrup
- Clinical Operations, Genentech Inc, South San Francisco, California
| | | | - Kristin R. Wildsmith
- Biomarker Development, Genentech Inc, South San Francisco, California
- Now with Eisai Inc, Woodcliff Lake, New Jersey
| | - Bali Toth
- Biostatistics, Genentech Inc, South San Francisco, California
| | | | | | - Ashwini Bobbala
- Product Development Safety, Genentech Inc, South San Francisco, California
| | - Sietske A. M. Sikkes
- Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
- Department of Clinical, Neuro- and Developmental Psychology, VU University, Amsterdam, the Netherlands
| | - Michael Ward
- Early Clinical Development, Genentech Inc, South San Francisco, California
- Now with Alector Inc, South San Francisco, California
| | - Reina N. Fuji
- Safety Assessment, Genentech Inc, South San Francisco, California
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Health-related quality of life of patients with multiple sclerosis: Analysis of ten years of national data. Mult Scler Relat Disord 2022; 66:104019. [PMID: 35839614 DOI: 10.1016/j.msard.2022.104019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a progressive autoimmune disease of the central nervous system. Both the physical and mental burden of MS affect patients' health-related quality of life (HRQoL). However, there is limited research at the national level evaluating the humanistic burden among MS patients. OBJECTIVES This study evaluated the HRQoL and functional limitations among MS patients using ten years of national survey data. METHODS Guided by the conceptual framework of the Wilson and Cleary model, this study compared HRQoL between adults diagnosed with MS (Clinical Classification Code= "080″) and non-MS adults using the 2006-2015 Medical Expenditure Panel Survey (MEPS) data. The humanistic burden included HRQoL and functional limitations. The HRQoL was evaluated using physical component summary (PCS) and mental component summary (MCS) based on the Short Form Health Survey (SF-12). The study applied the multivariable Generalized Linear Models (GLM) to estimate the marginal differences in PCS and MCS based on the SF-12. In addition, seeking help for activities of daily living (ADL) and instrumental activities of daily living (IADL) were modeled with multivariable logistic regression. RESULTS According to the MEPS, the estimated annual prevalence of MS was 0.52 million (95% Confidence Interval [CI]: 0.42-0.60). MS patients were mainly female (71.90%), middle aged (50-64 years, 40.21%), non-Hispanic whites (78.29%), and enrolled in private insurance plans (68.93%). The average PCS scores in MS and non-MS groups were 35.70 and 49.48, respectively. The average MCS scores were 45.58 and 51.25 for MS and non-MS groups, respectively. In addition, 18.26% of MS patients sought help for ADL, and 27.08% sought help for IADL. After adjusting for individual, biological, and environmental characteristics, the multivariable GLM with Poisson distribution indicated that the marginal difference of PCS score was 11.10 (95% CI: 9.50-12.61) units lower, and the MCS score was 4.89 (95% CI: 3.44-6.30) units lower among MS patients. In addition, MS patients were 17.32 (95% CI: 11.61-25.84) and 14.43 (95% CI: 10.09-20.65) times more likely to request assistance for ADL and IADL, respectively. CONCLUSIONS MS was associated with lower physical and mental HRQoL than their non-MS counterparts and MS patients were more likely to request help for ADL and IADL. More work is needed to evaluate the effect of treatment strategies on improving the HRQoL and functional limitations in MS.
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Assunção SS, Sperling RA, Ritchie C, Kerwin DR, Aisen PS, Lansdall C, Atri A, Cummings J. Meaningful benefits: a framework to assess disease-modifying therapies in preclinical and early Alzheimer's disease. Alzheimers Res Ther 2022; 14:54. [PMID: 35440022 PMCID: PMC9017027 DOI: 10.1186/s13195-022-00984-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/05/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The need for preventive therapies that interrupt the progression of Alzheimer's disease (AD) before the onset of symptoms or when symptoms are emerging is urgent and has spurred the ongoing development of disease-modifying therapies (DMTs) in preclinical and early AD (mild cognitive impairment [MCI] to mild dementia). Assessing the meaningfulness of what are likely small initial treatment effects in these earlier stages of the AD patho-clinical disease continuum is a major challenge and warrants further consideration. BODY: To accommodate a shift towards earlier intervention in AD, we propose meaningful benefits as a new umbrella concept that encapsulates the spectrum of potentially desirable outcomes that may be demonstrated in clinical trials and other studies across the AD continuum, with an emphasis on preclinical AD and early AD (i.e., MCI due to AD and mild AD dementia). The meaningful benefits framework applies to data collection, assessment, and communication across three dimensions: (1) multidimensional clinical outcome assessments (COAs) including not only core disease outcomes related to cognition and function but also patient- and caregiver-reported outcomes, health and economic outcomes, and neuropsychiatric symptoms; (2) complementary analyses that help contextualize and expand the understanding of COA-based assessments, such as number-needed-to-treat or time-to-event analyses; and (3) assessment of both cumulative benefit and predictive benefit, where early changes on cognitive, functional, or biomarker assessments predict longer-term clinical benefit. CONCLUSION The concept of meaningful benefits emphasizes the importance of multidimensional reporting of clinical trial data while, conceptually, it advances our understanding of treatment effects in preclinical AD and mild cognitive impairment due to AD. We propose that such an approach will help bridge the gap between the emergence of DMTs and their clinical use, particularly now that a DMT is available for patients diagnosed with MCI due to AD and mild AD dementia.
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Affiliation(s)
- Sheila Seleri Assunção
- US Medical Affairs - Neuroscience, Genentech, A Member of the Roche Group, South San Francisco, CA, USA.
| | - Reisa A Sperling
- Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Craig Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Scotland, UK
| | - Diana R Kerwin
- Kerwin Medical Center, Dallas, TX, USA
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Paul S Aisen
- University of Southern California Alzheimer's Therapeutic Research Institute, San Diego, CA, USA
| | | | - Alireza Atri
- Banner Sun Health Research Institute, Sun City, AZ, USA
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA
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Dubbelman MA, Terwee CB, Verrijp M, Visser LNC, Scheltens P, Sikkes SAM. Giving meaning to the scores of the Amsterdam instrumental activities of daily living questionnaire: a qualitative study. Health Qual Life Outcomes 2022; 20:47. [PMID: 35331258 PMCID: PMC8943938 DOI: 10.1186/s12955-022-01958-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/15/2022] [Indexed: 11/25/2022] Open
Abstract
Background Everyday functioning is a clinically relevant concept in dementia, yet little is known about the clinical meaningfulness of scores on functional outcome measures. We aimed to establish clinically meaningful scoring categories for the Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL-Q), representing no, mild, moderate and severe problems in daily functioning. Methods Informal caregivers (n = 6) of memory-clinic patients and clinicians (n = 13), including neurologists and nurse specialists, working at various memory clinics in The Netherlands. In focus groups, participants individually ranked nine summaries of fictional patients from least to most impairment in daily functioning. Then, they placed bookmarks to demarcate the thresholds for mild, moderate and severe problems. Individual bookmark placements were then discussed to reach consensus. Clinicians completed a survey in which they placed bookmarks, individually. Results While individual categorizations varied somewhat, caregivers and clinicians generally agreed on the thresholds, particularly about the distinction between ‘no’ and ‘mild’ problems. Score categories were no problems (T-score ≥ 60), mild problems (T-score 50–59), moderate problems (T-score 40–49), and severe problems in daily functioning (T-score < 40), on a scale ranging 20–80. Conclusions Our findings provide categories for determining the level of functional impairment, which can facilitate interpretation of A-IADL-Q scores. These categories can subsequently be used by clinicians to improve communication with patients and caregivers. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-01958-2.
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Affiliation(s)
- Mark A Dubbelman
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Caroline B Terwee
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, The Netherlands
| | - Merike Verrijp
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Leonie N C Visser
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Philip Scheltens
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Sietske A M Sikkes
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.,Faculty of Behavioural and Movement Sciences, Clinical Developmental Psychology and Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Milošević V, Malobabić M, Stojanović I, Bašić J. Importance of a functional measure in the evaluation of patients in a memory clinic: Validation of the Serbian version of the Amsterdam Instrumental Activities of Daily Living Questionnaire. Clin Neurol Neurosurg 2022; 214:107165. [DOI: 10.1016/j.clineuro.2022.107165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 01/11/2022] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
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Musa Salech G, Lillo P, van der Hiele K, Méndez-Orellana C, Ibáñez A, Slachevsky A. Apathy, Executive Function, and Emotion Recognition Are the Main Drivers of Functional Impairment in Behavioral Variant of Frontotemporal Dementia. Front Neurol 2022; 12:734251. [PMID: 35095710 PMCID: PMC8792989 DOI: 10.3389/fneur.2021.734251] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The cognitive and neuropsychiatric deficits present in patients with behavioral variant frontotemporal dementia (bvFTD) are associated with loss of functionality in the activities of daily living (ADLs). The main purpose of this study was to examine and explore the association between the cognitive and neuropsychiatric features that might prompt functional impairment of basic, instrumental, and advanced ADL domains in patients with bvFTD. Methods: A retrospective cross-sectional study was conducted with 27 patients with bvFTD in its early stage (<2 years of evolution) and 32 healthy control subjects. A neuropsychological assessment was carried out wherein measures of cognitive function and neuropsychiatric symptoms were obtained. The informant-report Technology-Activities of Daily Living Questionnaire was used to assess the percentage of functional impairment in the different ADL domains. To identify the best determinants, three separate multiple regression analyses were performed, considering each functional impairment as the dependent variable and executive function, emotion recognition, disinhibition, and apathy as independent variables. Results: For the basic ADLs, a model that explains 28.2% of the variability was found, in which the presence of apathy (β = 0.33, p = 0.02) and disinhibition (β = 0.29, p = 0.04) were significant factors. Concerning instrumental ADLs, the model produced accounted for 63.7% of the functional variability, with the presence of apathy (β = 0.71, p < 0.001), deficits in executive function (β = -0.36, p = 0.002), and lack of emotion recognition (β = 0.28, p = 0.017) as the main contributors. Finally, in terms of advanced ADLs, the model found explained 52.6% of the variance, wherein only the presence of apathy acted as a significant factor (β = 0.59, p < 0.001). Conclusions: The results of this study show the prominent and transverse effect of apathy in the loss of functionality throughout all the ADL domains. Apart from that, this is the first study that shows that the factors associated with loss of functionality differ according to the functional domain in patients with bvFTD in its early stage. Finally, no other study has analyzed the impact of the lack of emotion recognition in the functionality of ADLs. These results could guide the planning of tailored interventions that might enhance everyday activities and the improvement of quality of life.
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Affiliation(s)
- Gada Musa Salech
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Institute of Biomedical Sciences (ICBM), Neurosciences Department, East Neuroscience Department, Faculty of Medicine, University of Chile, Santiago, Chile
- Departamento de Neurología, Clínica Universidad de los Andes, Santiago, Chile
| | - Patricia Lillo
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Department of Neurology South, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Unidad de Neurología, Hospital San José, Santiago, Chile
| | - Karin van der Hiele
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | | | - Agustín Ibáñez
- Cognitive Neuroscience Center (CNC), National Scientific and Technical Research Council (CONICET), Universidad de San Andrés, Buenos Aires, Argentina
- The Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin, Ireland
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| | - Andrea Slachevsky
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Institute of Biomedical Sciences (ICBM), Neurosciences Department, East Neuroscience Department, Faculty of Medicine, University of Chile, Santiago, Chile
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN), Department of Neurology, Hospital del Salvador & University of Chile, Santiago, Chile
- Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
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36
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Verrijp M, Dubbelman MA, Visser LNC, Jutten RJ, Nijhuis EW, Zwan MD, van Hout HPJ, Scheltens P, van der Flier WM, Sikkes SAM. Everyday Functioning in a Community-Based Volunteer Population: Differences Between Participant- and Study Partner-Report. Front Aging Neurosci 2022; 13:761932. [PMID: 35069172 PMCID: PMC8767803 DOI: 10.3389/fnagi.2021.761932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Impaired awareness in dementia caused by Alzheimer's disease and related disorders made study partner-report the preferred method of measuring interference in "instrumental activities of daily living" (IADL). However, with a shifting focus toward earlier disease stages and prevention, the question arises whether self-report might be equally or even more appropriate. The aim of this study was to investigate how participant- and study partner-report IADL perform in a community-based volunteer population without dementia and which factors relate to differences between participant- and study partner-report. Methods: Participants (N = 3,288; 18-97 years, 70.4% females) and their study partners (N = 1,213; 18-88 years, 45.8% females) were recruited from the Dutch Brain Research Registry. IADL were measured using the Amsterdam IADL Questionnaire. The concordance between participant- and study partner-reported IADL difficulties was examined using intraclass correlation coefficient (ICC). Multinomial logistic regressions were used to investigate which demographic, cognitive, and psychosocial factors related to participant and study partner differences, by looking at the over- and underreport of IADL difficulties by the participant, relative to their study partner. Results: Most A-IADL-Q scores represented no difficulties for both participants (87.9%) and study partners (89.4%). The concordance between participants and study partners was moderate (ICC = 0.55, 95% confidence interval [CI] = [0.51, 0.59]); 24.5% (N = 297) of participants overreported their IADL difficulties compared with study partners, and 17.8% (N = 216) underreported difficulties. The presence of depressive symptoms (odds ratio [OR] = 1.31, 95% CI = [1.12, 1.54]), as well as memory complaints (OR = 2.45, 95% CI = [1.80, 3.34]), increased the odds of participants overreporting their IADL difficulties. Higher IADL ratings decreased the odds of participant underreport (OR = 0.71, 95% CI = [0.67, 0.74]). Conclusion: In this sample of community-based volunteers, most participants and study partners reported no major IADL difficulties. Differences between participant and study partner were, however, quite prevalent, with subjective factors indicative of increased report of IADL difficulties by the participant in particular. These findings suggest that self- and study partner-report measures may not be interchangeable, and that the level of awareness needs to be considered, even in cognitively healthy individuals.
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Affiliation(s)
- Merike Verrijp
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Mark A. Dubbelman
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Leonie N. C. Visser
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Roos J. Jutten
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Elke W. Nijhuis
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Marissa D. Zwan
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Hein P. J. van Hout
- Department of General Practice and Medicine for Older Persons, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam, Netherlands
| | - Sietske A. M. Sikkes
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
- Faculty of Behavioural and Movement Sciences, Clinical Developmental Psychology, Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Choudhury S, Ghodasara S, Stiffel M, Fischer CE, Tang-Wai DF, Smith EE, Massoud F, Robin Hsiung GY, Lee L, Bruneau MA, Laforce RJ, Ismail Z, Burhan AM, Kumar S. Informant-based tools for assessment and monitoring of cognition, behavior, and function in neurocognitive disorders: Systematic review and report from a CCCDTD5 Working Group. Int J Geriatr Psychiatry 2022; 37. [PMID: 35043452 DOI: 10.1002/gps.5678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 01/02/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE As part of the fifth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, we assessed the literature on informant-based tools for assessment and monitoring of cognition, behavior, and function in neurocognitive disorders (NCDs) to provide evidence-based recommendations for clinicians and researchers. METHODS A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards guidelines. Publications that validated the informant-based tools or described their key properties were reviewed. Quality of the studies was assessed using the modified Quality Assessment tool for Diagnostic Accuracy Studies. RESULTS Out of 386 publications identified through systematic search, 34 that described 19 informant-based tools were included in the final review. Most of these tools are backed by good-quality studies and are appropriate to use in clinical care or research. The tools vary in their psychometric properties, domains covered, comprehensiveness, completion time, and ability to detect longitudinal change. Based on these properties, we identify different tools that may be appropriate for primary care, specialized memory clinic, or research settings. We also identify barriers to use of these tools in routine clinical practice. CONCLUSION There are several good-quality tools available to collect informant-report for assessment and monitoring of cognition, behavior, or function in patients with NCDs. Clinicians and researchers may choose a particular tool based on their specific needs such as domains of interest, desired psychometric properties, and feasibility. Further work is needed to make the tools more user-friendly and to adopt them into routine clinical care.
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Affiliation(s)
- Samira Choudhury
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - Sheena Ghodasara
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Michael Stiffel
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Corinne E Fischer
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - David F Tang-Wai
- Department of Medicine (Neurology & Geriatric Medicine), University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, University Health Network Memory Clinic, Toronto, Ontario, Canada
| | - Eric Edward Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Fadi Massoud
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Ging-Yuek Robin Hsiung
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda Lee
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marie-Andrée Bruneau
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Quebec, Canada.,Geriatric Institute of Montreal Research Center, Montreal, Quebec, Canada
| | - Robert Jr Laforce
- Département des Sciences Neurologiques, Clinique Interdisciplinaire de Mémoire du CHU de Québec, Université Laval, Quebec, Quebec, Canada
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences and Community Health Sciences, Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Amer M Burhan
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - Sanjeev Kumar
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Adult Neurodevelopmental and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Yamasaki T, Kumagai S. Nonwearable Sensor-Based In-Home Assessment of Subtle Daily Behavioral Changes as a Candidate Biomarker for Mild Cognitive Impairment. J Pers Med 2021; 12:jpm12010011. [PMID: 35055326 PMCID: PMC8781414 DOI: 10.3390/jpm12010011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 12/12/2022] Open
Abstract
Patients show subtle changes in daily behavioral patterns, revealed by traditional assessments (e.g., performance- or questionnaire-based assessments) even in the early stage of Alzheimer's disease (AD; i.e., the mild cognitive impairment (MCI) stage). An increase in studies on the assessment of daily behavioral changes in patients with MCI and AD using digital technologies (e.g., wearable and nonwearable sensor-based assessment) has been noted in recent years. In addition, more objective, quantitative, and realistic evidence of altered daily behavioral patterns in patients with MCI and AD has been provided by digital technologies rather than traditional assessments. Therefore, this study hypothesized that the assessment of daily behavioral changes with digital technologies can replace or assist traditional assessment methods for early MCI and AD detection. In this review, we focused on research using nonwearable sensor-based in-home assessment. Previous studies on the assessment of behavioral changes in MCI and AD using traditional performance- or questionnaire-based assessments are first described. Next, an overview of previous studies on the assessment of behavioral changes in MCI and AD using nonwearable sensor-based in-home assessment is provided. Finally, the usefulness and problems of nonwearable sensor-based in-home assessment for early MCI and AD detection are discussed. In conclusion, this review stresses that subtle changes in daily behavioral patterns detected by nonwearable sensor-based in-home assessment can be early MCI and AD biomarkers.
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Affiliation(s)
- Takao Yamasaki
- Kumagai Institute of Health Policy, Fukuoka 816-0812, Japan;
- Department of Neurology, Minkodo Minohara Hospital, Fukuoka 811-2402, Japan
- School of Health Sciences at Fukuoka, International University of Health and Welfare, Fukuoka 831-8501, Japan
- Correspondence: ; Tel.: +81-92-947-0040
| | - Shuzo Kumagai
- Kumagai Institute of Health Policy, Fukuoka 816-0812, Japan;
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Vijverberg EGB, Axelsen TM, Bihlet AR, Henriksen K, Weber F, Fuchs K, Harrison JE, Kühn-Wache K, Alexandersen P, Prins ND, Scheltens P. Rationale and study design of a randomized, placebo-controlled, double-blind phase 2b trial to evaluate efficacy, safety, and tolerability of an oral glutaminyl cyclase inhibitor varoglutamstat (PQ912) in study participants with MCI and mild AD-VIVIAD. Alzheimers Res Ther 2021; 13:142. [PMID: 34425883 PMCID: PMC8381483 DOI: 10.1186/s13195-021-00882-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Varoglutamstat (formerly PQ912) is a small molecule that inhibits the activity of the glutaminyl cyclase to reduce the level of pyroglutamate-A-beta (pGluAB42). Recent studies confirm that pGluAB42 is a particular amyloid form that is highly synaptotoxic and plays a significant role in the development of AD. METHODS This paper describes the design and methodology behind the phase 2b VIVIAD-trial in AD. The aim of this study is to evaluate varoglutamstat in a state-of-the-art designed, placebo-controlled, double-blind, randomized clinical trial for safety and tolerability, efficacy on cognition, and effects on brain activity and AD biomarkers. In addition to its main purpose, the trial will explore potential associations between novel and established biomarkers and their individual and composite relation to disease characteristics. RESULTS To be expected early 2023 CONCLUSION: This state of the art phase 2b study will yield important results for the field with respect to trial methodology and for the treatment of AD with a small molecule directed against pyroglutamate-A-beta. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04498650.
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Affiliation(s)
- E. G. B. Vijverberg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Brain Research Center, Amsterdam, The Netherlands
| | - T. M. Axelsen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Sanos Clinic A/S, Vejle, Denmark
| | | | | | - F. Weber
- Vivoryon Therapeutics NV, Halle, Germany
| | - K. Fuchs
- Vivoryon Therapeutics NV, Halle, Germany
| | - J. E. Harrison
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Metis Cognition Ltd, Park House, Kilmington Common, Wiltshire, UK
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | | | - N. D. Prins
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Brain Research Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Alzheimercentrum Amsterdam, Amsterdam UMC, Locatie VUmc, De Boelelaan 1117/1118, 1091 HZ Amsterdam, The Netherlands
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40
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van Dam M, Sikkes SA, Rammeloo E, Reinders E, Jelgerhuis JR, Geurts JJ, Uitdehaag BM, Hulst HE. Cognitive functioning in everyday life: The development of a questionnaire on instrumental activities of daily living in multiple sclerosis. Mult Scler J Exp Transl Clin 2021; 7:20552173211038027. [PMID: 34408904 PMCID: PMC8365017 DOI: 10.1177/20552173211038027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/19/2021] [Indexed: 12/03/2022] Open
Abstract
Neuropsychological test scores in people with MS (PwMS) do not fully reflect cognitive functioning in daily life. Therefore, we developed a questionnaire based on instrumental activities of daily living (IADL), using the Amsterdam IADL-Q© for Alzheimer’s disease as starting point. Forty-eight items were evaluated on relevance and clarity by (inter)national experts (n = 30), PwMS (n = 61) and proxies (n = 30). Consequently, four items were omitted, two items were merged and seven items were added. Fifty items were included in the IADL questionnaire specific to cognitive functioning in MS (the MS-IADL-Q). Future studies are warranted to assess the psychometric properties of the MS-IADL-Q.
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Affiliation(s)
- Maureen van Dam
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sietske Am Sikkes
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Emma Rammeloo
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Evy Reinders
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Julia R Jelgerhuis
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jeroen Jg Geurts
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bernhard Mj Uitdehaag
- Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hanneke E Hulst
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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41
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Oort Q, Dirven L, Sikkes SAM, Aaronson N, Boele F, Brannan C, Egeter J, Grant R, Klein M, Lips I, Narita Y, Sato H, Sztankay M, Stockhammer G, Talacchi A, Uitdehaag BMJ, Reijneveld JC, Taphoorn MJB. Development of an EORTC questionnaire measuring instrumental activities of daily living (IADL) in patients with brain tumours: phase I-III. Qual Life Res 2021; 30:1491-1502. [PMID: 33496902 PMCID: PMC8068708 DOI: 10.1007/s11136-020-02738-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 04/02/2024]
Abstract
PURPOSE Being able to function independently in society is an important aspect of quality of life. This ability goes beyond self-care, requires higher order cognitive functioning, and is typically measured with instrumental activities of daily living (IADL) questionnaires. Cognitive deficits are frequently observed in brain tumour patients, however, IADL is almost never assessed because no valid and reliable IADL measure is available for this patient group. Therefore, this measure is currently being developed. METHODS This international multicentre study followed European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group module development guidelines. Three out of four phases are completed: phases (I) generation of items, (II) construction of the item list, and (III) pre-testing. This paper reports the item selection procedures and preliminary psychometric properties of the questionnaire. Brain tumour patients (gliomas and brain metastases), their informal caregivers, and health care professionals (HCPs) were included. RESULTS Phase I (n = 44 patient-proxy dyads and 26 HCPs) generated 59 relevant and important activities. In phase II, the activities were converted into items. In phase III (n = 85 dyads), the 59 items were pre-tested. Item selection procedures resulted in 32 items. Exploratory factor analysis revealed a preliminary dimensional structure consisting of five scales with acceptable to excellent internal consistency (α = 0.73-0.94) and two single items. For three scales, patients with cognitive impairments had significantly more IADL problems than patients without impairments. CONCLUSION A phase IV validation study is needed to confirm the psychometric properties of the EORTC IADL-BN32 questionnaire in a larger international sample.
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Affiliation(s)
- Quirien Oort
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Sietske A M Sikkes
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Alzheimer Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Developmental & Clinical Neuropsychology, Faculty of Behavioural and Movement Sciences (FGB), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Neil Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Florien Boele
- Leeds Institute of Medical Research, St James's University Hospital, Leeds, LS9 7TF, UK
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Christine Brannan
- East & North Hertfordshire NHS Trust Incorporating Mount Vernon Cancer Centre, Northwood, UK
| | - Jonas Egeter
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Robin Grant
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Martin Klein
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Irene Lips
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center, Tokyo, Japan
| | - Hitomi Sato
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center, Tokyo, Japan
- Department of Nursing, Teikyo Heisei University, Tokyo, Japan
| | - Monika Sztankay
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Andrea Talacchi
- Department of Neurosurgery, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Bernard M J Uitdehaag
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Neurology, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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Aftab A. Lost and found in translation: reflections on cross-cultural adaptation. Int Psychogeriatr 2021; 33:7-9. [PMID: 33543692 DOI: 10.1017/s1041610219002205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Awais Aftab
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
- Ohio Department of Mental Health and Addiction Services, Northcoast Behavioral HealthcareNorthfield, OH, USA
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Stringer G, Leroi I, Sikkes SAM, Montaldi D, Brown LJE. Enhancing 'meaningfulness' of functional assessments: UK adaptation of the Amsterdam IADL questionnaire. Int Psychogeriatr 2021; 33:39-50. [PMID: 32290875 PMCID: PMC8482374 DOI: 10.1017/s1041610219001881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Commonly used measures of instrumental activities of daily living (IADL) do not capture activities for a technologically advancing society. This study aimed to adapt the proxy/informant-based Amsterdam IADL Questionnaire (A-IADL-Q) for use in the UK and develop a self-report version. DESIGN An iterative mixed method cross-cultural adaptation of the A-IADL-Q and the development of a self-report version involving a three-step design: (1) interviews and focus groups with lay and professional stakeholders to assess face and content validity; (2) a questionnaire to measure item relevance to older adults in the U.K.; (3) a pilot of the adapted questionnaire in people with cognitive impairment. SETTING Community settings in the UK. PARTICIPANTS One hundred and forty-eight participants took part across the three steps: (1) 14 dementia professionals; 8 people with subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia due to Alzheimer's disease; and 6 relatives of people with MCI or dementia; (2) 92 older adults without cognitive impairment; and (3) 28 people with SCD or MCI. MEASUREMENTS The cultural relevance and applicability of the A-IADL-Q scale items were assessed using a 6-point Likert scale. Cognitive and functional performance was measured using a battery of cognitive and functional measures. RESULTS Iterative modifications to the scale resulted in a 55-item adapted version appropriate for UK use (A-IADL-Q-UK). Pilot data revealed that the new and revised items performed well. Four new items correlated with the weighted average score (Kendall's Tau -.388, -.445, -.497, -.569). An exploratory analysis of convergent validity found correlations in the expected direction with cognitive and functional measures. CONCLUSION The A-IADL-Q-UK provides a measurement of functional decline for use in the UK that captures culturally relevant activities. A new self-report version has been developed and is ready for testing. Further evaluation of the A-IADL-Q-UK for construct validity is now needed.
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Affiliation(s)
- Gemma Stringer
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Iracema Leroi
- School of Medicine, Global Brain Health Institute, Trinity College Dublin, Lloyd Building, Dublin 2, Ireland
| | - Sietske A. M. Sikkes
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Daniela Montaldi
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Laura J. E. Brown
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
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Priluck J, Fedio A. Factors associated with utilization of emotion and personality instruments among neuropsychologists. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:1112-1121. [PMID: 33950753 DOI: 10.1080/23279095.2020.1852238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Historically, assessment of emotion and personality functioning was not emphasized by clinical neuropsychologists, who instead focused almost exclusively on the evaluation of cognitive functioning. This study examined current practices regarding clinical neuropsychologists' usage of instruments for assessing emotion and personality, along with factors that may mediate their choice of measures and their beliefs about evaluating emotion and personality. Participants were 117 board-certified neuropsychologists as recognized by the American Board of Professional Psychology (ABPP-CN), many of whom had been practicing for over 20 years (39%). Participants generally indicated that examining emotion and personality is essential to evaluations. There was variability among participants as to whether assessment of emotion and personality functioning is challenging, as well as whether or not clinical interview was better suited than instruments. Patients' lack of self-awareness, purposeful over- and under-exaggeration, and lack of sensitivity and specificity of the assessment instruments for neurologic disorders/conditions were identified as the greatest challenges in this area of assessment. Results of the survey suggest that further advancement in the construction and availability of emotion/personality instruments is necessary.
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Affiliation(s)
- Jacob Priluck
- Department of Clinical Psychology, The Chicago School of Professional Psychology - Washington DC Campus, Washington, USA
| | - Alison Fedio
- Department of Clinical Psychology, The Chicago School of Professional Psychology - Washington DC Campus, Washington, USA
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Dubbelman MA, Jutten RJ, Tomaszewski Farias SE, Amariglio RE, Buckley RF, Visser PJ, Rentz DM, Johnson KA, Properzi MJ, Schultz A, Donovan N, Gatchell JR, Teunissen CE, Van Berckel BNM, Van der Flier WM, Sperling RA, Papp KV, Scheltens P, Marshall GA, Sikkes SAM. Decline in cognitively complex everyday activities accelerates along the Alzheimer's disease continuum. Alzheimers Res Ther 2020; 12:138. [PMID: 33121534 PMCID: PMC7597034 DOI: 10.1186/s13195-020-00706-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/12/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Impairment in daily functioning is a clinical hallmark of dementia. Difficulties with "instrumental activities of daily living" (IADL) seem to increase gradually over the course of Alzheimer's disease (AD), before dementia onset. However, it is currently not well established how difficulties develop along the preclinical and prodromal stages of AD. We aimed to investigate the trajectories of decline in IADL performance, as reported by a study partner, along the early stages of AD. METHODS In a longitudinal multicenter study, combining data from community-based and memory clinic cohorts, we included 1555 individuals (mean age 72.5 ± 7.8 years; 50% female) based on availability of amyloid biomarkers, longitudinal IADL data, and clinical information at baseline. Median follow-up duration was 2.1 years. All amyloid-positive participants (n = 982) were classified into the National Institute on Aging-Alzheimer's Association (NIA-AA) clinical stages ranging from preclinical AD (1) to overt dementia (4+). Cognitively normal amyloid-negative individuals (n = 573) served as a comparison group. The total scores of three study-partner reported IADL questionnaires were standardized. RESULTS The rate of decline in cognitively normal (stage 1) individuals with and without abnormal amyloid did not differ (p = .453). However, from stage 2 onwards, decline was significantly faster in individuals on the AD continuum (B [95%CI] = - 0.32 [- 0.55, - 0.09], p = .007). The rate of decline increased with each successive stage: one standard deviation (SD) unit per year in stage 3 (- 1.06 [- 1.27, - 0.85], p < .001) and nearly two SD units per year in stage 4+ (1.93 [- 2.19, - 1.67], p < .001). Overall, results were similar between community-based and memory clinic study cohorts. CONCLUSIONS Our results suggest that the rate of functional decline accelerates along the AD continuum, as shown by steeper rates of decline in each successive NIA-AA clinical stage. These results imply that incremental changes in function are a meaningful measure for early disease monitoring. Combined with the low-cost assessment, this advocates the use of these functional questionnaires for capturing the effects of early AD-related cognitive decline on daily life.
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Affiliation(s)
- Mark A Dubbelman
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Roos J Jutten
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | | | - Rebecca E Amariglio
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rachel F Buckley
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Pieter Jelle Visser
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Dorene M Rentz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Keith A Johnson
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael J Properzi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron Schultz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nancy Donovan
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer R Gatchell
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bart N M Van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wiesje M Van der Flier
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Reisa A Sperling
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathryn V Papp
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Philip Scheltens
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Gad A Marshall
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sietske A M Sikkes
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Clinical, Neuro- & Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Bruderer-Hofstetter M, Dubbelman MA, Meichtry A, Koehn F, Münzer T, Jutten RJ, Scheltens P, Sikkes SAM, Niedermann K. Cross-cultural adaptation and validation of the Amsterdam Instrumental Activities of Daily Living questionnaire short version German for Switzerland. Health Qual Life Outcomes 2020; 18:323. [PMID: 33008394 PMCID: PMC7530958 DOI: 10.1186/s12955-020-01576-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/23/2020] [Indexed: 01/18/2023] Open
Abstract
Background Instrumental Activities of Daily Living (IADL) limitations are associated with reduced health-related quality of life for people with mild cognitive impairment (MCI). For these people, the assessment of IADL is crucial to the diagnostic process, as well as for the evaluation of new interventions addressing MCI. The Amsterdam IADL Questionnaire Short Version (A-IADL-Q-SV) is an established assessment tool with good psychometric properties that has been shown to be robust to cultural differences in Western countries. The aims of this study were to: (1) cross-culturally adapt and validate the A-IADL-Q-SV for the German-speaking population of Switzerland; (2) investigate its cultural comparability; and (3) evaluate further psychometric properties. Methods The A-IADL-Q-SV German was pretested on clinicians and participants in a memory clinic setting. The psychometric properties and cultural comparability of the questionnaire were investigated in memory clinic settings including participants with MCI or mild dementia, as well as participants with normal cognition recruited from the community. Item response theory (IRT) was applied to investigate measurement invariance by means of differential item functioning to assess item bias. Additionally, the test–retest reliability on scale level, the construct validity through hypothesis testing and the discriminant validity of the A-IADL-Q-SV German were evaluated. Results Ninety-six informants of participants with normal cognition, MCI or mild dementia completed the A-IADL-Q-SV German. The basic assumptions for IRT scoring were met. No meaningful differential item functioning for culture was detected between the Swiss and Dutch reference samples. High test–retest reliability on scale level (ICC 0.93; 95% CI 0.9–0.96) was found. More than 75% of the observed correlations between the A-IADL-Q-SV German and clinical measures of cognition and functional status were found to be in the direction and of the magnitude hypothesized. The A-IADL-Q-SV German was shown to be able to discriminate between participants with normal cognition and MCI, as well as MCI and mild dementia. Conclusions The A-IADL-Q-SV German is a psychometrically robust measurement tool for a Swiss population with normal cognition, MCI and mild dementia. Thus, it provides a valuable tool to assess IADL functioning in clinical practices and research settings in Switzerland. Trial registration This study was registered retrospectively in July 2019 on ClinicalTrials.gov (NCT04012398).
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Affiliation(s)
- Marina Bruderer-Hofstetter
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | - Mark A Dubbelman
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - André Meichtry
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland
| | - Florian Koehn
- Geriatrische Klinik St. Gallen, St. Gallen, Switzerland
| | - Thomas Münzer
- Geriatrische Klinik St. Gallen, St. Gallen, Switzerland.,Department of Geriatrics and Aging Research, University Hospital and University of Zurich, Zurich, Switzerland
| | - Roos J Jutten
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sietske A M Sikkes
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Karin Niedermann
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland
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Duff K, Porter S, Dixon A, Suhrie K, Hammers D. The independent living scale in amnestic mild cognitive impairment: Relationships to demographic variables and cognitive performance. J Clin Exp Neuropsychol 2020; 42:725-734. [PMID: 32741256 PMCID: PMC7484154 DOI: 10.1080/13803395.2020.1798884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/15/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The Independent Living Scales (ILS) is an objective measure of day-to-day functioning, which can be used to aid in diagnosing dementia in older adults with cognitive impairments. However, no studies have examined this measure in individuals with Mild Cognitive Impairment (MCI), a prodromal phase of dementia. METHOD Therefore, we sought to examine three subscales of the ILS (Managing Money, Managing Home and Transportation, Health and Safety) in a sample of 132 individuals with amnestic MCI, focusing on the relationship of the ILS with demographic variables (age, education, sex) and cognitive abilities (assessed with the Repeatable Battery for the Assessment of Neuropsychological Status [RBANS]). RESULTS This MCI sample showed intact daily functioning on the three ILS subscales. In a series of three, separate hierarchical linear regression models, the Managing Money, Managing Home and Transportation, and Health and Safety subscales were all significantly related to demographic variables, and the RBANS Total Scale score significantly added to all models. These models would also allow one to predict an ILS score based on demographic and cognitive data, which could be compared to an observed ILS score to see if it meets expectations. CONCLUSIONS Overall, these results indicate that daily functioning, as measured with the ILS, is related to cognitive abilities in amnestic MCI, and that demographic variables also influenced ILS scores in this cohort. Although the ILS may be appropriate for identifying functional abilities in MCI, the consideration of these moderating variables seems necessary.
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Affiliation(s)
- Kevin Duff
- Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah , Salt Lake City, UT, USA
| | - Sariah Porter
- Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah , Salt Lake City, UT, USA
| | - Ava Dixon
- Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah , Salt Lake City, UT, USA
| | - Kayla Suhrie
- Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah , Salt Lake City, UT, USA
| | - Dustin Hammers
- Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah , Salt Lake City, UT, USA
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A French-Greek Cross-Site Comparison Study of the Use of Automatic Video Analyses for the Assessment of Autonomy in Dementia Patients. BIOSENSORS-BASEL 2020; 10:bios10090103. [PMID: 32825735 PMCID: PMC7558972 DOI: 10.3390/bios10090103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 11/24/2022]
Abstract
Background: At present, the assessment of autonomy in daily living activities, one of the key symptoms in Alzheimer’s disease (AD), involves clinical rating scales. Methods: In total, 109 participants were included. In particular, 11 participants during a pre-test in Nice, France, and 98 participants (27 AD, 38 mild cognitive impairment—MCI—and 33 healthy controls—HC) in Thessaloniki, Greece, carried out a standardized scenario consisting of several instrumental activities of daily living (IADLs), such as making a phone call or preparing a pillbox while being recorded. Data were processed by a platform of video signal analysis in order to extract kinematic parameters, detecting activities undertaken by the participant. Results: The video analysis data can be used to assess IADL task quality and provide clinicians with objective measurements of the patients’ performance. Furthermore, it reveals that the HC statistically significantly outperformed the MCI, which had better performance compared to the AD participants. Conclusions: Accurate activity recognition data for the analyses of the performance on IADL activities were obtained.
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Dubbelman MA, Verrijp M, Facal D, Sánchez‐Benavides G, Brown LJ, van der Flier WM, Jokinen H, Lee A, Leroi I, Lojo‐Seoane C, Milošević V, Molinuevo JL, Pereiro Rozas AX, Ritchie C, Salloway S, Stringer G, Zygouris S, Dubois B, Epelbaum S, Scheltens P, Sikkes SA. The influence of diversity on the measurement of functional impairment: An international validation of the Amsterdam IADL Questionnaire in eight countries. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12021. [PMID: 32420446 PMCID: PMC7219786 DOI: 10.1002/dad2.12021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To understand the potential influence of diversity on the measurement of functional impairment in dementia, we aimed to investigate possible bias caused by age, gender, education, and cultural differences. METHODS A total of 3571 individuals (67.1 ± 9.5 years old, 44.7% female) from The Netherlands, Spain, France, United States, United Kingdom, Greece, Serbia, and Finland were included. Functional impairment was measured using the Amsterdam Instrumental Activities of Daily Living (IADL) Questionnaire. Item bias was assessed using differential item functioning (DIF) analysis. RESULTS There were some differences in activity endorsement. A few items showed statistically significant DIF. However, there was no evidence of meaningful item bias: Effect sizes were low (ΔR 2 range 0-0.03). Impact on total scores was minimal. DISCUSSION The results imply a limited bias for age, gender, education, and culture in the measurement of functional impairment. This study provides an important step in recognizing the potential influence of diversity on primary outcomes in dementia research.
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Affiliation(s)
- Mark A. Dubbelman
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Merike Verrijp
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - David Facal
- Department of Developmental PsychologyUniversity of Santiago de CompostelaA CoruñaSpain
| | | | - Laura J.E. Brown
- Faculty of BiologyMedicine and HealthUniversity of ManchesterManchester Academic Science CentreManchesterUK
| | - Wiesje M. van der Flier
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam UMCAmsterdamThe Netherlands
| | - Hanna Jokinen
- Clinical NeurosciencesNeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Department of Psychology and LogopedicsFaculty of MedicineUniversity of HelsinkiFinland
| | - Athene Lee
- Butler HospitalWarren Alpert Medical School of Brown UniversityProvidenceRhode Island
| | - Iracema Leroi
- Faculty of BiologyMedicine and HealthUniversity of ManchesterManchester Academic Science CentreManchesterUK
| | - Cristina Lojo‐Seoane
- Department of Developmental PsychologyUniversity of Santiago de CompostelaA CoruñaSpain
| | | | - José Luís Molinuevo
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
| | | | | | - Stephen Salloway
- Butler HospitalWarren Alpert Medical School of Brown UniversityProvidenceRhode Island
| | - Gemma Stringer
- Faculty of BiologyMedicine and HealthUniversity of ManchesterManchester Academic Science CentreManchesterUK
| | - Stelios Zygouris
- School of MedicineAristotle University of ThessalonikiThessalonikiGreece
- Network Aging ResearchHeidelberg UniversityHeidelbergGermany
| | - Bruno Dubois
- Department of NeurologyInstitut de la Mémoire et de la Maladie d'Alzheimer (IM2A) of the Pitié‐Salpêtrière Hospital & ARAMISSorbonne UniversityInria de ParisInstitut du cerveau et de lamoelle épinière (ICM)ParisFrance
| | - Stéphane Epelbaum
- Department of NeurologyInstitut de la Mémoire et de la Maladie d'Alzheimer (IM2A) of the Pitié‐Salpêtrière Hospital & ARAMISSorbonne UniversityInria de ParisInstitut du cerveau et de lamoelle épinière (ICM)ParisFrance
| | - Philip Scheltens
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Sietske A.M. Sikkes
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam UMCAmsterdamThe Netherlands
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Jutten RJ, Harrison JE, Brunner A, Vreeswijk R, van Deelen R, de Jong FJ, Opmeer EM, Ritchie CW, Aleman A, Scheltens P, Sikkes SA. The Cognitive-Functional Composite is sensitive to clinical progression in early dementia: Longitudinal findings from the Catch-Cog study cohort. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12020. [PMID: 32313832 PMCID: PMC7164406 DOI: 10.1002/trc2.12020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/06/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION In an attempt to capture clinically meaningful cognitive decline in early dementia, we developed the Cognitive-Functional Composite (CFC). We investigated the CFC's sensitivity to decline in comparison to traditional clinical endpoints. METHODS This longitudinal construct validation study included 148 participants with subjective cognitive decline, mild cognitive impairment, or mild dementia. The CFC and traditional tests were administered at baseline, 3, 6, and 12 months. Sensitivity to change was investigated using linear mixed models and r 2 effect sizes. RESULTS CFC scores declined over time (β = -.16, P < .001), with steepest decline observed in mild Alzheimer's dementia (β = -.25, P < .001). The CFC showed medium-to-large effect sizes at succeeding follow-up points (r 2 = .08-.42), exhibiting greater change than the Clinical Dementia Rating scale (r 2 = .02-.12). Moreover, change on the CFC was significantly associated with informant reports of cognitive decline (β = .38, P < .001). DISCUSSION By showing sensitivity to decline, the CFC could enhance the monitoring of disease progression in dementia research and clinical practice.
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Affiliation(s)
- Roos J. Jutten
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam Neuroscience, AmsterdamAmsterdam UMCthe Netherlands
| | - John E. Harrison
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam Neuroscience, AmsterdamAmsterdam UMCthe Netherlands
- Metis Cognition LtdWiltshireUK
- Institute of PsychiatryPsychology & NeuroscienceKing's College LondonLondonUK
| | - A.J. Brunner
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam Neuroscience, AmsterdamAmsterdam UMCthe Netherlands
| | - R. Vreeswijk
- Department of GeriatricsSpaarne GasthuisHaarlemthe Netherlands
| | | | - Frank Jan de Jong
- Department of NeurologyErasmus Medical CenterRotterdamthe Netherlands
| | - Esther M. Opmeer
- Department of NeurosciencesUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
- Department of Health and Social WorkUniversity of Applied Sciences WindesheimZwollethe Netherlands
| | - Craig W. Ritchie
- Centre for Dementia PreventionUniversity of EdinburghEdinburghUK
| | - André Aleman
- Department of NeurosciencesUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Philip Scheltens
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam Neuroscience, AmsterdamAmsterdam UMCthe Netherlands
| | - Sietske A.M. Sikkes
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam Neuroscience, AmsterdamAmsterdam UMCthe Netherlands
- Department of Clinical, Neuro‐ & Developmental PsychologyVrije Universiteit AmsterdamAmsterdamthe Netherlands
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